Is taking hormonal drugs dangerous? Adverse reactions of hormonal drugs
Hormone therapy is used today to treat a wide range of diseases. However, most patients are wary of treatment with hormonal drugs, because it is believed that excess weight may be a side effect of this therapy. At the same time, recent studies indicate that there are many more side effects from taking these medications. It’s worth figuring out why hormone therapy is dangerous?
Scientists divide the side effects that occur with long-term treatment hormones, light and heavy. Moreover, lungs are much more common. These include: nausea, headaches and chest pain. Such symptoms do not cause fundamental harm to health, but they are quite annoying.
Contrary to popular belief, recent studies show that women undergoing long-term hormonal therapy are susceptible to a set of excess weight with the same probability as women not taking hormones.
What are the severe side effects of these medications?
1. Vein thrombosis
Hormonal therapy increases the risk of thrombosis lower limbs and pulmonary embolism approximately 2-3 times. However, it is worth noting that these ailments do not occur so often in women, and therefore, if the patient does not have a predisposition to the formation of blood clots, there is no need to worry about taking hormonal medications.
2. Endometrial cancer
Research shows that the use of these medications increases the likelihood of developing endometrial cancer (endometrial cancer). Moreover, the risk increases precisely when women take. This is why most modern doctors prescribe combination hormonal therapy with. Unlike estrogen, progesterone protects the uterus from endometrial cancer.
3. Breast cancer
After the studies, scientists agreed that long-term hormonal therapy may threaten the fairer sex with the development of breast cancer. The risk group includes women who have entered menopause. However, you should not be afraid, because compared to women who did not take hormones, this risk is very low (more by about 20 women out of 10,000). In addition, the likelihood increases malignant neoplasms at long-term use drugs of this group, that is, 5 years or more.
4. Heart disease
Although the use of hormonal drugs helps reduce LDL cholesterol in the blood and at the same time increases the level of HDL, women who take hormonal drugs for a long time increase the risk of heart attacks. Moreover, this side effect is especially dangerous for those representatives of the fairer sex who already have heart disease.
5. Abnormal vaginal bleeding
It is a generally accepted fact that women who regularly take medicines with hormones, are 4 times more likely to suffer from abnormal vaginal bleeding. Representatives of the fair sex with a normal menstrual cycle in this case complain of heavy and prolonged bleeding during menstruation. However, bleeding can also appear after menstruation. With hormonal therapy, they can occur in women even in the postmenstrual period. In this case, you should contact a specialist who will perform an endometrial biopsy, that is, take a sample of the uterine mucosa for analysis in order to exclude it. If the cause of bleeding is indeed the use of hormones, the doctor will adjust the dose of the medication to minimize or eliminate bleeding.
6. Stroke
Researchers suggest that regular use of hormonal drugs threatens women with the development of stroke. Although these studies have not yet been completed, scientists say that this risk will be minimal. Therefore, in the absence of predisposition and atherosclerosis, as well as with regular physical activity When taking any hormonal medications, you don’t have to worry about your health. Good health to you!
The term “hormones” evokes in most modern women negative associations with plump, mustachioed victims of the use of these substances. Hormone therapy has a powerful effect on human body and this influence can be both positive and negative. But for many people, hormonal medications can significantly improve the quality of life and prolong it. This applies to patients with diabetes, bronchial asthma, diseases thyroid gland.
Are hormonal pills harmful?
The effect of different hormones on the body is not the same, so the effect of different hormonal drugs, both positive and negative, will differ. The positive or harmful effect on the body after using hormonal therapy depends on the type of hormone in the drug, its dosage, duration and frequency of use.
Hormonal drugs, like almost any medicine, have a certain Negative influence on the body. But, as a rule, this negative effect is much less than that brought positive result during treatment specific disease. There are a number of diseases for which hormonal therapy is the only treatment method.
Why are hormonal drugs harmful?
With the development of medicine and the pharmaceutical industry, modern hormonal drugs differ significantly from those produced in the last century. If hormonal therapy 20 years ago caused mass side effects in the form of swelling, cellulite, excess hair growth, excess weight, then a similar effect from modern drugs is minimized. The side effects of hormonal drugs will be minimal only if they are selected correctly, based on individual characteristics the patient's body.
What possible harm can hormonal medications cause? This information is contained in the instructions for use a certain drug. A separate section “Side Effects” contains the entire list of side effects that are possible, but not required. Of these, the most common are metabolic disorders, excessive hair growth, weight gain, skin reactions, disturbances in the gastrointestinal tract.
Harm and benefits of hormonal contraceptives
For hormone therapy in women, they are usually used. oral contraceptives, which provide contraceptive effect, A therapeutic effect is a positive side effect. Disputes about the dangers and benefits of hormones have been going on for as long as these drugs have existed.
There are representatives of medicine, traditional and non-traditional areas, who categorically do not approve of the use of hormonal drugs due to the irreparable harm they cause to a woman’s body. The drugs suppress the natural function of the ovaries, disrupt the natural hormonal background and have dangerous side effects.
Research into the use of hormonal drugs suggests that all of the above does not apply to modern drugs. They do not contain such high concentrations hormones, as drugs of the first generations, which could cause serious harm to the body and have a mild effect on hormonal levels due to microdoses of the hormone and high-quality purification of the drug.
Taking OK additionally has the following effects:
The risk of developing inflammatory and tumor lesions of the mammary glands and uterus is significantly reduced;
Improves the condition of hair and skin;
The likelihood of mastopathy and heart and vascular diseases is reduced;
The manifestations of PMS are alleviated, the duration of menstruation decreases and they become less painful;
The positive effect of prescribing hormonal contraceptives is much higher than the negative effect.
If a woman has no contraindications to taking hormonal drugs, an accurate diagnosis is made and an individually selected dosage is prescribed, the harm of hormonal drugs is practically reduced to zero.
In the first three months of prescribing the drug, when the body gets used to it, side effects such as headache, nausea, dizziness, headache, engorgement of the mammary glands are possible. sudden changes mood, decreased sexual desire.
For many of us, the term “hormonal medications” sounds ominous. In the minds of most people who are not involved in medicine and pharmaceuticals, hormones are monstrous pills that bring a lot of equally monstrous side effects.
What are these fears based on? And if hormones are so harmful, why are they used so widely? Let's try to figure out together what hormonal pills actually are.
Classification
Hormonal medications contain hormones or substances that have properties similar to hormones (hormonoids). Hormones are produced in endocrine glands human and spread through the bloodstream to various organs and systems, regulating the vital functions of the body.
Hormonal drugs can be divided into hormone preparations:
- pituitary gland
These include human chorionic gonadotropin and oxytocin, probably known to every woman;
- thyroid gland.
These drugs are used to treat insufficient production of one's own hormones (for example, hypothyroidism) and the opposite condition - excess production of hormones;
- pancreas.
