Refilling Combined Oral Contraceptives for a 24-Year-Old Woman
Yes, you can safely refill her combined oral contraceptive after confirming she has no new contraindications and is not pregnant. 1
Essential Pre-Refill Assessment
Before refilling, you must screen for new Category 4 absolute contraindications that would make OCPs unacceptable:
Cardiovascular & Thrombotic Contraindications
- Active or recent DVT/PE – this is an absolute contraindication regardless of treatment status 2, 3
- History of DVT/PE with high recurrence risk – including known thrombophilias (antiphospholipid syndrome), active cancer, or recurrent events 2
- Smoking status if she has turned 35 – women ≥35 years who smoke are Category 4 2
- Current thrombophlebitis or thromboembolic disorders 3
- Cerebrovascular or coronary artery disease 3
Other Absolute Contraindications
- Pregnancy – must be reasonably certain she is not pregnant 1, 3
- Current or history of breast cancer 3
- Undiagnosed abnormal vaginal bleeding – requires evaluation before continuing OCPs 3
- Active liver disease – hepatic adenomas, carcinomas, or cholestatic jaundice 3
- Hepatitis C treatment with ombitasvir/paritaprevir/ritonavir combinations 3
Postpartum Timing (If Applicable)
- Less than 3 weeks postpartum – OCPs are Category 4 due to markedly elevated VTE risk during this period 2, 4
- 3 weeks to 6 weeks postpartum with VTE risk factors – generally should not use (Category 3) 4
Confirming She Is Not Pregnant
The patient can continue OCPs if it is "reasonably certain" she is not pregnant. This is established when: 1
- She has been taking pills correctly and consistently
- She has not missed two consecutive periods 3
- If she missed one period but adhered to the prescribed schedule, pregnancy should be considered and ruled out 3
- If she has missed two consecutive periods, pregnancy must be ruled out before continuing 3
When Refilling Is Appropriate
Refill the prescription when:
- No new Category 4 contraindications have developed 2, 3
- She is not pregnant or you are reasonably certain she is not pregnant 1
- She has been tolerating the medication without serious adverse events 5, 6
- Blood pressure remains normal (should be assessed periodically) 5
Clinical Pitfalls to Avoid
- Do not refill if she has undiagnosed abnormal vaginal bleeding – this requires evaluation to rule out pregnancy or malignancy before continuing 3
- Do not assume regular cycles mean no pregnancy – if she missed pills and then missed a period, rule out pregnancy first 3
- Do not overlook new VTE risk factors – even at age 24, new thrombophilias or other conditions may emerge 2
Non-Contraceptive Benefits to Reinforce
When refilling, you can remind her that continued OCP use provides: 5, 6, 7
- Reduced risk of ovarian and endometrial cancers
- Improved menstrual regularity and reduced dysmenorrhea
- Treatment of acne and other androgen-related symptoms
- Reduced risk of colorectal cancer
Practical Refill Guidance
- Typical use failure rate is 7-9% – counsel on the importance of consistent daily use 5
- Common side effects improve with time – breakthrough bleeding and spotting are most common in early cycles and typically resolve 3, 8
- Extended cycle regimens are an option – some patients prefer fewer withdrawal bleeds 5
- At age 24 without risk factors, she can safely continue OCPs for years as long as no contraindications develop 7