Effective Contraceptive Treatments Essay
Effective Contraceptive Treatments Essay
Week 3 discussion Discussion: Contraception Treatments Considering the potentially negative consequences of unintended pregnancy for a woman’s health and well-being, effective contraceptive treatments are an important part of gynecologic care. There are a variety of contraceptive treatment methods available for women, including hormonal, barrier, and fertility awareness options. Each method has its own strengths and limitations, and each patient often has individual factors that might also impact appropriateness of use. In your role as the advanced practice nurse, it is important to keep in mind that while you may make contraceptive recommendations to patients, contraceptive selection is a joint decision between the patient and the provider. Effective Contraceptive Treatments Essay . For this Discussion, consider which contraceptive treatments would be most appropriate for the patients in the following three case studies: Case Study 1: A 23-year-old Caucasian female presents with concerns about mood swings around the time of her menses. She believes she has PMS and wants to know if there is medication to control it. Case Study 2: A 25-year-old Latina female presents with menstrual cramping that has been getting worse over time. She has never been pregnant and she has one male sex partner. Her gynecologic exam is normal. Case Study 3: A 33-year-old Caucasian female is being seen in clinic for contraception.
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She is using birth control pills, but forgets to take them because her work schedule changes every week. She has been married for 14 years and has two children. She is looking for an effective method that will be easy to remember. She has a history of chronic headaches and hypertension during pregnancy. She has never been treated for a sexually transmitted infection and is in a mutually monogamous relationship. Family history is significant for an aunt with breast cancer. She smokes half a pack of cigarettes per day. She is 5 ft. 8 in. and 215 lbs. Her vital signs are: BP 120/78, p 72, reg. To prepare: Review Chapter 12 of the Schuiling and Likis text and the Dragoman et al. article in this week’s Learning Resources Select one of the three provided case studies. Reflect on the patient information. Consider an appropriate contraception treatment for the patient case study you selected. Think about how you might facilitate the selection of contraception treatments with patients who do not agree with your recommendations. Tutorials for this Question. Effective Contraceptive Treatments Essay
Contraceptive methods have been there for thousands of years but in the last fifty years the methods of contraception have increased tremendously. Different contraceptions work in different ways. There are hormonal methods like the pill, barrier method like the cervical cap, Intrauterine devices and sterilization. There is also the emergency pill. Most contraceptives work in different ways such as preventing release of the egg, blocking the sperm from reaching the egg , blocking the functioning of the reproductive organs or ensuring the fertilized egg from implantation (Committee on Contraceptive Development 134). A fertile woman who is sexually active has many options to family planning but should bear in mind that no method is 100% effective against sexually transmitted diseases except abstinence from sex.Effective Contraceptive Treatments Essay
There are two types of hormonal contraception.
The differences involve the type of hormone contained, the amount of hormone that is used and how that hormone is administered in the woman’s body. The hormone of use is usually progesterone or estrogen and can be taken orally, injected into the skin, implanted in the body, absorbed from a patch or placed in the vagina (Darney 68). How the hormone is delivered determines how effective it is and if the exposure is continuous or not.
All the hormonal methods are very effective and reversible but do not protect against sexually transmitted diseases. The pill is made from synthetic hormones and is one of the most effective barrier methods. It comes in two forms one is the combined form which contains estrogen and progestin, it works by preventing the ovaries from reaching maturity interfering with ovulation. When there is no ovulation there is no egg to be fertilsed. The pill is packed in small caps of either 21 days or 28 days.
