original contraceptives. Contraceptive pills - which are better? Novinet - a drug with a minimum number of side effects

Means for the prevention of pregnancy can rightly be attributed to the oldest. After all, they were used in ancient times. For example, women of the indigenous population of America for this purpose used douching with a remedy made from lemon and a decoction of mahogany bark. In ancient Egypt, tampons soaked in honey and decoction of acacia were used. Even condoms are not a modern method of protection against unexpected pregnancy.

Of course, the effectiveness of all these tools was extremely low, and there was no need to talk about ease of use at all. Everything changed around the second half of the 20th century, when doctors first started talking about combined oral contraceptives (COCs). The first drug created for the purpose of protection was Enovid, which appeared on the pharmacy market in 1960. It was with him that the development of hormonal contraception began.

What is hormonal contraception?

The mechanism of action of contraceptive pills is based on the ability of substances that are synthetic analogues of sex hormones produced by the female body to influence the hormonal background. In this case, the brain receives a signal that there are enough hormones in the blood and the command to the ovaries to produce their own does not pass.

The hormones that enter the body, depending on the type, trigger several mechanisms at once. All of them lead to the fact that pregnancy, even with the occurrence of ovulation and fertilization of the egg, does not occur.

Estrogens help:

The next egg does not mature in the ovaries and ovulation does not happen.
In the uterus, there is a violation of secretory processes, due to which there is a development of edema of the mucous membrane - the endometrium, which, in turn, makes implantation of a fertilized egg impossible.
A process called luteolysis is launched - that is, the reverse development of the corpus luteum, which normally forms after ovulation and serves to synthesize the hormone progesterone, which prepares the body for a possible pregnancy.

Stimulate the compaction of cervical mucus, which clogs the cervix and makes it impermeable to sperm.
They inhibit the activity of enzymes that help the sperm enter the egg.
They reduce the contractile activity of the fallopian tubes and the uterus itself and prevent the egg from moving along them.
They thin the endometrium, making it unsuitable for egg implantation.
Block the release of hormones that are responsible for ovulation in the middle of the cycle.

Regardless of the type of components and composition, all hormonal contraceptives have almost the same mechanism of action.

Application features

Any hormonal pills should be taken strictly according to the scheme, preferably at the same time of the day. You can't miss another appointment. Depending on the composition and type of the drug, in case of omission, the contraceptive effect will last on average only up to 12 hours. After the expiration of this time, the effectiveness of the drug decreases.

The start of taking most COCs coincides with the first day of the cycle. At the same time, you can choose the most convenient time for you. Most women prefer to take birth control pills in the evening, before bed. In this case, negative effects such as nausea, headache or mood changes are not so pronounced.

All hormonal birth control pills are prescription drugs and are used only on prescription. Before you start drinking the drug, carefully read the instructions and rules for taking.

Advantages

Of course, the main advantage of COC contraception using both monophasic and multiphasic drugs is the simplicity of the method itself. Agree, taking a pill is much easier than, for example, using a vaginal ring. And with such means as injectable contraception or intrauterine devices, which can not be used without a doctor, there is no comparison at all.

However, this is far from the only plus, the undoubted advantages of hormonal contraception are:

High efficiency, even for three-phase preparations, the reliability index does not exceed 0.6%. In other words, out of one thousand women using this method of protection for one year, pregnancy occurred in only one case.
Safety. Despite the fact that all birth control pills interfere with the hormonal background, their effect is much more harmless than the consequences that abortion is dangerous for.
Normalization of the menstrual cycle, which becomes regular while taking the pills, and the menstruation itself is not so painful, long and plentiful.
Due to the improvement of the barrier properties of cervical mucus, the incidence of inflammatory diseases or exacerbation of chronic pathologies is almost halved.
The use of hormonal contraceptives during the year reduces the risk of endometrial cancer by 50%, ovarian cancer by 30%, and the risk of developing mastopathy is reduced by 70%.

Flaws

Despite the many positive aspects, hormonal contraceptive pills also have disadvantages. The main one, of course, is the side effects, which sometimes make taking the drug simply impossible. In addition, birth control pills:

They do not protect against sexually transmitted infections, including such dangerous ones as HIV or cytomegalovirus.
They affect the blood coagulation system and can increase the risk of blood clots and the development of thromboembolism.
They can aggravate the course of chronic liver and gallbladder diseases or provoke the occurrence of cardiovascular pathologies, disorders in the circulatory system, as well as severe headaches and migraines.

Types of COCs

The whole variety of birth control pills can be divided into two main groups. The first includes drugs containing only gestagens, their other name is mini-pills. The second group is combined contraceptives, which contain several hormones.

Usually these are synthetic analogues of estrogens and progesterone. It is this group that is most popular and is prescribed by doctors most often. Combined drugs are also divided into three types.

Monophasic

They are the first generation of drugs intended for hormonal contraception. They contain two hormones: estrogen and progesterone, which are contained in each tablet in the same amount. The most famous of this group are Janine, Yarina or Diane-35.

Despite the fact that this generation of drugs is not new and has been around for a long time, in terms of their effectiveness they are practically in no way inferior to multi-phase drugs.

The advantage of monophasic contraceptives can be considered ease of use and the possibility of doubling the dose in case you forget to take another pill. But with multi-phase agents, this is not always possible, and their use requires more caution and attention.

In addition, monophasic drugs can help treat endometriosis, normalize the menstrual cycle, reduce its duration and pain. Also, in monophasic drugs, cases of intermenstrual bleeding are less common than in other groups.

Monophasic contraceptives are by far the most studied and frequently prescribed group of drugs by doctors.

