 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, Managing Contraceptive Pill Patients, 15 th ed.  Section 11: Initial Selection of OCs (pp.60-69)  Table 5: list of every pill you may encounter (pp )  Table 6: breakdown of biological activity of each pill (pp )  Table 8: choosing initial oral contraceptive by patient characteristics (pp )  Table 9: pills grouped by similar characteristics (pp )  Table 14: list of drug interactions (pp )  Hatcher, Contraceptive Technology, 20 th ed.  Chapter 11 – COCs (pp )  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