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Hormonal Contraceptives

2 min read

Hormonal Contraceptives

Key Points

  • Hormonal contraceptives use estrogen and/or progestin to prevent pregnancy.
  • Combined oral contraceptives (COCs) suppress ovulation, thicken cervical mucus, and thin the endometrium.
  • Progestin-only methods (mini-pill, implant, injection) are options when estrogen is contraindicated.
  • Estrogen-containing methods carry increased risk for venous thromboembolism, especially in smokers over age 35.

Mechanism of Action

Combined hormonal contraceptives suppress the hypothalamic-pituitary-ovarian axis, preventing the LH surge needed for ovulation. Progestin thickens cervical mucus (blocking sperm penetration), thins the endometrial lining (reducing implantation potential), and slows tubal motility. Estrogen stabilizes the endometrium and enhances ovulation suppression.

Formulations

  • Combined oral contraceptives (COCs): Estrogen plus progestin; taken daily.
  • Transdermal patch: Weekly application of combined hormones.
  • Vaginal ring: Monthly combined hormone delivery.
  • Progestin-only pill (mini-pill): Daily progestin without estrogen.
  • Injectable (DMPA): Depot medroxyprogesterone acetate every 3 months.
  • Implant: Subdermal progestin rod lasting up to 3 years.

Nursing Considerations

  • Assess for contraindications to estrogen: history of DVT/PE, stroke, migraine with aura, liver disease, breast cancer, smokers over age 35.
  • Monitor blood pressure periodically because COCs may increase blood pressure.
  • Counsel on consistent daily timing for oral contraceptives, especially progestin-only pills (must take within a 3-hour window).
  • Assess for drug interactions: certain antibiotics, anticonvulsants, and St. John’s Wort may reduce contraceptive efficacy.
  • Evaluate for signs of thromboembolism: unilateral leg swelling, sudden chest pain, severe headache, or vision changes.

Side Effects and Adverse Effects

  • Common: Nausea, breast tenderness, breakthrough bleeding, headache, mood changes, weight fluctuation.
  • Serious: Venous thromboembolism (DVT/PE), stroke, myocardial infarction (estrogen-containing methods).
  • Other: Hypertension, hepatic adenoma (rare), gallbladder disease.

Thromboembolism Risk

Estrogen-containing contraceptives significantly increase venous thromboembolism risk. Smokers over age 35 should NOT use estrogen-containing methods.

Health Teaching

  • Take pills at the same time daily; use backup contraception if doses are missed.
  • Stop smoking to reduce cardiovascular risk with estrogen-containing methods.
  • Report sudden severe headache, leg pain/swelling, chest pain, or vision changes immediately.
  • Understand that contraceptives do not protect against sexually transmitted infections.
  • Return for DMPA injection every 12 weeks; late injection requires pregnancy testing.
  • reproductive-system - Hormonal regulation of the reproductive cycle.
  • Venous Thromboembolism - Major risk associated with estrogen-containing contraceptives.
  • Family Planning - Contraceptive counseling and reproductive health context.

Self-Check

  1. Why is estrogen contraindicated in smokers over age 35?
  2. How do progestin-only methods prevent pregnancy differently from combined methods?
  3. What instructions are critical for clients taking progestin-only pills?

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