Two-phase

The second generation of hormonal contraceptives is different in that each tablet contains a constant dose of estrogen, and the concentration of the second component, gestagen, varies depending on the day of the cycle. Of the drugs in this group, for example, Anteovin is currently used.

Two-phase contraceptives are prescribed mainly only for women with abnormal sensitivity to progestogens. Another indication for such drugs is hyperandrogenism. This is a pathology in which a large amount of male sex hormones begins to be produced in the body of a woman.

Three-phase

This group of drugs differs in that the tablets intended for different days of the cycle contain their own, specific dose of hormones. Such a change in the concentration of estrogens and gestagens is as close as possible to those hormonal fluctuations that occur in a woman's body. Due to this, three-phase contraceptives are considered the most physiological.

Typically, this group of drugs is prescribed to women over 35 or under 18, as well as smokers or obese. Such drugs include, for example, Tri-regol, Triziston or Tri-merci.

The main positive quality of this group of drugs is to reduce the risk of side effects from progestins. The main disadvantage is higher, compared with monophasic drugs, the incidence of bleeding between periods. A more complex regimen and not always possible to double the dose in case of missing the next pill.

Studies have shown that triphasic contraceptives are inferior to monophasic contraceptives in terms of reliability of protection against unplanned pregnancy.

The Pearl index for monophasic preparations is 0.15–0.18, while for three-phase preparations, depending on the characteristics of the composition, the values can range from 0.19 to 0.68.

Criterias of choice

If before this experience of taking hormonal contraceptives a woman did not have, then usually the doctor prefers monophasic preparations containing minimal doses of hormones. But only after receiving the results of all necessary tests. Such as: smear for cytology, hormone analysis, general and biochemical blood tests, ultrasound of the pelvic organs. In some cases, an additional consultation with a mammologist may be necessary. In addition, the doctor must take into account the peculiarities of the menstrual cycle and the phenotype of the woman.

It is simply impossible to choose the right drug without consulting specialists and a series of tests. You should not buy hormonal contraceptives on your own, this can harm your health.

To date, combined oral contraceptives are considered one of the most reliable methods of protection against pregnancy. However, from a woman they require a careful attitude to their condition and strict adherence to the regimen.

Nowadays, there is a huge choice of contraceptive methods that prevent the onset of an unplanned pregnancy. Despite this, in Russia the percentage of abortions is only growing. The negative attitude of women towards hormonal contraceptives is based on existing myths about the dangers of their use. However, the new generation of contraceptives differ from the previous ones in the minimum content of hormones, as well as the minimum number of side effects. However, hormonal contraceptives can also be used by young nulliparous women who have multiple sexual partners.

Birth control pills have the highest effectiveness in preventing pregnancy among available contraceptives (98% of cases). This is due to the content of artificially synthesized sex hormones in the composition of hormonal contraceptives. It should be noted that after stopping taking hormonal pills, all the changes that have occurred in the female body are quickly restored, resulting in the desired pregnancy. It is also worth saying that taking hormonal contraceptives significantly improves the condition of the skin, hair and nails, as well as the general well-being of a woman.

Birth control may be prescribed by a doctor to treat hormonal disorders. Do not forget that only a gynecologist can prescribe certain contraceptives for you. It is not recommended to do this on your own, because when choosing a remedy, the doctor takes into account the individual characteristics of the body of a particular patient. In addition, it is imperative that before prescribing a particular hormonal contraceptive, the doctor directs the patient to take tests for hormones. Only after receiving the results of the tests, he can choose one or another drug for you.

Mechanism of action.
Hormonal contraceptives are divided into two groups: combined oral contraceptives (COCs) and mini-pills (non-combined oral contraceptives). The first group includes artificially synthesized hormones (ethinyl estradiol and progestins). The drugs of this group suppress ovulation, change the structure of the internal mucous membrane of the endometrium (uterine cavity), excluding the implantation of the embryo even in the case of fertilization of the egg. In addition, COCs contribute to the thickening of mucus in the cervical canal, as a result of which the penetration of spermatozoa into the uterine cavity is much more difficult. Thus, combined oral contraceptives provide a multi-stage level of protection against the onset of an unplanned pregnancy. Therefore, pills are by far the most reliable and preferred contraceptive method.

The composition of the mini-pill includes only progestogens. Tablets of this group are recommended for women during breastfeeding, since they do not affect the woman's body in any way. The mechanism of action of such drugs is simple: they contribute to the thickening of the cervical mucus and change the structure of the internal mucous membrane of the uterine cavity, which prevents the implantation of the embryo.

The benefits of new generation birth control pills:

They have a highly effective contraceptive effect.
Normalize the menstrual cycle in women with irregular cycles.
They help reduce blood loss, and also eliminate the manifestations of PMS and pain during menstruation.
Prevent the development of diseases such as iron deficiency anemia.
Reduces the likelihood of developing ovarian and endometrial cancer.
Significantly reduces the risk of developing inflammatory diseases of the genital area.
Some drugs have a pronounced therapeutic effect (in the case of fibroids, the condition improves significantly or, in some cases, a complete cure occurs).
Some drugs have antiandrogenic effects.
Several times reduces the risk of developing osteoporosis.
They have a positive effect on the skin, hair and nails, as well as a therapeutic effect in skin diseases against the background of hormonal disruptions.
They are an excellent prophylactic against uterine fibroids and endometriosis.
Prevention of ectopic pregnancy.

New birth control pills.
Among the combined oral tablets, taking into account the content of hormones in them, there are: micro-dose, low-dose, medium-dose, as well as tablets with a high content of hormones.

