Managing adverse effects of hormonal contraceptives.

Adverse effects of hormonal contraceptives usually diminish with continued use of the same method. Often, physi- cians only need to reassure patients that these symptoms will likely resolve within three to five months. Long-acting injectable depot medroxyprogesterone acetate is the only hormonal contraceptive that is consistently associated with weight gain; other hormonal methods are unlikely to increase weight independent of lifestyle choices. Switching com- bined oral contraceptives is not effective in treating headaches, nor is the use of multivitamins or diuretics. There are no significant differences among various combined oral contraceptives in terms of breast tenderness, mood changes, and nausea. Breakthrough bleeding is common in the first months of combined oral contraceptive use. If significant abnormal bleeding persists beyond three months, other methods can be considered, and the patient may need to be evaluated for other causes. Studies of adverse sexual effects in women using hormonal contraceptives are inconsistent, and the pharmacologic basis for these symptoms is unclear. If acne develops or worsens with progestin-only contra- ceptives, the patient should be switched to a combination method if she is medically eligible. There is insufficient evidence of any effect of hormonal contraceptives on breast milk quantity and quality. Patient education should be encouraged to decrease the chance of unanticipated adverse effects. Women can also be assessed for medical eligibility before and during the use of hormonal contraceptives.