Contraceptive	Adverse effect	Possible treatments
Combined oral contraceptives	Breakthrough bleeding	Reassure patient that bleeding will likely resolve in three to five cycles1; increase estrogen dose if less than 20 mcg per day9,10
	Decreased libido	Reassurance23; consider increasing estrogen dose if current dose is very low13; consider prescribing 10 mcg of estrogen per day during the placebo week if patient is perimenopausal26; consider other reasons for decreased libido8
	Depressed mood	Reassure patient that mood changes will likely improve with time1
	Headache	Discontinue contraceptive if patient has migraine with aura25; reassure patient that headache will likely resolve after the first few cycles16; if headaches occur during the placebo week and the patient is older than 40 years, add 10 mcg of ethinyl estradiol per day during five days of the placebo week26
	Weight gain	Combined oral contraceptives are not associated with weight gain; consider lifestyle factors that may be causing weight gain22
Combined oral contraceptives (extended cycle)	Breakthrough bleeding	Reassure patient that bleeding will likely diminish by the fourth month11; consider a hormone-free interval of three or four days beginning on the first day of breakthrough bleeding27; consider changing progestin from levonorgestrel to norethindrone12
Depo-Provera (long-acting injectable depot medroxyprogesterone acetate)	Acne	Consider changing to a combined method if patient is medically eligible8
	Amenorrhea	Reassurance
	Hirsutism	Consider changing to a combined method if patient is medically eligible28
	Weight gain	Careful adherence to diet and exercise regimen
Emergency contraceptive regimens	Nausea	Metoclopramide (Reglan), 10 mg, or meclizine (Antivert), 50 mg, one hour before taking emergency contraceptive19,29; use progestin-only emergency contraceptive30
Implanon (single-rod etonogestrel implantable device)	Breakthrough bleeding (single episode)	Mifepristone (Mifeprex), 25 mg twice per day, then ethinyl estradiol, one 10-mg tablet twice per day for four days, beginning on the first day of bleeding31
	Breakthrough bleeding (continuous)	No treatment has been proven effective; consider changing contraceptive method31,32
	Heavy menses	Reassurance, but it is unclear if bleeding will diminish with time7; change contraceptive methods if persistent
Nuvaring (ethinyl estradiol/etonogestrel vaginal ring), standard use	Increased vaginal discharge	Reassure patient that discharge usually does not indicate pathology; consider changing to nonvaginal contraceptive4
Nuvaring, continuous use*	Breakthrough bleeding	Remove the contraceptive ring for four days at the start of bleeding, then replace for the remainder of the month33
Ortho Evra (norelgestromin/ethinyl estradiol contraceptive patch)	Breast tenderness	Consider changing to a combined oral contraceptive4
Progestin-only pills	Acne	Change to a combined oral contraceptive if patient is medically eligible34
	Breakthrough bleeding	Change to a combined oral contraceptive if patient is medically eligible9,10
	Hirsutism	Change to a combined oral contraceptive if patient is medically eligible28