Microdosed hormonal contraceptive pills are well tolerated and are recommended for young and pre-natal women who have regular sex life (once a week or more). Ideal for women who have never used hormonal contraceptives. Due to the minimum amount of hormones in the preparations of this group, the likelihood of side effects is minimized. The most popular microdosed drugs are: Mercilon, Lindinet, Minisiston, Novinet, Yarina, Jess with antiandrogenic effect, Tri-Merci, Logest.

Low-dose hormonal preparations in the form of tablets are prescribed for young women who do not have a history of childbirth and have a regular sex life, in the absence of a positive result from the use of microdosed drugs. In addition, drugs in this group are suitable for women of late reproductive age. They have some side effects. The most popular drugs in the group are: Lindinet-30, Silest, Minisiston 30, Marvelon (may cause menstrual irregularities), Microgynon, Femoden, Regulon, Rigevidon, Janine (with antiandrogenic action), Belara (with antiandrogenic action).

Medium-dose hormonal tablets are ideal for use by women who have given birth and women in the late reproductive period who have a regular sex life. The drugs have a high degree of protection and contribute to the normalization of the menstrual cycle: Chloe (has an antiandrogenic effect), Diane-35 with an antiandrogenic effect, Demulen, Trikvilar, Triziston, Triregol, Milvane.

High-dose hormonal pills are prescribed only by a doctor as therapeutic drugs. This kind of contraception is recommended for women with children, as well as women of late reproductive age who have regular sex life in the absence of the effect of the use of low- and medium-dose drugs. The most common representatives of this group of contraceptives are: triquilar trisiston, non-ovlon, Ovidon.

Mini-drank.
The composition of the mini-pill contains only progestogens. This contraceptive option is suitable for women who have given birth and women of late reproductive age who have regular sex life in the presence of contraindications to the use of COCs. These drugs have fewer side effects, but are inferior in effectiveness to COCs. These are drugs such as: lactinet, Norkolut, Exluton, Micronor, Charozetta, Microlut.

Application disadvantages.
In women using COCs as a means of preventing the onset of an unplanned pregnancy, blood pressure may periodically increase (in three to five percent of cases), and in some cases, the course of existing hypertension may worsen.

COC does not contribute to the development of gallstone disease. However, if a woman has gallstones, there may be an increase in cases of biliary colic.

When taking hormonal contraceptive pills, you should know that in the first months of taking, menstrual irregularities may occur. Usually there are spotting spotting, or menstruation does not occur at all. These phenomena are absolutely normal, after some time (usually two to three months) after the start of taking the pills, the process normalizes. If this did not happen, and this occurs in rare cases, a woman should consult a gynecologist to select another most suitable drug.

Taking COCs, contrary to popular belief, does not affect weight gain. If there is a set of excess weight, then its cause is not hormonal drugs, but an improper diet and a low level of physical activity. Properly selected new generation contraceptives with a low content of hormones do not affect body weight in any way.

Some contraceptives, due to their use, can cause discomfort in the mammary glands. This can be expressed in the appearance of a feeling of tension or pain. The manifestation of symptoms is similar to the state of pregnancy in the early stages. There is no need to worry about this either. Everything will go away by itself after a few doses of the drug.

In rare cases, taking COCs can cause severe headaches. If cases of headaches become frequent, while in combination with hearing and vision impairments, it is recommended to stop taking the drug and consult a gynecologist.

Often, women after forty, when taking these oral contraceptives, feel bouts of nausea, which in rare cases turn into vomiting. Experts attribute this to age-related hormonal changes in the female body. Usually taking pills just before bedtime helps to significantly reduce the manifestations of these attacks.

In some cases, after taking the drug, women experience emotional mood swings. Despite the fact that doctors deny the connection of this phenomenon with the use of COCs, it is still worth consulting a doctor.

Taking hormonal pills has a positive effect on a woman's libido, significantly enhancing it. But in some cases, the effect can be reversed. You should not be afraid of this, since this phenomenon is temporary.

While taking oral hormonal contraceptives, age spots may occur, especially on exposed areas of the body, which are most often exposed to sunlight. In this case, it is recommended to stop taking this drug. Usually this phenomenon is temporary.

Properly selected contraceptives individually for each woman minimize the risk of side effects.

Contraindications for the use of COCs:

the presence of coronary heart disease now or in the past;
women who smoke (15 or more cigarettes per day) over 35;
women with estrogen-dependent tumors;
blood pressure readings above 160/100 mm Hg;
damage to the valvular apparatus of the heart;
severe diabetes mellitus;
the presence of vascular changes and thrombotic complications;
tumors and liver dysfunction.

This group of women can be given mini-pills as a substitute.

Many women are afraid to take birth control pills for fear of side effects. Innovative technologies allow the production of contraceptive preparations containing a minimum amount of hormones and affecting only the process of conception.

pharmachologic effect

New generation birth control pills contain a complex of progestogens and estrogens. These sex hormones inhibit the synthesis of gonadotropins (follicle-stimulating and luteinizing hormone) in the pituitary gland of the brain. As a result, the process of egg maturation and rupture of the follicle is blocked, so pregnancy cannot occur.

Oral contraceptives contribute to the thickening of cervical mucus, which makes it difficult for sperm to move and enter the uterus. After taking birth control pills, a secretory transformation of the endometrial layer occurs, even if spontaneous ovulation occurs, fertilization of the egg, the embryo cannot implant into the uterine wall.

Third-generation progestogens have a high affinity for progesterone hormonal receptors, so they can bind to them and have a contraceptive effect, blocking ovulation and the release of FSH, LH. At the same time, progestogens have a low affinity with androgen receptors, which reduces the risk of side effects in the form of male-type hair growth, acne, excess weight, hair loss, irritability, etc.

