8.12 Spotlight Application
Sierra is a 30-year-old female who visits the women’s health clinic seeking information on long-acting reversible contraception (LARC) options. Sierra is interested in exploring reliable contraceptive methods that offer extended coverage without daily maintenance. In discussing her contraceptive needs further, Sierra reveals that her irregular menstrual cycles have been a source of frustration, causing occasional disruptions to her daily activities. She expresses concerns about unpredictable bleeding patterns and severe dysmenorrhea during her periods, impacting her overall quality of life. Sierra, otherwise healthy, maintains an active lifestyle and is not currently taking any medications.
Sierra states she is considering intrauterine contraception and wants to understand her options.
Reflective Question 1: Compare the mechanisms of action, duration of effectiveness, and potential side effects of LNG-IUCs (e.g., Mirena) and copper-containing IUCs (e.g., Paragard). How might the differences in these devices align with Sierra’s contraceptive needs and concerns about irregular bleeding?
LNG-IUCs (levonorgestrel-releasing intrauterine contraceptives) like Mirena and copper-containing IUCs like Paragard work through different mechanisms and have distinct effects on bleeding patterns and side effects.
Mechanisms of Action
- LNG-IUCs (Mirena, Kyleena, etc.): Release levonorgestrel, a progestin, which thickens cervical mucus (preventing sperm penetration), suppresses endometrial growth (reducing implantation likelihood), and in some cases, inhibits ovulation.
- Copper IUCs (Paragard): Release copper ions, which create an inflammatory reaction toxic to sperm and eggs, preventing fertilization without hormonal effects.
Duration of Effectiveness
- LNG-IUCs: Depending on the device, they can last 3–8 years before replacement is needed.
- Copper IUCs: Can last up to 10 years, making it the longest-lasting reversible contraceptive option.
Potential Side Effects
- LNG-IUCs:
- Irregular bleeding and spotting in the first few months.
- Lighter or absent periods over time due to endometrial thinning.
- Hormonal side effects (e.g., headaches, breast tenderness, mood changes) but at a lower incidence than systemic hormonal methods.
- Copper IUCs:
- Heavier, longer, and potentially more painful periods, especially in the first few months.
- No hormonal side effects, making it a good option for those who prefer non-hormonal contraception.
If Sierra is particularly concerned about irregular bleeding, the choice depends on whether she prefers lighter periods or a completely hormone-free option:
- If Sierra wants lighter or no periods, an LNG-IUC like Mirena would be ideal, as it reduces and may eliminate menstrual bleeding over time.
- If Sierra wants a non-hormonal option the concern would be that Sierra would need to tolerate heavier, crampier periods, then the copper IUC might be better as it does not contain hormones.
Reflective Question 2: Sierra states she is also considering contraceptive implants. Compare the mechanism of action, duration of effectiveness, and potential side effects of Nexplanon with those of intrauterine contraception devices. How might these differences influence Sierra’s decision-making process, given her concerns about menstrual irregularities?
A comparison of Nexplanon and Intrauterine Contraceptive Devices (e.g., LNG-IUCs & Copper IUCs) is provided in the following box.
| Etonogestrel (Implant) | LNG-IUCs (e.g., Mirena) | Copper IUC (e.g., Paragard) | |
| Mechanism of Action | Releases etonogestrel (a progestin), which inhibits ovulation, thickens cervical mucus, and thins the endometrium. | Releases levonorgestrel (a progestin), which thickens cervical mucus, suppresses endometrial growth, and sometimes inhibits ovulation. | Releases copper ions that create an inflammatory reaction toxic to sperm and eggs, preventing fertilization. |
|
Duration of Effectiveness |
Up to 3 years |
3–8 years, depending on the specific device |
Up to 10 years |
| Effects on Menstruation | Irregular bleeding is common; periods may be lighter, heavier, or absent. Some users experience prolonged spotting. | Lighter or absent periods over time; irregular spotting in the first few months. | Heavier, longer, and crampier periods, especially initially. |
| Potential Side Effects | Irregular bleeding, headaches, weight gain, mood changes, and breast tenderness. | Irregular bleeding initially, but reduced periods over time; possible hormonal side effects (mild mood changes, acne, breast tenderness).
|
No hormonal side effects, but heavier bleeding and increased cramping. |
Given Sierra’s concerns about menstrual irregularities, each option has trade-offs that the nurse can further reinforce as she makes her decision:
- If Sierra wants to avoid irregular bleeding, an LNG-IUC (e.g., Mirena) would be the best choice, as it tends to reduce or eliminate periods over time after an initial adjustment period.
- If Sierra prefers a non-hormonal method, the copper IUC is an option, but it could worsen bleeding and cramping, therefore does not align with Sierra’s concerns regarding bleeding.
- If Sierra wants a long-acting but non-intrusive method, the etonogestrel implant is effective but most likely to cause unpredictable bleeding patterns, which would not align with Sierra’s concerns regarding bleeding
