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Although amenorrhea is not unusual among COC users, the possibility of pregnancy should be considered. If the woman is correctly and consistently taking COCs and has no other symptoms of pregnancy, only reassurance is needed because the probability of pregnancy is extremely low. Even if the woman is pregnant and the embryo is exposed to COCs, the best evidence is that there is no harm to the embryo.
If symptoms or other reasons to suspect pregnancy exist, such as missed pills, evaluate accordingly. If pregnancy evaluation cannot be performed immediately, the client can be advised to continue taking the pills until this evaluation is completed or referred to a health unit where she can be evaluated.
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Amenorrhea may be a side effect of COCs. Amenorrhea is not uncommon in women using the low dose pills, 35 mcg or less of estrogen, due to a lack of buildup of the uterine lining.
While pregnancy is a possibility, COCs are over 99% effective when used correctly.
It is always recommended that a pregnant woman avoid unnecessary medication. However, if the woman is pregnant and is using COCs, there does not seem to be an increased risk of birth defects for the embryo.
- Hatcher R, Trussell J, Stewart F, Stewart G, Kowal D, Guest F, et al. The pill: combined oral contraceptives. In: Contraceptive Technology. New York: Irvington Publishers, 1994:223-84.
- Bracken M. Oral contraception and congenital malformations in offspring: a review and meta-analysis of the prospective studies. Obstetrics and Gynecology 1990;76:552-7.
- Simpson JL, Phillips OP. Spermicides, hormonal contraception and congenital malformations. Advances in Contraception 1990;6:141-67.
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