The most known remedies this group includes insulin preparations;
- parathyroid glands;
- adrenal cortex.
This group includes glucocorticosteroids, which are widely used in many branches of medicine as anti-inflammatory, antiallergic and analgesic agents;
- sex hormones: estrogens, gestagens, androgens;
- anabolic agents.
What is treated with hormonal pills?
Despite the very wary attitude towards hormonal drugs on the part of patients, we can safely say that these drugs are extremely necessary and important. Often only hormonal drugs can provide a chronically ill person with a decent quality of life, and sometimes save life itself.
Therapy hormonal pills required for:
- hormone replacement therapy in postmenopausal women and elderly men suffering from testosterone deficiency;
- treatment of inflammatory and allergic diseases;
- treatment of hormonal deficiency.
These pathologies include hypothyroidism, type 1 diabetes mellitus, Addison's disease and other diseases;
- treatment of many oncological diseases.
Oral contraception. Achievements of modern medicine
The first studies that laid the foundation for the development of hormonal contraceptives were carried out back in 1921. Ten years later, scientists had already precisely clarified the structure of steroid hormones and discovered that high doses of sex hormones inhibit, that is, block ovulation.
The first combined hormonal contraceptive was released in 1960 by American pharmacists. It contained really high doses of hormones, and therefore had not only contraception, but also a lot of side effects.
Over time, the situation has changed dramatically. In the 90s of the last century, hormonoids were synthesized, which, along with high activity have excellent tolerability. That's why modern women may not worry about the extra pounds gained from taking hormonal birth control pills. This side effect is a thing of the past along with the loading doses of active ingredients contained in the first contraceptives.
The effectiveness of all contraceptives is assessed using the Pearl index, which determines the probability of pregnancy within one year with constant use of the drugs. On average, the Pearl index of hormonal contraceptives ranges from 0.3% to 2-3%. The maximum value of this indicator reaches 8%.
If a woman has average fertility and does not become pregnant from her husband's toothbrushes, the chance of pregnancy rarely exceeds 1%. Of course, subject to daily use of the tablets.
However, let's return to classifications. Modern hormonal contraceptives can be:
1. combined;
2. non-combined (mini-pill);
3. tablets for emergency contraception.
Let's try to figure out how these groups differ.
1. Combined hormonal contraceptives: COCs
The funny abbreviation COC hides very serious medications, which are the most popular modern contraceptives. All COCs include two active ingredients - estrogen and gestagen. Ethinyl estradiol is used as estrogen, and levonorgestrel, norgestrel, desogestrel and other synthetic hormones can act as a gestagen.
The dose of ethinyl estradiol in modern COCs is much lower than in the first “killer” tablets. Because of this, side effects of estrogen such as weight gain, breast tenderness, and nausea are rare when taking new medications.
Monophasic COCs have a constant dose of estrogen and progestin in each tablet. Despite the fact that during the menstrual cycle the concentration of hormones in a woman’s body is not constant, monophasic contraceptives are a strictly defined dose taken daily.
Biphasic contraceptives contain two types of pills in one package. The main difference between the second type of tablets is increased content gestogen, which is also characteristic of the physiological cycle.
However, three-phase COCs are traditionally considered the most adapted to the menstrual cycle. They include three groups of tablets. The concentration of active substances in each group approaches the content of estrogens and gestagens in a certain phase of the menstrual cycle. The first group of tablets imitates the follicular phase, which lasts 5 days, the second - the periovulatory phase, which lasts 6 days, and the last - the luteal phase, the longest 10-day phase. At the same time, the concentration of estrogen in three-phase COCs, as well as in the menstrual cycle, is maximum, and the level of gestagen increases from the first phase to the third.
Pharmacology: how do hormonal birth control pills work?
The contraceptive effect of all hormonal birth control pills, regardless of composition and dosage, is based on blocking the release of hormones responsible for ovulation and implantation. The ovaries practically “fall asleep”, decreasing in size. Ultimately, hormonal pills:
- suppress ovulation;
- change properties cervical mucus. As a result of this effect cervical canal becomes a real barrier for nimble sperm;
- change the state of the endometrium, as a result of which the “lining” inner surface The uterus does not allow the egg to implant if fertilization does occur.
How to take hormonal birth control pills?
The answer to the question of how to take hormonal pills that protect against pregnancy can be expressed in one single word: regularly. Depending on the period for which the course is designed - 21 or 28 days - the tablets should be taken once a day throughout the entire treatment period, preferably at the same time.
An important question that concerns most women taking COCs is what to do if the patient forgot to take the pill on time. First of all, don't panic. The situation is solvable and, in general, very banal.
Secondly, the missed pill should be taken immediately after memory is restored. Next pill- drink according to the schedule, even if you have to take two tablets at the same time.
Thirdly, the period during which the woman forgot about the need to use protection should be assessed. The following actions depend on the statute of limitations.
If the delay is no more than 12 hours, you can calm down - the effectiveness of contraception will remain the same, that is, close to 100%. If this period lasted more than 12 hours, you will have to use additional methods protection, for example, barrier or spermicidal.
Monophasic COCs: effectiveness and popularity
The most popular and widespread hormonal contraceptives include monophasic drugs. Many gynecologists believe that these products are the best hormonal pills for women under the age of 35, and patient reviews confirm this.
Monophasic contraceptives contain tablets of the same color. Despite the fact that the packaging may contain a strict diagram of the use of tablets (usually in order of priority), this does not carry any special meaning. And if you manage to take a pill at the very beginning of the cycle, intended for use, say, on day 25, absolutely nothing bad will happen - after all, all the pills have the same composition.
Most of the COCs with which the Russian market is saturated pharmaceutical market, are classified as monophasic. The choice of drugs is so wide that even experienced gynecologists sometimes hesitate before prescribing the drug to patients. Therefore, we will consider only those hormonal pills that can be classified as “new”, modern means.
The German drug Logest, which is produced by the well-known company SCHERING, S.A., contains 20 mcg of ethinyl estradiol and 75 mcg of gestodene. The product is available in a package of 21 tablets. Logest is an excellent drug for young women.
Lindineth
Hormonal tablets Lindinet 20 are a complete analogue of the German Logest. The drugs have the same composition, and the only difference can be considered the color - Lindineta tablets have a pale yellow shell. Lindineta is manufactured by the Hungarian company GEDEON RICHTER.
Lindinet 30 differs from its brother only in the dosage of estrogen (30 mcg).
Hormonal tablets Zhanine produced by SCHERING contain 30 mcg ethinyl estradiol and 2 mg progestin (dienogest). The Pearl index with regular use of Janine does not exceed 1%.
The main difference between Zhanine and other COCs is the antiandrogenic activity that dienogest has. Therefore, Janine is prescribed to patients with increased level male sex hormones. In addition, the hypocholesterolemic, that is, lowering cholesterol levels in the blood, effect of dienogest has been proven.
