Irregular Menses in a 23-Year-Old Woman

In Episode 22 of Med School Question of the Week for USMLE, Leigh Finnegan answers the following: A 23-year-old woman presents to her gynecologist for irregular menses. The patient reports that she has menarche at age 12, and since then her menses have always been irregular, with an average of about 4 menses per year. When she does have menses, they are prolonged, with heavy bleeding. The patient’s medical history is notable for facial acne which is treated with topical clindamycin and tretinoin, and one urinary tract infection last year which was treated with antibiotics. She is sexually active with one male partner, and uses condoms for contraception. Her vital signs are a temperature of 37.2° C, pulse 78/min, blood pressure 115/80 mm Hg, and respiratory rate 14/min. She has a BMI of 32. Her physical examination is notable for facial acne and hirutism. Her pelvic exam is notable for well-rugated vagina with a regular-sized, mobile uterus, and bilaterally enlarged ovaries without cervical motion tenderness or adnexal tenderness. A urine beta-hCG is negative. The physician considers putting the patient on an oral medication to relive her symptoms, regulate her periods, and prevent future malignancy. Which of the following would be a contraindication to starting such a medication?

• Migraine with aura
• History of first-trimester spontaneous abortion without clear cause
• Use of non-steroidal anti-inflammatory drugs for menstrual cramps
• Hyperthyroidism treated with levothyroxine
• Von Willebrand’s disease