Combined contraceptive. Contraceptives COCs: how combined oral pills work, how to take, reviews

When taken correctly, the pills provide more than 99% protection against unwanted pregnancy. The tablet should be taken every day for 21 days, then stopping for seven days, during which discharge occurs, as with menstruation. Seven days later, taking the tablets is resumed.

You must take the tablet at the same time each day. The absence of a schedule threatens pregnancy, and a missed pill can lead to vomiting or diarrhea.

The combination tablet can help relieve heavy, painful periods. Minor side effects include mood swings, breast tenderness, and headaches.

There is no evidence that the pills are associated with weight gain.

The tablets offer a very low risk for serious side effects such as thick blood and cervical cancer.

Combined birth control pills are not suitable for women over 35 who smoke, or for women with certain medical conditions.

The tablet does not protect against sexually transmitted infections (STIs).

Combined oral contraceptives: principle of action

suppress ovulation (maturation and release of the egg)
contributes to the thickening of mucus in the cervix, making it impassable to sperm
change the lining of the uterus, making it impossible for a fertilized egg to attach to it
reduce the motor ability of spermatozoa in the fallopian tubes

There are many manufacturers of pills, but the main thing you need to know is that combined oral contraceptives come in three types:

monophasic 21 days : the most common type - each tablet contains the same amount of the hormone. Reception provides for 21 tablets, and then a break for 7 days. Representatives of this type are Microgynon, Brevinor, Celeste
phase 21 days : The tablets contain two or three sections of different colored tablets per package. Each section contains a different amount of hormones. One tablet is taken every day for 21 days, then - a break for 7 days. Phase tablets must be taken in the correct order. Examples are Binovum and Loginon.
daily tablets: The package contains 21 active tablets and seven inactive (dummy) tablets. The two types of tablets look different. One tablet is taken every day for 28 days without a break between packs. The tablets must be taken in the correct order. Representatives of this type are Microgynon ED and Loginon ED.

Follow the instructions that come inside the package. If you have any questions about how to take a tablet, ask your doctor or pharmacist for advice. It is important to take the tablets as directed, because an incorrect schedule or concomitant use with another medication may reduce the effectiveness of the drug.

How to take combined oral contraceptives

Take the first pill from the pack marked with the correct day of the week or the first pill of the first color (phase pills).
Continue taking the tablets at the same time each day until the pack is finished.
Stop taking the tablets for 7 days (during these seven days you will bleed).
Start the next pack of tablets on the eighth day, whether or not there is a discharge. This must be on the same day of the week that you took your first tablet.

How to take a daily tablet:

Take the first tablet from the section of the package marked "start". This will be the active tablet.
Continue taking the tablets every day, in the correct order and preferably at the same time, until the pack is finished (28 days).
You will have discharge within seven days of taking the inactive pills.
Start the next pack of tablets, regardless of the end of the discharge.

Most women can start taking the pill at any time during their menstrual cycle. There are special rules for those who have had a childbirth, abortion or miscarriage.

You may need to use additional contraception during the first days on the pills - this depends on what phase of your menstrual cycle you start taking.

If you start taking the combination pill on the first day of your cycle (menstrual period), you will immediately receive protection against unwanted pregnancy and no additional contraception is needed.

Only in the case of a non-short cycle (over 23 days), if you started taking the pill before the 5th day of the cycle, protection against pregnancy also occurs immediately.
If the cycle is short, up to 23 days, you will need additional protection until the tablets are taken for 7 days.

If you start taking the pills on any other day of your cycle, protection will not come immediately, so you will need additional contraception until you have been on the pills for 7 days.

Taking pills without interruption

For monophasic combination pills (pills of the same color and with the same hormone levels), it is normal to start a new pack of pills immediately after the previous one has ended - for example, if you want to delay your period for a trip.

However, do not take more than two packs without interruption unless advised by your doctor. This is explained by the fact that you may experience unexpected bleeding, since the lining of the uterus does not hold fluid. Some women complain of a feeling of swelling after taking several packs of pills one after the other.

What to do if you miss your birth control pill

If you miss one or two tablets, or start the pack too late, this may reduce the effectiveness of the drug in preventing pregnancy. The chance of getting pregnant after missing a pill or pills depends on:

when they are missed
how many tablets missed

A pill is considered "too late" if you forget to take it at the usual time.

A tablet is "missed" if more than 24 hours have passed since you should have taken it. One forgotten pill in a pack or starting a new pack a day early is not catastrophic, as you will still be protected from pregnancy (you have what is called a contraceptive coating).

However, if you miss two or more tablets, or start a new pack two or more days late (more than 48 hours), your protection may be affected.

In particular, if you extend your 7-day break by another two days by forgetting to take the pill, your ovaries may release an egg and you have a very real risk of getting pregnant. This is because the ovaries do not get any effect from the pill during the seven-day break.

If you miss a tablet, follow the advice below. If you are not sure what to do, keep taking the pills and use another method of contraception and seek professional advice as soon as possible.

If you miss one tablet, anywhere on the package:

continue taking the rest of the pack as usual
you do not need to use additional contraceptives such as condoms
observe the seven-day break as usual

If you miss two or more tablets (you are taking your next tablet more than 48 hours later) anywhere in the package:

take the last pill you need, even if it means taking two pills on the same day
leave all missed pills
continue to take the rest of the pack as usual using an additional method of contraception for the next seven days
you may need emergency contraception
you may have to start taking the next pack without interruption

You may need if you have had unprotected sex in the last seven days and missed two or more tablets in the first week of packing.