The German drug Yarina is one of the most popular monophasic hormonal contraceptives in tablets. The medicine contains 30 mcg ethinyl estradiol and 3 mg drospirenone.
The properties of Yarina and Zhanin are very similar. Yarina helps reduce high-density lipoprotein levels and has an antiandrogenic effect. Thanks to this quality, Yarina is also considered a remedy for acne: hormonal tablets are prescribed as part of complex therapy acne. The drug helps reduce production sebum and reducing the manifestations of the disease.
One of the very well-known hormonal contraceptives in tablets is Diane-35, which is produced by SCHERING. The drug contains 35 mcg ethinyl estradiol and 2 mg of the antiandrogenic gestagen cyproterone acetate.
Diane has pronounced antiandrogenic activity, which makes it possible to prescribe it for the treatment of acne and seborrhea. In addition, Diane-35 is the drug of choice for contraception in women who have mild manifestations of hirsutism - excess hair growth.
Among tablets with antiandrogenic activity, the popular hormonal contraceptive Jess occupies a special place. It contains 20 mcg ethinyl estradiol and 3 mg drospirenone. The gestagen included in Jess neutralizes the side effects of estrogen. In this regard, the drug is very well tolerated, and swelling and weight gain are practically excluded.
In addition, drospirenone softens the manifestations of premenstrual syndrome, including pronounced ones. To all positive properties Jess can be added beneficial influence on cholesterol levels, which manifests itself in increased concentrations of high-density lipoproteins (HDL). But it is HDL that removes excess cholesterol from the body.
COCs containing drospirenone also include the Hungarian hormonal tablets Midiana. They differ from Jess only more high content ethinyl estradiol, the dose of which is 30 mcg.
Among the low-dose COCs, it is also worth noting the hormonal tablets Rigevidon, Femoden, Novinet, Miniziston, Microgynon, Regulon.
This is not the end of the list of monophasic contraceptives registered in Russia. However, they are used much less frequently, so we will immediately move on to the following categories of COCs.
Table “Monophasic COCs”:
| Drugs | Manufacturer, country | Compound |
| Logest, analogue - Lindinet 20 | Ethinyl estradiol 20 mcg Gestodene 75 mcg |
|
| Femoden, analogue - Lindinet 30 | Schering, Germany (Gedeon Richter, Hungary) | Ethinyl estradiol 30 mcg Gestodene 75 mcg |
| Miniziston | Jenafarm, Germany | Ethinyl estradiol 30 mcg Levonorgestrel 125 mcg |
| Mercilon, analogue - Novinet | Ethinyl estradiol 20 mcg Desogestrel 150 mcg | |
| Microgynon | Schering, Germany | Ethinyl estradiol 30 mcg Levonorgestrel 150 mcg |
| Marvelon, analogue - Regulon | Organon, Netherlands (Gedeon Richter, Hungary) | Ethinyl estradiol 30 mcg Desogestrel 150 mcg |
| Silest | Silag, Belgium-Switzerland | Ethinyl estradiol 35 mcg Norgestimate 250 mcg |
| Diana-35 | Schering, Germany | Ethinyl estradiol 35 mcg Cyproterone acetate 2 mg |
| Janine, analogue - Silhouette | Schering, Germany (Gedeon Richter, Hungary) | Ethinyl estradiol 30 mcg Dienogest 2 mg |
| Regividon | Gedeon Richter, Hungary | Ethinyl estradio 30 mcg Levonorgestrel 150 mcg |
| Jess, analogue - Dimia | Bayer, Germany (Gedeon Richter, Hungary) | Ethinyl estradiol 20 mcg Drospirenone 3 mg |
| Yarina | Schering, Germany | Ethinyl estradiol 30 µg Drospirenone 2 mg |
| Midiana | Gedeon Richter, Hungary | Ethineestradio 30 mcg Drospirenone 3 mg |
Two-phase and three-phase COCs: time-tested
As we have already said, two- and three-phase hormonal contraceptives act more physiologically. However, most often doctors prefer to use the first group of drugs. What causes this?
The fact is that changes in hormone concentrations are associated with an inevitable increase in the dose of active substances. As a result, the side effects of biphasic and triphasic drugs are more pronounced than low-dose monophasic drugs.
Biphasic COCs are among the rarely used drugs. Among them there are products whose names are often unusual even for the pharmacist, not to mention the patients - Anteovin, Nuvelle, Orfo-Novum, Bi-Novum.
Three-phase contraceptives are better known and popular. However, their disadvantages in the form of standard side effects are no less pronounced than those of biphasic drugs. Three-phase COCs are easy to “calculate” by their name, which, as a rule, begins with “three”: Triziston, Triquilar, Tri-mercy, Tri-regol, Trister.
Tablets of two- and three-phase hormonal contraceptives are colored different colors depending on the composition: in two-phase preparations - in two colors, and in three-phase preparations - in three. Such medications must be taken strictly according to the schedule. Usually, the COC currency is replete with various arrows and other bright marks designed to help a woman understand the peculiarities of using multi-colored tablets. After all, if you accidentally mix up the color of the tablets, contraceptive effect decreases.
Useful contraceptives? Advantages of COC
Oral contraceptives are designed not only to provide a direct, contraceptive effect. They have a lot of other, often no less important, indications, including:
— treatment of menstrual disorders and PMS.
The use of COCs helps to normalize the cycle, reduce blood loss during menstruation, and also reduce premenstrual syndrome;
- treatment of acne, seborrhea and acne.
As part of complex therapy dermatological diseases in women, COCs with an antiandrogenic effect are often included. Hormonal tablets significantly reduce sebum synthesis, helping to reduce the appearance of acne. In patients suffering from seborrhea who take COCs, the level of sebum is normalized and hair loss is noticeably reduced;
- prevention benign diseases mammary gland and pelvic organs.
COCs suppress the stimulation of the ovaries by follicle-stimulating and luteinizing hormones. Therefore, regular use of hormonal birth control pills significantly reduces the risk of the formation of functional cysts and benign nodes in the mammary glands;
- prevention of ovarian cancer and endometrial carcinoma.
When taken regularly oral contraceptives The risk of ovarian cancer is reduced by as much as 40%. This protection lasts even 15 years after stopping taking hormonal pills. The longer you take a COC, the longer it takes for the anti-cancer effects to appear.
And that is not all. The likelihood of developing endometrial adenocarcinoma (uterine cancer) in women treated with hormonal birth control pills is reduced by 50%. The protective effect persists for 15 years after stopping COC use.
