Hormonal contraception - types of oral contraceptives. Hormonal contraception

There are many rumors about hormonal contraceptives today, and not all of them are true. Many women, having heard enough "horror stories" are still afraid to use this method of contraception. But in fact, hormonal contraceptives today are the most effective and gentle way to prevent unwanted pregnancy. If used correctly, the protection index will be 99.9%, which proves the effectiveness of this method of contraception.

What is the correct use of hormonal contraceptives, and what side effects can they cause? What prejudices prevent women from using this method of contraception and how far are they from the truth? How to choose the right type of hormonal contraceptive? We will try to find answers to these and other questions.

Are hormonal contraceptives harmful to health?

The legend about the unthinkable harmfulness of birth control pills has been preserved since the time when the first pills appeared, which really had a lot of unpleasant side effects. They contained too many hormones that caused headaches, palpitations, as well as nausea and inflammation of the pancreas. But that was more than 30 or 40 years ago. Modern pills contain third-generation synthetic estrogens, they contain three times less hormones and the risk of side effects is much lower.

It must be understood that modern hormonal contraceptives are not at all the drugs that frightened our mothers and grandmothers, these are completely new drugs that are successfully used not only to protect against unwanted, but also to solve many other problems. They help to correct the hormonal background and the menstrual cycle, cure skin problems and prepare the body for conception and childbearing. Therefore, you should not be afraid of such drugs, their effect on health is usually positive, and in case of a negative reaction, you can always choose another remedy.

Who should not use hormonal contraceptives

There are very few contraindications to the use of hormonal contraceptives, and most women can choose the optimal drug. There are medicines for young and older women, for women with various health problems, but there are also a number of contraindications in which this type of contraception is prohibited.

You can not use hormonal contraceptives for thrombophlebitis and thrombosis of the pulmonary arteries and lower extremities. Also, a contraindication to this type of contraception are hormone-dependent forms of neoplasms, which include a variety of tumors of the breast, uterus and ovaries. The use of these drugs is also prohibited for women with thyroid diseases, which are characterized by increased production of estrogen, diabetes mellitus and hepatitis. In addition, contraceptives are not compatible with pregnancy.

In the first seven days of taking the contraceptive effect remains weak, so it is necessary to use other methods of protection in parallel. Only after seven days of regular intake, the level of estrogen in the body can guarantee the contraceptive effect. The first seven days is the accumulation of the drug in the body.

Oral contraceptives are usually taken according to the standard scheme, which includes 21 tablets.. After the end of the prima, withdrawal bleeding begins, and after 7 days it is necessary to start taking the pills in a new circle. There are also schemes with the use of dummy pills or placebo for a week. This allows you not to go astray and not miss the start of taking the pills.

With the correct intake of tablets, after a few months, all the inconvenience caused by their intake disappears. The side effects disappear, and the daily intake of the pill becomes habitual and automatic. If the discomfort associated with taking the medicine persists, then it is necessary to consult a doctor about the selection of a more suitable remedy.

Some popular questions about hormonal contraception (Video)

Hormonal contraceptives are still a curiosity for many of our women and therefore raise a lot of questions. We will look at some of the most popular questions and their answers.

Women often ask how long after stopping contraceptives can you get pregnant. If you took OK and did it correctly, then almost immediately the field of their cancellation, the ability to conceive will be restored. In just 3-6 months, the ability to conceive will be 85%, as in most women who have not used hormonal contraception.

Does the use of hormonal contraceptives affect a woman's libido? There is no definite answer to this question, since this influence is very individual, but most women note an increase in sexual desire. Perhaps this is due to the lack of fear of unwanted pregnancy. If a decrease in libido is noted, then the problem can be solved by changing the drug.

Very often, women are concerned Do OK really contribute to weight gain. The fear of gaining weight due to pills has been around for a very long time, and it is not without reason. Indeed, at the very beginning of taking the pills, a slight (by 2-3 kilograms) weight gain is possible due to fluid retention in the body, which then disappears on its own. In addition, OK can increase, which, in the absence of nutritional control, can lead to weight gain. But in many women, the use of this type of drug, on the contrary, provokes weight loss. Therefore, it can be said that the influence of OK here is insignificant and it all depends on the woman herself, on her nutrition and activity.

From previous publications, we know about the abortive effect of hormonal contraceptives (GC, OK). Recently, in the media, you can find reviews of affected women from the side effects of OK, we will give a couple of them at the end of the article. To highlight this issue, we turned to the 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 HA.

Side effects of hormonal contraceptives.

The actions of hormonal contraceptives, like those of other drugs, are determined by the properties of their constituent substances. Most contraceptive pills prescribed for planned contraception contain 2 types of hormones: one gestagen and one estrogen.

Gestagens

Gestagens = progestogens = progestins- hormones that are produced by the corpus luteum of the ovaries (a formation on the surface of the ovaries that appears after ovulation - the release of the egg), in a small amount - by the adrenal cortex, and during pregnancy - by the placenta. The main progestogen is progesterone.

The name of the hormones reflects their main function - "pro gestation" = "to [preserve] pregnancy" by restructuring the uterine endothelium into a state necessary for the development of a fertilized egg. The physiological effects of gestagens are combined into three main groups.

1. vegetative effect. It is expressed in the suppression of the proliferation of the endometrium, 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.
2. generative action. In small doses, progestins increase the secretion of follicle-stimulating hormone (FSH), which is responsible for the maturation of ovarian follicles 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 provides ovulation and progesterone synthesis). Gestagens affect the center of thermoregulation, which is manifested by an increase in temperature.
3. General action. Under the influence of gestagens, amine nitrogen in the blood plasma decreases, the excretion of amino acids increases, the separation of gastric juice increases, and the separation of bile slows down.

The composition of oral contraceptives includes various gestagens. For a while it was believed that there was no difference between progestins, but now it is known for sure that the difference in 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 in all of them. The characteristics of modern progestins are shown 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 is not characteristic of 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 atherosclerosis increases. In addition, there are symptoms of virilization (male secondary sexual characteristics).

Explicit antiandrogenic effect available for only three drugs. This effect has a positive meaning - an improvement in the condition of the skin (cosmetic side of the issue).

Antimineralocorticoid activity associated with an increase in diuresis, sodium excretion, and a decrease in blood pressure.

Glucocorticoid effect affects metabolism: there is a decrease in the body's sensitivity to insulin (risk of diabetes), increased synthesis of fatty acids and triglycerides (risk of obesity).

Estrogens

The other ingredient in birth control pills is estrogen.

Estrogens- female sex hormones, which are produced by the ovarian follicles and the adrenal cortex (and in men also by the testicles). There are three main estrogens: estradiol, estriol, and 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 action (increased blood clotting);

- an increase in the content of HDL ("good" cholesterol) and triglycerides, a decrease in the amount of LDL ("bad" cholesterol);

- retention of sodium and water in the body (and, as a result, an increase in blood pressure);

- ensuring the acidic environment of the vagina (normally pH 3.8-4.5) and the growth of lactobacilli;

- increased production of antibodies and activity of phagocytes, increased resistance of the body to infections.

Estrogens in oral contraceptives are needed to control the menstrual cycle, they do not take part in protection against unwanted pregnancy. Most often, the composition of the tablets includes ethinylestradiol (EE).

Mechanisms of action of oral contraceptives

So, given 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 the pH of the vagina to a more acidic side (the effect 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 HA from women.

Gynecologist's commentary on the abortive mechanism of action of hormonal contraceptives

When implanted in 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 actually not an egg at all, but an embryo.

Unwanted estrogen...