The contraceptive effect of the pills is mainly provided by progestogens, estrogens support the proliferation of the inner layer of the uterus, control the course of the menstrual cycle, replace the lack of estradiol, the synthesis of which is blocked along with ovulation. Thanks to synthetic estrogens, intermenstrual bleeding does not occur while taking modern birth control pills.

Depending on the composition of the active substances, COCs are distinguished - combined oral contraceptives containing progestogens + estrogens, and purely progestogen contraceptive pills (mini-pills).

Taking into account the daily dosage of synthetic estrogens, COCs are classified:

High-dose contain up to 50 mcg / day. ethinylestradiol.
Low-dose contraceptives include no more than 35 mcg / day. estrogen component.
Microdosed tablets differ in the smallest amount, not exceeding 20 mcg / day.

High-dose hormonal contraceptives are used only for medicinal purposes and for emergency protection after unprotected intercourse. Currently, preference is given to low and microdosed contraceptives for the prevention of unwanted pregnancies.

Depending on the combination of progestogens and estrogens, COCs are divided into:

Monophasic tablets are characterized by a constant daily dose of both sex hormones.
Multiphasic contraceptives are characterized by a variable dosage of estrogens. This creates an imitation of fluctuations in the hormonal balance in a woman's body at different phases of the menstrual cycle.

Pills with a low content of hormones provide reliable protection against unplanned pregnancy (99%), are well tolerated, and allow you to control the menstrual cycle. After stopping the use of COCs, reproductive function is restored within 1-12 months.

In addition to the contraceptive effect, oral contraceptives are prescribed for the treatment of dysmenorrhea, reducing the amount of blood loss during menstruation, ovulatory pain, and reducing the frequency of recurrence of inflammatory diseases of the genitourinary system. COCs reduce the risk of endometrial cancer of the uterus, ovaries, rectum, anemia, ectopic pregnancy.

Pros and cons of taking COCs

The main benefits of taking combined birth control pills include:

high level of reliability - 99%;
additional therapeutic effect;
prevention of chronic diseases, cancerous tumors;
rapid contraceptive effect of tablets;
protection against ectopic pregnancy;
accidental use of COCs in early pregnancy is not dangerous;
prevent the appearance of intermenstrual, dysfunctional uterine bleeding;
contraceptives are suitable for long-term contraception;
the possibility of canceling pills if you want to get pregnant;
the condition of the skin improves.

After a short-term use of combined oral contraceptives (3 months), the sensitivity of hormonal receptors in the ovaries increases, therefore, after the abolition of COCs, there is an increased stimulation of ovulation and the release of gonadotropins - a rebound effect. This method of therapy helps women suffering from anovulation to become pregnant.

The disadvantages of taking birth control pills include the high cost and possible side effects. Undesirable manifestations are rare (10-30%), mainly in the first few months. Later, the condition of women is normalized. Simultaneous use of COCs and anticonvulsants, anti-tuberculosis drugs, tetracyclines, antidepressants reduces the therapeutic effect of contraceptives.

Common side effects include:

irritability, aggressiveness, tendency to depression;
migraine;
swelling of the mammary glands;
impaired glucose tolerance;
weight gain;
chloasma - the appearance of age spots on the skin;
acne, seborrhea;
breakthrough bleeding;
intermenstrual bleeding;
thrombophlebitis;
decreased libido;
amenorrhea due to endometrial atrophy;
increase in blood pressure.

If the side effects do not go away after 3 months of taking contraceptives, the pills are canceled or replaced with other drugs. A complication such as thromboembolism is extremely rare.

Indications and contraindications for taking COCs

Combined oral contraceptives are suitable for women who have a regular sex life, suffering from painful, heavy menstruation, endometriosis, and benign tumors of the mammary glands. Perhaps the appointment of birth control pills in the postpartum period, if the mother is not breastfeeding.

Contraindications:

thrombophlebitis;
diseases of the cardiovascular system;
diabetes;
pregnancy or suspicion of a possible conception;
pancreatitis;
inflammatory diseases, liver tumors;
kidney failure;
lactation;
uterine bleeding of unknown etiology;
migraine;
individual intolerance to the active ingredients.

When pregnancy occurs, birth control pills should be discontinued immediately. But if a woman drank the medicine after conception, there is no significant risk for the intrauterine development of the child.

COC regimens

Contraceptives are selected individually for each woman. This takes into account the presence of diseases of the gynecological sphere, concomitant systemic ailments, possible contraindications.

The doctor advises the patient on the rules for taking COCs, conducts observation for 3-4 months. During this period, an assessment of the tolerability of tablets is carried out, a decision can be made to cancel or replace the contraceptive. Dispensary records are maintained during the entire period of use of contraceptives.

First-line drugs include monophasic COCs containing no more than 35 mcg of estrogen per day. and gestagens with a weak androgenic effect. Three-phase tablets are prescribed for primary or secondary estrogen deficiency, decreased sexual desire, dryness of the mucous membranes of the vagina, and menstrual irregularities.

After the start of taking birth control pills, side effects may occur in the form of spotting, intermenstrual, breakthrough uterine bleeding caused by changes in hormonal levels. After 3 months, all symptoms should be gone. If the discomfort persists, the drug is replaced taking into account the problems that have arisen.

Birth control pills are taken every day at the same time. For convenience, serial numbers are indicated on the blister. Take COC start on the first day of the menstrual cycle and continue for 21 days. Then they take a break for 1 week, during this period there is withdrawal bleeding, ending after the start of a new package.

