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P A R T 7
Drugs acting on the reproductive system
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Oestrogens are hormones associated with the
development of the female reproductive system and
secondary sex characteristics; pharmacologically,
oestrogens are used to prevent conception, to stimulate
ovulation in women with hypogonadism and, to a
lesser extent, to replace hormones after menopause.
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Progestogens maintain pregnancy and are also involved
with development of secondary sex characteristics.
Progestogens are used as part of combination
contraceptives, to treat amenorrhoea and functional
uterine bleeding and as part of fertility programs.
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Oestrogen receptor modulators are used to stimulate
specific oestrogen receptors to achieve therapeutic
effects of increased bone mass without stimulating
the endometrium and causing other, less desirable
oestrogen effects.
KEY POINTS
pregnancy, decreased risk factors for coronary
artery disease, palliation of certain cancers).
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Monitor for adverse effects (liver changes,
GI upset, oedema, changes in secondary sex
characteristics, headaches, thromboembolic
episodes, breakthrough bleeding).
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Monitor for potential drug–drug interactions as
indicated.
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Evaluate the effectiveness of the teaching plan:
person can name drug, dosage, adverse effects to
watch for, specific measures to avoid them and
warning signs and symptoms.
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Monitor the effectiveness of comfort measures and
compliance with the regimen.
CRITICAL THINKING SCENARIO
Birth control
THE SITUATION
J.M. is a 25-year-old woman who is being seen in her
gynaecologist’s office for a routine annual physical
examination and Pap test. J.M. reports that she has just
become sexually active and would like to start using
contraceptives. She has some concerns about stories she
has heard about “the pill” and would like to know the safest
and most effective birth control to use. She is interested in
what other methods are available and what the advantages
and disadvantages of each form might be.
CRITICAL THINKING
What teaching and counselling issues will be important for
J.M. at this time?
What important issues should be discussed when
explaining the benefits and drawbacks of various
contraceptive measures?
What teaching information needs to be stressed with J.M. if
she elects to use oral contraceptives?
DISCUSSION
This appointment presents a good opportunity for the
healthcare provider to allow J.M. to discuss this new aspect
of her life. She may have questions about the experience
and about things she should be doing or should be
questioning. The risk of sexually transmitted infections,
as well as pregnancy, can be discussed. J.M. needs full
information about the various forms of birth control that are
available for use. Non-pharmacological measures such as
condoms and the rhythm method and their reliability can
be discussed.
The use of hormones for birth control should then
be explained, including the 96% to 98% reliability of these
methods when used correctly. The numerous delivery
methods for these hormones should be outlined. A variety
of possibilities exist, ranging from the transdermal patch, to
injection, to the vaginal ring, to the traditional tablet, and
the use of the subdermal implant and intrauterine devices.
J.M. elects to go with an oral contraceptive (OC). She
states that she has a good memory, and taking them
every day won’t be a problem. She swims regularly and
thinks that the patch might be an issue if it comes off, and
she is not comfortable with anything being injected or
inserted into her body. J.M. will need teaching about drug
and herbal interactions with the OC and will need to have
written instructions on what to do if a dose is missed. The
action that should be taken if a dose is missed can be very
complicated and involves knowing on which day in the
cycle the dose was missed.
It is also important to stress that the OC will not
protect J.M. from sexually transmitted infections and that
precautions will need to be taken to avoid exposure to
these diseases. She should also be advised not to smoke
because smoking combined with OC use increases the risk
for emboli. The adverse effects that she might experience
should be reviewed and the importance of an annual pelvic
examination and Pap test should be stressed. A trusting
relationship is important at this time so that J.M. can feel
free to call with questions or problems in the future.