Negative aspects of combined hormones
We would be lying if we say that COCs are extremely healthy drugs. During treatment with hormonal contraceptive pills, sometimes adverse consequences cannot be avoided. TO negative aspects COCs include:
- the likelihood of side effects, including nausea, breakthrough bleeding, increased sensitivity and breast enlargement. However, some ladies use hormonal pills just to enlarge their bust, so sometimes this effect can be attributed to the positive qualities of COCs;
- the need for regular daily use;
— probability of delay ovulatory cycles after discontinuation of COCs.
When is hormonal contraception prohibited?
There are several conditions in which the use of any hormonal contraceptive pills is excluded. These pathologies include:
- cardiovascular diseases;
- deep vein thrombosis;
- diabetes mellitus with vascular complications;
- oncological diseases;
- abnormal vaginal bleeding;
- liver diseases;
- age over 35 years;
- smoking.
Drugs containing drospirenone - Jess, Angelique and others - are also contraindicated in patients with kidney, adrenal or liver diseases. This is due to the fact that drospirenone has an antimineralocorticoid effect.
Hormonal contraceptives and venous insufficiency: incompatibility No. 1
Many women know that hormonal pills are not recommended for varicose veins and are strictly contraindicated for thrombophlebitis. But the answer to the question of what causes such a ban is unknown to most patients.
It turns out that the constant component of all hormonal birth control pills - estrogen - activates the blood clotting mechanism, resulting in an increased risk of blood clots. It is known that modern drugs with low estrogen levels are associated with a low risk of thromboembolism, while high-dose hormonal pills do the opposite.
In addition, the likelihood of developing blood clots increases significantly in smoking women, patients with high cholesterol blood, severe diabetes mellitus, hypertension or obesity.
2. Mini-pills: special hormonal contraceptives
Under the affectionate and usually little-understood name “mini-pill” are hidden hormonal birth control pills containing only one component - gestagen. Moreover, the dose active substance in the mini-pill it is really minimal.
Hormonal mini-pills can be prescribed to patients over 35 years of age, including those over 40, as well as to women with diabetes. Even breastfeeding is not an obstacle to the use of these medications. However, minipills have a lower Pearl index compared to COCs. In addition, drugs in this group can cause intermenstrual bleeding, the appearance of cysts in the ovaries, and even ectopic pregnancy.
Note that the contraceptive effect of the mini-pill is reduced if taken in different time days. This drawback often tips the scales in favor of combined hormonal pills.
Among the mini-pills, we will name several drugs registered in Russia: Norgestrel, Levonorgestrel, Linestrenol.
3. Urgent contraception: when you can’t wait
Hormonal emergency contraception drugs are a kind of emergency pills in case of unforeseen circumstances. They hurried, forgot, tore it up, didn’t find it and other verbs in the past tense can briefly describe standard reasons, through which women begin to rush around in search of miracle cures for all problems.
And, of course, there are such drugs. They contain high doses of hormones that either prevent ovulation if the problem happened in the first half of the cycle, or change the state of the endometrium if fertilization does occur.
The most well-known emergency contraceptives include Postinor, Microlut and Escapelle. These pills should be used as rarely as possible - after all, the hormonal surge that occurs after taking the drugs is akin to a blow. And not a single organism can withstand being beaten high doses hormones regularly.
Down with amateur performances!
All hormonal contraceptives, including tablets, are prescription drugs only. And this is no coincidence. After all, the wrong medicine can easily cause menstrual irregularities and other gynecological problems.
Therefore, if you decide to take hormonal agent, the first person who should know about this is an obstetrician-gynecologist. Remember: the right to select a hormonal contraceptive should be given not to a neighbor, not to a friend on the forum, or even to a pharmacist, but to a doctor.
Menopause: if there is little estrogen
Unfortunately, menopause brings with it a lot of clinical symptoms, which are hard to miss. Classic symptoms Menopause is characterized by irregular or complete absence of the menstrual cycle. In 60% of women sharp drop estrogen levels lead to vascular disorders, which are manifested by hot flashes, sweating and increased heart rate.
Other, no less striking symptoms are also possible. After all, it is estrogens that provide sufficient hydration to the vagina and regulate urination. Until a woman’s body adapts to the new hormonal background, neurological manifestations menopause: depression, insomnia, mood swings.
An extremely dangerous consequence of menopause is a catastrophic decrease in bone mass. As a result, a disease associated with brittle bones develops - osteoporosis.
If no action is taken, these manifestations can poison a woman’s life for many years. However, the body can be “deceived” if such necessary estrogens are introduced from the outside. And this can be done with the help of hormonal pills, which for some reason some patients are so afraid of. Is the game worth the candle? Let's figure it out together.
Add estrogen: hormonal pills
Hormonal pills used during menopause may contain:
- estrogen only;
- a combination of estrogen and progesterone;
- a combination of estrogen, progesterone and androgen.
The most popular are estrogen preparations. Hormonal pills are taken constantly, that is, daily, or in cycles of several weeks.
In most cases, these medications contain something called conjugated estrogen, which is obtained from the urine of mares. Among them, we note Estrofeminal, Premarin and Hormoplex. All these medications are used cyclically for 21 days, followed by a week-long break.
Biphasic agents
These tablets consist of two components - estrogen and progestogen.
Divina- a drug produced by the Finnish company Orion. The first group of tablets contains only estradiol in a dose of 2 mg, and the second - a combination of 2 mg of estradiol valeriat and 10 mg of gestagen (medroxyprogesterone).
Klimonorm- a German medicine from the Bayer corporation. The main difference from Divina lies in the gestagen: 0.15 mg of levonorgestrel is used as a progesterone-containing component in Klimonorm.
Klymen contains the same 2 mg of estradiol and 1 mg of cyproterone (gestagen).
In addition, at Russian gynecologists Other hormonal replacement pills are no less popular, including Cycloprogynova, Femoston, Divitren, Angeliq.
Triphasic hormonal pills
These drugs are designed for continuous use and include three groups of tablets: the first and third contain estrogens, the latter in a lower dose, and the second group includes a combination of estrogen and progestogen.
Only two three-phase drugs are registered in Russia - Trisequens and Trisequens forte.
Hormone replacement pills: contraindications and side effects
Hormonal therapy during menopause is contraindicated for breast or endometrial cancer, severe liver disease, thrombophlebitis, endometriosis, and fibroids.
Side effects of hormone therapy include mood swings, breast engorgement, and intermenstrual bleeding.
And one last thing. Before prescribing hormone replacement pills, carry out thorough examination women, which includes general analysis urine, analysis of sugar levels and blood lipid profile, ultrasound of the pelvic organs, ECG, cytological examination of cervical scraping and mammography. And if replacement therapy is not contraindicated, the benefits significantly outweigh the risks.
Hormones for the treatment of inflammation: why are glucocorticoids needed?
A separate group of hormonal tablets are glucocorticosteroids (GCs). They have three properties at the same time: anti-inflammatory, antiallergic and analgesic. This unique triad is the basis for the widespread use of glucocorticoids in almost all areas of medicine.
