Lactational Amenorrhea Method ................................................257

y

y

Breast tenderness

Recommend that she wear a supportive bra (including during strenuous activity and sleep).

Try hot or cold compresses. y Suggest aspirin (325–650 mg), ibuprofen (200–400 mg), paracetamol (325–1000 mg), or other pain reliever. y Consider locally available remedies.

Weight change

y Review diet and counsel as needed.

Mood changes or changes in sex drive

y Some women have changes in mood during the hormone-free week (the 7 days when a woman does not take hormonal pills). Consider extended use (see Extended and Continuous Use of Combined Oral Contraceptives, p. 21). y Ask about changes in her life that could affect her mood or sex drive,

y

y

including changes in her relationship with her partner. Give her support as appropriate.

Clients who have serious mood changes such as major depression should be referred for care.

Consider locally available remedies.

Acne

y Acne usually improves with COC use. It may worsen for a few women. y 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 new pills for at least 3 months. y Consider locally available remedies.

New Problems That May Require Switching Methods

May or may not be due to the method.

Unexplained vaginal bleeding (that suggests a medical condition not related to the method) or heavy or prolonged bleeding y Refer or evaluate by history and pelvic examination. Diagnose and treat as appropriate. y She can continue using COCs while her condition is being evaluated. y If bleeding is caused by sexually transmitted infection or pelvic inflammatory disease, she can continue using COCs during treatment.