Clinical meaning
The NP manages contraception through understanding of reproductive endocrinology and evidence-based method selection. Combined hormonal methods suppress the HPO axis via synthetic estrogen (ethinyl estradiol or estetrol) and progestin, inhibiting FSH-driven follicular development and the LH surge needed for ovulation. Different progestin generations offer varying androgenic, anti-androgenic, and anti-mineralocorticoid profiles affecting side effect management. LARC methods (IUDs and implants) achieve superior efficacy through user-independent mechanisms: levonorgestrel IUDs create local progestin effect on the endometrium while the copper IUD induces a cytotoxic inflammatory reaction. The etonogestrel implant provides steady-state progestin levels suppressing ovulation for 3 years.
Diagnosis & workup
Diagnostics & workup: - Blood pressure measurement (required before estrogen-containing methods) - Pregnancy test before initiation - BMI assessment (obesity affects method efficacy and VTE risk) - Cervical cancer screening per current USPSTF guidelines - STI screening (chlamydia/gonorrhea) per risk factors - Lipid panel if starting estrogen in patients with dyslipidemia risk