After initiating combined hormonal contraception, patients should be counseled to monitor for which warning signs?

• A. Symptoms such as unilateral leg swelling, chest pain, or sudden severe headache with focal deficits.
• B. Mild fatigue only.
• C. Itchy skin only.
• D. Weight gain.

Answer: (A)

Estrogen-containing combined hormonal contraception increases the risk of venous thromboembolism, so patients must watch for signs that a clot could be forming or traveling to the lungs or brain. The most critical warning signs are unilateral leg swelling with pain or warmth (suggesting deep vein thrombosis), chest pain or new or worsening shortness of breath (suggesting pulmonary embolism), and a sudden severe headache with focal neurological symptoms (suggesting a stroke). Other symptoms like mild fatigue, itchy skin, or general weight gain are nonspecific and not reliable indicators of a clot, though any new or concerning symptoms should be discussed with a clinician. If any warning signs occur, discontinue the contraception and seek urgent medical evaluation to assess for VTE.