Combination Oral Contraceptives (OCs) (Nursing)

by Rhonda Lawes, PhD, RN

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      Slides 13-05 Womens Health Hormone Oral Contraceptives.pdf
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    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.

    About the Lecture

    The lecture Combination Oral Contraceptives (OCs) (Nursing) by Rhonda Lawes, PhD, RN is from the course Medications for Men's and Women's Health (Nursing). It contains the following chapters:

    • Combination Oral Contraceptives (OC)
    • Adverse Effects of Combination OC
    • Who Should Not Take Combination OC
    • Take Combination OC with Caution

    Included Quiz Questions

    1. Follicles will not mature.
    2. Estrogen suppresses the release of Luteinizing Hormone (LH).
    3. Progestin disallows ovulation.
    4. Cervical mucus becomes thick.
    5. The endometrium deters the fertilized ovum from implanting.
    1. Clot development
    2. Abnormal pregnancy
    3. Normal uterine bleeding
    4. Multiple miscarriages
    1. History of clots
    2. Normal liver function
    3. Smoker younger than age 35
    4. No history of breast cancer

    Author of lecture Combination Oral Contraceptives (OCs) (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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