If you miss taking another birth control pill, you need to drink it no later than 12 hours later. If more time has passed, the contraceptive effect of the drug will be lower. Therefore, over the next 7 days, it is necessary to use additional barrier means against unwanted pregnancy (condom, suppositories). Do not stop taking COCs.

Admission schemes

Schemes of prolonged use of combined oral contraceptives for menstrual irregularities:

Short dosing of birth control pills allows you to increase the interval between periods by 1-4 weeks. Such schemes are used to delay spontaneous menstruation, prevent bleeding, and cancel after a course of oral contraceptives.
Long-term dosing is prescribed to delay menstruation from 7 weeks to several months. Treatment with contraceptive pills is prescribed for anemia, endometriosis, premenstrual syndrome, hyperpolymenorrhea.

Some women prefer cyclic use of COCs with a seven-day break because of the fear of pregnancy and the development of infertility. Some patients believe that menstruation is a physiological process.

Popular combined oral contraceptives

Microdosed low hormone tablets:

The median is a monophasic estrogen-progestin COC. The drug contains drospirenone, which has an antimineralcorticoid effect, prevents the accumulation of excess body weight, the appearance of edema, acne, oily skin, seborrhea.
contains ethinylestradiol 20 mcg, dospirinone 3 mg. A contraceptive drug is prescribed for contraception, for the treatment of severe acne, painful menstruation.
Lindinet 20 tablets include ethinyl estradiol 20 mcg, gestodene - 75 mcg. It is indicated for use in painful menstruation, with an irregular cycle, for contraception.
Zoely. Active ingredients: estradiol hemihydrate - 1.55 mg, nomegestrol acetate - 2.5 mg. Nomegestrol acetate is a highly selective progestogen having a similar structure to progesterone. The active component has a mild androgenic activity, does not have mineralcorticoid, estrogenic and glucocorticoid effects.

mini pili

Popular contraceptive pills with a minimum content of hormones - mini-pills are an alternative method of contraception for women who are contraindicated in taking COCs. The composition of the preparations includes microdoses of progestin, an analogue of progesterone. One capsule contains 300–500 mcg/day. The effect of mini-pills is inferior to COCs, but they have a milder effect, they are recommended for women who experience side effects after taking combined contraceptive pills.

Women can take low-dose progestin preparations during lactation, the active substance does not affect the taste of breast milk and does not reduce its volume. Unlike COCs, mini-pills do not cause blood clotting, do not contribute to thrombosis, increase blood pressure, therefore they are approved for use in cardiovascular pathologies, thrombophlebitis.

Contraceptive progestin pills do not affect ovulation, they thicken the cervical mucus, preventing the penetration of sperm into the uterine cavity and ovaries. In addition, the peristalsis of the fallopian tubes slows down, proliferative changes in the endometrium occur, which does not allow the embryo to be implanted in case of fertilization of the egg. When taking gestagenic drugs, the menstrual cycle and regular bleeding are preserved.

The contraceptive effect is achieved 3-4 hours after taking the pill and persists for a day. Mini-pills provide 95% protection against unplanned pregnancy.

Rules for using the minipill

Before starting the use of contraceptives, women need to be examined by a gynecologist to exclude pregnancy, chronic diseases of the reproductive system. To get the desired result, you must strictly follow the rules for using the mini-pill:

Taking the pills starts from the first and continues until the 28th day of the menstrual cycle, they are drunk continuously at the same time. Skipping the next intake of contraceptives for more than 3 hours completely eliminates the contraceptive effect.
During the first few weeks, nausea may bother you, usually this symptom gradually disappears. To reduce discomfort, it is recommended to take the tablet with meals.
If vomiting occurs after taking the mini-pill, the tablet should be taken again as soon as the patient feels better. This recommendation also applies to diarrhea. In the next 7 days, you must use additional contraception (condom) to protect against unwanted pregnancy.
When switching from COCs, you need to drink mini-pills immediately after finishing the packaging of combined contraceptives.
Pregnancy can occur in the first month after the abolition of progestin tablets. Ovulation occurs 7-30 days (on average 17) after the end of the 56-day course.
Women who are prone to developing age spots (chloasma) after exposure to the sun should avoid prolonged exposure to ultraviolet radiation.
With the simultaneous administration of mini-pills and barbiturates, activated charcoal, laxatives, anticonvulsants, Rifampicin, the effectiveness of contraceptives becomes less.
In the postpartum period, progestin contraceptives are prescribed on the first day of the onset of menstruation, but not earlier than 6 months after the birth of the child.
After an abortion, the pills begin to drink immediately after the operation, additional contraceptives are not required.
The contraceptive effect of the mini-pill is weakened if the gap between taking the next contraceptive pill is more than 27 hours. In the case when a woman forgot to take the medicine, it is necessary to do this as soon as possible and strictly follow the treatment regimen in the future. Over the next week, you need to use additional means of protection against the onset of pregnancy.

Contraindications

It is contraindicated to take oral contraceptives with a low dose of hormones during pregnancy, with uterine bleeding of unknown etiology, liver disease, steroids, exacerbation of herpes, liver failure. You can not drink pills if ectopic pregnancies have previously occurred, if malignant tumors of the mammary glands are detected or suspected of them. Contraindication is lactose intolerance, glucose-galactose malabsorption.

A decrease in the effectiveness of contraceptives can be observed in violation of the rules of admission, the use of laxatives, barbiturates, anticonvulsants, after vomiting, diarrhea. Against the background of progestogen tablets, irregular menstruation may appear. In such cases, it is necessary to stop taking the mini-pills, exclude a possible pregnancy (including ectopic) and only then resume the course.

