A 16-year-old girl attends her GP complaining of worsening dysmenorrhoea. She notes that the pain associatedwith her period has gradually been worsening and she has also noticed worsening bleeding. She denies any risk factors for venousthrombosis

a. Combined oral contraceptives should be started with caution in patients. Questions should be asked about past or family history of venous thrombosis. Other factors that should be discussed include obesity, immobility and varicose veins. Two or more of these risk factors should urge you to think again about contraceptive solutions. In this case, she is a young healthy girl who wants to control excessive bleeding and the combined oral contraceptive should help reduce the proliferation of the uterine endometrium and in turn the associated pain and bleeding.