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Nursing Knowledge
ACHES is a mnemonic used to remember the warning signs for serious adverse effects of hormonal contraceptives.
A – Abdomen: severe pain may indicate liver tumor or ectopic pregnancy
C – Chest: severe pain and SOB may indicate MI or PE
H – Head: sudden severe headache may indicate stroke
E – Eye: blurriness or loss of vision may indicate blood clot in eye
S – Sudden pain or swelling in leg: may indicate VTE
COCs contain estrogen and progestin, for example:
Adverse effects may vary based on the type and dose of each component. Clients should be taught the ACHES warning signs and report concerning symptoms. Reporting of benign adverse effects should also be encouraged though, as a change of formulation may improve symptoms.
Progestin-only contraceptives like implants, IUDs, injections or the mini pill do not contain estrogen. For this reason, they have fewer adverse effects than COCs and
may be safe for individuals who are unable to take estrogen.
Benign, common adverse effects include irregular bleeding and increased acne. Contraindications are a known or suspected pregnancy, unexplained vaginal bleeding, and breast cancer.
Clients should be informed that irregular bleeding often improves after the first 6 months of use, but should be encouraged to report it if persistent and/or bothersome.
Tip: COCs and the mini pill have many drug–drug interactions. Take a thorough medication history to identify interactions that may decrease contraceptive efficacy.
Plan B is a morning-after emergency contraception pill. Potential adverse effects of taking Plan B while taking hormonal contraceptive pills can include:
Adverse effects can start immediately or within a few months of starting contraceptive use. A lot of adverse effects may improve within a few months, so giving it a little time before changing to another option may be suggested if symptoms are acceptable to clients.
Some clients can experience adverse effects when stopping the use of hormonal birth control options. For combined oral contraceptives, these include:
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