Synthetic hormonal tablets containing HA are taken continuously for autoimmune diseases, including multiple sclerosis and rheumatoid arthritis.
It is impossible to do without hormonal tablets containing HA in the treatment of allergic diseases, including bronchial asthma. Glucocorticoids can reduce the inflammatory response and counteract the activity of immune cells who participate in pathological process. Most often, HA is administered by inhalation, but in some severe cases, hormonal drugs in tablets and ampoules are used.
Glucocorticoids are certainly included in the treatment regimen for oncological diseases. Their main purpose is to reduce side effects chemotherapy. In addition, hormonal pills can help destroy cancer cells at lymphoblastic leukemia, Hodgkin's lymphoma, non-Hodgkin's lymphoma and multiple myeloma.
Glucocorticoids in tablets
Most often, several tableted glucocorticoids are used.
The drug effectively reduces inflammation by suppressing the function of leukocytes. Interestingly, the anti-inflammatory effect of Dexamethasone is 30 times greater than the activity of another GC - hydrocortisone.
Dexamethasone tablets are indicated for the hormonal treatment of Addison's disease, hypothyroidism, bronchial asthma, rheumatoid arthritis, nonspecific ulcerative colitis, eczema, malignant tumors in advanced stages.
The dosage of Dexamethasone is selected individually.
The drug is an analogue of hydrocortisone. Prednisolone can affect all stages inflammatory process and have a pronounced anti-inflammatory effect.
There are indeed many indications for the use of Prednisolone tablets - hormonal treatment prescribed for systemic lupus erythematosus, multiple sclerosis, joint diseases, bronchial asthma, oncological diseases, adrenal insufficiency, allergies, autoimmune pathologies and many others.
The drug produced by the Polish plant Polfa contains triamcinolone GC in a dose of 4 mg. The main indications of Polcortolone include joint diseases, allergic pathologies that are difficult to treat, rheumatic, dermatological, hematological, oncological and other diseases.
Side effects of glucocorticoids
HAs have truly unique qualities. Therefore, glucocorticoids could be called healing drugs, if not for the side effects. Due to the large number of adverse events due to treatment, long-term use of these drugs may even be dangerous.
We list the most common side effects of hormonal tablets of the glucocorticoid group:
- decreased immunity;
- increased blood sugar levels. With long-term treatment with GC, the development of diabetes mellitus is possible;
- decreased calcium absorption, which can lead to osteoporosis - dangerous disease bone tissue;
- amyotrophy;
- increased levels of cholesterol and triglycerides in the blood;
- mood changes, depression, memory impairment, in severe cases - psychosis;
- gastritis and peptic ulcer;
- menstrual irregularities, decreased libido;
- slow wound healing;
- weight gain.
Another extremely unpleasant side of corticosteroids is withdrawal syndrome: after stopping long-term use With hormonal pills, there is a possibility of significant side effects. To avoid such a development of events, medications should be discontinued gradually, gradually reducing the dose over a certain period of time.
Hormonal deficiency: when can you not do without pills?
The most common pathologies that require constant use of hormonal medications are diseases of the thyroid gland.
Thyroid insufficiency - hypothyroidism - is a common disease in which the production of hormones is reduced. Treatment is based primarily on compensating for the lack of hormones. For this purpose, hormonal tablets are prescribed, which include sodium levothyroxine.
Levothyroxine sodium is a levorotatory isomer of thyroxine. It is a synthetic analogue of thyroid hormone. Thyroxine is the first-line medicine for hypothyroidism, euthyroid goiter, and also after removal or resection of the thyroid gland.
Despite the fact that thyroxine is a hormonal medicine, when the correct dosage is prescribed according to indications, there are practically no side effects.
Hormones in oncology: when drugs save lives
Hormone therapy in oncology, along with chemotherapy, is one of the main drug treatments for cancer. Hormone treatment is used for several types of hormone-sensitive tumors, including breast, prostate, endometrial (uterine cancer), and adrenal cortex.
Most medications used for hormonal treatment dependent tumors, inhibit, that is, block the release of hormones. These drugs include one of the most known drugs for the treatment of breast cancer - Tamoxifen.
Many drugs can reduce the production of other hormones, which are responsible for the growth of malignant tumors. Often, hormonal treatment is almost the only opportunity to fight the tumor and prolong the patient’s life.
Hormonal pills are a whole pharmaceutical world, in which there is a place for efficiency, uniqueness, and side effects. And only doctors can untie this tangled tangle of complex concepts, indications and contraindications. Then the correctly prescribed remedy turns out to be the right path to a fulfilling life.
Prescribing hormonal medications often frightens people. There are many myths surrounding hormones. But most of them are completely wrong.
Myth 1: Hormonal drugs are special birth control pills for women.
No. Hormonal drugs are drugs obtained synthetically. They act like natural hormones produced in our body. There are many organs in the human body that secrete hormones: female and male genital organs, glands internal secretion, central nervous system and others. Accordingly, hormonal drugs can be different, and they are prescribed for a wide variety of diseases.
Female hormonal preparations (contain female sex hormones) may have both contraceptive effect, never possess it. Sometimes, on the contrary, they normalize hormonal levels and promote pregnancy. Preparations containing male sex hormones are prescribed to men when the quality of the ejaculate decreases (that is, sperm motility), hypofunction, or a decrease in the level of male sex hormones.
Myth 2: Hormones are prescribed only for very severe illnesses
No. There are a number of mild diseases for which hormonal drugs are also prescribed. For example, decreased thyroid function (hypofunction). Doctors often prescribe hormones in this case, for example, thyroxine or euthyrox.
Myth 3: If you don’t take a hormonal pill on time, nothing bad will happen
No. Hormonal medications must be taken strictly according to the clock. For example, a hormonal birth control pill is valid for 24 hours. Accordingly, you must drink it once a day. There are medications that you need to take 2 times a day. These are some male sex hormones, as well as corticosteroids (for example, dexamethasone). Moreover, it is recommended to take hormones at the same time of day. If you take hormones irregularly, or forget to take them altogether, the level necessary hormone may drop sharply.
Let's give an example. If a woman forgot to take a hormonal contraceptive pill, the next day she should take the forgotten evening pill in the morning, and the next pill in the evening of the same day. If the interval between doses is more than a day (remember: a hormonal contraceptive pill is valid for 24 hours), then the level of hormones in the blood will decrease very significantly. In response to this, slight bleeding will certainly appear. In such cases, you can continue taking birth control pills, but use additional protection for the next week. If more than 3 days have already passed, you need to stop taking hormones, use other contraceptives, wait until your menstruation arrives and additionally consult a doctor.