The second type is the mini pill; it has only one hormone progestin which works by thickening the cervical mucus preventing the sperm from going through the cervix. It also makes the uterine lining less receptive to an egg that has been fertilized and has to be taken every day. The pill cannot protect against sexually transmitted diseases. The pill needs discipline when taking it for it to be effective (Mastroianni 98).Effective Contraceptive Treatments Essay
The mini pill is recommended for women who need to avoid estrogen due to medical reasons such as liver disease and some types of blood clots in the veins. It is also best for nursing mothers since it has no effects on breastfeeding. The pill may lose its effectiveness when taken with drugs like tetracycline. It might also lessen its effects when a woman vomits or diarrhea. Symptoms such as spotting or vaginal bleeding, tender breasts or nausea can be expected within the first three months after use.Effective Contraceptive Treatments Essay
Studies show there is no significant weight gain while on the pill contrary to popular belief. Mood swings, pigmented skin, melasma may occur with contraceptives. There is also possibility of amenorrhea which is rare. Using the hormonal pill does not increase possibility of birth defects in babies though a nursing mother should not use combination contraceptives because it can limit the milk and proteins in the milk and the hormone also gets into the breastmilk. Female smokers using pill risk getting a stroke or a heart disease contrary to non smoking females on the pill.
Blood clots are frequent with low dose oral pills but at a low risk as compared to pregnant women. The pill is not for women with clotting tendencies. Female smokers over 35 years should not be using contraceptives. When a woman experiences cramps in the legs, blurred vision or loss and flashing lights, shortness of breath, pain in the abdomen, coughing blood or swelling in the leg, they should contact a doctor immediately (Darney 123). The benefits of taking the pill apart from being highly effective is that it can influence regular menstruation, it can reduce the menstrual flow and cramps.Effective Contraceptive Treatments Essay
Researchers have evidence that the pill might protect against pelvic inflammatory disease (PID) and anemia. Combination pill can reduce t acne, cysts in breast and ovaries and ectopic pregnancy, uterine and ovarian cyst. Women on the pill are unlikely to develop rheumatoid arthritis and osteoporosis (Committee on Contraceptive Development 102). The patch is worn on the skin on the low part of the abdomen, buttocks or upper part of the body except the breast. It releases estrogen to the blood. One patch can be used for a week and is not worn during menstruation.
The vaginal ring also releases progestin and estrogen and is worn for about three weeks inside the vagina. It is also taken out during menstruation and a new ring inserted. Emergency contraception is not like the other methods of birth control. It is used after sex if the chosen birth control method fails like a condom burst. The implant also offers a long term protection against and can stay for up to three years and offers no protection from STI’s. It also contains progestin which is released daily and has same effects as the pill. A nurse or a doctor inserts it in the arm and is more effective than the pill due to lack of human error.
Those opposing hormonal contraceptive use usually argue that is not right, is anti life and not natural. They also say it is the same as abortion and separates sex from its intended purpose of reproduction. This is a problem for Muslims and Christians who believe life starts at contraception. They also argue that hormonal contraception has consequences such as health risk because of the side effects it carries and it also raises many questions among the medical fraternity of how it really works because it allows conception to take place and then makes the uterus a hostile place. Hormonal contraceptives do not prevent sexually transmitted diseases and allows people to have multiple sex partners and also unlike barrier methods offers no protection against these diseases (Darney 67).Effective Contraceptive Treatments Essay
They say it gives rise to a dangerous contraceptive culture. Those opposing contraception argue that it is against humanity because potential humans are not born and can be used as eugenic. Sometimes types of hormonal contraception are mistaken for population mass control for certain races. There are also beliefs that contraception leads to depopulation. Some form of contraception like pills are prone to human error and therefore might lack to fulfill the intended purpose of preventing pregnancy.
Contraception gives rise to a culture of sexual immorality because it makes it easier for unmarried people to have sex and not have children. It allows people to have sex purely for fun. This makes immoral behavior less risky and undermines public view on morality making it easy for people to cheat on their partners and in the process might weaken family ties.
Works Cited
Committee on Contraceptive Development. Developing New Contraceptives: Obstacles and Opportunities. New York: National Academies Press, 2000. Print.
Darney, Philip D. A Clinical Guide for Contraception. New York: Lippincott Williams & Wilkins, 2010. Print.
