Contraceptive Update



While it may not seem immediately applicable for emergency room nurses or geriatric nurses, a working knowledge of contraceptive technology is useful.  When a daughter’s friend asks candidly about contraception, you want to be able to offer her accurate, up-to-date information.  

There was a time when the phrase “birth control” was synonymous with two words:  The Pill.  While today’s menu of contraceptive options is considerably broader, the pill is still with us in multiple new and improved forms. 

As relative newcomers to the pill family, extended-use combined hormonal contraceptives such as Seasonale can safely reduce the number of withdrawal bleeds women experience yearly.  Although the public has been hesitant to embrace the concept of “continuous cycling”, a term which refers to the back-to-back use of active hormonal pills to induce as few as 4 or less periods annually, evidence-based research demonstrates that monthly menstruation is not biologically necessary.  Although extended-use pills initially cause more break-through bleeding, their side-effect and risk profiles are similar to those of traditional pills.  Nurses can confidently reassure women that continuous cycling is safe and effective.

Nurses should also know that within the last year the emergency contraceptive pill, known as Plan B, gained over-the-counter status.  Women over the age of 18 can now bypass a time-taking trip to a clinician’s office and proceed directly to their local pharmacies for post-coital pregnancy prevention.  Because emergency contraception, or EC, is most effective when taken immediately after an act of unprotected intercourse, the sooner women access the medication the better. 

While most effective if taken in the first 72 hours, EC can be taken up to 5 days after unprotected sex.  Despite the fact that the original indications stipulated that the 2 tablets should be taken 12 hours apart, it is acceptable for women can take both tablets simultaneously as this regimen is more convenient for most women.  Reassure women that taking EC during an established pregnancy does not pose a medical risk to that pregnancy.  Further, women need not worry that Plan B will induce miscarriages since EC prevents implantation of fertilized eggs into uterus linings.

A device known by the tradename Implanon is the newest player on the contraceptive market.  This match-sized progesterone-only implant is placed by a trained clinician into the flesh of the upper arm.  Similar in mechanism of action to its predecessor Norplant, Implanon is effective for 3 years.  The implant is removed via a quick office procedure.  Benefits of Implanon include over 99% pregnancy prevention rates, low medication burden for patients, and fewer periods.  The most common side effects of Implanon is unpredictable menstrual bleeding/spotting. 

As new pharmaceutical products flood pharmacy storerooms, healthcare providers need to know how to comfortably advise healthcare consumers.  Informed nurses can confront popular fallacies and point men and women in the right direction for accurate information about contraception.



World Health Organization Department of Reproductive Health and Research

(WHO/RHR) and Johns Hopkins Bloomberg School of Public Health/ Center for Communication Programs (CCP), INFO Project.  Family Planning:  A Global Handbook for Providers.  Baltimore and Geneva:  CCP and WHO, 2007.


Hatcher et al.  A Pocket Guide to Managing Contraception. Tiger, GA:  Bridging the Gap

Foundation, 2004.    


Copyright 2008- American Society of Registered Nurses (ASRN.ORG)-All Rights Reserved




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