Transcript Contraception Expandedx


Contraception Expanded
NURS 541
Winter 2015
How to choose an oral contraceptive?
 Patient preference
 “My friend/sister/cousin is taking A, B, or C”
 Patient characteristics
 Age, ethnicity, weight, risk factors
 Menstrual characteristics
 Heavy and painful, light and painless, irregular/regular
 Hormone sensitivity/deficiency
Biological activity
 Combined activity of estrogen and progestin
 Estrogenic activity
 Progestational activity
 Androgenic activity
 Endometrial activity
 Effect on serum lipoproteins
Dickey, 2015
Estrogenic activity
 Estrogen-sensitive signs/symptoms
 Nausea or edema mid-cycle or during pregnancy
 Enlarged uterus, uterine fibroids
 Breast tenderness, large breasts, fibrocystic breast changes
 Heavy menstruation
 Cramps and/or pain during menses
 WOULD BENEFIT FROM A 20mcg ESTROGEN/PROGESTIN PILL
 Estrogen-deficiency signs/symptoms
 Light/scant menses
 Small uterus, small breasts
 Mid-cycle spotting
 COULD BENEFIT FROM ANY ESTROGEN/PROGESTIN PILL
Progestational activity
 Progesterone-sensitive signs/symptoms
 PMS symptoms (edema, bloating, headache, depression)
 Pregnancy symptoms (excessive appetite, excessive weight gain,
tiredness, hypertension, varicose veins)
 WOULD BENEFIT FROM A LOW PROGESTATIONAL ACTIVITY PILL
 Progesterone-deficiency signs/symptoms
 Prolonged menses
 Heavy menses
 Severe cramping
 Premenstrual spotting, BTB
 PMS symptoms
 WOULD BENEFIT FROM A HIGHER PROGESTATIONAL AND/OR HIGHER
ANDROGENIC ACTIVITY PILL
Androgen and endometrial activity
 Androgen excess signs/symptoms





Oily skin
Acne
Male-pattern baldness
Hirsutism
WOULD BENEFIT FROM A LOW OR NO ANDROGENIC ACTIVITY PILL
 Endometrial activity

The amount of an effect the combined biological activities have on the
endometrium in terms of BTB, spotting, and irregular bleeding
 Low = mild effect
 High = stronger effect
Helpful resources for oral contraceptives
 Dickey, 2015. Managing Contraceptive Pill Patients, 15th ed.
 Section 11: Initial Selection of OCs (pp.60-69)
 Table 5: list of every pill you may encounter (pp. 137-51)
 Table 6: breakdown of biological activity of each pill (pp. 152-5)
 Table 8: choosing initial oral contraceptive by patient characteristics (pp.
159-60)
 Table 9: pills grouped by similar characteristics (pp. 161-2)
 Table 14: list of drug interactions (pp. 171-2)
 Hatcher, 2011. Contraceptive Technology, 20th ed.
 Chapter 11 – COCs (pp. 249-341)
 Color plates of what pills look like (pp. 296)
 Great info re: risks, starting COCs, managing side effects, medical
complicated patients and COCs
Pearls for initiating oral contraception
 Make sure there are no contraindications for estrogen
 Memorize contraindications
 Choose your own favorite “starter” pill – mid level estrogen,
moderate biologic activity
 Allows for adjustments in either direction if side effects occur
 Always check blood pressure at contraception visits!
 Go generic!
 Less expensive for patients, also most likely to be covered by
insurance