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J Endocrinol (2020) 245(1):112

Report all medications to your provider so they can advise on timing and potential interactions

Counsel patients that they may experience some withdrawal or breakthrough bleeding if they miss doses Combined oral contraceptives can also provide relief Exercise caution when prescribing an estrogen to patients with a history of smoking, hypercoagulability, or who are over the age of 35 as it can increase the risk for malignancy