Myth 4: If you take hormones, they accumulate in the body
No. When a hormone enters the body, it immediately breaks down into chemical compounds, which are then excreted from the body. For example, a birth control pill breaks down and leaves the body within 24 hours: that is why it needs to be taken every 24 hours.
However, hormonal drugs continue to “work” after they are no longer taken. But they influence indirectly. For example, a woman takes hormonal pills for several months, then stops taking them, and in the future she has no problems with her cycle.
Why is this happening? Hormonal medications act on different target organs. For example, female contraceptive pills affect the ovaries, uterus, mammary glands, and parts of the brain. When the pill “leaves” from the body, the mechanism that it started continues to work.
Need to know: The mechanism of prolonged action of hormones is not associated with their accumulation in the body. This is simply the principle of action of these drugs: to “work” through other structures of the body.
Myth 5: Hormonal medications are not prescribed during pregnancy
Discharged. If a woman had hormonal disorders before pregnancy, then during pregnancy she needs medicinal support so that the production of female and male hormones was normal, and the child developed normally.
Or another situation. Before the woman became pregnant, everything was fine, but when she got pregnant, something suddenly went wrong. For example, she suddenly notices that intense hair growth has begun from the navel down and around the nipples. In this case, you should definitely consult a doctor who can prescribe a hormonal examination and, if necessary, prescribe hormones. Not necessarily female sex hormones - these could be, for example, adrenal hormones.
Myth 6: Hormonal drugs have a lot of side effects, primarily weight gain
There are practically no medications without side effects. But it is necessary to distinguish between side effects that do not require discontinuation of the drug. For example, swelling of the mammary glands when taking contraceptive hormones is considered a normal phenomenon. Scanty bleeding in the first or second months of use during the intermenstrual period also has the right to occur. Headache, dizziness, weight fluctuations (plus or minus 2 kg) - all this is not a pathology or a sign of a disease. Hormonal drugs are prescribed for a fairly long period. By the end of the first month, the body adapts and everything returns to normal.
But so that it doesn't really happen serious problems associated, say, with blood vessels, before prescribing a medicine and while taking it, it is imperative to be examined and tested. And only a doctor can prescribe you a specific hormonal drug that will not harm your health.
Myth 7: There is always an alternative to hormones
Not always. There are situations when hormonal drugs are irreplaceable. Let's say a woman under 50 has had her ovaries removed. As a result, she begins to age and lose health very quickly. In this case, her body must be supported with hormone therapy until she is 55-60 years old. Of course, provided that her underlying disease (due to which the ovaries were removed) has no contraindications to such a prescription.
Moreover, for some diseases, even a neuropsychiatrist can strictly recommend female sex hormones. For example, with depression.
latest comments
Updates by email
- Categories:
From previous publications we know about the abortifacient effect of hormonal contraceptives (GC, OK). IN Lately In the media you can find reviews of women who suffered from the side effects of OK, we will give a couple of them at the end of the article. To shed light on this issue, we turned to a doctor who prepared this information for the ABC of Health and also translated for us fragments of articles with foreign studies on the side effects of GCs.
Side effects of hormonal contraceptives.
The actions of hormonal contraceptives are the same as those of others medicines, are determined by the properties of the substances included in them. Most birth control pills prescribed for routine contraception contain 2 types of hormones: one gestagen and one estrogen.
Gestagens
Progestogens = progestogens = progestins– hormones that are produced yellow body ovaries (formation on the surface of the ovaries that appears after ovulation - the release of an egg), in small quantities - by the adrenal cortex, and during pregnancy - by the placenta. The main gestagen is progesterone.
The name of the hormones reflects their main function - “pro gestation” = “to [maintain] pregnancy” by restructuring the endothelium of the uterus into the state necessary for the development of a fertilized egg. The physiological effects of gestagens are combined into three main groups.
- Vegetative effects. It is expressed in the suppression of endometrial proliferation caused by the action of estrogens and its secretory transformation, which is very important for a normal menstrual cycle. When pregnancy occurs, gestagens suppress ovulation, lower the tone of the uterus, reducing its excitability and contractility (“protector” of pregnancy). Progestins are responsible for the “maturation” of the mammary glands.
- Generative action. In small doses, progestins increase the secretion of follicle-stimulating hormone (FSH), which is responsible for the maturation of follicles in the ovary and ovulation. In large doses, gestagens block both FSH and LH (luteinizing hormone, which is involved in the synthesis of androgens, and together with FSH ensures ovulation and progesterone synthesis). Gestagens affect the thermoregulation center, which is manifested by an increase in temperature.
- General action. Under the influence of gestagens, amine nitrogen in the blood plasma decreases, the excretion of amino acids increases, and the separation of gastric juice, the secretion of bile slows down.
Oral contraceptives contain various gestagens. For some time it was believed that there was no difference between progestins, but it is now known for sure that the difference is molecular structure provides a variety of effects. In other words, progestogens differ in spectrum and in the severity of additional properties, but the 3 groups of physiological effects described above are inherent to all of them. The characteristics of modern progestins are reflected in the table.
Pronounced or very pronounced gestagenic effect common to all progestogens. The gestagenic effect refers to those main groups of properties that were mentioned earlier.
Androgenic activity characteristic of not many drugs, its result is a decrease in the amount of “good” cholesterol ( HDL cholesterol) and an increase in the concentration of “bad” cholesterol (LDL cholesterol). As a result, the risk of developing atherosclerosis increases. In addition, symptoms of virilization (male secondary sexual characteristics) appear.
Explicit antiandrogenic effect only three drugs have it. This effect has a positive meaning - improvement in skin condition (cosmetic side of the issue).
Antimineralocorticoid activity associated with increased diuresis, sodium excretion, and decreased blood pressure.
Glucocorticoid effect affects metabolism: the body's sensitivity to insulin decreases (risk of diabetes), the synthesis of fatty acids and triglycerides increases (risk of obesity).
Estrogens
Another component of birth control pills is estrogens.
Estrogens– female sex hormones that are produced by the ovarian follicles and the adrenal cortex (and in men also by the testicles). There are three main estrogens: estradiol, estriol, estrone.
Physiological effects of estrogens:
- proliferation (growth) of the endometrium and myometrium according to the type of their hyperplasia and hypertrophy;
— development of genital organs and secondary sexual characteristics (feminization);
- suppression of lactation;
- inhibition of resorption (destruction, resorption) of bone tissue;
- procoagulant effect (increased blood clotting);
- increasing the content of HDL (“good” cholesterol) and triglycerides, reducing the amount of LDL (“bad” cholesterol);
- retention of sodium and water in the body (and, as a result, increased blood pressure);
— ensuring an acidic vaginal environment (normal pH 3.8-4.5) and the growth of lactobacilli;
- increased antibody production and phagocyte activity, increasing the body's resistance to infections.
Estrogens in oral contraceptives are needed to control the menstrual cycle and protect against unwanted pregnancy they don't take part. Most often, the tablets contain ethinyl estradiol (EE).