Side effects of birth control pills

Mini-pills have fewer side effects than COCs. The negative effects of taking birth control pills include:

vaginal candidiasis (thrush);
nausea, vomiting;
intermenstrual bleeding;
intolerance to contact lenses;
swelling of the mammary glands, discharge from the nipples;

contraceptives cause weight gain;
the appearance of chloasma;
urticaria, erythema nodosum;
headache;
acne;
breakthrough bleeding while taking drugs that affect liver function;
decreased libido;
follicular ovarian cyst;
amenorrhea, dysmenorrhea.

Mini-pills may increase the need for insulin in diabetic patients. Therefore, before taking birth control pills, it is necessary to consult an endocrinologist and, if necessary, adjust the dosage of hypoglycemic agents. Women should constantly monitor their blood sugar levels during the first month of taking the mini-pill.

In rare cases, the use of progestogens can provoke the development of thromboembolism. It should be borne in mind that in women over 40 years of age, the risk of developing breast cancer increases during treatment with hormonal drugs. If serious side effects appear, mini-pills are canceled.

If after the onset of pregnancy there was an accidental use of contraceptives, there is no risk to the fetus, but a further course of pills should be canceled. At high dosages of progestogens, masculinization of the female embryo can be observed. During lactation, part of the active substances of the drug penetrates into breast milk, but its taste does not change.

Popular mini-pills

Femulen (ethinodiol).
Exluton (linestrenol 0.5 mg).
Charosetta. The active substance is desogestrel at a dosage of 75 mcg. Tablets do not cause significant disturbances in carbohydrate, lipid metabolism, hemostasis.
Microlut (levonorgestrel 0.03 mg).
Continuin (ethinodiol acetate 0.5 mg).

The disadvantages of using progestin contraceptive pills include the possible formation of follicular ovarian cysts, menstrual irregularities, edema, weight gain, irritability. The contraceptive effect of the mini-pill is lower than that of COCs, it is 90-97%.

Modern contraceptives contain small doses of hormones, provoke the development of side effects to a lesser extent, and provide reliable protection against unplanned pregnancy. The attending physician prescribes tablets, taking into account the individual indications of the woman. The patient should be registered with the dispensary for the entire period of COC or mini-pill use. Particularly careful monitoring is carried out during the first 3-4 months from the start of the use of oral contraceptives.

More than 55 years have passed since the appearance of the first hormonal contraceptive, Enovida. Today, drugs have become more low-dose, safer and more diverse in form.

Combined oral contraceptives (COCs)

Most drugs use the estrogen ethinyl estradiol at a dosage of 20 micrograms. As a gestagen is used:

norethindrone;
levonorgestrel;
norgestrel;
norethindrone acetate;
norgestimate;
desogestrel;
drospirenone is the most modern progestin.

A new trend in the production of COCs is the release of drugs that increase the level of folates in the blood. These COCs contain drospirenone, ethinyl estradiol and calcium levomefolate (a folic acid metabolite) and are indicated for women planning pregnancy in the near future.

Monophasic COCs have a constant dose of estrogen and progestin. Biphasic COCs contain two, three-phase - three, and four-phase - four combinations of estrogen and progestogen. Multiphasic drugs do not have advantages over monophasic combined oral contraceptives in terms of efficacy and side effects.

About three dozen COCs are available on the pharmaceutical market, the vast majority of which are monophasic. They are available in the form of 21+7:21 hormonally active tablet and 7 placebo tablets. This facilitates consistent daily monitoring of regular COC use.

Combined oral contraceptives (COCs) list: types and names

Mechanism of action

The basic principle of COCs is to inhibit ovulation. Drugs reduce the synthesis of FSH and LH. The combination of estrogen and progestin gives a synergistic effect and increases their antigonadotropic and antiovulatory properties. In addition, COC contraceptives change the consistency of cervical mucus, cause endometrial hypoplasia and reduce the contractility of the fallopian tubes.

Efficiency largely depends on compliance. The frequency of pregnancy during the year ranges from 0.1% with correct use to 5% with violations in the regimen.

Advantages

Combined hormonal contraceptives are widely used to treat menstrual disorders, reduce or eliminate ovulatory syndrome. Taking COCs reduces blood loss, so it is advisable to prescribe them for menorrhagia. COCs can be used to adjust the menstrual cycle - if necessary, delay the onset of the next menstruation.

COCs reduce the risk of developing benign breast formations, inflammatory diseases of the pelvic organs, and functional cysts. Taking COCs with existing functional cysts contributes to their significant reduction or complete resorption. The use of COCs helps to reduce the risk of malignant ovarian diseases by 40%, endometrial adenocarcinoma by 50%. The protective effect lasts up to 15 years after drug withdrawal.

Flaws

Side effects: Nausea, breast tenderness, breakthrough bleeding, amenorrhea, headache.

Estrogen, which is part of the COC, is able to activate the blood coagulation mechanism, which can lead to the development of thromboembolism. The risk group for the development of such complications while taking COCs includes women with high levels of LDL and low levels of HDL in the blood, severe diabetes, accompanied by damage to the arteries, uncontrolled arterial hypertension, and obesity. In addition, women who smoke are more likely to develop clotting disorders.

Contraindications for the use of combined oral contraceptives

thrombosis, thromboembolism;
angina pectoris, transient ischemic attacks;
migraine;
diabetes mellitus with vascular complications;
pancreatitis with severe triglyceridemia;
liver disease;
hormone-dependent malignant diseases;
vaginal bleeding of unknown etiology;
lactation.