In the course of a thorough study of hormonal contraceptives and their effect on the body, it was concluded that undesirable effects are associated to a greater extent with the influence of estrogens. Therefore, the smaller the amount of estrogens in a tablet, the fewer side effects, but it is not possible to completely eliminate them. It was 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 estrogen in the preparations and the introduction of newer progesterone analogues into the composition of the tablets.

The first generation of contraceptives include "Enovid", "Infekundin", "Bisekurin". These drugs have been widely used since their discovery, but later their androgenic effect was noticed, manifested in the coarsening of the voice, the growth of facial hair (virilization).

Second-generation drugs include Microgenon, Rigevidon, Triregol, Triziston and others.

The most commonly used and widespread are third-generation drugs: Logest, Merisilon, Regulon, Novinet, Diane-35, Zhanin, Yarina and others. A significant advantage of these drugs is their antiandrogenic activity, which is 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 estrogen in them. It is impossible to completely remove estrogens from the composition, since they play an important role in maintaining a normal menstrual cycle.

In this regard, the division of hormonal contraceptives into high-, low- and microdosed preparations has appeared.

High-dose (EE = 40-50 mcg per tablet).

• "Non-ovlon"
• Ovidon and others
• Not used for contraception.

Low-dose (EE = 30-35 mcg per tablet).

• "Marvelon"
• "Janine"
• "Yarina"
• "Femoden"
• "Diana-35" and others

Microdosed (EE = 20 mcg per tablet)

• "Logest"
• Mercilon
• "Novinet"
• "Minisiston 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 contraceptive pills are approximately the same, it makes sense to consider them, highlighting the main (severe) and less severe ones.

Some manufacturers list conditions that should stop taking immediately. These states include the following:

1. Arterial hypertension.
2. Hemolytic-uremic syndrome, manifested by a triad of signs: acute renal failure, hemolytic anemia and thrombocytopenia (decrease in the number of platelets).
3. Porphyria is a disease in which the synthesis of hemoglobin is impaired.
4. Hearing loss due to otosclerosis (fixation of the auditory ossicles, which should normally be mobile).

Almost all manufacturers designate thromboembolism as rare or very rare side effects. But this grave condition deserves special attention.

Thromboembolism is the blockage of a blood vessel by a thrombus. This is an acute condition that requires qualified help. Thromboembolism cannot occur out of the blue, it needs special “conditions” - risk factors or existing vascular diseases.

Risk factors for thrombosis (formation of blood clots inside the vessels - thrombi - interfering with the free, laminar blood flow):

- age over 35 years;

- smoking (!);

- high levels of estrogen in the blood (which occurs when taking oral contraceptives);

- increased blood clotting, which is observed with a deficiency of antithrombin III, proteins C and S, dysfibrinogenemia, Marchiafava-Michelli disease;

- trauma and extensive operations in the past;

- venous congestion with a sedentary lifestyle;

- obesity;

- varicose veins of the legs;

- damage to the valvular apparatus of the heart;

- atrial fibrillation, angina pectoris;

- diseases of the cerebral vessels (including transient ischemic attack) or coronary vessels;

- arterial hypertension of moderate or severe degree;

- connective tissue diseases (collagenoses), and primarily systemic lupus erythematosus;

- hereditary predisposition to thrombosis (thrombosis, myocardial infarction, cerebrovascular accident in the closest blood relatives).

If these risk factors are present, a woman taking hormonal contraceptive pills has a significantly increased risk of developing thromboembolism. The risk of thromboembolism increases with thrombosis of any localization, both present and past; with myocardial infarction and stroke.

Thromboembolism, whatever its localization, is a serious complication.

	… coronary vessels →	myocardial infarction
	… brain vessels →	stroke
	… deep leg veins →	trophic ulcers and gangrene
	... pulmonary artery (PE) or its branches →	from pulmonary infarction to shock
Thromboembolism…	... hepatic vessels →	liver dysfunction, Budd-Chiari syndrome
	… mesenteric vessels →	ischemic bowel disease, intestinal gangrene
	... renal vessels
	... retinal vessels (retinal vessels)

In addition to thromboembolism, there are other, less severe, but still uncomfortable side effects. For example, candidiasis (thrush). Hormonal contraceptives increase the acidity of the vagina, and in an acidic environment, fungi multiply well, in particular Candidaalbicans, which is an opportunistic pathogen.

A significant side effect is the retention of sodium, and with it water, in the body. This may lead to edema and weight gain. Decreased tolerance to carbohydrates, as a side effect of the use of hormonal pills, increases the risk of diabetes.

Other side effects, such as: decreased mood, mood swings, increased appetite, nausea, stool disorders, satiety, swelling and soreness of the mammary glands, and some others - although they are not severe, however, affect the quality of life of a woman.

In the instructions for the use of hormonal contraceptives, in addition to side effects, contraindications are listed.

Contraceptives without estrogen

Exist gestagen-containing contraceptives ("mini-drank"). In their composition, judging by the name, only gestagen. But this group of drugs has its indications:

- contraception for lactating women (they should not be prescribed estrogen-progestin drugs, because estrogen suppresses lactation);

- prescribed for women who have given birth (because the main mechanism of action of "mini-drank" is the suppression of ovulation, which is undesirable for nulliparous women);

- in late reproductive age;

- in the presence of contraindications to the use of estrogen.

In addition, these drugs also have side effects and contraindications.

Particular attention should be paid to emergency contraception". The composition of such drugs includes either a progestogen (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 (desquamation) of the functional layer of the endometrium in order to prevent the attachment of a fertilized egg. And Mifepristone has an additional effect - an increase in the tone of the uterus. Therefore, a single use of a large dose of these drugs has a very strong simultaneous effect on the ovaries, after taking emergency contraceptive pills, there can be serious and prolonged menstrual irregularities. Women who regularly use these drugs are at great risk to their health.

Foreign studies of side effects of GC

Interesting studies on the side effects of hormonal contraceptives have been carried out in foreign countries. Below are excerpts from several reviews (translation by the author of the article 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, the estimated cardiovascular - vascular risk and the volume of screening studies that were carried out before the appointment of contraceptives. While the risk of venous thrombosis is more important in younger patients, the risk of arterial thrombosis is more relevant in older patients. Among older women who smoke and use oral contraceptives, the number of deaths is from 100 to just over 200 per million every 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 thrombosis, so they should not be given as first choice in hormonal contraceptive beginners.

Reasonable 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 PE were investigated, and often the cause was an unaccounted for risk by doctors.

Reasonable prescription can prevent arterial thrombosis. Almost all women who had a myocardial infarction while using oral contraceptives were either of an older age group, or smoked, or had other risk factors for arterial disease - in particular, arterial hypertension. Avoidance of oral contraceptives in these women may lead to a reduction in the incidence of arterial thrombosis, as reported by recent studies in industrialized 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 if the patient has ever had a venous thrombosis in the past, to determine if there are contraindications to prescribing oral contraceptives, and what is the risk of thrombosis while taking hormonal drugs.

Nixodosed progestogen oral contraceptives (first or second generation) caused a lower risk of venous thrombosis than combination drugs; however, the risk in women with a history of thrombosis is not known.

Obesity is considered a risk factor for venous thrombosis, but it is not known whether this risk is increased with oral contraceptive use; thrombosis is uncommon among obese people. Obesity, however, is not considered a contraindication to oral contraceptive use. Superficial varicose veins 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 tangibility as a high risk factor remains unclear. Superficial thrombophlebitis in history can also be considered as a risk factor for thrombosis, especially if it is combined with aggravated heredity.

Venous thromboembolism and hormonal contraception

Royal College of Obstetricians and Gynecologists, UK

July, 2010

Do combined hormonal contraceptive methods (pills, patch, vaginal ring) increase the risk of venous thromboembolism?