Mechanisms of action of oral contraceptives
So, taking into account the basic properties of gestagens and estrogens, the following mechanisms of action of oral contraceptives can be distinguished:
1) inhibition of the secretion of gonadotropic hormones (due to gestagens);
2) a change in vaginal pH to a more acidic side (the influence of estrogens);
3) increased viscosity of cervical mucus (gestagens);
4) the phrase “ovum implantation” used in instructions and manuals, which hides the abortive effect of GC from women.
Commentary by a gynecologist on the abortifacient mechanism of action of hormonal contraceptives
When implanted into the wall of the uterus, the embryo is a multicellular organism (blastocyst). An egg (even a fertilized one) is never implanted. Implantation occurs 5-7 days after fertilization. Therefore, what is called an egg in the instructions is in fact not an egg at all, but an embryo.
Unwanted estrogen...
In the course of a thorough study of hormonal contraceptives and their effects on the body, it was concluded that undesirable effects are associated to a greater extent with the influence of estrogens. Therefore, the lower the amount of estrogen in the tablet, the fewer side effects, but it is not possible to completely eliminate them. It was precisely these conclusions that prompted scientists to invent new, more advanced drugs, and oral contraceptives, in which the amount of the estrogen component was measured in milligrams, were replaced by tablets containing estrogen in micrograms ( 1 milligram [ mg] = 1000 micrograms [ mcg]). There are currently 3 generations of birth control pills. The division into generations is due to both a change in the amount of estrogens in the drugs and the introduction of newer progesterone analogues into the tablets.
The first generation of contraceptives include Enovid, Infekundin, Bisekurin. These drugs have been widely used since their discovery, but later their androgenic effects were noticed, manifested in deepening of the voice, growth of facial hair (virilization).
Second generation drugs include Microgenon, Rigevidon, Triregol, Triziston and others.
The most frequently used and widespread drugs are the third generation: Logest, Merisilon, Regulon, Novinet, Diane-35, Zhanin, Yarina and others. A significant advantage of these drugs is their antiandrogenic activity, most pronounced in Diane-35.
The study of the properties of estrogens and the conclusion that they are the main source of side effects from the use of hormonal contraceptives led scientists to the idea of creating drugs with an optimal reduction in the dose of estrogens in them. It is impossible to completely remove estrogens from the composition, as they play important role in maintaining a normal menstrual cycle.
In this regard, a division of hormonal contraceptives into high-, low- and micro-dose drugs has appeared.
Highly dosed (EE = 40-50 mcg per tablet).
- "Non-ovlon"
- "Ovidon" and others
- Not used for contraceptive purposes.
Low dosage (EE = 30-35 mcg per tablet).
- "Marvelon"
- "Janine"
- "Yarina"
- "Femoden"
- "Diane-35" and others
Microdosed (EE = 20 mcg per tablet)
- "Logest"
- "Mersilon"
- "Novinet"
- "Miniziston 20 fem" "Jess" and others
Side effects of hormonal contraceptives
Side effects from the use of oral contraceptives are always described in detail in the instructions for use.
Since the side effects from the use of various birth control pills are approximately the same, it makes sense to consider them, highlighting the main (severe) and less severe.
Some manufacturers list conditions that require immediate discontinuation of use if they occur. These conditions include the following:
- Arterial hypertension.
- Hemolytic-uremic syndrome, manifested by a triad of symptoms: acute renal failure, hemolytic anemia and thrombocytopenia (decreased platelet count).
- Porphyria is a disease in which hemoglobin synthesis is impaired.
- Hearing loss due to otosclerosis (fixation) auditory ossicles, which should normally be mobile).
Almost all manufacturers list thromboembolism as a rare or very rare side effect. But this serious condition deserves special attention.
Thromboembolism- this is a blockage blood vessel thrombus. This is an acute condition that requires qualified assistance. Thromboembolism cannot occur out of the blue; it requires special “conditions” - risk factors or existing vascular diseases.
Risk factors for thrombosis (formation of blood clots inside vessels - thrombi - interfering with the free, laminar flow of blood):
— age over 35 years;
- smoking (!);
- high level of estrogen in the blood (which occurs when taking oral contraceptives);
— increased coagulability blood, which is observed with a deficiency of antithrombin III, proteins C and S, dysfibrinogenemia, Marchiafava-Michelli disease;
- injuries and extensive operations in the past;
- venous stagnation with sedentary life;
- obesity;
— varicose veins leg veins;
- damage to the valvular apparatus of the heart;
- atrial fibrillation, angina pectoris;
- cerebrovascular diseases (including transient ischemic attack) or coronary vessels;
- moderate or severe arterial hypertension;
- diseases connective tissue(collagenosis), and primarily systemic lupus erythematosus;
— hereditary predisposition to thrombosis (thrombosis, myocardial infarction, cerebrovascular accident in close blood relatives).
If these risk factors are present, a woman taking hormonal birth control pills has a significantly increased risk of developing thromboembolism. The risk of thromboembolism increases with thrombosis of any location, either currently present or suffered in the past; at suffered a heart attack myocardium and stroke.
Thromboembolism, whatever its location, is a serious complication.
| … coronary vessels → | myocardial infarction | |
| ... brain vessels → | stroke | |
| ... deep veins of the legs → | trophic ulcers and gangrene | |
| … pulmonary artery(TELA) or its branches → | from pulmonary infarction to shock | |
| Thromboembolism... | … hepatic vessels → | liver dysfunction, Budd-Chiari syndrome |
| … mesenteric vessels → | ischemic intestinal disease, intestinal gangrene | |
| ...renal vessels | ||
| ... retinal vessels (retinal vessels) |
In addition to thromboembolism, there are other, less severe, but still inconvenient side effects. For example, candidiasis (thrush). Hormonal contraceptives increase the acidity of the vagina, and fungi reproduce well in an acidic environment, in particular Candidaalbicans, which is a conditionally pathogenic microorganism.
A significant side effect is the retention of sodium, and with it water, in the body. This may lead to swelling and weight gain. Decreased tolerance to carbohydrates, as a side effect of the use of hormonal pills, increases the risk of developing diabetes mellitus
Other side effects, such as: decreased mood, mood swings, increased appetite, nausea, stool disorders, satiety, swelling and tenderness of the mammary glands and some others - although not severe, however, affect a woman’s quality of life.
In addition to side effects, the instructions for the use of hormonal contraceptives list contraindications.
Contraceptives without estrogen
Exist gestagen-containing contraceptives (“mini-pill”). Judging by the name, they contain only gestagen. But this group of drugs has its own indications:
- contraception for nursing women (they should not be prescribed estrogen-progestin drugs, because estrogen suppresses lactation);
— prescribed for women who have given birth (since the main mechanism of action of the “mini-pill” is suppression of ovulation, which is undesirable for nulliparous women);
- in late reproductive age;
- if there are contraindications to the use of estrogens.
