This woman may be prescribed a combined hormonal oral contraceptive after a negative screening pregnancy test is obtained. A pregnancy test should be obtained prior to initiating contraception if more than 1 week has passed since the last menstrual period, as in this patient.

In healthy women without chronic conditions, few tests are needed before initiation of combined hormonal contraceptives, and this patient has no history of smoking, thromboembolism, or migraine that could influence the choice of contraceptive method. Blood pressure should be measured before initiation of combined hormonal contraceptives. Baseline weight and BMI are useful for monitoring contraceptive users over time. In this patient, no other screening tests are indicated.

Newer-generation oral contraceptives that contain lower dosages and less androgenic hormones have minimized their effect on different lipid parameters. Because lipid changes seen with hormonal contraception are mild, usually transient, and not clearly associated with increased cardiovascular risk, testing lipid parameters prior to starting treatment is not indicated.

Breast cancer screening with mammography is also not recommended prior to initiation of hormonal contraception. Breast cancer screening should be performed according to recommended guidelines.

In healthy women of reproductive age, a screening pelvic examination or cervical cancer screening is not required prior to initiation of combined hormonal contraceptives in the absence of symptoms or other clinical findings. Cervical cancer screening should follow recommended guidelines, and this patient is up to date with her age-appropriate screening.

Combined hormonal contraceptives, which include pills, transdermal patches, and vaginal rings, can be initiated at any time in the menstrual cycle. Because these are contraceptive methods that depend on consistent and correct use, patient education and engagement are essential. The provision of information about common side effects such as unscheduled bleeding, especially during the first 3 to 6 months of use, has been shown to increase continuation rates. Bleeding irregularities are generally not harmful and usually improve with continued use. The patient should also be counseled regarding the continued need for condom use to reduce risk of sexually transmitted infections and HIV infection.