Pediatric emergency medicine trisk 2159 2159

intrauterine system (Mirena IUS). Consultation to adolescent medicine,
hematology, or gynecology may be warranted.
TABLE 92.6
CONTRAINDICATIONS TO THE USE OF ESTROGEN-CONTAINING
MEDICATIONS
History of migraine with aura
History of venous thromboembolism (deep venous thromboembolism,
pulmonary embolism, stroke)
Inherited prothrombotic disorders
Systemic lupus erythematosus with positive or unknown antiphospholipid
antibodies
Hypertension (SBP >160 mm Hg or DBP >100 mm Hg)
Certain heart conditions (ischemic heart disease, complicated valvular disease,
peripartum cardiomyopathy)
Certain liver conditions (hepatocellular adenoma, liver malignancy, severe
cirrhosis)
Postpartum <21 days
Current diagnosis of breast cancer
History of complicated solid organ transplant
Adapted from Centers for Disease Control and Prevention. United States Medical Eligibility Criteria
Contraceptive Use, 2010. MMWR Recomm Rep 2010;59(RR-4):1–85; For a full list see the United States
Medical Eligibility Criteria for Contraceptive Use at
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For the patient who has developed anemia from ongoing vaginal bleeding, it is
important to provide iron supplementation to rebuild iron stores. Because iron and
estrogen may cause gastrointestinal discomfort, some practitioners delay
administration of the first dose of iron until the estrogen is tapered to a lower
dosage. It is important for the patient to have follow-up with her outpatient
primary care doctor, adolescent medicine specialist, or gynecologist for long-term
control of AUB and irregular menses.
CLINICAL PEARLS AND PITFALLS