Family Planning

óóóóóóóóóóóóBreast tendernessRecommend that she wear a supportive bra (including during strenuousactivity and sleep).Try hot or cold compresses.Suggest aspirin (325–650 mg), ibuprofen (200–400 mg), paracetamol(325–1000 mg), or other pain reliever.Consider locally available remedies.Weight changeReview diet and counsel as needed.Mood changes or changes in sex driveSome women have changes in mood during the hormone-free week(the 7 days when a woman does not take hormonal pills). Considerextended use (see Extended and Continuous Use of Combined OralContraceptives, p. 21).Ask about changes in her life that could affect her mood or sex drive,including changes in her relationship with her partner. Give her supportas appropriate.Clients who have serious mood changes such as major depression shouldbe referred for care.Consider locally available remedies.AcneAcne usually improves with COC use. It may worsen for a few women.If she has been taking pills for more than a few months and acne persists,give her a different COC formulation, if available. Ask her to try the newpills for at least 3 months.Consider locally available remedies.1Combined Oral ContraceptivesNew Problems That May Require Switching MethodsMay or may not be due to the method.óóóUnexplained vaginal bleeding (that suggests a medical condition notrelated to the method) or heavy or prolonged bleedingRefer or evaluate by history and pelvic examination. Diagnose and treatas appropriate.She can continue using COCs while her condition is being evaluated.If bleeding is caused by sexually transmitted infection or pelvicinflammatory disease, she can continue using COCs during treatment.Helping Continuing Users of Combined Oral Contraceptives19