Oral Contraceptives

By Abdulla Israr & Simran Rani

ORAL CONTRACEPTIVES

Description also available in video format (attached below), for better experience use your desktop.

IntroductionTop of FormTop of Form

·       Oral contraceptives are one of the most effective and widely used methods of birth control.

·       They work primarily by preventing ovulation, thickening cervical mucus to hinder sperm movement, and altering the uterine lining to prevent implantation.

Definition

·       Oral contraceptives are pharmaceutical preparations containing synthetic hormones designed to prevent pregnancy.

·       They are categorized into combined oral contraceptives (COCs) that contain both estrogen and progestin, and progestin-only pills (POPs).

Classification

1.     Combined Oral Contraceptives (COCs)

o   Monophasic Pills: Each pill contains the same dose of estrogen and progestin. Example: Alesse, Loestrin.

o   Biphasic Pills: Hormone dose changes once during the cycle. Example: Ortho-Novum 10/11.

o   Triphasic Pills: Hormone dose changes three times during the cycle. Example: Ortho Tri-Cyclen, Triphasil.

o   Extended Cycle Pills: Taken continuously for 3 months followed by a placebo week. Example: Seasonale, Seasonique.

2.     Progestin-Only Pills (POPs)

o   Also known as the "mini-pill," contains only progestin. Example: Micronor, Nor-QD.

Pharmacokinetics

·        Absorption: Oral contraceptives are well absorbed from the gastrointestinal tract.

·        Distribution: The hormones bind to plasma proteins and are distributed throughout the body.

·        Metabolism: They are metabolized in the liver.

·        Excretion: Metabolites are excreted through urine and feces.

Mechanism of Action

·        Inhibition of Ovulation: Estrogen and progestin inhibit the release of gonadotropins (FSH and LH) from the pituitary gland, preventing ovulation.

·        Thickening of Cervical Mucus: Progestin thickens the cervical mucus, making it difficult for sperm to enter the uterus.

·        Alteration of the Endometrium: Changes in the uterine lining prevent implantation of a fertilized egg.

Uses

·        Prevention of pregnancy

·        Regulation of menstrual cycles

·        Reduction of menstrual cramps

·        Treatment of acne

·        Management of endometriosis symptoms

·        Reduction of the risk of ovarian cysts

Adverse Effects

·        Nausea

·        Breast tenderness

·        Weight gain

·        Mood changes

·        Headaches

·        Increased risk of blood clots

·        Hypertension

·        Liver disorders

Contraindications

·        History of thromboembolic disorders

·        Breast cancer

·        Liver disease

·        Uncontrolled hypertension

·        Smoking (especially in women over 35)

·        Migraines

Role of Nurse

·        Education: Provide detailed information on the correct use of oral contraceptives, potential side effects, and the importance of adherence to the prescribed regimen.

·        Assessment: Evaluate the patient's medical history to identify any contraindications.

·        Monitoring: Regularly monitor the patient for adverse effects and any changes in health status.

·        Support: Offer support and counseling for patients experiencing side effects or having difficulty adhering to the medication.

·        Follow-up: Schedule regular follow-up appointments to assess the effectiveness of the contraceptive and make any necessary adjustments.

·        Promotion of Safe Practices: Encourage patients to use additional protection methods to prevent sexually transmitted infections (STIs).

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