The relative risk of venous thromboembolism increases with the use of any combined hormonal contraceptive (pills, patch and vaginal ring). However, the rarity of venous thromboembolism in women of 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 as a background it remains until the cessation of the use of hormonal drugs.

In this table, the researchers compared the incidence of venous thromboembolism per year in different groups of women (in terms of 100,000 women). It is clear from the table that in non-pregnant women and women not using hormonal contraceptives (non-pregnantnon-users), an average of 44 (with a range of 24 to 73) cases of thromboembolism per 100,000 women are registered per year.

Drospirenone-containingCOCusers - users of drospirenone-containing COCs.

Levonorgestrel-containingCOCusers - using levonorgestrel-containing COCs.

Other COCs not specified - other COCs.

Pregnantnon-users are pregnant women.

Strokes and heart attacks while using hormonal contraception

"New England Journal of Medicine"

Medical Society of Massachusetts, USA

June, 2012

CONCLUSIONS

Although the absolute risks of stroke and heart attack associated with hormonal contraceptives are low, the risk was increased from 0.9 to 1.7 with drugs containing ethinylestradiol at a dose of 20 mcg and from 1.2 to 2.3 with the use of drugs containing ethinyl estradiol at a dose of 30-40 mcg, with a relatively small risk difference depending on the type of gestagen included.

Risk of thrombosis of oral contraception

WoltersKluwerHealth is a leading provider of qualified health information.

HenneloreRott - German doctor

August, 2012

CONCLUSIONS

Different combined oral contraceptives (COCs) are characterized by a different risk of venous thromboembolism, but the same unsafe use.

COCs with levonorgestrel or norethisterone (the so-called second generation) should be the drugs of choice, as recommended by national contraceptive guidelines in the Netherlands, Belgium, Denmark, Norway and the UK. Other European countries do not have such guidelines, but they are essential.

In women with a history of venous thromboembolism and/or with known defects in the blood coagulation system, the use of COCs and other contraceptive preparations with ethinyl estradiol is contraindicated. On the other hand, the risk of venous thromboembolism during pregnancy and the postpartum period is much higher. For this reason, such women should be offered adequate contraception.

There is no reason to abstain from hormonal contraception in young patients with thrombophilia. Progesterone-only preparations are safe in relation 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 users of oral contraceptives (3-9/10,000 women per year) compared with non-pregnant and non-users of these drugs (1-5/10,000 women per year). There is evidence that drospirenone-containing oral contraceptives have a higher risk (10.22/10,000) than drugs containing other progestins. However, the risk is still low and much lower than during pregnancy (approximately 5–20/10,000 women per year) and postpartum (40–65/10,000 women per year) (see table).

Tab. risk of thromboembolism.

Hormonal contraception is a very popular way to protect against unwanted pregnancies. Its application is quite simple, the main thing is not to forget to take a pill on time, and everything will be fine. How does this method work? The tablets contain a special hormone derived synthetically, it is similar to the natural hormones that secrete the ovaries. This tool is quite effective as a contraceptive.

Tablets for daily use

Types of hormonal contraception are not limited to pills. But they are the most sought after due to their ease of use. The most popular are combined drugs. They contain two hormones - estrogen and gestagen, the amount of which varies from tablet to tablet, or not.

In monophasic contraceptives, estrogens and gestagens are constant, but in multiphasic contraceptives it changes. Every gynecologist has a list of hormonal contraceptives of both types. But usually the drugs of first choice are monophasic tablets. They are more reliable in the sense that it is more difficult to make a mistake with their reception. But confusion when taking multi-phase drugs can result in extraordinary uterine bleeding and pregnancy. In addition, when taking a multi-phase drug, a woman will not have the opportunity to sometimes "skip" menstruation, delay their onset if critical days fall unsuccessfully on vacation days, for example.

Taking hormonal contraceptives can also be used as a conservative treatment. It is known that hormonal drugs have a beneficial effect on the endometrium, reduce the risk of cancer. Endometriosis treatment with hormonal contraceptives is also often performed. This is an excellent tool to contain the development of the disease, when pregnancy is not yet planned, but menopause is still far away. The most commonly prescribed drug in this case is Janine. Hormonal contraceptives of the new generation, that is, the latest, are also well suited for these purposes. Their difference lies in the fact that they contain the so-called natural estrogen. The drug is called "Klaira" and is often prescribed to women over 35 years old.

Hormonal contraceptives of the fourth generation, although they contain synthetic estrogen, are also not bad, their names are: Angelique, Jess, Dimia, Midiana and others. That is, those that contain synthetic progesterone - drospirenone. It is believed that it less often provokes puffiness, helps to get rid of seborrhea, acne.

Non-combined hormonal contraceptive pills contain only gestagens - synthetic progesterone, and they are more suitable for nursing mothers. This drug should be taken every day. They have one side effect - spotting between periods is possible in the first few months of use, but after that it usually stops. Such hormonal contraceptives are also called mini-pills.

They operate in the following way. Gestagen changes the qualitative characteristics of cervical mucus, making it very dense, inaccessible to the penetration of spermatozoa. The peristalsis of the fallopian tubes weakens, and the endometrium does not grow, favorable for the implantation of a fertilized egg.

Side effects of hormonal contraceptives that do not contain estrogen are usually milder. Their intake less often leads to problems with veins, excess weight, and headaches. Although everything is individual.

emergency contraception

Postcoital contraceptives or hormonal tablets of the next day contain loading doses of active substances - hormones. They are taken within 3-5 days after intercourse if there is a chance of becoming pregnant. Drugs have a negative effect on the body, and they should not be used more than once every six months. The action of hormonal contraceptives in this case often leads to disruption of the menstrual cycle. Commercial names of emergency contraceptive drugs: Postinor, Escapel, Ginepriston, Zhenale.

Injections, patches, coils and rings

Prolonged drugs are injections that are made based on 1-5 months. They contain special substances that prevent pregnancy.

Much longer, up to 5 years, the hormonal spiral, also known as Mirena, works. It is good because it practically does not have a systemic effect on the body, it is a local contraceptive. The downside is that it is installed inside the uterus, and therefore is not recommended for nulliparous women, as well as for those women who have serious uterine defects.

A simpler option is subcutaneous implants, they look like silicone capsules, they are injected under the skin on the shoulder, they release a special substance every day that prevents unwanted pregnancy. One capsule is valid for 5 years. The most common implant is the Norplant. A side effect is spotting between periods during the first year.

There are also vaginal rings on the market. The hormonal ring, which can be purchased at Russian pharmacies, is called NovaRing. The content of estrogen in it is minimal, so many side effects can be avoided. Unless with the exception of intermenstrual daubing, which occurs just because of low dosages of estrogen, and thrush, provoked by a long stay of the ring in the vagina.

Convenience, which consists in the absence of the need for daily pills, is also provided by the Evra hormonal patch. But doctors cannot call it safer or more effective. Nevertheless, tablets have been studied by doctors better, and therefore are more often recommended.

How the pills work

The action of oral contraceptives is quite complex. This is the suppression of ovulation, a change in the function of the corpus luteum, the structure of the endometrium.
And what about implantation? A fertilized egg or blastocyst, 5-6 days after fertilization, should attach to the wall of the uterus. In order for this to happen, the walls of the uterus must be ready for this, the surface glands must secrete the necessary amount of secretion, and the endometrium must be of a certain structure. However, contraceptives change the ratio of estrogens and progesterone, and this is reflected in the inner lining of the uterus. It no longer corresponds to the parameters under which implantation could occur.