COCs and breast cancer

The most comprehensive analysis of cases of breast cancer development while taking COCs was presented in 1996 by the Collaborative Group on Hormonal Factors in Breast Cancer. The study evaluated epidemiological data from more than 20 countries around the world. The results of the study showed that women who currently take COCs, as well as those who have taken them within the past 1-4 years, have a slightly increased risk of developing breast cancer. The study emphasized that the patients participating in the experiment were much more likely to undergo breast examinations than women who did not take COCs.

Today it is assumed that the use of COCs can act as a cofactor, which only interacts with the main cause of breast cancer and possibly potentiates it.

Transdermal Therapeutic System (TTS)

The transdermal therapeutic system patch is applied for 7 days. The used patch is removed and immediately replaced with a new one on the same day of the week, on the 8th and 15th days of the menstrual cycle.

TTS appeared on the market in 2001 ("Evra"). Each patch contains a week's supply of norelgestromin and ethinylestradiol. TTS is glued to dry, clean skin of the buttocks, abdomen, outer surface of the upper shoulder or torso with minimal hair growth. It is important to monitor the density of TTS attachment every day and not apply cosmetics nearby. The daily release of sex steroids (203 mcg norelgestromin + 33.9 mcg ethinyl estradiol) is comparable to a dose of low-dose COCs. On the 22nd day of the menstrual cycle, the TTS is removed and a new patch is applied after 7 days (on the 29th day).

The mechanism of action, efficacy, disadvantages and advantages are the same as those of COCs.

vaginal ring

Hormonal vaginal ring ("NovaRing") contains etonogestrel and ethinylestradiol (daily release 15 mcg + 120 mcg, respectively). The ring is set for three weeks, after which it is removed and kept for a week break. On the 29th day of the cycle, a new ring is introduced.

The dosage of ethinyl estradiol in the vaginal ring is lower than that of COCs, due to the fact that absorption occurs directly through the vaginal mucosa, bypassing the gastrointestinal tract. Due to the complete suppression of ovulation and regular release, independent of the patient, the effectiveness is higher than that of COCs (0.3-6%). Another advantage of the ring is the low chance of dyspeptic side effects. Some patients develop vaginal irritation, discharge. In addition, the ring may accidentally slip out.

The effect of hormonal contraceptives on libido has not been studied enough, research data are contradictory and depend on the average age in the sample and gynecological diseases, drugs used, methods for assessing the quality of sexual life. In general, 10-20 percent of women may experience a decrease in libido while taking drugs. In most patients, the use of GCs does not affect libido.

Acne and hirsutism usually have low levels of sex hormone-binding globulin (SHBG). COCs increase the concentration of this globulin, having a beneficial effect on the condition of the skin.

Subtleties of application

The estrogen in the composition of COCs promotes the elimination of LDL and an increase in HDL and triglycerides. Progestins counteract the estrogen-induced change in lipid levels in the body.

For acne, preparations containing cyproterone acetate, drospirenone, or desogestrel as a progestin are prescribed. COCs containing cyproterone acetate and ethinylestradiol are more effective for acne than the combination of ethinylestradiol and levonorgestrel.
With hirsutism, drugs containing progestogens with antiandrogenic properties are recommended: cyproterone acetate or drospirenone.
Combinations of estradiol valerate and dienogest are more effective in reducing menstrual blood loss than ethinyl estradiol and levonorgestrel. In addition, an intrauterine system is indicated for the treatment of menorrhagia.
Preparations containing drospirenone 3 mg and ethinyl estradiol 20 mcg are recognized as the most effective combination for the correction of PMS symptoms, including psychogenic ones.
Taking oral contraceptives increases systolic blood pressure (BP) by 8 mm Hg. Art., and diastolic - 6 mm Hg. Art. . There is evidence of an increased risk of cardiovascular events in women taking COCs. Due to the increased likelihood of myocardial infarction and stroke in patients with arterial hypertension, when prescribing COCs, the benefit / risk ratio must be carefully weighed.
In non-smoking women under 35 years of age with compensated hypertension, COCs may be prescribed with careful monitoring of blood pressure during the first months of admission.
In the case of an increase in blood pressure while taking COCs or women with severe hypertension, an intrauterine system or DMPA is indicated.
The selection of a contraceptive for patients with dyslipidemia should be carried out taking into account the effect of drugs on lipid levels (see Table 5).
Since the absolute risk of cardiovascular events in women with controlled dyslipidemia is low, in most cases, COCs containing estrogen at a dosage of 35 mcg or less can be used. For patients with LDL levels above 4.14 mmol / l, alternative contraceptives are indicated.
The use of COCs in women with diabetes associated with vascular complications is not recommended. A suitable hormonal contraceptive option for diabetes mellitus is the levonorgestrel-releasing intrauterine system, while dose adjustment of hypoglycemic drugs is usually not required.
The results of epidemiological studies studying the risk of developing myocardial infarction when prescribing oral contraceptives to smoking women are contradictory. Due to the limited amount of convincing data, COCs are recommended to be used with caution in all women who smoke over 35 years of age.
Obesity with a body mass index of 30 kg/m2 and above reduces the effectiveness of COCs and transdermal GCs. In addition, the use of COCs in obesity is a risk factor for venous thromboembolism. Therefore, the method of choice for such patients are mini-pills (gestagen-containing tablet contraceptives) and intrauterine contraceptives (levonorgesterel-releasing system).
The use of COCs with an estrogen dosage of less than 50 mcg in non-smoking, healthy women over the age of 35 years may have a beneficial effect on bone density and vasomotor symptoms in perimenopause. This benefit must be viewed through the lens of the risk of venous thromboembolism and cardiovascular factors. Therefore, COCs are prescribed individually for women of the late reproductive period.

