NAPLEX (North American Pharmacist Licensure Examination) Practice Exam

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What action is advised if breakthrough bleeding occurs and the user is already taking >/= 30 mcg estrogen daily?

Increase the estrogen dosage further
Switch to a non-hormonal contraceptive
Try a different progestin
Begin a regimen of continuous formulation contraceptives

The correct answer is: Try a different progestin

If breakthrough bleeding occurs while taking a contraceptive with >/= 30 mcg estrogen, increasing the estrogen dosage is not advised as it can increase the risk of side effects. Switching to a non-hormonal contraceptive would eliminate the estrogen and likely stop the breakthrough bleeding, but it would also remove the contraceptive benefits of the estrogen-progestin combination. Beginning a regimen of continuous formulation contraceptives (taking active pills continuously) may help stop the breakthrough bleeding, but it is not necessary if the bleeding is not bothersome or does not occur frequently. Trying a different progestin is the recommended action as it can help adjust the hormonal balance and control the breakthrough bleeding without the potential risks of increasing estrogen dosage or switching to a non-hormonal contraceptive. Each progestin has a different hormonal effect, so a different one may work better for the specific user.