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Pharmacology · chapter 36 · Reproductive Health Drugs

Hormonal, Contraception, and Infertility Drugs

The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 6 practice questions with the reasoning.

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Key points

  1. Estrogen adverse effects

    Migraine headaches, bloating, weight gain, mood depression, stroke, and cardiovascular disease are known adverse reactions and can be life-threatening.

  2. Estrogen contraindications

    Contraindications for estrogens include hormone-positive breast cancer, undiagnosed uterine bleeding, and active or history of thrombophlebitis or thromboembolism. Pregnancy and breastfeeding are also contraindications because estrogens cross the placenta and enter breast milk.

  3. Estrogen boxed warning

    Estrogen (both estrogen alone or estrogen-progestin combinations) can significantly increase the risk of cardiovascular events such as stroke and heart attack in postmenopausal clients. It can significantly increase the risk of invasive breast cancer in postmenopausal clients.

  4. How progestins prevent pregnancy

    Progestins thicken cervical mucus, which hinders sperm migration and changes the endometrium to decrease the likelihood that an egg can be implanted.

  5. Progesterone in postmenopausal HRT

    It can be added to estrogen in postmenopausal HRT to reduce the risk of endometrial cancer.

  6. No protection against STIs

    One important fact concerning all contraceptives, except male and female condoms, is that they do not prevent sexually transmitted infections (STIs). Therefore, client education about this topic is crucial.

  7. Managing nausea from birth control

    Instructing the client to take the medication before going to bed is one of the best ways to manage nausea so that the client is asleep when the worst of the nausea occurs.

  8. Progestin-only when estrogen is not safe

    Progestin-only contraceptives are used when estrogen is not appropriate for the client’s situation. For instance, the client may have significant risk factors such as obesity, smoking, hypertension, and age over 35 years.

  9. Progestin-only during breastfeeding

    These are also commonly used by clients who are breastfeeding, as they have less effect on the breast milk supply than oral contraceptives containing estrogen.

  10. Most concerning IUD complications

    The most concerning complications of all IUDs are infection, expulsion, or perforation; however, the risk for these complications is extremely low (Andersen Spanfeller, 2022; Britton et al., 2020; Casey, 2022; Madden, 2023).

  11. Vaginal ring out too long

    If the ring is removed for more than 3 hours, clients should be advised to use a backup contraceptive method concurrently for 7 days (Britton et al., 2020; Casey, 2022).

  12. Ovarian overstimulation

    Adverse effects of infertility drugs include a significant risk of multiple births and birth defects. Ovarian overstimulation is another side effect that is manifested by abdominal pain, distention, ascites (fluid accumulation in the abdomen), and pleural effusion.

  13. Backup method after missed pills

    For clients using contraceptives, understand the need for using a barrier or nonhormonal birth control method to prevent pregnancy when beginning contraception and any time 3 or more consecutive doses of oral contraceptive are missed. The alternate method should generally be used for a minimum of 7 days.

  14. Warning signs to report at once

    Notify the health care provider immediately of chest pain and/or shortness of breath; any pain, swelling, and/or redness in calves; severe headache; signs and symptoms of stroke; and any significant change in mood (depression).

Terms to know

Contraceptives
Contraceptives Contraceptives are a group of medications, generally natural or synthetic hormone preparations, used to prevent pregnancy.
Monophasic contraceptive pills
Monophasic contraceptive pills contain a fixed ratio of estrogen and progestin.
Quick start method
The quick start method means that the client starts the contraceptive immediately, regardless of the timing of their menstrual period.
Clomiphene
Clomiphene is a selective estrogen receptor modulator (SERM) with both estrogen antagonist and agonist effects that increase gonadotropin release as well as increase production of FSH and LS.

Practice questions

Stuck on select-all-that-apply? How to take them one option at a time.

The graded version needs JavaScript. Every question is below anyway, with the answer and why.

Every question here, with the answer

  1. A client taking a combined oral contraceptive calls with pain, swelling and redness in one calf. What should the nurse tell her?

    1. Rest and elevate the leg; call if it lasts a week.
    2. Take the next pill with food.
    3. Contact the health care provider immediately.
    4. This is a normal side effect for the first 3 months.

    Answer: Contact the health care provider immediately.

    Pain, swelling or redness in a calf must be reported immediately because hormonal drugs raise the risk of thrombotic events. Waiting or treating it as an expected side effect delays care.

  2. A 38-year-old client who smokes and has hypertension asks for an oral contraceptive. Which option is most appropriate to discuss?

    1. A combined estrogen-progestin pill
    2. A progestin-only contraceptive
    3. No hormonal option is possible for her
    4. Estrogen alone

    Answer: A progestin-only contraceptive

    Progestin-only contraceptives are used when estrogen is not appropriate, such as with smoking, hypertension, obesity and age over 35. Estrogen-containing products increase the risk in these clients.

  3. A nurse is teaching a client who is starting a combined oral contraceptive. Which statements are correct? Select all that apply.

    1. If you miss 3 or more pills in a row, use a backup method for at least 7 days.
    2. The pill is 100% effective once you start it.
    3. Use a backup method when you first begin the pill.
    4. Taking the pill at bedtime can help with nausea.
    5. Condoms are still needed to protect against sexually transmitted infections.

    Answer: If you miss 3 or more pills in a row, use a backup method for at least 7 days., Use a backup method when you first begin the pill., Taking the pill at bedtime can help with nausea., Condoms are still needed to protect against sexually transmitted infections.

    Clients use backup contraception when starting and after 3 or more missed pills, use condoms for STI protection, and can take the pill at bedtime to manage nausea. No contraceptive is 100% effective.

  4. A client using a vaginal contraceptive ring says it came out and she found it 5 hours later. What should the nurse advise?

    1. Nothing further is needed once it is reinserted.
    2. Throw the ring away and wait for the next period.
    3. Use a backup contraceptive method for 7 days.
    4. Take an emergency contraceptive pill every day for a week.

    Answer: Use a backup contraceptive method for 7 days.

    If the ring is out for more than 3 hours, a backup contraceptive method is used for 7 days. The other responses are not supported by the section.

  5. A client receiving fertility drugs calls the clinic. Which findings suggest ovarian overstimulation? Select all that apply.

    1. Abdominal distention
    2. Abdominal pain
    3. Shortness of breath from pleural effusion
    4. Increased appetite
    5. Fluid in the abdomen

    Answer: Abdominal distention, Abdominal pain, Shortness of breath from pleural effusion, Fluid in the abdomen

    Ovarian overstimulation is manifested by abdominal pain, distention, ascites and pleural effusion. Increased appetite is not a listed sign.

  6. A postmenopausal client with a uterus is starting hormone replacement therapy. She asks why progesterone was added to her estrogen. What is the nurse's best answer?

    1. It prevents dementia.
    2. It prevents heart disease.
    3. It reduces the risk of endometrial cancer.
    4. It makes the estrogen work faster.

    Answer: It reduces the risk of endometrial cancer.

    Progesterone is added to estrogen in postmenopausal HRT to reduce the risk of endometrial cancer. HRT should not be used to prevent dementia, and progesterone should not be used to prevent cardiovascular disease.

Where every quote comes from

Section 36.2 Hormonal, Contraception, and Infertility Drugs of Pharmacology for Nurses by Tina Barbour-Taylor, Leah Mueller (Sabato), Donna Paris, Dorie Weaver, OpenStax, 2024. Read the whole section free at openstax.org.

The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.