We can say that if you do not violate the rules for taking pills, then the effectiveness of this method is 100%. In addition, they are convenient to use, and the effectiveness does not depend on the sexual contact itself. The body easily restores the function of childbearing when hormonal contraceptives are canceled. Here it should also be said about the rebound effect, when the ovaries, when the drug that inhibits their work is canceled, begin to produce eggs twice as efficiently. Therefore, multiple pregnancy after taking hormonal contraceptives occurs more often.

Before you start taking contraceptives, you should definitely consult your doctor. You should not start drinking drugs on the advice and experience of friends and acquaintances, because what suits one organism may be contraindicated in another. The question of how to choose hormonal contraceptives is best addressed to a gynecologist.

In addition, there are certain contraindications, diseases in which it is impossible to take drugs. These include cardiovascular disease, liver disease, diabetes, severe obesity, and kidney pathology. Such drugs are not recommended for women over 40 who smoke.

Hormonal contraception can lead to some complications and changes in the body. They are insignificant if you initially did not have any diseases. This remedy for pregnancy is quite common, effective and safe.

We continue the story about the various means of contraception. we have already discussed protection from unwanted pregnancy. Today we’ll talk about the most reliable and, according to doctors, the most useful remedy for women’s health - combined oral contraceptives (COCs). How do they work, who are contraindicated and how to prepare for a visit to the doctor so that he prescribes birth control pills for you?

COC: what is it?

Hormonal contraception includes:

1. Combined oral contraceptives;
2. Contraceptives containing only gestagens;
3. Partially - other types of intrauterine contraception.

Combined oral contraceptives: COC- my favorite group of contraceptives. And not only mine. Most civilized women in civilized countries of the world prefer combined oral contraceptives. And that's why. Firstly, they are the most physiological - they contain a combination of two hormones and, thus, to the greatest extent "tuned" to the natural hormonal rhythm of the female body. Second, they are very reliable. They have the lowest Pearl Index - 0.1-1. Yes, and that takes place only because women forget to take pills.

The Pearl Index is the number of unwanted pregnancies per hundred women using this method in one year. (For some methods, the value of the Pearl Index varies considerably, mainly due to misuse, and not at all due to the method itself.)

Thirdly, combined oral contraceptives have a lot of favorable "side" effects. For example, they give rest to the ovaries. Cycles against the background of taking COCs are anovulatory. Ovulation does not occur.

COOK have a central and peripheral effect. Central action COC It manifests itself in the fact that estrogens and progestogen coming from outside inhibit the release of luteinizing (LH) and follicle-stimulating (FSH) hormones by the pituitary gland. This prevents the development of follicles in the ovary and, accordingly, the onset of ovulation.

Peripheral action of COCs It is expressed in the development of endometrial atrophy, which prevents the implantation of the embryo, as well as in an increase in the viscosity of the cervical mucus, which inhibits the penetration of spermatozoa into the uterine cavity.

How does hormonal contraception work in a woman's body?

And here in this place one should not faint - but rejoice. Because a couple of years of rested ovaries is their reliable protection from, for example, oncology. Reversible atrophy of the endometrium is the prevention of hyperplastic processes in the uterus - that is, again, the prevention of background precancerous diseases and, consequently, oncology.

Remember those very notorious grandmothers of ours who gave birth under a haystack. Grandmothers gave birth - breastfed - and became pregnant again. Who survived there from those born under the haystacks - few people thought, and no one was particularly worried about this: we will make new workers, we will give birth.

But in a collective woman who gave birth as a result of her lifestyle: childbirth - feeding - pregnancy - childbirth, it was the ovaries that felt very comfortable, namely the “calm”, the epithelium of the inner surface of the uterus that does not grow and exfoliate every month. That's why there was less cancer. Yes, more people died - for completely different reasons. But oncological diseases of the ovaries, endometrium and mammary glands were less.

Combined oral contraceptives allow our ovaries to rest without forcing the rest of the body to constantly plow for pregnancy and childbirth. And stop carrying on the myth that has worked out your myth that a beard grows from combined oral contraceptives and obesity happens (did you try to eat less?). Modern preparations are already the fourth generation! - Very low dose. And if you do not smoke two packs a day, if you do not have advanced thrombophlebitis and you do not weigh one hundred and twenty kilograms, combined oral contraceptives are not harmful to you!

In addition, combined oral contraceptives (except for all the advantages I have already listed) are comfortable and purely psychological: menstrual bleeding is present (unlike contraceptive preparations containing only progestogen). The ovaries and endometrium are resting - and there is menstrual bleeding. This is very important for women, they are, sorry, imprisoned for this.

Types of oral contraceptives

According to their composition, combined oral contraceptives are divided into monophasic, two-phase and three-phase. Monophasic contraceptives contain a standard daily dose of estrogens and gestagens. In two- and three-phase tablets, there are two or three types of tablets containing increasing doses of hormones, even more “sharpened” for the natural course of the natural menstrual cycle.

If you are a young healthy woman, then ... at this point I will urgently bite my tongue and will not tell you for anything that I recommend taking monophasic drugs. It has not been proven that two- and three-phase drugs have at least some advantage over monophasic drugs, and the scheme for taking them is a little more complicated than the dumbest-simplest scheme for taking monophasic drugs: for twenty-one days you take it orally by mouth - eat - one tablet from the package, then a seven-day break. On the eighth day - start taking from a new package. For those who have a completely sieve instead of a head and for very busy women, there are monophasic preparations for a continuous twenty-eight-day intake: they include seven placebo tablets.

With regular intake of monophasic drugs, maximum contraceptive reliability is ensured and favorable “side” effects are most pronounced. Getting your monophasic medications on a regular basis is as easy as shelling pears: put them in the bathroom near your toothbrush; or in the kitchen, near the coffee maker - in general, where you go every morning. Toilets and showers are fine too.

How the doctor selects pills

To select the drug, contact your obstetrician-gynecologist. It is he who will select the most suitable drug for you! He and no one else! Not a girlfriend. And not a drugstore pharmacist. The pharmacist does not know everything about the female body - especially your specific one! Not to mention the fact that not every salesperson in a pharmacy is now a pharmacist (did they even stay there, pharmacists in pharmacies?).

By the way, if you really decide to ask a pharmacy or a girlfriend which one is best for you to take a combined oral contraceptive, then do not be lazy, spend a month of time (waking up five minutes earlier - it's all business!) And build the notorious curve of your personal. Put it in your bag.

We ran into a pharmacy or to a girlfriend to ask which COC would be better for you to take? Take your personal basal temperature curve out of your purse (preferably also the levels of LH and FSH, natural estrogens, progesterone and androgens - well, this is for the especially advanced) - and show it to the pharmacist in the window or to a friend. If they hatch their eyes at you, then they are clearly not obstetrician-gynecologists. And, therefore, for advice on combined oral contraceptives, you are not to them.

Those birth control pills that contained "horse" doses of hormones (not horse, of course!), Are not currently used as contraceptives. Now they are used only in clinical practice (“clinical practice” means only for patients, only by prescription and only under medical laboratory control) - for the treatment of a number of conditions associated with endocrine disruption and oncology.

Contraindications to hormonal contraception

Alas and ah, in our dear country, distrust of combined oral contraception is still high. But I am glad that compared to the nineties of the twentieth century (just then civilized hormonal contraceptives began to appear on our market), the consumption of hormonal contraception has increased significantly (tens of times!).

And, having praised (quite deservedly!) Combined oral contraception to the skies, I cannot but note that it also has disadvantages. No, the word "disadvantages" is incorrect here. The word "contraindications" is more appropriate. And these very contraindications are already directly related to your shortcomings. More precisely, of course, - conditions and diseases. And these contraindications are divided into absolute(“You can’t at all!”) and relative("it is possible, but...").

