In a patient on combined oral contraceptives with decreasing menstrual flow but regular cycles, the most appropriate management is?

• A. Endometrial biopsy
• B. Reassurance
• C. Progestin withdrawal
• D. Pelvic ultrasound

Answer: (B)

Light or absent menses while using combined oral contraceptives with regular cycles is a common, benign effect of the medication. These pills suppress endometrial growth and stabilize the cycle, so lighter menses can occur without signaling pathology as long as there are no red flags and pregnancy is not a concern. The appropriate approach is reassurance and continuation of the current contraceptive regimen. Endometrial biopsy would be unnecessary unless there are abnormal bleeding patterns or other risk factors; pelvic ultrasound isn’t needed without suspected structural disease; progestin withdrawal isn’t indicated for this scenario, as there’s no irregular or problematic bleeding to evaluate. If the pattern changes or new symptoms arise, reassessment can be considered.