List of sources

Van Vliet H. A. A. M. et al. Biphasic versus triphasic oral contraceptives for contraception //The Cochrane Library. - 2006.
Omnia M Samra-Latif. contraception. Available from http://emedicine.medscape.com
Collaborative Group on Hormonal Factors in Breast Cancer. Breast cancer and hormonal contraceptives: collaborative reanalysis of individual data on 53,297 women with breast cancer and 100,239 women without breast cancer from 54 epidemiological studies. Lancet 1996; 347(9017):1713–1727.
Carlborg L. Cyproterone acetate versus levonorgestrel combined with ethinyl estradiol in the treatment of acne. Results of a multicenter study. Acta Obstetricia et Gynecologica Scandinavica 1986;65:29–32.
Batukan C et al. Comparison of two oral contraceptives containing either drospirenone or cyproterone acetate in the treatment of hirsutism. Gynecol Endocrinol 2007;23:38–44.
Fruzzetti F, Tremollieres F, Bitzer J. An overview of the development of combined oral contraceptives containing estradiol: focus on estradiol valerate/dienogest. Gynecol Endocrinol 2012;28:400–8.
Lopez LM, Kaptein AA, Helmerhorst FM. Oral contraceptives containing drospirenone for premenstrual syndrome. Cochrane Database Syst Rev 2012.
Armstrong C, Coughlin L. ACOG releases guidelines on hormonal contraceptives in women with coexisting medical conditions. - 2007.
Carr BR, Ory H. Estrogen and progestin components of oral contraceptives: relationship to vascular disease. Contraception 1997; 55:267–272.
Burrows LJ, Basha M, Goldstein AT. The effects of hormonal contraceptives on female sexuality: a review. The journal of sexual medicine 2012; 9:2213–23.

Low-dose hormonal contraceptives are a type of monophasic combined oral contraceptives, which include progesterone and ethinyl estradiol. The dosage of the latter in such preparations is 30-35 mcg.

Low-dose oral contraceptives have a high contraceptive efficacy, and, in addition, affect the stability of the woman's menstrual cycle, and also have a certain therapeutic effect. Such means of protection can be recommended for both young mothers and ladies of Balzac age. As for young girls who have not yet gone through childbirth, it would be better for them to offer another category of COCs - microdosed tablets.

Impact of low-dose contraceptives

Since the appearance of combined contraceptives on the market, scientists have been steadily moving towards reducing the dosage of hormones in them. It is generally accepted that the lowest doses of progesterone and estrogen provide a reduction in side effects when taking contraceptives for unwanted pregnancy.

Low-dose contraceptives have the following mechanism of action on the woman's body, contributing to the contraceptive effect:

suppression of ovulation, i.e. the creation of such a hormonal background in which the development of the follicle and egg does not occur, and, as a result, ovulation of the ovaries;
preventing the implantation of the embryo to the uterus;
slowing down the movement of the villi of the fallopian tubes involved in the movement of the egg into the uterine cavity, as well as the thickening of the mucus that accumulates in the cervical canal and prevents the penetration of spermatozoa through it.

Low-dose contraceptives, in addition to their proven high effectiveness of protection against pregnancy and safety, also have a number of other positive aspects. In practice, very often young women begin to take such drugs in order to achieve a certain cosmetic effect. Like all other COCs, low-hormone contraceptives reduce the production of male sex hormones in the ovaries, and, as a result, contribute to the disappearance of acne, oily skin, and a decrease in excess hair growth. Among the non-contraceptive properties of low-dose contraceptives, others are widely known:

stabilization of the woman's menstrual cycle, regulation of its duration, intensity of bleeding and pain;
reduction or complete removal of PMS symptoms;
reducing the risk of developing diseases of the female genitourinary system;
prevention of ovarian and endometrial cancer, etc.

Many people wonder which contraceptives have fewer hormones, focusing when choosing COCs only on the doses of progesterone and estrogen contained in them. This approach is fundamentally wrong, since a large number of factors must be taken into account when prescribing a particular drug. This includes the age of the woman, and the regularity of her menstrual cycle, and the peculiarities of its course, the tolerance of drugs, as well as the need to achieve certain therapeutic effects when they are taken.

There is a fairly large list of low-dose contraceptives, each of which has a different hormonal load. At the same time, the tactics of prescribing COCs by doctors is determined by the following sequence - first, contraceptives with a low content of estrogen and progestogen hormones, the so-called microdose contraceptive pills, are used. But sometimes low-estrogen contraceptives do not provide sufficient tolerance, causing a woman to spot spotting, irregular cycles, or not giving the desired therapeutic, non-contraceptive effect. That's when it makes sense to switch to low-dose birth control pills, in which the dose of estrogen varies from 30 to 35 mg.

The most low-dose hormonal contraceptive today are Logest, as well as Lindinet. Low-dose contraceptive pills (list of low-ethinyl estradiol COCs currently on the market):

Yarina;
Midian;
Femodene;
Tri-merci;
Silest;
Jeannine;
Lindinet-30;
minisiston;
Marvelon;
Regulon;
Silhouette;
Rigevidon;
Belara;
Chloe;
Diana-35;
Microgynon.

It should be noted that these birth control pills should not be used by women over 35 years of age. This limitation is due to the fact that with age, women begin to lose estrogen production, and menopause is completely characterized by a complete stop of their secretion. To maintain the desired level of estrogen, ladies of Balzac's age should, on the contrary, take a closer look at which contraceptives have more estrogen hormones and make a choice in their favor (of course, after consulting with a personal gynecologist).