Absolute contraindications(impossible!) to the use of combined oral contraceptives:

1. Thrombophlebitis in the past, present or history of thromboembolic complications;
2. Violations of cerebral or coronary circulation;
3. Cardiac ischemia;
4. Severe hypertension;
5. malignant tumors;
6. Local migraine;
7. Pregnancy and suspected pregnancy;
8. Bleeding from the genital tract of unknown origin;
9. Acute liver diseases;
10. Estrogen-dependent tumors, especially breast cancer.

Relative contraindications(possible, just be careful!) to the use of combined oral contraceptives:

1. Generalized migraine;
2. Prolonged immobilization (long immobility - due to an increased tendency to thrombosis and embolism);
3. Irregular menstruation (oligomenorrhea or amenorrhea in nulliparous women - and there is no time for sex, then urgently see a gynecologist-endocrinologist!);
4. Smoking more than two packs of cigarettes per day over the age of thirty-five and significantly overweight;
5. Transient disorders of blood pressure (until the cause is clarified and stabilization-correction);
6. Severe varicose veins (no, that “one blue wreath” is not it);
7. History of familial thrombosis;
8. Epilepsy;
9. Diabetes;
10. Frequent bouts of depression in history (go to a psychiatrist already!);
11. Chronic cholecystitis and hepatitis.

Relative contraindications are more related to two- and three-phase drugs, not at all to monophasic ones.

To whom - what

And I will not write the names of combined oral contraceptives. Firstly, although they are sold without a prescription - but I have already said (and I will not be too lazy to repeat!): It is better to check with an obstetrician-gynecologist what exactly is right for you. Now there are a lot of family planning clinics where you will be provided with advice.

Secondly - a lot of proprietary and generic names, just a sea. Current specialists are watching them much more closely than me. Go to the doctor. Then, at least, you will have someone to appeal to if three-phase COCs start your mood to “jump”. And bribes from girlfriends and sellers are completely smooth!

What should a competent obstetrician-gynecologist do, to whom you turn for advice on contraception?

Now I will list everything in detail: find out in detail your family history and the diseases you have had; measure blood pressure; conduct a general objective (examine, listen) and gynecological examination (yes, look at the chair too). If, in general, everything is in order with you and there are no frightening details-details that are in your stories that the doctor did not find during the examination, then he will immediately prescribe you a drug based on your phenotype (appearance, so to speak).

Young slender normosthenic women prefer to prescribe low-dose types of marvelon, femoden, microgynon, regulon. And, perhaps, three-phase (which I don’t like too much, but who cares) tri-regol, trisiston, triquilar ... (Oh horror, it seems that I still write and list the names! But you know what? .. Knowing the names does not free reasonable women from a visit to the doctor!)

Women with signs of androgenization - such, somewhat "male type": short, stocky, tightly knocked down, with a light mustache - are prescribed, as a rule, COCs with an antiandrogenic component: Diane-35, janine. Smokers older than thirty-five, women with uterine fibroids older than forty are prescribed mainly microdose COCs: Mercilon, Novinet, Logest.

Another doctor should explain to you in detail the essence of the method of combined oral contraception; tell you how to use the prescribed drug specifically for you; explain what to expect, what to look for and what to do if the pill is not taken on time. After three months of taking it (if you are taking COC for the first time), it is advisable (mandatory!) to see an obstetrician-gynecologist. Thereafter, once every six months.

Buy this book

Discussion

Thanks for the interesting article!

11.12.2017 01:35:01, olgams

Pluuuda, I wonder how this can be detected by analyzes?

The article is good, but it is not indicated that now you can do an analysis and find out how much you can generally take oral contraceptives, whether there are risks of developing thrombosis as a result of taking them.

I have a negative attitude to any OK, Mirena, IUD and other methods of protection. It can lead, for example, to an ectopic pregnancy and a bunch of other side effects.

The doctor picked up contraception for me, we stopped at Zhanina. I know that there is a strong drug and side effects, so I drink them together with Lavit vitamins. I have been taking OK for six months and everything is super!

01/08/2017 02:35:52, Lapka888

In vain you are so talking about the author, the article is written awesomely)) And yes, I absolutely agree with everything - only a consultation with a specialist and only she, no one else will direct you and advise the right remedy. It's all very individual, you can not take it negligently! I’m regularly seeing a gynecologist, he picked up OK for me, so I’ve been sitting with the same ones for almost a year now and I don’t complain about anything) And together with OK, as they told me, it’s good to periodically drink courses of vitamins. Recently, I drank the Lavita vitamin-mineral complex, it just combines with OK and is designed for a month. The effect of them is gorgeous, I'm still not overjoyed)) Hair and skin have never looked so good. In general, you should not sin on OK - a regular dose of vitamins, and you are a beauty, and besides, you are also healthy!))

10/28/2016 10:58:17 AM, Yuliana13

I have been taking hormonal contraceptives for a very long time. I have nothing bad in a feminine way, everything is normal, but you need to protect yourself somehow. Spiral is not an option at all. I lost weight from hormones, it's good) I was 54 - I became 47)) I'm small, petite, so I'm ok. My husband is happy too. In principle, everything is in order with my health, I regularly - twice a year drink another complex of vitamins "Lavita". Therefore, everything is in order with my hair, nails and skin)) Yes, and vitamins are always in abundance.

09/27/2016 18:43:33, Arinochka 09/27/2016 04:20:41 PM, katarh 01/02/2015 16:11:12, a woman on a teapot

Comment on the article "Hormonal contraception: how a doctor selects birth control pills"

Hormonal contraception: how a doctor selects birth control pills. Modern means of contraception (part 1). And don't trust the doctors that it can be fixed.

Discussion

If the hormonal ones do not scare you, but the oral form does not suit you, that is, the novaring ring (inserted there), after 3 weeks it is pulled out. Convenient, fewer side effects and no risk of forgetting to take a pill. Another spiral horm. you can put.

03/10/2017 05:46:22 PM, Tetyaz40

For such questions, it is better to consult with your gynecologist. I wonder who advised you diaphragms, this is the century before last. As far as I remember, the efficiency of using diaphragms is on average only 80%.
I can recommend Pharmatex cream, I have been using it for a long time, it did not give misfires. No side effects were observed either. Enough for 10 hours, but if there are several PAs per night, then the cream needs to be renewed. Each PA has its own dose of cream. I just know one woman who forgot about this rule, and then complained to everyone that the cream did not work. Read the instructions carefully.

Discussion

I have a similar situation, it’s too early to get married and it’s not time to become a mother either. The spirals didn’t fit, there was even a flight with them, the gynecologist picked up a drug, pills, they are called Chloe. Ugh, ugh, no problems right now, the cycle has become like clockwork, even my breasts have begun to pancake grow, although I don’t really need it, with my natural not small size. MCH only rejoices, the weight has not changed much from them, Well, maybe a little plus, But this is most likely from the fact that I finally calmed down. Here it is. I don't know, maybe it helps to each his own.

In such cases, the most sensible thing is the sterilization of the "cat".

See other discussions: Smoking and birth control pills. 8. Only a doctor can choose the right hormonal contraceptive.

Tell me about contraceptives, pliz. Mood. Women Health. Tell me about contraceptives, pliz. To regulate the cycle, the gynecologist prescribed contraceptives to me.

In this article, we will look at 2 "sides of the coin" - the positive aspects of taking oral contraceptives and the potential health hazards:

• at the beginning of the article, we will consider the classification, contraindications, side effects and all the positive aspects of taking hormonal contraceptives
• then about the potential risk of developing long-term consequences of taking such drugs, even for a healthy woman.

