Tri-phasics OC: For exam, had role in days gone by when contained lower estrogen than

monophasic. At one point, of all OC used, 80% were given away by sampling, why many people
are started on triphasics. May only switch to it if coincidentally people not tolerating other pills
and tolerate it better.
Abnormal Bleeding
Abnormal Bleeding: Irregular, heavy, irregular heavy. Can be associated with ovulation or not.
Ovulatory or non-ovulatory dysfunctional bleeding.
 < 40, just go ahead and treat her. Find out if they need contraception.
COC: Less bleeding and more regular cycle. Monophasic, low estrogen (or lower estrogenic high
progestin, typically same thing/go together anyway).
IUS: With levonorgestrol – Mirena. Would probably work better than the COC – Just progestin
and right at the source.
Secondary to dysmenorrhea: Could use NSAIDS if they didn’t need contraception, given during
menses. Cause vasoconstriction in the uterus, actually decrease the amount of bleeding.
Tranexemic acid: Doesn’t need contraception and no pain – just bleeding heavily or irregularly.
Given 1g q6h x 1st 4 days of menses. Doesn’t change irregular bleeding but will decrease the
amount of bleeding.
>40 = don’t just treat, do some investigations first.
Oligomenorrhea: Irregular bleeding Metrorasia: Weird bleeding in middle of cycle. Menorrasia:
Heavy bleeding.