Review Question - QID 210727

A 21-year-old Caucasian woman presents to her gynecologist's office with a chief complaint of irregular periods. In the past 2 years, she has often gone > 3 months without menstruating. Menarche was at 13 years old, and prior to the past 2 years, she had regular periods every 28 days lasting 5 days with normal flow and no pain. She denies other symptoms of headache, vision changes, excessive fatigue or sweating, feelings of a racing heart, or hair loss. Since starting college, she has been bothered by weight gain and acne that she attributes to her habit of late-night pizza and french fries. On exam, she is well-appearing and has severe acne. Her temperature is 98.6°F (37°C), blood pressure is 120/80 mmHg, pulse is 60/min, respirations are 12/min, and BMI is 30 kg/m^2. Lab work confirms the most likely diagnosis and includes a hemoglobin A1c level of 5.4. If she is not interested in childbearing at this time, what is the most appropriate initial medication to treat this disease?