By doing this, we want to draw women's attention to a longer-term prognosis of their health and think about the fact that any intervention in the natural processes in the female body is fraught with consequences - for someone insignificant, subtle, for someone much more serious, even tragic.

In no case do we call for abandoning the drugs prescribed by the doctor, the article is for informational purposes and the decision to take oral contraceptives is made by a woman after consultation and examination by a gynecologist. But, every woman should be aware of the possible risks she is exposed to when taking oral contraception for a long time.

Groups of contraceptive pills, names and their action

Despite the rather rich assortment of contraceptives presented in the pharmacy, hormonal contraceptive pills today occupy a leading position (and bring billions of dollars a year to their manufacturers). Unfortunately, not everyone knows about contraindications to taking them, side effects, rules for taking pills, that they should not be taken for a long time and the choice of oral contraceptives should be made only by a doctor after a thorough diagnosis and taking the patient's history.

All contraceptive hormonal pills are divided into two "companies": combined oral contraceptives (COCs) and mini-pills.

Monophasic tablets In these tablets, the percentage of estrogenic and progestogen components does not change in each tablet.
Desogestrel and ethinylestradiol: Regulon (400-1100 rubles) prices 2018.	Ethinylestradiol and dienogest: Jeanine (price 1000 rubles) Silhouette (price about 680 rubles)	Gestodene and ethinylestradiol: Lindinet (380-500 rub.), Logest (800 rubles), Femoden (950 rubles)
Rigevidon (price 280 rubles)	Microgynon (380 rubles)	Minisiston (450 rubles)
Biphasic drugs In them, the dose of estrogen is the same in all tablets, and the dose of progestogen changes in the 1st and 2nd periods of the menstrual cycle.
Femoston Dydrogesterone + Estradiol (900 rubles).	(Ethinylestradiol + Levonorgestrel): Anteovin, Binordiol, Sekvularum, Adepal, Sequilar, Bifazil	Binovum (Ethinylestradiol + Norethisterone) Neo-Eunomine (Ethinylestradiol + Chlormadinone Acetate)
Triphasic Tablets In the OK data, the doses of hormones are changed three times in one package, which is associated with a change in the periods of the menstrual process.
Tri-Regol (280 rubles)	Three merci (120 rubles)	Triziston

The main point in the mechanism of action of COCs is the blocking of ovulation, due to inhibition of the formation of FSH and LH in the pituitary gland. In parallel, ovarian function and local obstruction of ovulation are blocked. In addition, “glandular regression” occurs in the structure of the uterine mucosa, which makes implantation of a fertilized egg impossible. Changes also occur in the mucus of the cervical canal, it thickens, which disrupts the movement of spermatozoa deep into the uterus.

COCs are also divided into 3 groups according to the quantitative content of active components:

Microdosed OK

The dose of hormones in these pills is minimal, so they are ideal for young women up to 25 years old, and, in addition, for those who are faced with the need to take birth control pills for the first time. Examples of drugs: Zoeli (monophasic), Qlaira (3-phase) and other monophasic ones - Jess, Dimia, Logest, Mercilon, Minisiston, Lindinet, Novinet.

Low-dose OK

Such tablets are recommended for young and mature representatives of the weaker sex, including those who have gone through childbirth, or are prescribed to those patients who, when using microdose drugs, experience intermenstrual bleeding. According to manufacturers' research, a group of low-dose tablets has an antiandrogenic effect (hair growth in uncharacteristic places decreases, acne and increased skin greasiness disappear, decreases). The list of contraceptive pills includes: Diana, Yarina (Midiana), Femoden, Siluet, Jeanine, Trimerci, Lindinet, Silest, Minisiston, Regulon, Marvelon, Microgynon, Rigevidon, Belara, Chloe, Demulen.

High-dose OK

The dose of hormones in these contraceptive pills is quite high, so they are prescribed either for the purpose of treatment (for example, endometriosis), or at the stage of therapy for hormonal disorders (Non-ovlon, Triquilar, Ovidon, Triseston, Triregol) only as prescribed by a doctor.

It can be said about mini-pills that they contain only progestogen. The mechanism of their action lies in the local influence on the peripheral parts of the reproductive system. Firstly, mini-pills affect the composition of cervical mucus and its quantity. So, in the middle of the cycle, its volume decreases, but the viscosity of the mucus remains high in any of the phases of the menstrual cycle, which prevents the free movement of spermatozoa. There are also changes in the morphological and biochemical structures of the endometrium, which create "bad" conditions for implantation. About half of women are blocked from ovulation. Mini-pills include: linestrenol (Exluton, Microlut, Orgametril), desogestrel (Lactinet, Charozetta).

Charozetta (1300 rubles) desogestrel	Lactinet (600 -700 rubles) desogestrel	Orgametril (3300 rub.) linestrenol	Exluton (3300 rubles) linestrenol

How to choose good birth control pills

Which contraceptive pills are good, the best, you can’t deal with this issue on your own, especially buying them at a pharmacy on the recommendation of friends or a pharmacist. To find the best birth control pills, you need to visit a doctor. The gynecologist will collect an anamnesis, dwell separately on a family history, existing diseases or past ones, since all of the above may be a contraindication to the use of hormonal contraceptives.

After that, the doctor will conduct an examination, during which he will evaluate:

• skin (telangiosis, petechiae, signs of hyperandrogenism, presence / absence of hypertrichosis, etc.)
• measure weight and blood pressure
• palpates the mammary glands
• prescribe tests for liver enzymes, blood sugar, blood coagulation, hormonal levels, ultrasound of the mammary glands, ultrasound of the pelvic organs, if necessary, mammography
• then perform a gynecological examination with swabs
• a woman should also visit an ophthalmologist, since long-term use of OK increases the risk of developing other eye diseases.

For the appointment of tablets that are most favorable for this patient, her constitutional and biological type is taken into account, which takes into account:

• height, appearance
• milk glands
• pubic hair
• skin, hair
• menstruation and premenstrual symptoms
• cycle irregularities or lack of menstruation
• as well as existing chronic diseases

There are 3 phenotypes:

The prevalence of estrogens

Women of short or medium height, very feminine in appearance, skin and hair are prone to dryness, menstruation with significant blood loss and long, and the cycle is more than four weeks. Medium and high-dose COCs are suitable for patients with this phenotype: Rigevidon, Milvane, Triziston and others.

Milvane (ethinylestradiol and gestodene): Logest (720 rubles) Femoden (600-650 rubles) Lindinet (average price 320 rubles)	Rigevidon (price 180 rubles), Microgynon (320 rubles), Minisiston (370 rubles) Tri-regol (200 rubles), Triquilar (530 rubles), Triziston

Balanced type

Women of average height, feminine, mammary glands of medium size and developed, skin and hair of normal oiliness, no premenstrual signs, menstruation 5 days after 4 weeks. Such women are recommended second-generation drugs: Marvelon, Silest, Lindinet-30, Microgynon, Femoden and others.

Ethinylestradiol and desogestrel: Marvelon (630 rubles), Novinet (330 rubles), Regulon (280-320), Tri-merci (650r) Mercilon (630 rubles)	Ethinylestradiol and Norgestimate: Silest	Eethinylestradiol and Gestodene (Milvane): Lindinet (280-350 rub.), Logest (720 rubles), Femoden (600-650 rubles)	Ethinylestradiol and levonorgestrel: Rigevidon (180r), Tri-regol (200r) Microgynon (320r), Minisiston (370r) Triquilar (530r), Triziston

The prevalence of gestagens / androgens

Women are tall, “boyish” in appearance, underdeveloped mammary glands, skin and hair with increased fat content, depression on the eve of menstruation and pain in the abdomen, in the lumbar region, menstruation is scanty, less than 5 days, the cycle is short, less than 28 days. In this case, the doctor will advise hormonal preparations with an antiandrogenic component: Diane-35, Janine, Yarina, Jess.