In addition, these drugs also have side effects and contraindications.
Particular attention should be paid to " emergency contraception". These drugs contain either a progestin (Levonorgestrel) or an antiprogestin (Mifepristone) in a large dose. The main mechanisms of action of these drugs are inhibition of ovulation, thickening of cervical mucus, acceleration of desquamation (squamation) of the functional layer of the endometrium in order to prevent the attachment of a fertilized egg. And Mifepristone has an additional effect - increasing the tone of the uterus. Therefore, a single use of a large dose of these drugs has a very strong immediate effect on the ovaries; after taking emergency contraceptive pills, there can be serious and long-term disturbances in the menstrual cycle. Women who regularly use these drugs are at great risk to their health.
Foreign studies of side effects of GCs
Interesting studies examining the side effects of hormonal contraceptives have been conducted in foreign countries. Below are excerpts from several reviews (translation by the author of fragments of foreign articles)
Oral contraceptives and the risk of venous thrombosis
May, 2001
CONCLUSIONS
Hormonal contraception is used by more than 100 million women worldwide. The number of deaths from cardiovascular diseases (venous and arterial) among young, low-risk patients - non-smoking women from 20 to 24 years old - is observed worldwide in the range from 2 to 6 per year per million, depending on the region of residence expected cardiovascular -vascular risk and the volume of screening studies that were carried out before prescribing contraceptives. While the risk venous thrombosis more important in younger patients, the risk of arterial thrombosis is more relevant in older patients. Among women who smoke, more mature age of those using oral contraceptives, the number of deaths ranges from 100 to just over 200 per million each year.
Reducing the dose of estrogen reduced the risk of venous thrombosis. Third-generation progestins in combined oral contraceptives have increased the incidence of adverse hemolytic changes and the risk of thrombus formation, so they should not be prescribed as first-choice drugs for new users of hormonal contraception.
The judicious use of hormonal contraceptives, including avoidance of their use by women who have risk factors, is absent in most cases. In New Zealand, a series of deaths from pulmonary embolism were investigated, and the cause was often due to a risk that doctors had not considered.
Judicious administration can prevent arterial thrombosis. Almost all women who had a myocardial infarction while using oral contraceptives were either of an older age group, smoked, or had other risk factors for arterial disease - in particular, arterial hypertension. Avoiding oral contraceptives in these women may reduce the incidence of arterial thrombosis reported latest research industrial countries. The beneficial effect that third-generation oral contraceptives have on the lipid profile and their role in reducing the number of heart attacks and strokes has not yet been confirmed by control studies.
To avoid venous thrombosis, the doctor asks whether the patient has ever had venous thrombosis in the past to determine whether there are contraindications to the use of oral contraceptives, and what is the risk of thrombosis while taking hormonal medications.
Low-dose progestogen oral contraceptives (first or second generation) were associated with a lower risk of venous thrombosis than combination drugs; however, the risk in women with a history of thrombosis is unknown.
Obesity is considered a risk factor for venous thrombosis, but it is unknown whether this risk is increased by oral contraceptive use; thrombosis is rare among obese people. Obesity, however, is not considered a contraindication to the use of oral contraceptives. Superficial varices are not a consequence of pre-existing venous thrombosis or a risk factor for deep venous thrombosis.
Heredity may play a role in the development of venous thrombosis, but its significance as a high-risk factor remains unclear. A history of superficial thrombophlebitis can also be considered a risk factor for thrombosis, especially if it is combined with a family history.
Venous thromboembolism and hormonal contraception
Royal College of Obstetricians and Gynecologists, UK
July, 2010
Do combined methods increase hormonal contraception(tablets, patch, vaginal ring) risk of venous thromboembolism?
The relative risk of venous thromboembolism increases with the use of any combined hormonal contraceptives (pills, patch and vaginal ring). However, the rarity of venous thromboembolism in women reproductive age means that the absolute risk remains low.
The relative risk of venous thromboembolism increases in the first few months after starting combined hormonal contraception. As the duration of taking hormonal contraceptives increases, the risk decreases, but it remains as a background risk until you stop using hormonal drugs.
In this table, researchers compared the incidence of venous thromboembolism per year in different groups women (calculated per 100,000 women). From the table it is clear that in women who are not pregnant and do not use hormonal contraceptives (non-pregnant non-users), an average of 44 (with a range from 24 to 73) cases of thromboembolism per 100,000 women were registered per year.
Drospirenone-containingCOCusers – users of drospirenone-containing COCs.
Levonorgestrel-containingCOCusers – using levonorgestrel-containing COCs.
Other COCs not specified – other COCs.
Pregnantnon-users – pregnant women.
Strokes and heart attacks when using hormonal contraception
New England Journal of Medicine
Massachusetts Medical Society, USA
June, 2012
CONCLUSIONS
Although the absolute risks of stroke and heart attack associated with hormonal contraceptives are low, the risk increased from 0.9 to 1.7 with products containing 20 mcg ethinyl estradiol and from 1.2 to 2.3 with using drugs containing ethinyl estradiol in a dose of 30-40 mcg, with a relatively small difference in risk depending on the type of progestogen included in the composition.
Risk of thrombosis of oral contraception
WoltersKluwerHealth is a leading provider of expert health information.
HenneloreRott – German doctor
August, 2012
CONCLUSIONS
Different combined oral contraceptives (COCs) have different risks of venous thromboembolism, but the same unsafe use.
COCs with levonorgestrel or norethisterone (so-called second generation) should be the drugs of choice, as recommended national guidelines on contraception in the Netherlands, Belgium, Denmark, Norway and the UK. Other European countries do not have such guidelines, but they are urgently needed.
In women with a history of venous thromboembolism and/or known coagulation defects, the use of COCs and other contraceptives containing ethinyl estradiol is contraindicated. On the other hand, the risk of venous thromboembolism during pregnancy and postpartum period much higher. For this reason, such women should be offered adequate contraception.
There is no reason to withhold hormonal contraception in young patients with thrombophilia. Pure progesterone preparations are safe with respect to the risk of venous thromboembolism.
Risk of venous thromboembolism among users of drospirenone-containing oral contraceptives
American College of Obstetricians and Gynecologists
November 2012
CONCLUSIONS
The risk of venous thromboembolism is increased among oral contraceptive users (3-9/10,000 women per year) compared with non-pregnant and non-users (1-5/10,000 women per year). There is evidence that drospirenone-containing oral contraceptives have more high risk(10.22/10.000) than drugs containing other progestins. However, the risk is still low and much lower than that during pregnancy (approximately 5-20/10,000 women per year) and in the postpartum period (40-65/10,000 women per year) (see table).
Table Risk of thromboembolism. 
