What monitoring is recommended after initiating combined hormonal contraception?

• A. Blood pressure assessment and assessment for contraindications; counsel on warning signs of VTE and stroke; periodic follow-up.
• B. Monthly glucose tolerance testing.
• C. Annual mammography.
• D. Sleep study.

Answer: (A)

Monitoring after starting combined hormonal contraception focuses on safety and ongoing appropriateness. The key step is to assess blood pressure and review for any contraindications to estrogen-containing products, since certain conditions—like uncontrolled hypertension, history of thromboembolism, migraines with aura, liver disease, or significant cardiovascular risk—can change whether CHCs are suitable. Along with this, counsel the patient on warning signs of venous thromboembolism and stroke so they know what to watch for and when to seek urgent care. Finally, arrange periodic follow-up to reassess blood pressure, any new risk factors, adherence, and tolerance, ensuring continued suitability of the method. Routine glucose testing, annual mammography, or sleep studies are not part of standard monitoring for initiating CHCs.