Yarina (price 800 rubles)	Ethinylestradiol and drospirenone: Jess (820 rubles)	Ethinylestradiol and drospirenone: Dimia (550 rubles)	nomegestrol and estradiol Zoely (1000 rubles)

Ethinylestradiol and dienogest: Janine (800 rubles), Silhouette (400 rubles)		Ethinylestradiol and cyproterone: Diana 35 (820 rubles), Chloe 35 (450 rubles), Erica 35 (360 rubles)

How to take hormonal oral contraceptives correctly

Standard blisters with COCs contain 21 tablets. There are only a few exceptions, for example, Jess - a new generation of birth control pills, in which there are 24 pills and which are often prescribed by gynecologists to young women. For women after 35 years, the doctor may recommend Qlaira tablets, a new generation of oral contraceptives containing 28 tablets.

How to take birth control pills:

• Tablets should be taken every day, at about the same hour, starting on the first day of menstruation.
• In order not to forget about taking the next pill, it is better to put them in the place where a woman looks every day (in a cosmetic bag, on a toothbrush or attach a magnet to the refrigerator).
• Every day one tablet is drunk until the blister is over.
• Then you need to take a break for a week.
• During this time period, menstrual-like bleeding will begin.
• At the end of 7 days, start taking COC again, regardless of whether the period has ended or not.
• In case of vomiting, it is necessary to take an extraordinary tablet.
• If you miss taking a pill, you need to drink it as soon as possible.
• In these two cases, during the day you need to additionally protect yourself.
• At the very beginning of taking COCs, if they have not been used before, additional protection should be taken during the first 14 days.
• Intermenstrual bleeding is not considered a reason to stop taking pills (see)
• Usually they are noted in the first 2 - 3 months, and indicate a reconfiguration of the body from hormones that are synthesized in the ovaries and pituitary gland to hormones that come from outside.

Taking hormonal combination drugs after medical termination of pregnancy should be started either on the day) or a month later, when the first menstruation begins.

The contraceptive effect of hormonal drugs may decrease when used simultaneously with a number of drugs, for example, rifampicin (it stimulates the activity of liver enzymes). Therefore, when prescribing treatment for any disease, inform your doctor about taking oral contraceptives, carefully study the instructions for using the drugs prescribed to you. In the case of prescribing drugs that reduce the effect of COCs, additionally use other methods of protection (condoms).

The standard mini-pill blister contains 28 tablets. These tablets are drunk without a break for 7 days, just like COCs, at the same hour. Mini-pills are suitable for women who are breastfeeding. If a woman is not lactating or prefers artificial feeding, then low-dose COCs (Belara, Miniziston, Regulon and others) are recommended to her. You can start taking COCs as early as 21-28 days after delivery.

It is worth knowing that the contraceptive effect begins to manifest itself after 2 weeks of taking the pills, and the 100% effect and reliability of such a contraceptive method as OK occurs in the second month of taking the drugs. Ovarian blockade begins as soon as hormones begin to flow from the outside, but the maximum guarantee comes after a month's course of their use.

Side effects of birth control pills

Side effects are signs or conditions that develop when using contraceptives, but do not threaten the health of women. They are divided into 2 groups:

Minor side effects: pain in the head; bleeding between periods; soreness and swelling of the mammary glands; nausea; lack of appetite; lack of menstruation; dizziness, weight gain, increased gas formation, skin rashes, chloasma; increased hair growth; decreased sex drive

Serious side effects: pain and swelling of the calf muscle on one side; acute pain behind the sternum; migraine, hemicrania; shortness of breath, wet cough with streaked mucus; tendency to faint; loss of visual fields; speech problems (difficulty); sudden jumps in blood pressure; urticaria as an allergic reaction to the drug (see)

In the event of serious, as well as persistent small side effects, contraceptives are canceled.

Regardless of the chosen OK, a woman needs a periodic assessment of her health status in connection with possible side effects from taking them, namely:

• Blood pressure: measure every 6 months
• Physical examination (breast, liver palpation, gynecological examination), urinalysis: 1 r / year
• Monthly breast self-examination.

It is no secret that regular checkups are unlikely in many developing countries, and there are programs (in some countries) to distribute OCs to women who do not have access to medical care. This indicates a high likelihood that OCs will be used by high-risk groups of women. Consequently, it will be more difficult for such women to receive medical attention in case of dangerous side effects.

Absolute contraindications to oral contraceptives

Diseases in which the appointment of oral contraceptives is not desirable: (congenital hyperbilirubinemia), bronchial asthma, rheumatoid arthritis, multiple sclerosis, thyrotoxicosis, myasthenia gravis, sarcoidosis, retinitis pigmentosa, thalassemia, renal dialysis.

Absolute contraindications to combined OK: the period of breastfeeding; less than 1.5 months after delivery; existing and possible pregnancy; pathology of the cardiovascular system; pathological changes in the vessels of the brain; pathology of the liver and tumors of this organ; migraines of unknown origin; bleeding from the genital tract of unknown nature; hypertension 2A - 3 degrees, kidney pathology; gestational herpes; cancer of the genital organs and endocrine glands; prolonged immobility; 4 weeks before surgery; overweight (from 30%); smoking at age 35 and beyond; long-term or progressive diabetes mellitus diseases that predispose to thrombosis.

Absolute contraindications to taking pure progestins: present or suspected pregnancy; malignant neoplasms of the mammary glands; acute liver disease; bleeding from the genital tract of unknown origin; problems of the cardiovascular system; the presence of an ectopic pregnancy in the past; genital cancer.

At the end of the article, there is a video of a TV show detailing the dangers of using OCs by any woman, because even in the absence of the above contraindications (the woman and the doctor may not know about them), a seemingly healthy woman has an extremely high risk of developing pulmonary thromboembolism, developing oncology.

Hormonal contraceptives and possible pregnancy

Can you get pregnant while taking birth control?

This question worries many women. Of course, pregnancy against the background of the use of hormonal oral contraceptives is not excluded, but its probability is too small.

• First of all, an unwanted pregnancy occurs when the rules for using pills are violated (missing, irregular, taking at different times, the expiration date of the drug has expired).
• You should also take into account the possible vomiting in case of poisoning or co-administration with drugs that reduce the contraceptive effect of hormonal pills.

Is it possible to take contraceptives when pregnancy has already occurred or is suspected?

The answer to this question is negative. If pregnancy after taking contraceptives has happened, it is desirable, then there is no indication for its termination (interruption). You just have to stop taking the pills right away.

Taking hormonal pills in late childbearing age

Currently, in economically developed countries, about half of married couples after 40 years of age prefer sterilization. Of the hormonal drugs, COCs or mini-pills are used. Women who are over the age of 35 should stop using hormones with existing cardiovascular pathology, coupled with smoking, a high risk of oncology. A good alternative for women after 40 - 45 years old are mini-pills. These drugs are indicated for uterine fibroids, endometrioid inclusions and endometrial hyperplasia.

Emergency and non-hormonal contraception

• emergency contraception

If sexual intercourse has occurred without the use of means that protect against pregnancy, emergency (fire) contraception is carried out. One of the well-known and widely used drugs is Postinor, Escapel. You can take Postinor no later than 72 hours after coitus without the use of contraceptives.

First you need to drink one tablet, and after 12 hours, the second is taken. But COCs can also be used for fire contraception. The only condition is that one tablet must contain at least 50 micrograms of ethinylestradiol and 0.25 mg of levonorgestrel. First, you should drink 2 tablets as soon as possible after intercourse, and repeat the intake of 2 more after 12 hours.

