Oral contraceptives are hormonal medications used primarily to prevent pregnancy. They generally fall into two main categories: Combined Oral Contraceptives (COCs) and Progestin-Only Pills (POPs).
Beyond pregnancy prevention, oral contraceptives offer several therapeutic and prophylactic advantages for women. Medical providers frequently prescribe them to manage various gynecological disorders.
Safety screening is paramount because hormonal contraceptives carry serious systemic risks for certain patient populations. The World Health Organization Medical Eligibility Criteria guide these safety evaluations.
Absolute contraindications for combined oral contraceptives include a history of thromboembolic events, cerebrovascular disease, ischemic heart disease, known or suspected breast cancer, severe liver disease, and complicated valvular heart disease. Furthermore, women over age 35 who smoke heavily face sharply elevated cardiovascular risks from estrogen therapy. Progestin-only pills have far fewer absolute contraindications, making them safer for patients with cardiovascular risk factors or those with a history of migraines with aura.
Before dispensing oral contraceptives, the nurse must conduct a thorough health assessment. This process identifies underlying health problems and ensures the chosen formulation is safe and effective.
The initial evaluation includes taking a detailed medical, surgical, and family history, alongside an accurate blood pressure measurement and weight check. A routine pelvic exam or breast exam is not strictly required before initiating hormonal contraception, provided baseline screening questions rule out active pathologies. Nurses must screen specifically for recent migraines with aura, undiagnosed abnormal uterine bleeding, and potential drug interactions with liver enzyme-inducing medications like certain anticonvulsants or rifampicin.
Effective counselling ensures high continuation rates and reduces the risk of accidental discontinuation due to manageable side effects. Nurses explain how to take the pills correctly and what to expect during the first few months of use.
Clients are instructed to take one pill daily at approximately the same time. For combined pills, various packaging options exist, such as 21 active pills followed by 7 inactive pills, or continuous dosing regimens. The nurse should explain that unscheduled spotting or light bleeding is common during the first three months as the endometrium adjusts to exogenous hormones. Clear instructions regarding backup contraception during the first week of a new pack are crucial if initiation does not coincide with the first days of menses.
Mistakes happen with daily medication regimens, and clear protocols must be followed to maintain contraceptive efficacy. Managing side effects proactively prevents unnecessary dropouts from family planning programs.