Does a woman require treatment if she becomes amenorrheic on the combined oral contraceptive pill (OCP)?
No specific treatment is required (as long as pregnancy is initially ruled out) as the amenorrhoea is usually due to a relative deficiency of estrogen (endometrial stimulator) in comparison to progestin (endometrial suppressor) in the combined OCP. Permanent atrophy does not occur, and resumption of normal ovarian function after the pill is stopped will quickly restore endometrial growth and development. If the woman cannot reconcile herself to the lack of bleeding or if she fears pregnancy each month a brief course of supplemental estrogen will often induce sufficient endometrial regrowth to result in withdrawal bleeding for the next few cycles. Typically conjugated estrogen 1.25 mg, or estradiol 2 mg can be administered daily in addition to the usual oral contraceptive for the first 10 days of the next cycle of combined OCP treatment. This can be repeated as often as desired. I have a 21-day pack of pills. I missed the last pill of my pack and did not notice until today, the first da