These drugs can only be used in emergency cases (rape, condom breakage), WHO does not recommend their use more than 4 times a year, but in Russia they are popular and used by women much more often (see). In fact, they have an abortive effect, of course, this is not a surgical procedure like a medical abortion, but it is no less harmful from the point of view of the further reproductive function of the female body.

• Non-hormonal contraception

They are spermicides that are used topically to prevent unwanted pregnancy. The active component of such tablets inactivates spermatozoa and “does not let” them into the uterine cavity. Moreover, non-hormonal tablets have anti-inflammatory and antimicrobial effects. These tablets are used intravaginally, that is, they are inserted deep into the vagina before intercourse. Examples of non-hormonal tablets: Pharmatex, Benatex, Patentex Oval and others.

Arguments FOR taking hormonal birth control pills

Contraceptive pills, especially new birth control pills (new generation) have advantages over barrier contraceptives. The positive aspects of using OK, which are promoted by gynecologists:

• one of the most reliable and high-quality methods of contraception (efficiency reaches 100%);
• can be used at almost any age;
• against the background of taking contraceptive pills, the menstrual cycle becomes regular, pain may disappear during menstruation (see);
• good cosmetic effect (disappearance of acne, oiliness or dryness of hair and skin disappear, reduction of pathological hair growth);
• peace of mind (no fear of getting pregnant);
• the possibility of accelerating the onset of menstruation or its delay;
• therapeutic effect - endometriosis, uterine fibroids, ovarian cysts (whether OK have a therapeutic effect is still a very controversial issue, since most studies are carried out by manufacturers of hormonal contraceptives);
• after refusing to take pills, fertility is usually restored within 2-6 menstrual cycles (with rare exceptions up to a year).

But despite all the advantages, there are much more negative consequences from taking hormonal contraceptives and they outweigh the arguments FOR. Therefore, the decision to drink birth control pills is made by the doctor and the woman herself, based on the presence of contraindications, possible side effects of these drugs, general health, and the presence of chronic diseases. According to the results of many studies, taking oral contraceptives (long-term) has long-term negative consequences for the health of a woman, especially those who smoke and have any chronic diseases.

Arguments AGAINST oral contraceptives

In the modern world, the pharmaceutical industry is the same business as any other sector of the economy, and the material benefit from the sale of drugs that a woman needs every month is fabulous. Over the past decades, several studies have been conducted by independent American experts, the results of which suggest that taking hormonal contraceptives by a woman before the birth of 1 child increases the risk, and increases the cervix. In addition, OK causes depression, contributes to the development of osteoporosis, hair loss, and the appearance of pigmentation on the body.

Hormones produced by the body perform certain functions in the body, controlled in the higher hormonal centers - the pituitary and hypothalamus, which are associated with the adrenal glands, thyroid gland and ovaries (peripheral organs). The ovaries have a clear hormonal interaction with the whole body, the uterus waits for a fertilized egg every cycle, and even small doses of hormones coming from outside disrupt this fragile interaction.

With prolonged use of hormonal contraceptives, the functions of the genital organs completely change. Every day, taking the pill suppresses ovulation, the release of the egg does not occur, the functions of the ovaries are suppressed, which in turn depresses the regulatory centers. With prolonged use of tablets (for years), a woman in the uterus changes the inner layer, since it is rejected unevenly (hence bleeding and). The mucous layer and tissue of the uterus gradually change, which in the future (more often during menopause) threatens with oncological degeneration.

With prolonged use of oral contraceptives, the amount of sex hormones is reduced, the ovaries are reduced in size, their nutrition is disturbed - this is a powerful blow to the reproductive function of the body. Both at the beginning of the intake and after stopping the intake of OK, a failure occurs in the hormonal system, therefore, in some women, the restoration of reproductive function occurs within a year, and in some cases it may not recover at all. So:

• women who have the above contraindications should never take oral contraceptives, since serious complications may develop, up to death (development of vascular thrombosis), oncology;
• with prolonged use of OK, the excretion of vitamin B6 from the body is accelerated, which can lead to hypovitaminosis B6, as well as vitamin B2 (see), which negatively affects the nervous system (weakness, insomnia, irritability, skin diseases, etc., see);
• OK also disrupt the absorption of folic acid, which is very important for the body, which is very necessary 3 months before conception and during a future desired pregnancy and (see), the addition of which to some hormonal contraceptives is only a marketing ploy;
• With prolonged use (over 3 years), the risk of developing glaucoma increases by 2 times. Studies by scientists at the University of California showed that (3500 women over 40 years old, from 2005 to 2008 took contraceptives) when taken for 3 years without interruption of oral contraception, women are more likely to be diagnosed with glaucoma.
• oral contraceptives significantly increase the risk of developing osteoporosis in women in the future (after 40 years, see);
• taking OK for 5 years or more increases the risk by 3 times (see). Researchers attribute the growth of this disease to the "Era of hormonal contraception";

Today, in the age of oncological tension and unimproved early diagnosis of the initial asymptomatic stages of oncology, a woman taking OCs may not be aware of her early stages of oncology, in which contraceptives are contraindicated and contribute to aggressive tumor growth;

• studies by Danish scientists show that long-term use in women is 1.5-3 times;
• oral contraceptives contribute to thrombosis in any vessels, incl. and vessels of the brain, heart, pulmonary artery, which increases the risk of stroke and death from pulmonary thromboembolism. The risk increases depending on the dose of hormones, as well as additional risk factors - high blood pressure, smoking (especially over 35 years old), genetic disposition, see;
• taking oral contraceptives increases the risk of developing chronic venous insufficiency - pain in the legs, night cramps, feeling of heaviness in the legs, transient edema, trophic ulcers;
• increases the risk of developing inflammatory diseases of the cervix, breast cancer
• in some cases, the return of fertility is delayed (1 - 2%), that is, the body gets used to the intake of hormones from the outside and in the future, some women may have difficulty conceiving;
• do not provide protection against genital infections, so their use is not advisable if there are many partners, women who have a promiscuous sex life (only condoms protect against genital infections and viruses, including), syphilis, etc.);
• taking oral contraceptives can provoke the appearance of a woman's body;
• according to American studies, in women taking oral contraceptives, the risk of early development of multiple sclerosis increases by 35% (see, which today can be in both a 20-year-old and a 50-year-old woman);
• one of them may be taking oral contraceptives;
• the risks of developing transient increase;
• women taking OCs are more likely to develop depression;
• some women have significantly reduced libido;
• the need for self-monitoring and daily intake;
• errors are not excluded when using contraceptive pills;
• the need to consult a gynecologist before taking;
• the price is quite high

According to WHO, about 100 million women use oral contraception, which brings fabulous profits to drug cartels. Manufacturers of hormonal contraceptives are extremely uninterested in disseminating truthful information about the dangers of products that bring them huge profits.

Today, there is strong public opposition around the world to ban the sale of dangerous drugs, and information about their potential harm is publicly available. The result of this is that European and American gynecologists strongly recommend condoms, which protect not only from unwanted pregnancy, but also from genital infections. Next in popularity is the hormonal patch and then the spiral.

After reports of the dangers of OK, several deaths and lawsuits, Diane-35 is banned in some countries (USA, Germany, France), and polls of Europeans showed that 67% of people aged 15-63 try to protect themselves with condoms, this is married couples and single women, 17% prefer the patch, 6% use the spiral, the remaining 5-10% continue to use OK.

Russian doctors actively continue to offer (advertise) oral contraception to women, moreover, they prescribe them to girls from the age of 14-18, without reporting a potential and very real threat to their health.