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  #1  
Old 06-05-2011
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Drug Screening before starting oral contraceptive pills

a 35 years old patient who has a history of PCOS is asking for OCP prescribed: what is the appropriate screening?

1- Endometrial swab

2- blood sugar

3- Blood pressure
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Old 06-05-2011
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one of complication of pcos is increase the risk of endometerial ca due to unopposed estrogen so
if she want to use ocp (has C.I estrogen dependant ca ) so she must screen for it
so the answer is 1
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Old 06-05-2011
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3-blood pressure

All women should be screened for hypertension before starting OCPs.
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miss patho: i dont think we ever (screen) for Endomet Ca

Healer: i was hesitant between BP and Glucose (as OCP ALSO causes diabetes)


could you confirm the priority of BP in this setting?
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Old 06-06-2011
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I l agree with healer2b
All women should be screened for HTN before starting OCPs.
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agree with all of you

i must though draw your attention to the fact that OCP also causes and exacerbates diabetes
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Old 06-06-2011
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Quote:
Originally Posted by docoftheworld View Post
agree with all of you

i must though draw your attention to the fact that OCP also causes and exacerbates diabetes
Do you have any stats on this? I don't think it has much clinical significance.

The American Diabetes Association guidelines state that the selection of a method of contraception for an individual patient should be based on the same considerations that apply to women without diabetes. (UpToDate)
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in kaplan they mention diabetes as Relative Contraindication to OCP use (Kaplan Gynecology)
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Old 06-06-2011
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Quote:
Originally Posted by docoftheworld View Post
in kaplan they mention diabetes as Relative Contraindication to OCP use (Kaplan Gynecology)
Per UpToDate:

Better methods of contraception for women with diabetes include the following:

Oral contraceptives are highly effective in preventing pregnancy. Estrogen doses of ≤35 mcg have no effect on carbohydrate metabolism, plasma glucose, or insulin sensitivity; estrogen also increases HDL and total cholesterol and decreases LDL cholesterol. On the other hand, progestins increase peripheral insulin resistance, lower HDL cholesterol, and increase LDL cholesterol; the magnitude of the these changes depends on the preparation. Other estrogen-progestin preparations (eg, ring, patch) appear to have similar effects, but have not been extensively studied in diabetics. The lowest dose of estrogen and progestin should be prescribed to minimize the risk of complications.

The American College of Obstetricians and Gynecologists recommends, based on theoretical concerns, that use of combination oral contraceptives be limited to diabetic women who do not smoke, are younger than 35 years of age, and are otherwise healthy (ie, without evidence of hypertension, nephropathy, retinopathy, or other vascular disease). Other estrogen-progestin preparations (eg, ring, patch) may also be used; restrictions are the same as those described above.

American Diabetes Association guidelines state that the selection of a method of contraception for an individual patient should be based on the same considerations that apply to women without diabetes.
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  #10  
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the matter is settled .... pressure it is
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