Oral Contraceptives
ORAL CONTRACEPTIVES
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Introduction
· 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 with aura
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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