P.B. comes back in a week and tells you that she can get a low-cost oral contraceptive (OC) through a local

Question

store. you convey this information to the nurse practitioner, who examines P.B.

and writes a prescription
for a biphasic 28-day pill pack containing ethinyl estradiol and norethindrone. you are asked to discuss
the use of the pill with P.B.
What key factors should you address with P.B.?

Answer 1

• Explain how OC pills work. Biphasic pills vary the amount of estrogen, progestin, or both over the
active pill days in an attempt to mimic the normal menstrual cycle and minimize side effects.
• Show her a pill package and explain how to use it. OCs can be started one of three ways:
1) Same-day start: She starts that day. A backup method of birth control (e.g., condoms,
spermicides, diaphragm, abstinence) is recommended during the first week of initial use.
2) First-day start: She can start within 24 hours of the onset of her menses.
3) Sunday start: She starts on the first Sunday after the menses begins. Backup contraception for
7 days is necessary if menses did not begin on a Sunday. The only advantages of the traditional
Sunday start are avoidance of periods on the weekend and convenience, in that many
manufacturers label the first pill in a pack as a "Sunday" pill.
• She should take one pill every day at the same time. If using a 28-day pill pack, start the next pack
as soon as the last pack is finished. Encourage associating pill taking with a daily routine, such as
brushing teeth or mealtime, to avoid missed pills.
• If nausea occurs, switch to the opposite time (morning to evening) or take with food.
• Advise her that breakthrough bleeding is the most common adverse effect during the first few
months, and it usually improves with each cycle. If bleeding persists despite correct use, tell her to
come in for an examination to rule out infection or other problems. Advise her that scanty periods
or amenorrhea is common with low-dose cyclic OCs.
• If and when pregnancy is desired, contraceptive pills should be stopped approximately 2 months
ahead of conception.
• Review with her that the concomitant use of some drugs might interfere with the pill's
effectiveness. She needs to call if she is placed on a new medication and, if indicated, use a backup
method until the next menstrual period.
• Provide instructions on what to do in the event of missed pills. Missed pills, especially at the
beginning or the end of the pack, might allow ovulation and unintended pregnancy to occur.
Increasing the time between active pills increases the risk of ovulation.