Follow-Up Schedule for Loestrin (Ethinyl Estradiol/Norethindrone)
No routine follow-up visit is required after initiating Loestrin in healthy reproductive-age women without pre-existing medical conditions. 1
Initial Assessment Requirements
Before prescribing Loestrin, confirm the following baseline parameters:
- Pregnancy status must be documented as negative 1, 2
- Blood pressure measurement is mandatory at baseline 1
- Screen for absolute contraindications including active or history of thromboembolic disease, hepatic dysfunction, undiagnosed vaginal bleeding, breast cancer, and migraine with focal neurologic symptoms 1, 2, 3
Ongoing Monitoring Strategy
When to Return
Advise the patient to return at any time if she experiences:
- Side effects or problems with the medication 1
- Desire to change contraceptive methods 1
- Concerns about the medication 1
At Other Routine Healthcare Visits
When a patient on Loestrin presents for unrelated routine care, healthcare providers should:
- Assess satisfaction with the contraceptive method and address any concerns about use 1
- Measure blood pressure at every encounter, as hypertension is a common adverse effect that increases stroke risk 1, 3
- Evaluate for new contraindications by assessing any changes in health status or new medications that would make combined hormonal contraceptives inappropriate (U.S. MEC category 3 or 4 conditions) 1
- Consider assessing weight changes and counsel women concerned about weight changes they perceive to be associated with their contraceptive method 1
Practical Considerations
Blood Pressure Monitoring
Since no routine follow-up is required, consider recommending patients obtain blood pressure measurements in nonclinical settings such as pharmacies or fire stations between healthcare visits 1. This is particularly important because monitoring blood pressure is essential for combined hormonal contraceptive users, yet few women develop hypertension after initiating oral contraceptives 1.
Prescription Supply
Provide up to 13 cycles (one year supply) of pill packs at initial prescription, depending on the woman's preferences and anticipated use 1. Providing a greater number of pill packs is associated with:
Restricting the number of pill packs can result in unwanted discontinuation and increased pregnancy risk 1.
Common Pitfalls to Avoid
Do not require routine follow-up visits as there is no evidence that such visits improve correct or continued use of combined hormonal contraceptives 1. This unnecessary requirement creates barriers to access and may reduce continuation rates.
Do not prescribe to women ≥35 years who smoke, as this substantially increases stroke risk 3.