Rachel is a 15-year-old grade 9 student who has come to the walk-in clinic requesting ‘the pill’. She has been dating John, who has not accompanied her, for 6 months and she feels that it is time for them to have sex. She has never had intercourse. John is 18 and will finish grade 12 this year. Rachel lives with her mother and two younger brothers. She has always been healthy and is on no medications. She states that she smokes occasionally and sometimes drinks. After a discussion regarding the implications of her decision and the issues of the options available, Rachel is given three months of oral contraceptives (OCP) and instructions. There is a plan to follow-up with her family doctor for a refill and a pap smear. Three months later, Rachel experiences heavy vaginal bleeding accompanied by suprapubic pain. She is very frightened and comes to the ER with her mother. She states that she thinks her last period was a month ago but it was not really normal and she has had spotting intermittently since starting the pill. She says that she is not on any other medications but two months ago she was on an antibiotic for 5 days for a bad cough. The antibiotic made her very nauseated.