NR 602 Midterm Study Guide 2021
■ First day start
- NO BACKUP method
○ Mechanism of Action:
(Progestin and estrogen inhibit the hypothalamic-pituitary -ovarian axis and subsequent
steroidogenesis
■ The progestin in COCS is the main actor in preventing pregnancy.
○ Prevents the luteinizing hormone (LH) surge thereby inhibiting ovulation
○ Thickening the cervical mucus→ inhibits sperm penetration and transport
○ Changes the fallopian tubes so that transport of sperm or ova is impaired
○ Causes endometrium to become atrophic.
■
The estrogen primarily inhibits follicle-stimulating hormone secretion.
■ The estrogen also works synergistically with the progestin to affect the uterine lining and cervical
mucus production.
○ Candidates:
■ Women with dysmenorrhea and menorrhagia
■ Women who want to regulate menses
■ Women who will use a daily method consistently
■ Post abortion (any trimester)
■ Past ectopic pregnancy
○ Advantages:
■ Reduced menstrual flow and dysmenorrhea for most users
■ Reduce the risk of ovarian cancer
20 % for every 5 years- Even after discontinuing COC use, protection
continues for 15-20 years.
■ COCs also
reduce the risk of endometrial cancer
by 40-50%, and like ovarian cancer, protection
increases with duration of use.
■ Reduces risk of colon cancer
■ 90 percent protection from ectopic pregnancy with current OC use.
■ Reduced incidence of benign breast disease
■ Effective in reducing acne.
■ Lower incidence of endometriosis
■ Possible Advantages: 1) May preserve bone density, and 2) May protect against iron deficiency anemia,
ovarian cysts with higher doses, and pelvic inflammatory disease.
○ Contraindications:
■ Multiple risk factors for arterial cardiovascular disease, such as smoking, diabetes, hypertension
■ Known thrombogenic mutations
■ Current or history of current ischemic heart disease, history of stroke, history of or current deep venous
thrombosis or pulmonary emboli
■ Vascular disease
■ Complicated valvular heart disease
■ Hypertension (systolic ≥160 or diastolic ≥ 100)
■ Smoking (>15 cigarettes/day and age 35 or older)
■ Migraine headache with aura
■ Major surgery with prolonged immobilization
■ Current breast cancer
■ Active viral hepatitis