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Scenario E
Mrs. Jasmine, 30 years old, married 5 years, has a child. 1. Vaginal bleeding 2. Lower abdominal discomfort 3. Period delay 4 days 4. Used COC, has stopped since 6 months ago. 5. No history of chronic diseases or surgery procedure.
Differential diagnosis
1. Menstrual abnormality 2. Laceration of internal or external genitalia 3. Tumor of uterus or adnexa 4. Impending abortion
Menstrual cycle
Normal menstrual cycle 1. Follicular phase final stage of follicular maturation most variable segment of cycle end in ovulation in uterus : proliferative phase
Menstrual cycle
2. Luteal phase from ovulation to mens formation of Corpus Luteum variation of length ; little 14 days primary indicator of luteal function increase of progesterone in uterus: secretory phase
Types of COCs
Monophasic: All 21 active pills contain same amount of Estrogen/Progestin (E/P) Biphasic: 21 active pills contain 2 different E/P combinations (e.g., 10/11) Triphasic: 21 active pills contain 3 different E/P combinations (e.g., 6/5/10)
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et al 1998.
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COCs: Limitations
User-dependent (require continued motivation and daily use) Some nausea, dizziness, mild breast tenderness, headaches or spotting may occur Effectiveness may be lowered when certain drugs are taken Forgetfulness increases method failure Can delay return to fertility Rare serious side effects possible Resupply must be readily and easily available Do not protect against STDs (e.g., HBV, HIV/AIDS)
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