Clinical Challenge #2: Pregnancy After Contraception Use

QUESTION

A 26 year old woman began using oral contraceptives shortly after menarche. She stopped seven months ago in order to conceive. She is still awaiting a menses. Her physical examination is without anomalies. Her pregnancy test is negative. The best next step in management is:


A. Hysterosalpingography

B. Endometrial biopsy

C. Pelvic ultrasonography

D. Serum P, TSH, prolactin levels

E. Expectant management


ANSWER

D. Serum P, TSH, prolactin levels

"Post pill amenorrhea," once defined as amenorrhea for more than one year after stopping hormonal contraception occurs in about 1% of women. This was historically thought to be secondary to prolonged hypothalamic suppression. However, 1% of women not using oral contraception also develop amenorrhea. Indeed, the average time to menses after discontinuance is 32 days with a range of 15 to 82 days. Thus, any woman who does not have a menses within 6 months after discontinuing hormonal contraception, should be evaluated as any woman with secondary amenorrhea.



RELATED TOPICS COVERED AT THE 2016 MEETING

Access the latest research on contraception and current, hot topics in ob-gyn field at the 2016 ACOG Annual Meeting. Register now.


CLINICAL SEMINAR - Monday, May 16

LARC in 2016: Getting the Most from Intrauterine Devices and Implants – CS63

Rameet Harpal Singh, MD


CLINICAL SEMINAR - Tuesday, May 17

Contraception: What You Need to Know in 2016 – CS75

Eve Espey, MD MPH


LUNCH WITH THE EXPERTS - Tuesday, May 17

CDC's Contraceptive Guidance: Tools and Tips for Use

Naomi Katz Tepper, MD

American Congress of Obstetricians and Gynecologists
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