28 year old female presents with irregular slight bleeding after taking combined OCPs 3 months for heavy menstrual bleeding. What is your advice
With hormone replacement therapy, irregular spotting or bleeding is side effect. There is no need to sample endometrium, as this is seen only in early months of use.
Endometrial sampling to rule out neoplasia.
Change over to progestin only preparations.
Reassure the patient as it is break through bleeding.
Discontinue OCPs.