Mastroianni, Luigi. Developing New Contraceptives: Obstacles and Opportunities. New York: National Academies, 2000. Print.Effective Contraceptive Treatments Essay
| “After years of little innovation in birth control, an assortment of new methods offering a broad variety of choices is emerging, including a skin patch that is changed weekly, a hormone-enhanced IUD and a permanent sterilization procedure that requires no anesthesia” (Berger, 2002, p.1). After reading this article in the New York Times, I became very interested in the new forms of birth control. Currently I am prescribed to an oral contraceptive, and have difficulty taking the pill at the same time everyday and on a regular basis, which lowers the effectiveness of the contraceptive. I was looking for a contraceptive that is not necessarily taken everyday and is reversible in that I am able to become pregnant at a later date in life. After completing research on the many different forms that have emerged in the last few years, I narrowed my concentration to three. An injectable form entitled Depo-Provera, a transdermal patch entitled Ortho-Evra, and a vaginal ring entitled NuvaRing. These all met the criteria that I wanted in a new form of birth control as well as presented enough information to research in making a decision.Effective Contraceptive Treatments Essay “The new devises offer longer lasting alternatives to a daily pill and are viewed as long overdue in light of an estimated three million unplanned pregnancies in the United States each year, about half of them ending in abortion” (Berger, 2002, p.1). The overall effectiveness has increased with these new forms of birth control, which can help women and our country’s unplanned pregnancy rate. The lack of variety of birth control has been seen as a result of the length of time in developing these new forms as well as the Puritan culture our country is based on. There also have been many developments, such as Norplant, that have emerged just to be taken off the market soon after it premiered (Berger, 2002, p.1). It has been a long time since a new method has emerged, but Depo-Provera, Ortho Evra and NuvaRing are three examples that have emerged and has effectively increased the accuracy of pregnancy protection.Effective Contraceptive Treatments Essay In order to correctly evaluate the risks and benefits of new emerging birth control methods, a basic understanding of those associated with oral contraceptives is first needed. Birth control pills use synthetic hormones that imitate those naturally produced in the body and were first introduced and approved by the FDA in 1960. There are many health benefits to birth control in addition to the decrease of incidence of unwanted pregnancy including prevention of osteoporosis by impacting bone mineral density as well as regulating the menstrual cycle and decreasing the chance on anemia by restricting blood loss. It is also used in the treatment of acne and uncomfortable cramps associated with the menstrual cycle. Like most pharmaceutical treatments, there are many health risks associated with the use of oral contraceptives. Many of these include an increase in risk for breast and cervical cancer, myocardial infarction, and stroke. There is a 5% failure rate associated with the pill (Shvarts, 2002, pgs. 11-13). “On October 3, 2001, the FDA approved a combination vaginal ring called NuvaRing” (Likis, 2002, p.150). It is a doughnut shaped devise that is flexible, translucent and about two inches in diameter. It is self inserted into the vagina on or before the fifth day of menses. Its positioning within the vagina is not imperative to its effectiveness because it is not a barrier method. It releases either progestin or a combination of progestin and estrogen everyday for three weeks, when it is then removed from the vaginal so that the woman can experience bleeding. Rarely does the ring slip out of the vagina, but if this occurs and is noticed within three hours, it can be rinsed in lukewarm waster and re-inserted (Shvart, 2002, p.15). The advantages of NuvaRing compared to the traditional pill is the lack of direct effort in the woman because the ring is inserted and left alone for three weeks instead of having a constant reminder of taking the pill everyday. The failure rate compared to that of the pill is much lower, at .65%, and cycle control remains comparable to oral contraceptives. Infrequently was their irregular bleeding associated with NuvaRing, much lower than that of the pill and other contraceptives (). “In clinical trials, the most common adverse events reported by 5-14% of women using NuvaRing were, vaginitis, headache, upper respiratory tract infection, leucorrhea, sinusitis, weight gain and nausea. Other adverse reactions that have been reported are similar to those seen with other combination hormone contraceptives” (Shvart, 2002, p.15).Effective Contraceptive Treatments Essay “The Ortho Evra patch was approved by the FDA in November 2001 and is expected to be available to the public in winter 2002” (Shvart, 2002, P.20). This was the first transdermal system used in birth control and introduced to the public. It is beige in color and is the size of a matchbook. It is first