Sylvia is a 35-year-old mother of three children. She is requesting refills for her birth control pills (COC). During her examination, she reports that every month since starting COCs (3 months ago) she has had several days of spotting in the middle of her cycle. This concerns her and she would like to know if this pattern will continue as long as she continues using COCs. She also experienced nausea and headaches often during the first month but much less frequently during the second and third months.
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