Peer Responses:
- Relate to another journal reading.
- Length: A minimum of 180 words per post, not including references
- Citations: At least two high-level scholarly reference in APA per post from within the last 5 years
Birth control options for patients require patient-centered discussions and suggestions that promote compliance. When we talk about compliance, we also address what will be the most convenient choice for a patient. Convenience can mean price, fewer side effects, low maintenance, covered by insurance, and/or delivered directly to our patient’s household. Teenagers require convenience and low maintenance to uphold their end of compliance. Our patient, a 17-year-old who is considered obese with a BMI of 35, reports being newly sexually active and is requesting birth control options. We will discuss the benefits, risks, contraindications, and indications for 3 plausible contraceptive options for her keeping in mind she has an allergy to Copper.
Birth control can range from oral pills (systemic birth control) to subcutaneous implants, or rings and intrauterine devices. Intrauterine devices would be the most invasive choice and Paraguard (10-year IUD) is already contraindicated for this patient as it is made of Copper. For a patient newly sexually active with no history of labor, a smaller IUD such as the 3-year Skyla would be a better choice and is generally an easier insertion for the Nurse Practitioner.
Skyla IUD (Levonorgestrel local releasing system)
- Pros – Local hormones are emitted into the uterus, no copper, and no daily pills to remember to take or refill for 3 years.
- Cons – unfavorable bleeding, ectopic pregnancy, and risk for pelvic inflammatory disease (Costescu et al., 2022). According to Ganguli & Dimov, Chronic Urticaria has been reported as well as susceptibility to HPylori, Vitamin D deficiencies, and subsequent thyroid antibody dysfunction which have all been linked to exogenous Progesterone disrupting the immune and metabolic systems (2023).
Annovera Ring (Segesterone acetate and ethinyl estradiol intravaginal system)
- Pros – Gastrointestinal and hepatic metabolism are bypassed which makes the drugs more readily available in the body. This medication does not need to be refrigerated and can be used for up to 13 cycles (Britton et al.,2020) The ring is approved by the FDA for up to one year of proven efficacy of birth control (Nelson, 2019).
- Cons – Vaginal discharge and irritation may occur as a side effect. Minimal bleeding has been reported and its efficiency is not affected by a patient’s body mass index (Nelson, 2019).
Slynd (Drospirenone 4mg tablets)
- Pros – Systemic hormones, but estrogen-free. Has a 24-hour missed opportunity window which provides coverage of efficacy for up to 24 hours to give the user a chance to remember to take the pill due to its 30-hour plasma half-life (Baker & Chen, 2022). Which for a teenager would be a great choice as they have busy school schedules and perhaps a busy social calendar. There is a 98.2% efficacy rate of birth control when the product is used correctly (Baker & Chen, 2022).. There are no increased hematology risk factors when it comes to blood clots, myocardial infarctions, or thromboembolism in any clinical trials or studies (Baker & Chen, 2022)..
- Cons – May cause spotting in between cycles. Research has proven that this medication can increase potassium in the blood and can affect the liver and kidneys, therefore, it’s not suitable for anyone with hyperkalemia, cardiac, hepatic, or renal problems (Baker & Chen, 2022).
As providers, we can utilize the Pearl index to determine the rates of efficacy of birth control options for patient-centered care to enable our patients to make informed decisions (Baker & Chen, 2022). We are at liberty to provide facts, not sway decisions. Innately as Nurses, we are trusted, however, it is within our power to educate our patients to trust their own choices. Yet with minors, we must include the choice of the parents but at almost a legal age, it would behoove the parents to teach their child about their body and the repercussions of poor versus beneficial choices. Below is a link to a story provided by ACOG about guiding teenagers with birth control options.
A story about teens and birth control by The American College of Obstetrics and Gynecologists
References
Al-Haddad, S., Branham, K. K. R., & Clare, C. A. (2023). Advances in contraception: vaginal
contraceptive rings. Therapeutic advances in reproductive health, 17, 26334941231186733. https://doi.org/10.1177/26334941231186733
Baker, C. C., & Chen, M. J. (2022). New Contraception Update – Annovera, Phexxi, Slynd, and
Twirla. Current obstetrics and gynecology reports, 11(1), 21–27. https://doi.org/10.1007/s13669-021-00321-4
Britton, L. E., Alspaugh, A., Greene, M. Z., & McLemore, M. R. (2020). CE: An Evidence-
Based Update on Contraception. The American journal of nursing, 120(2), 22–33. https://doi.org/10.1097/01.NAJ.0000654304.29632.a7
Costescu, D., Chawla, R., Hughes, R., Teal, S., & Merz, M. (2022). Discontinuation rates of
intrauterine contraception due to unfavourable bleeding: a systematic review. BMC women’s health, 22(1), 82. https://doi.org/10.1186/s12905-022-01657-6
Ganguli, M. P., & Dimov, V. (2023). Chronic Urticaria Suspected to be Caused by a 13.5 mg
Levonorgestrel Intrauterine Device (Skyla®). Cureus, 15(7), e42287. https://doi.org/10.7759/cureus.42287
Nelson A. L. (2019). Comprehensive overview of the recently FDA-approved contraceptive
vaginal ring releasing segesterone acetate and ethinylestradiol: A new year-long, patient-controlled, reversible birth control method. Expert review of clinical pharmacology, 12(10), 953–963. https://doi.org/10.1080/17512433.2019.16
