What factor should the nurse first assess for a client experiencing breakthrough bleeding while on oral contraceptives for 3 months?

When a client experiences breakthrough bleeding after being on oral contraceptives for three months, the first factor to assess is likely nonadherence to the prescribed protocol. Oral contraceptives require consistent daily use to maintain effective hormone levels in the body and ensure that contraception is effective. If doses are missed or not taken at the same time each day, the efficacy of the contraceptive can be compromised, leading to breakthrough bleeding.

Assessing for nonadherence is crucial because it directly addresses the potential cause of the unwanted bleeding. It allows the healthcare provider to reinforce the importance of taking the medication as directed. Understanding a patient’s adherence habits provides insights into whether the breakthrough bleeding may be a result of inconsistent use rather than an inherent problem with the medication itself or other underlying issues.

While factors such as medication side effects, hormonal imbalance, and underlying health issues are also important to consider, they may not be the most immediate or impactful variable to assess in this situation. Nonadherence can frequently contribute to breakthrough bleeding, making it the priority in assessment.