Readers share strategies on OC use
Readers share strategies on OC use
Your next patient is a newly divorced 41-year-old woman who wants to use an oral contraceptive (OC). When you check her chart, you note that she smokes 10 cigarettes a day. What is your next move?
Offer her other forms of birth control, say participants in the 2006 Contraception Survey conducted by Contraceptive Technology Update (CTU). About 81% of survey participants say they will not write prescriptions for women ages 35-39 who smoke 10 cigarettes a day. For women ages 40 and older who smoke, about 93% say they will not prescribe OCs.
"Most women that I see in the 35-39 and over-40 age groups who smoke have other health issues as well, including obesity, high cholesterol, and hypertension," says Glenda Martinez, RN, ARNP, a nurse practitioner at Clark County Health Department in Winchester, KY. "Barrier methods are most favorable with them — sometimes sterilization or Mirena," which is the levonorgestrel intrauterine system (IUS) from Berlex Laboratories, Montville, NJ."
According to Contraceptive Technology, "the older the smoker, the more cigarettes she smokes, and the more concomitant cardiovascular problems she faces, the less likely she is to be a candidate for OCs."1 Offer such women effective progestin-only methods, such as depot medroxyprogesterone acetate (DMPA, Depo-Provera; Pfizer, New York City, and Medroxyprogesterone Acetate Injectable Suspension USP; Teva USA, North Wales, PA) and the IUS, the authors advise.
Along with prescribing a safe birth control method, clinicians should encourage and aid women to stop smoking, or to significantly reduce the number of cigarettes each day.1 Use Internet resources such as www.smokefree.gov, a site operated by the Tobacco Control Research Branch of the National Cancer Institute, for tips on smoking cessation. Click on "Get More Materials to Help You Quit" and "Fact Sheets and FAQ" to access several fact sheets and a set of frequently asked questions.
If a woman is in her 40s, healthy and a nonsmoker, she is a potential candidate for combined oral contraceptives. Not only will she benefit from regulation of menstrual bleeding, she will be reducing the risks of irregular bleeding and endometrial hyperplasia associated with anovulatory cycling during the perimenopausal years.1 When it comes to pill options for older women, about 39% of participants in the 2006 survey choose Alesse, a monophasic 20 mcg pill from Wyeth Pharmaceuticals, Collegeville, PA. Other leading selections choices include Loestrin, a monophasic 20 mcg pill from Duramed, a subsidiary of Barr Pharmaceuticals, Pomona, NY, and Ortho Tri-Cyclen Lo, a multiphasic 25 mcg pill from Ortho-McNeil Pharmaceutical, Raritan, NJ.
Many women may experience nausea when beginning use of a new OC. Which pill do survey participants prescribe for women who have experienced nausea on previous OCs?
About half (44%) of 2006 participants choose Alesse, as their top pill choice for such women. Alesse continues to lead all choices in this survey category; it has held the top spot since 1999. Other top selections in the 2006 survey include Ortho Tri-Cyclen Lo and Loestrin (Organon; West Orange, NJ).
When it comes to initiating combined OC use in postpartum women who are not breast-feeding, about 40% of 2006 survey participants say they will begin pill use four to six weeks after delivery. About 30% say they start pills one to three weeks postpartum, while about 13% begin OC use upon hospital discharge.
For breast-feeding women who wish to use progestin-only pills, about 43% indicate they will initiate pill use four to six weeks postpartum, while about 24% say they begin pill use one to three weeks following delivery. About 23% state they start minipills upon hospital discharge.
While oral contraceptives provide reliable birth control, they also offer noncontraceptive benefits; use of combined OCs can lead to reduced risk of ovarian cancer and endometrial cancer.1
How do you approach women with information on the noncontraceptive benefits of OCs? Cindy Morgan, RN, MSN, a public health nurse at Sanders County Health Department in Thompson Falls, MT, uses the initial visit to speak to all women about the benefits of OCs, especially women who have a family history for ovarian cancer. She then reminds women at each annual visit about the benefits they are gaining from OC use.
Should OCs be moved to over-the-counter status? Most 2006 CTU survey participants say, "No" about 69% of 2006 participants gave a thumbs down, representing a slight drop from 2005's 72% level.
Reference
- Hatcher RA, Trussell J, Stewart F, et al. Contraceptive Technology. 18th revised edition. New York City: Ardent Media; 2004.
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