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16:-What is the most safe OCP – the i.e. first choice COC for Early   reproductive Years in married women where the primary indication is contraception    :Ans:- Initial choice will be 20 , 25  ug EE OCs .  Admitting the fact that young women may  have increased bleeding problems on 20 ug  OCPs  with a  traditional    7 day pill free  interval   or a  25 ug  EE OCP but we should keep in mind that LNG containg pills   may result in better bleeding  control in contrast to Cyproterone, Desogestrel, Drospirenone , Gestodene (Femovan brand) containg Pills.

 LNG containg COC will  have acceptable   bleeding   control and will hopefully continue the pills after proper counseling. NSAID and or Tranexamic acid may be supplemented if BTB occurs at all or she can consume two pills per days on the days of BTB for two-three months provided1) BTB do not respond to Tx acid & NSAID and 2)  USG reveals no abnormality in the form of polyps .In such an even she has to  consume two packs for every 40-Days for two months .Later she can switch over 21 days pack.  Reviews have shown levonorgestrel  containing   OCs    to have good   bleeding  control .

Ideal COC in  Late    reproductive Years??  Ans: The    first choice menorrhagia is a problem: All OCPs show will exhibit some   benefit.  Initially start with 20-25 ug EE OCs at this age . But if   

Menorrhagia is not well controlled  with low dosed OCP and it remains a  problem with  first choice  OCP then one should  switch over to   OCP with  levonorgestrel ( like Mala-D,N, Ecroz, Ovipauz-L,  or Ovral-L one with    lower EE  dose( 20 mcg is Femilon) . Switching to pill with higher   progestin   to estrogen    ratio results   in less endometrial stimulation    and may result   in less menstrual   bleeding .