Maternity - Preconception, part 2: Hormonal Methods of Contraception

Hi, I'm Meris, and in this video, I'm going to be talking to you about hormonal methods of contraception. I'm going to be following along using our maternity nursing flashcards. These are available on our website, leveluprn.com, and if you already have a set for yourself, I would absolutely invite you to follow along with me. All right. Let's get started.

Okay, so first up, we are talking about oral contraceptives, oral contraceptives, or the birth control pill, and these are going to be very popular. You will see many patients taking these. But there's some really important stuff to understand. First of all, there's something called the mini pill or a progestin-only pill, meaning that it only contains the synthetic form of progestin, it does not have any estrogen. Then we have combined oral contraceptives, and as their name may imply, that's going to be a contraceptive that is a combination of estrogen and progestin. Very important to understand because the teaching is different.

So with the mini pill, the progestin only-pill, there is no increased risk of clots, DVTs, anything like that. That risk comes from the estrogen. But what you do need to know is that this is the only birth control pill that is safe for breastfeeding patients. Because estrogen is passed through breast milk the only one that can be used when breastfeeding is the progestin-only mini pill. Very important to educate patients that they need to take it at the exact same time every day with the same amount of food in their stomachs because it can change the absorption time if there's food in the stomach one day and not the other, these are very time-sensitive.

Now, combined oral contraceptives, again, very important to take it every single day. But this one has some better coverage, it's more effective, but it carries the risk for thromboembolic events such as deep vein thrombosis. So educate your patients on what to look for there, pain in the leg, redness in the leg, chest pain, difficulty breathing, all of those would be a big deal. And if my patient were a smoker, if they had a personal or family history of blood clots or if they were over the age of 35 and a smoker, I would very much encourage them not to be taking a combined oral contraceptive. We do have a nice, cool chicken hint down here at the bottom. It says oral contraceptives cause clotting, but I would add another word in front of that and say combined oral contraceptives cause clotting. Very important to remember that. You'll see a lot of different side effects on here, too, that are worth reviewing, but not the huge red flags that the DVTs are.

All right. So let's move on to medroxyprogesterone. Medroxyprogesterone, the trade name is going to be Depo-Provera, so this is going to be an injection. This is actually an IM injection that a patient should receive. It's going to be about every three months and the patients will be receiving a card at each injection that tells them when their next one is due. And most of the time, it's a really good idea to go ahead and schedule that next injection as well. Lots of things that can go on with this one, but the biggest one that I want to call your attention to, and it is in big, bold red letters, is going to be that with long-term use of medroxyprogesterone, the patient can experience bone demineralization. So important patient teaching is going to be increase your intake of calcium and vitamin D along with weight-bearing exercise. Super duper important to know about that.

All right, moving on to a few more that you may have heard of. They're not quite as common, though, so we didn't go super in-depth. The transdermal patch, the vaginal ring, and the subdermal implant. And stay until the end of this video, because I'm going to tell you a true story about one of these. So the transdermal patch, this is a patch that is applied to the abdomen, the buttocks or the arm, do not apply it to the breast, though. This one is going to be a patch left in place for one week. It will be changed, so you'll wear it for a week, a new patch for a week, a third patch for a week, and then one week off. The vaginal ring is an actual ring, it's a small clear ring that is inserted vaginally and left in place for three weeks, removed for the fourth week, and that triggers a menstrual cycle. Okay, very important to know that. Subdermal implants, a subdermal implant is placed subcutaneously here in the arm and it can be left in place for three years. Really, really great option. It may cause menstrual irregularities, though. As with all hormonal methods of birth control, it is very important to educate your patients that these do not provide any protection against STIs, okay, only against pregnancy.

And lastly, we're going to talk about the intrauterine device. So this is commonly called an IUD, there are multiple different types. There are hormonal and non-hormonal types, such as the copper IUD, Paragard, is non-hormonal, but we kind of lump it in with hormonal because most of them are. So this one can be left in place for multiple years, depending on which type the patient receives. So anywhere from 3 to 12 years, it can be left in place, but it must be placed by a health care provider. Super duper important patient teaching. There are some strings that hang out of the cervix from the IUD, this allows the health care provider to grasp the strings and remove it when the patient would like to have it removed. These strings are kind of similar to fishing line, but the longer they are left in the body, they will soften and they will kind of curl up at the edges and they will be non-obstructive, non-obtrusive. You need to educate your patient, though, to check the strings once a month. The patient needs to make sure that they can still feel the strings, that they haven't suddenly gotten much longer or much shorter or disappeared entirely because it is possible for an IUD to be expelled, meaning pushed out of the body. It is also possible for the IUD to become dislodged and either be too low in the cervix, not the uterus, or perforate the uterus entirely and possibly escape into the abdomen. So this is why it's important for patients to check their string length and if there's a change in their string length, to call their provider immediately.

Okay, that is it for hormonal methods of contraception. Super duper important stuff, so be sure to brush up on it. I hope that review was helpful. If it was please like this video so that I know. If you have a great way to remember something or a great story you want to share, I definitely want to hear it, and I know everybody else does, too. So please comment below so that we can see it. And you definitely want to subscribe to the channel, you want to be the first to know when more videos come out. The next video in this series is going to be talking about permanent sterilization and also about infertility. All right, thanks so much and happy studying.

So when I was working outpatient OBGYN, one of my jobs was to be the phone triage person, so somebody would call the office and I would listen to their complaint or their question or whatever and either give them advice or move it on to the physician. And one time I got a call from a patient who said, "I was just in the other day, and I think I'm allergic to this NuvaRing," and I said, "Okay, tell me a little bit about what's going on." And she was like, "It's turned my fingers blue," and I thought, "What? The NuvaRing, the vaginal ring is turning your fingers blue? What?" And so I keep probing and asking her some more questions, and she says, "It's just so tight," and I had to say to her, "I'm so sorry. Where is the NuvaRing?" And she said, "It's around my wrist," she'd been wearing it like a bracelet, like a hair tie around her wrist, and it was cutting off the circulation to her fingers. If you've ever seen one or felt one, they are flexible, but they're not stretchy. So she had to fight it to get it over onto her wrist. And it was cutting off circulation to her fingers. Okay, it's a funny story. It's a true story. It really happened to me. But it also is just another example of why patient education is so important, why it is so important not to assume that your patients have the same level of health literacy as you do, because they definitely don't, and to take your time to go line-by-line and just really make sure that they understand what they're supposed to be doing with their medication or their lifestyle changes because otherwise, stuff like that can happen.

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