What is the most appropriate initial step in managing an 18-year-old female seeking birth control with significant family history of ovarian cancer?

The most appropriate initial step in managing an 18-year-old female seeking birth control, especially with a significant family history of ovarian cancer, is to prescribe a combined oral contraceptive (OCP).

Combined oral contraceptives have been shown to provide several benefits related to ovarian cancer risk. Specifically, the use of OCPs has been associated with a reduced risk of ovarian cancer, particularly in women with a family history of the disease. This protective effect is attributed to the way hormonal contraceptives suppress ovulation and stabilize endometrial and ovarian tissues.

In this scenario, given the patient's age and her expressed need for birth control, combined OCPs not only serve the immediate purpose of contraception but also align with a proactive approach to mitigating her potential risk for ovarian cancer due to her family history.

Other management options, such as recommending condom use, do not address her need for effective contraception or cancer risk in a comprehensive manner. Prescribing a progestin-only pill could limit estrogen intake but may not provide the same level of cancer risk reduction as combined OCPs. Moreover, performing a work-up for cyclical abdominal cramping may delay addressing her primary concern of birth control and is unnecessary at this initial stage. Thus, initiating