00:01
Now let's take a look at oral contraceptives that are
combinations. An example would be ethinyl
estradiol and norethindrone. That's a very long name, but
it's the generic name for a combination
oral contraceptive. See that slash mark in between estradiol
and the norethindrone? That lets
us know there are 2 different medications. Okay, so we know
what estrogen does. It suppresses
the release of the follicle stimulating hormone from the
pituitary. So, when you suppress the
FSH, the follicle doesn't mature. Because remember that
follicle has an immature egg in it that
oocyte. So, with this medication, the follicle won't mature.
The progestin in this medication will
suppress the hormone that triggers ovulation, luteinizing
hormone or LH. So, so far what this
combination medication does, we've talked about the FSH will
be suppressed so the follicles won't
mature, they won't be stimulated and the LH will not trigger
ovulation. And also the cervical mucous
becomes a barrier, it becomes super thick. So the sperm
don't have a very easy time of getting
through it and the endometrium is less hospitable. So if an
egg does manage to get fertilized,
it's not really going to implant. Alright. So, combination
oral contraceptives stop the follicle
from maturing, stop the egg from ovulating, the mucous
becomes thicker so sperm have a hard
time getting through it but when one of those swimmers does
then the endometrium is going to
be less hospitable to the fertilized ovum implanting in the
uterus. Okay, see your title up there?
Effectiveness equals consistency. If your client wants birth
control to work and it's an oral
contraceptive, a lot of it is in their hands. Because if you
have perfect use, the failure rate is
much lower than typical use. Nobody is perfect so know that
an oral contraceptive doesn't guarantee
that they won't get pregnant. Birth control needs to be
taken at the same time and it needs to
be taken on a daily basis. So, effectiveness equals
consistency and it's really important that
your patient understands the role they play in being
effective. Women of a higher rate will also
have less effective results. So, if your client is
overweight or they're a bariatric client, you
want to help them understand that this might affect the
effectiveness of their oral birth control.
02:33
Now, when you have some adverse effects that most people are
not really excited about but this kind
of come along with combination oral contraceptives. Now you
have an increased risk of developing
clots. We've talked about that but that one we put right at
the top for you to remember. So
you've got an increased risk of clots. Then clots can turn
into things like pulmonary embolism
(PE), an MI, a heart attack, or stroke. You might have a
risk for abnormal uterine bleeding and
you want to stay, have an open conversation with your
healthcare provider and with your nurse to let
them know if this is happening. If these women has
migraines, they might have an increased risk for
stroke particularly if they have an aura. So, if you have an
aura with a migraine you don't want
to take it. If you don't have an aura depends on your age or
if you're a non-smoker or your
other factors. Now sometimes these can cause a benign
hepatic adenoma. It's rare but there is
a risk for that. Now the other mild effects come from like
an estrogen or progestin imbalance
and you know how those hormones impact your body. So, what
you want to make sure that you're clear
on so you can educate your patients as a professional and
address these topics in a test question
you want to know that combination oral contraceptives
increase your risk for clots and when
those clots travel it's bad news. They might have abnormal
uterine bleeding and it might increase
the risk for stroke for patients who have migraines
particularly if they have an aura. Now the
last one, if you can remember that, that is kind of like not
necessarily the most essential point
but they can develop a rare benign hepatic adenoma but if I
was looking to know the most important
things I would definitely make sure I knew about the clots
and the abnormal uterine bleeding.
04:24
The stroke can also be an issue but those would be my top 3
that I want to make sure I had clear in
my mind so as ready to practice. Now, who should not take
the combination oral contraceptives?
We're going to present this to you in just a little bit
different way. Right? If you have a history of clots
if you have abnormal liver function. Remember that adenoma.
Known or possible breast
cancer. Estrogen kind of feed certain breast cancers so we
would not want you to take an oral contraceptive.
04:54
What if you think you might be pregnant? Well, then oral
contraceptives
don't have a rule. So you should if you are taking them,
stop. And if you're a smoker over the
age of 35, we don't recommend. Okay, so why do we put the
slide in here again? Because this is
a great summary slide. Right there you've got it. Look,
you've got just the 6 boxes, it's clean,
you got a big red stop sign in that so you can use it as a
graphic visual to help your brain
remember. This is who should not take a combination oral
contraceptive. So, take a minute, make any
notes on the slide that you needed to help it stick in your
brain but I would star and circle this
slide so when I was doing my quick review on a daily basis I
would absolutely zero in on this
slide. Now who has caution? Well we've got a lot of list
here. Right? The heart things,
hypertension, cardiac disease, long-term history of
diabetes. If they are smokers, if they have
uterine leiomyoma. These are people who have those fibroid
tumors in their uterus. If they
have epilepsy, history of seizures, if they have migraines.
Remember particularly, they don't
have an aura it might be okay but we have to look at all
their factors. They have a history of
gallbladder disease or gallbladder problems in pregnancy.
Whoosh, that is like a really long list.
06:21
Well, you know what I'm going to recommend. Stop, don't just
look at a list like this. What
things can you group together, shown together so you will
remember them together.