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  #1  
Old 12-02-2011
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Drug On OCPs for the last 10 years!

A 42-year-old woman comes to your office for an annual examination. She states that she has been feeling good over the past year. She exercises three times a week and watches her diet. She has no medical problems. She had an appendectomy at the age of 25, and no other surgeries. She uses a 35 μg combined oral contraceptive pill (OCP) daily, and takes no other medications. She has been on “the pill” for birth control for the past 10 years and is happy with it. She has no known drug allergies. Physical examination, including breast and pelvic exams, is normal. She wants to know if she can continue to take the oral contraceptive pill. Which of the following is the most appropriate advice to give her?

A. Change from the combined OCP to hormone replacement therapy (HRT) now
B. Change to HRT plus aspirin now
C. Continue on the OCP
D. Stop the OCP immediately
E. Stop the OCP gradually over the next 3 years
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Old 12-02-2011
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C. Continue on the OCP
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Old 12-02-2011
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C. Continue on the OCP
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Old 12-03-2011
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continue on ocp
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Old 12-03-2011
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continue on ocp
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Old 12-04-2011
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The correct answer is C. There is much confusion regarding whether or not older women can safely use the combined oral contraceptive pill (i.e., the OCP containing both an estrogen and a progestin.) Women who are older than 35 years and smoke cigarettes should not be on a combination OCP because of the risk of myocardial infarction and stroke. However, this contraindication does not apply to women >35 years of age who do not smoke. These women (>35 years old and nonsmoking) can take the combined OCP. Recent large United States case-control studies have shown no increased risk of MI or stroke in healthy nonsmoking women >35 years old who use a combined OCP that contains less than 50 μg of estrogen. This patient is a healthy 42-year-old woman who doesn’t smoke and has no health problems. She is happy with her current OCP. She should, therefore, be told to continue on her current pill. The OCP provides her not only with birth control but also with more regular menses, improved bone mineral density (BMD), and a decreased risk of ovarian and endometrial cancer. This patient can stay on her OCP until she no longer needs contraception. This usually occurs between the ages of 50 and 55. She should stop, of course, if a medical condition arises that represents a contraindication to the OCP.
Telling her to change from the combined OCP to hormone replacement therapy (HRT) now (choice A) is incorrect. HRT will not provide her with the contraception that she is seeking.
Telling her to change to HRT plus aspirin now (choice B) is also not correct. Again, HRT will not provide her with contraception. Adding aspirin to the HRT regimen will do nothing to improve contraception for her.
Telling her to stop the OCP immediately (choice D) is incorrect. This patient does not have a contraindication to the use of the pill. She is 42 years old and still needs contraception. The pill provides her with contraception and is, overall, safe for her.
Advising her to stop the OCP gradually over the next 3 years (choice E) would be incorrect. Again, she can stay on the OCP for as long as she needs contraception, provided that her health remains good and no contraindication to the pill arises.
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