9.8 Hormonal Contraceptives

This section will introduce classes of common hormonal contraceptives. Hormonal methods of contraception use hormones to prevent pregnancy. These methods work by preventing ovulation, thickening cervical mucus, and altering the lining of the uterus. Hormonal methods of birth control include combined and progestin only medication options. Contraceptive medications are available in various forms, including pills, patches, rings inserted into the vagina, injections, intrauterine devices, and implants inserted under the skin.

Combined Hormonal Contraceptives

Combined hormonal contraceptives (CHCs) are a type of birth control that contain estrogen and progestin hormones. These hormonal contraceptives are widely available in various forms such as pills, patches, vaginal rings, and injections. Ortho Tri-Cyclen is a popular prototype contraceptive.

Mechanism of Action: CHCs, such as Ortho Tri-Cyclen, prevent ovulation while thickening mucus to prevent the sperm from reaching the egg and thicken the lining of the uterus to prevent implantation of the fertilized egg.

Indications: These medications are used to prevent pregnancy.

Nursing Considerations: Clients should be monitored for adverse effects such as hypertension, thromboembolic events, and abnormal vaginal bleeding.

Side Effects/Adverse Effects: Common side effects of Ortho Tri-Cyclen include nausea, breast tenderness, and mood changes. Adverse effects include thromboembolic events, especially in clients who smoke.

Health Teaching & Health Promotion: Clients should take the medication at the same time every day. They must adhere to dosing schedule in order to ensure optimal contraceptive efficacy. Clients should be educated that although CHCs prevent pregnancy, they do not prevent sexually transmitted diseases. Many medications also decrease effectiveness of CHCs, and clients should be instructed to use back-up contraception when on certain medications such as antibiotics.^[1]

Progestin-Only Contraceptive

Progestin-only contraceptives only contain progestin rather than combined estrogen and progestin. An example of a progestin only contraceptive is norethindrone, also known as a mini-pill.

Mechanism of Action: The mini-pill works by thickening the cervical mucus, which makes it difficult for sperm to enter the uterus, and by thinning the lining of the uterus, which makes it less receptive to implantation of a fertilized egg.

Indications: This medication prevents pregnancy.

Nursing Considerations: The mini-pill is commonly prescribed for women who cannot tolerate estrogen or those who are breast feeding. It does not impact milk production.

Side Effects/Adverse Effects: Common side effects include irregular menstrual bleeding or spotting, headache, breast tenderness, nausea, weight gain, and mood changes. Adverse effects of the mini-pill include potential ectopic pregnancy, thrombosis, and liver problems.

Health Teaching & Health Promotion: It must be taken at the same time each day, without interruption. It may not be as effective as combined hormonal contraceptives due to the challenges many clients have with taking the medication at the same time every day.^[2]

Now let’s take a closer look at the contraceptive medication grid in Table 9.6.^[3]

Table 9.6 Contraceptive Medication Grid