Reproduction

Oral Contraceptives and Hormone Replacement Therapy

• Purpose of Oral Contraceptives:

  • Prevent pregnancy.
  • Do not protect against sexually transmitted diseases.
  • Treat symptoms of premenstrual syndrome (PMS).
  • Regulate menstrual cycles.

• Client Education on Side Effects:

  • Educate clients on the acronym "ACHE":
  • A - Abdominal pain: This indicates possible gallbladder issues, particularly gallbladder sludge correlated with certain conditions.
  • C - Chest pain: Elevated blood pressure can lead to heart attacks.
  • H - Headaches: Sudden or persistent headaches may indicate elevated blood pressure and risk of stroke.
  • E - Eye problems: Possible indicators of increased blood pressure or stroke due to microvascular damage in the eyes.

• Severe Leg Pain:

  • Indicative of thromboembolic issues like blood clots in legs, leading to swelling, decreased pulse, and discoloration.

• Complications with Hormonal Therapies:

  • Adverse reactions to hormonal therapies such as estrogen and progesterone can lead to tumor growth in estrogen-sensitive tumors.
  • Example: Breast cancer in men can be estrogen fed, necessitating careful management of hormone therapy.
  • Contraindications for hormone therapy include:
  • Existing pregnancy.
  • Thrombotic events (e.g. sudden leg edema, vision changes, severe headaches, shortness of breath).

• Administering Oral Contraceptives:

  • Should be taken at the same time each day to maintain effective hormone levels.
  • If missed, refer to manufacturer's guidelines for action.

Hormone Replacement Therapy (HRT)

• HRT can relieve menopausal symptoms, but must be cautiously prescribed due to the risk of heart attacks.

  • Symptoms to monitor include nausea, hypertension, thromboembolic disorders, and potential breast cancer.
  • Administer at the same time daily with food if it causes nausea.

• Administration Forms of Hormones:

  • Patches:
  • Should be applied to clean areas without scars or implantable devices.
  • Change application site to prevent irritation.
  • Apply pressure for ten seconds after placement.
  • Intravaginal forms (tablets or creams):
  • Best inserted at night to prevent leakage.
  • Monitoring Requirements:
  • Regular mammograms, self-breast exams, and education on risks of vaginal bleeding.

Testosterone Management

• Used to treat male hypogonadism and breast cancer in females:

  • Side effects may include virilization in women, prostate enlargement in men.
  • Contraindications:
  • Pregnancy.
  • History of breast cancer, prostate cancer, or benign prostatic hyperplasia (BPH).
  • Hypertension due to potential blood pressure increases.

• Administration Routes for Testosterone:

  • Patches, gels, or buccal forms for absorption.
  • Important Notes:
  • Avoid waistline and areas with scars or devices for patch applications.
  • Ensure proper hand hygiene post-application of gels.

• Patient Education for Testosterone Use:

  • Women taking testosterone should expect increased body hair and voice changes.
  • Men should monitor for urination changes, pain during ejaculation, or blood in urine.
  • Advocacy for prostate screenings and testicular exams.

Genitourinary (GU) Medications

• Anticholinergic Medications:

  • Example: Oxybutynin, indicated for incontinence (stress, overactive, neurogenic bladder).
  • Side effects include dry mouth, dry eyes, constipation, urinary retention.
  • Monitor for:
  • Hydration to alleviate dry mouth/eyes.
  • Report urinary retention.

• Cholinergic Medications:

  • Example: Bethanechol, promoting urination for those unable to void.
  • Expected to have opposite effects:
    • Increased salivation, potential diarrhea, and blood pressure drops.

• Urinary Tract Analgesics:

  • Example: Phenazopyridine (e.g., Azo, UroTrac) alleviates burning but does not treat the infection.
  • Will turn urine orange.
  • Advised to increase fluid intake to prevent darkening of urine.