ACHES
OCP Warning Signs (Stop Taking!)
Any one of these → stop the pill, call the office, consider ED.
For the FNP boards, oral contraceptive counseling is recurring exam territory and ACHES is the acronym that drives the safety message. Abdominal pain (hepatic adenoma, mesenteric thrombosis), Chest pain (PE, MI), Headache (stroke, especially with aura), Eye changes (retinal vein thrombosis), Severe leg pain (DVT) — any one of these means stop the pill, contact the office, and consider the ED. AANP vignettes pair ACHES with a smoker over 35 or a new migraine with aura to test whether you would discontinue combined hormonal contraception. The answer is yes, every time.
- AAbdominal pain (severe)Think thromboembolism, hepatic adenoma, or gallbladder.
- CChest painPulmonary embolism until proven otherwise.
- HHeadache (severe or focal)Sudden-onset or with neuro symptoms → stroke risk.
- EEye problemsVision loss, diplopia, or blurring → stroke or retinal vein thrombosis.
- SSevere leg painUnilateral calf pain or swelling → DVT.
Clinical Context
Counsel every patient starting combined oral contraceptives (or estrogen HRT) on ACHES. Estrogen elevates thromboembolic risk — highest in the first 3-6 months of use, and magnified by smoking >35, BMI >30, migraine with aura, and inherited thrombophilia.
AANP heavily tests the contraindications: smoker >35, migraine with aura, DVT history, or active cancer → avoid estrogen. Any ACHES symptom = stop the pill and evaluate urgently. Review at the initial prescription visit and every renewal.
Related Mnemonics
Sources
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