Combined Hormonal Therapy (CHC)
There are 2 agents (Hormone) in the medication- an estrogen and progesterone
What are examples of CHC?
Combined oral contraceptives (COC)
Transdermal patch
Transvaginal patch
Progestin Only Products (POP)
No estrogens
What are alternative birth control methods?
Barrier precautions, abstinence, implantable that doesn't contain hormones
What is the mechanisms of action for CHC?
FSH and LH is suppressed=
Ovulation prevented
Cervical mucous is increased (environment not friendly to sperm b/c pH level is altered)
Affects uterine lining (line becomes thinned making an ovum less likely to attach to wall)
What is a typical pill cycle?
21 days on (active pills)/ 7 days off (placebo pills)
Ethinyl estradidol and drospirenone
Yasmin (typical pill)
Ethinyl estradiol and norethindrone
Necon 1/35 (typical pill)
Ethinyl estradiol and norgestimate
Ortho Tri-Cyclen (typical pill)
Ethinyl estradiol and norethindrone acetate
Loestrin (24 on/4 off)
Ethinyl estradiol and drospirenone
Yaz (24 on/4 off)
EE, drospirenone, levometoflate calcium
BEYAZ (24 on/4 off)
Ethinyl estradiol and levonorgesterel
Seasonique (84 days on/7 days off)
What is dropirenone?
Adrenal gland excrete aldosterone into kidneys, which encourages the kidneys to hold on to sodium and water and excrete potassium
What effect does drospirenone have on the body?
Inhibit the release of aldosterone
What are important nursing interventions for a woman taking brith control with dropirenone?
Assess potassium levels
Take patient history to assess for potassium levels
Risk of becoming hypokalemicc
Take medication history, potassium supplements
What are the advantages of COC?
Very easy to use
Decrease premenstrual symptoms
Decrease incidence of ovarian cycsts
Decrease risk of cervical/endometrial cancers
Decrease incidence of pelvic inflammatory disease
What are the disadvantage of COC?
Important to education patient- doesn't protect against STIs
Side effects
Requires medical follow up
Compliance- taking pill everyday
Transdermal patch
ORtho-Evra
Slow release of hormones to prevent contraception
What is the cycle of the transdermal patch?
Lasts a week, patient removes old patch and puts the new patch on for a series of 3 weeks, on fourth week there is no placement and the patient menstruates
Where can transdermal patches be placed?
Arm, chest, lower back, stomach, upper torso
** DO NOT place on breasts
Advantages of transdermal patches
Same mechanism as oral contraceptives but levels of circulating hormones is higher because there is no first pass effect
No daily pill
Decreases daily PMS symptoms more than oral contraceptives
Disadvantages of transdermal patches
Local skin reaction to patch placement
Effective rate decreases when a patient is more than 198 pounds
IRregular bleeding pattern
Which patients are considered high risk for transdermal patches?
Women with history of thromboembolisms (DVT, pulmonary ebolism, myocardial infarction)
Smokers
What are the side effects of CHC?
Weight gain, changes in mood, fluid retention, irregular uterine bleeding, chloasma
What are adverse reactions associated with CHC?
Thromboembolism
Increased risk for breast malignancy (because of more estrogen)
Hypertension
Hyperkalemia
What patients are contraindicated to take CHC?
Pregnancy of VTE/CAD/PE
Liver disease (undergo first pass)
History of breast cancer (don't want to give more estrogen)
Smoking
Age- 35+
What is the mechanism of action of POP?
Increase cervical mucous
Interfere with endometrial lining
Doesn't consistently inhibit ovulation
Which women are candidates for POP who are not candidates for CHC?
Smokers greater than 35
DVT
Breast cancer
What are the side effect of POP?
Depression
Break through bleeding
Weight gain
Oral POP
Take an active pill every day, no inactive pills
Must take pill at same time every day
No menstration
What is an example of an oral POP?
Norgestrel (Ovrette)
Injection POP
IM/SC injection
Increases compliance
Need injection every 3 months
Level of progesterone is higher
Less risk of unwanted pregnancy
What is an example of injection POP?
Medroxyprogesterone (depo-prevera)
Implantable POP
Size of match
Stick rod that gets surgically implanted into arm
Lasts 3 years
Very expensive
Can migrate to other parts of the arm that can affect release of hormones
No menstrual period
What is an example of an implantable POP?
Etonogestrel implant (Nexoplanon)
Intrauterine device (IUD)- POP
Inserted into vagina
Effective for 5 years
Can experience temporary pain or bleeding, mgirates, infection
What is an example of a intrauterine device POP?
Levonorgestrel-releasing intrauterine system (Mirena)(Skyla)
ParaGard
Releases copper that inhibits sperm migration
Make sure individual is not allergic to copper
Can remain in for 10 years
Can use while breast feeding
MAy cause heavier bleeding
How long do breast feeding mothers need to wait to take CHC?
2-3 months
What is an immediate first choice birth control for new mothers?
Depo-provera
How can estrogen affect a breast feeding mother?
Affect the amount of milk produced
What are S/S of menopause?
Lighter (irregular) menstrual flow
Hot flashes
Vaginal dryness
HA
Irritability
Insomnia
Bone loss (increased risk of osteoporosis)
Pain during intercorse
What are different treatment options for menopause?
Pharmacologic agents
CAM- St. John's worts, Soy, Black Cohosh
Conjugated equine estrogen
Premarin
Transdermal estradiol
Climara
Estradiol Intravaginal tablets
Vagifem
Estradiol Cream
Estrace
Conjugated estrogen and mdroxyprogesterone
PRempro
Estradiol and norethindrone
Cambipatch
What are contraindications to hormonal therapy?
Breast, endometrial cancer
Pregnancy
Thromboembolic disorders
Acute liver disease
Active gall bladder or pancreatic disease
Coronary artery disease
Undiagnosed vaginal bleeding
Black box warnings
Drug carries ability to cause serious or even fatal effects
Hormonal replacement therapy
Osteoporosis
Excessive amounts of bone breakfown without being built up again, as a result of bones become brittle and patients at increased risk of fractures
What are non-pharmacological interventions for osteoporosis?
Exervise
Consume calcium
Consume vitamin D
Smoking cessation
Healthy diet
Estradiol transdermal system
Menostar, osteoporosis treatment
Alendronate
Fosamax
Inhibits osteoclastic activity
Take with 8 oz of water, sit/stand upright for 30 min
Ibandronate sodium
Boniva
Raloxifene
Evista
Selective to estrogen receptors in bone
Less risk of side effects
Don't give to patients with VTE