A nurse is counseling a young woman about starting combined oral contraceptives (COCs). Which potential risk is important to discuss for long-term use?

1. A

   Decreased risk of ovarian cancer

2. B

   Increased risk of breast and cervical cancer

3. C

   Significant weight loss

4. D

   Increased bone mineral density

Appeared in: AIIMS Delhi NO- 2019

Explanation

• Long-term use of combined oral contraceptives (COCs), particularly for 5 years or more, is associated with a slightly increased risk of developing cervical cancer.
• Studies also show a small, slightly elevated relative risk of breast cancer among current users of COCs.
• These risks are important for patient counseling but are relatively small and tend to decrease over time after discontinuing the medication, returning to baseline levels after about 10 years.

Why Other Options Were Wrong

• Option A: This statement describes a significant benefit of COC use, not a risk. COCs are known to be protective against ovarian cancer.
• Option C: Significant weight loss is not a recognized side effect of COCs. While some women report weight changes, large studies have not found a consistent or significant effect on weight.
• Option D: This is a potential positive effect, not a risk. The estrogen component in COCs helps to maintain or can even slightly increase bone mineral density.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Risks and benefits of long-term use of combined oral contraceptives (COCs) to guide bedside assessment, documentation, and the next nursing action.
• A nurse's primary role in contraceptive counseling is to provide balanced information on both risks and benefits, enabling the patient to make an informed decision.
• Teaching the 'ACHES' mnemonic (Abdominal pain, Chest pain, Headaches, Eye problems, Severe leg pain) is a critical patient safety intervention to help users recognize and immediately report signs of serious complications like blood clots (VTE).
• What if? If the patient has a significant family history of breast cancer or a known persistent HPV infection, the nurse must emphasize that while the absolute risk increase from COCs is small, her baseline risk is higher, warranting a more detailed discussion and possibly consideration of non-hormonal contraceptive methods.

How to Approach the Question

• First, analyze the question to identify the key components: the medication (Combined Oral Contraceptives), the duration (long-term use), and the type of effect to identify (a potential risk).
• Evaluate each option to determine if it represents a risk or a benefit.
• Option A describes a 'decreased risk,' which is a benefit, not a risk. This can be eliminated.
• Option C, 'significant weight loss,' is not a commonly reported or evidence-based side effect of COCs. This makes it an unlikely answer.
• Option D, 'increased bone mineral density,' is a positive effect due to the estrogen component, making it a benefit, not a risk. This can be eliminated.
• Option B describes an 'increased risk' of two types of cancer. This aligns with the prompt asking for a risk. Recall or deduce from clinical knowledge that COCs have a complex relationship with cancer, decreasing the risk for some types while slightly increasing it for others.

Concept Tested & Keywords

• Concept Tested: Risks and benefits of long-term use of combined oral contraceptives (COCs).
• Stem keywords: combined oral contraceptives, COCs, long-term use, risk, counseling
• Lead-in keywords: potential risk

Question ID

Qh7MYY-5GD4b6xjmbFZd7D

Copy ID

Reference Book

E6 Gynecology Williams p. 130-158

E6 Obstetrics Williams p. 82-95