applied on the first day of menses to clean and dry skin. It may be placed on the buttocks, abdomen, upper arm or torso. There are no restrictions on usual activity like showering or swimming, but lotions and other ointments should not be placed on the area of the patch (Likis, 2002, p.151). Ortho Evra is applied and left on the skin for seven days. After seven days the patch is removed and replaced by a new patch. This continues for three weeks and is followed by a patch free week in which bleeding occurs. While it is on the skin, continuous hormones of estrogen and progestin are releases through the skin and into the blood stream. Because the patch consists of three layers, a clear liner removed before fixation to the skin, a medicated middle layer, and a polyester protective outer layer, it is rarely detached from the skin. If it happens to detach, a new patch must be reapplied immediately (Shvarts, 2002, 20). “The combination transdermal contraceptive patch is very effective with estimated failure rates of 0.4% and 0.7% for perfect and typical use respectively” (Likis, 2002, p.151). It is much more effective than the traditional pill, and eliminates the annoyance of daily contraceptive use. Because it is a transdermal process, lower serum levels are seen which reduces nausea. “Although breast symptoms were more common with the contraceptive patch than with oral contraceptive, most cases were mild or moderate, occurred only once or twice, and generally were not treatment limiting” (Sibai, 2002, p.S24). Other negative side effects include higher incidence of breakthrough bleeding, skin reactions at or near the application site, and a higher incidence of cramps. In women with body weight greater than 198, failures of the contraceptive increased because of the increase in body mass (Zieman, 2002, p.S18).Effective Contraceptive Treatments Essay Progestogen injectables have been available for consumers since 1992. Depo-Provera is one of the main injectable forms of contraceptives on the market. It is dispensed into the deep intramuscular tissue every 12 weeks. “The first injection should be given on day 1-5 of the menstrual cycle, on the day of the abortion or miscarriage, on the day the last pill is taken if switching over from a progestogen only pill or a combined oral contraceptive pill or at 6 weeks after childbirth” (Gupta, 2003, p.30). It works by keeping the ovaries in a resting state so that eggs are not released, and therefore the sperm has nothing to fertilize. Each shot suppresses ovulation for three months; therefore the shot is administered four times a year. By suppressing ovulation, Depo-Provera gradually reduces menstrual bleeding and eventually stops menstruation all together. This happens because during the monthly cycle, the uterus builds up and is shed when the egg is not fertilized. Depo-Provera causes less and less buildup in the uterus, and usually after a year, the buildup stops, and the monthly period ends (Gupta, 2003, p.30). Depo-Provera is one of the most favorable new forms of birth control on the market. This is most likely because of the convenience of the dosage as well as the privacy in utilizing it. Those who have trouble with pills seem to find great use in the injectable. “Endometriosis, painful heavy periods, iron deficiency anemia, and premenstrual syndrome improve with the use of injectables, possible due to the suppressant effect on ovulation and the resultant amenorrhoea in long term Depo-Provera users” (Gupta, 2003, p.30). This is benefit similar to most other contraceptives including the pill. There have been many recent studies that say it reduces seizures in epileptic women. Unlike the pill, there is no increase risk of myocardial infarction or stroke. The rate effectiveness is 99.7% which is much higher than most other forms of contraceptives. Irregular vaginal bleeding, headaches, dizziness, and depression are common side effects (Gupta, 2003, p.30). In a study done and published in the Journal of Adolescent Health, it was concluded that an average of 9.2 pounds were gained on average every year that the injectable was used (Miller, 1996, p.132). “This may be due to modification of the hypothalamic appetite control centre, with extra weight being mainly from fat as opposed to water retention” (Gupta, 2003, p.31). All other risks and benefits are similar to that of the pill and many other forms of contraceptives. After finishing the research and comparison on Ortho Evra, Nuva Ring and Depo-Provera and weighing the many advantages and disadvantages of each, I believe that Ortho-Evra would be the best method for me. It seemed to have the least amount of risks because I never experienced cramps previously to taking birth control. It is much more effective than traditional oral contraceptives and in comparison to Depo-Provera, it is much easier to discontinue use because it is not internally injected. Because I do not have to worry about taking a pill every day or changing any daily habits, the transdermal patch would be an effective contraceptive for me. The research I performed fully assisted my decision and eased the worrying that the daily pill has given me in the past. Effective Contraceptive Treatments Essay |