Starting a new pack of pills after missing two or more pills: If there are seven or more pills left in the pack after the last missed pill, you need to:

finish packing
take the usual seven-day break

If there are less than seven tablets left in the pack after the last missed tablet, you need to:

finish packing and start a new one the next day, without interruption

If you vomit within two hours of taking the combined birth control pill, it means that the drug has not been fully absorbed into your bloodstream. Take another tablet immediately and the next one at the usual time.

If you continue to feel unwell, continue using another form of contraception for as long as you experience discomfort and discomfort, and for two days after recovery.

Very severe diarrhea (six to eight watery stools in 24 hours) may also mean that the pill is not working properly. Continue taking the tablets as usual, but use additional contraceptives such as , and for two days after recovery.

For more information, and in case the symptoms persist, it is best to talk to your doctor.

Combined oral contraceptives: contraindications

pregnant
smoke and you are over 35 years old
quit smoking less than a year ago and are now 35 or older
are overweight
are taking certain medications (check with your doctor is required)
thrombosis (thick blood)
heart disease or heart disease, including high blood pressure
severe migraines, especially with aura (alarm symptoms)
mammary cancer
gallbladder or liver disease
diabetes mellitus with complications or diabetes within the past 20 years

Taking combined oral contraceptives after childbirth

If you have just given birth and are not breastfeeding, you can start taking the pills on the 21st day after giving birth. Protection from pregnancy comes immediately. If you start taking the pill later than 21 days after giving birth, you will need additional contraception (such as a condom) for the next seven days.

If you are breastfeeding a baby less than 6 months old, taking the tablets may reduce your milk flow. It is recommended that you use another method of contraception until you stop breastfeeding.

Taking combined oral contraceptives after a miscarriage or abortion

If you have had a miscarriage or an abortion, you can start taking the pills up to five days later and get immediate protection. If you start taking the pills more than five days after your miscarriage or abortion, you will need to use extra contraception until you have been on the pills for seven days.

Combined oral contraceptives: benefits

The pill does not interrupt sex
Establishes a regular cycle, menstruation becomes easier and less painful
Reduces the risk of developing ovarian, uterine and colon cancers
May reduce PMS symptoms
Can sometimes help reduce breakouts and acne
May protect against pelvic inflammatory disease
May reduce the risk of fibroids and non-cancerous breast conditions

Combined oral contraceptives: disadvantages

May cause side effects such as headaches, nausea, breast tenderness and mood swings - if these do not go away after a few months, you may need to change the drug
May increase blood pressure
Does not protect against sexually transmitted infections
Causes sudden bleeding and spotting, which often occur during the first few months of using the pill
The pill has been linked to an increased risk of certain serious conditions, such as thrombosis (thick blood) and breast cancer.

Combined oral contraceptives: combination with drugs

Some medicines interact with the combination tablet in such a way that it is unable to continue working properly. You should always ask your doctor about the compatibility of the drug with other drugs, and also carefully read the instructions in the package yourself.

Antibiotics

The antibiotics rifampicin and rifabutin (which may be used to treat conditions such as tuberculosis and meningitis) may reduce the effectiveness of the combination pill. Other antibiotics do not have this effect.

If you have been prescribed rifampicin or rifabutin, you may need additional contraception (such as condoms).

Epilepsy, HIV drugs and St. John's wort

Combination tablets may interact with enzyme-inducing drugs. These drugs speed up the breakdown of progestogen in the liver, making the pill less effective.

Examples of such drugs are:

drugs used in the treatment of epilepsy - carbamazepine, oxcarbazepine, phenytoin, phenobarbital, primidone and topiramate
St. John's wort (herbal remedy)

antiretroviral drugs used to treat HIV infection (studies show that interactions between these drugs and progestogen-only pills can affect the safety and effectiveness of both)

Your doctor may prescribe alternative or additional forms of contraception while taking any of these drugs.

Combined oral contraceptives: dangers

There are some risks associated with using combined birth control pills. However, these risks are small and, for most women, the benefits of the pill outweigh the possible risks.

Thick blood

The estrogen in the pill can cause the blood to clot more "willingly". If thick blood disease develops, it can cause deep vein thrombosis (blood clots in the leg), pulmonary embolism (blood clots in the lung), stroke, or heart attack.

The risk of getting blood clots is very small, but before prescribing, the doctor should definitely check if you have certain risk factors that make you more vulnerable to this disease.

Tablets should be taken with caution if you have one of the risk factors listed below. If there are more than two risk factors, you should not take pills at all.

You are over 35 years old
You smoke or quit smoking in the past year
You are excessively overweight (in women with a BMI of 35 or more, the risks of using the pill usually outweigh the benefits)
Having a migraine (you should not take the pills if you have a severe or regular migraine attack, especially if it has an aura or a warning sign before an attack)
High blood pressure
Medical history: blood clot or stroke
Having a close relative who had a blood clot before the age of 45
Being immobile for a long time, such as sitting in a wheelchair or with a leg in a cast

Research to establish a connection between and the pill is still ongoing. To date, they show that users of all types of hormonal contraception are slightly more likely to be diagnosed with breast cancer compared to women who do not use them.

However, 10 years after you stop taking the pill, your risk of developing breast cancer returns to normal.

Research is also trying to establish or disprove the link between the pill and the risk of cervical cancer and a rare form of liver cancer. However, the pill does provide some protection against the development of endometrial (uterine lining) cancer, ovarian cancer, and colon cancer.

In recent years combined oral contraceptives widely used to prevent unwanted conception. It is hormonal contraceptives that are rightfully considered one of the most effective and at the same time reliable means. In addition, this has a positive effect on the female body, strengthening reproductive health.

To understand the mechanism of action of such contraceptives, one should turn to the physiology of the woman's body. All changes that occur in it are cyclical and repeat after a clear period of time. A cycle is the time from the first day of menstruation to the start of the next bleeding. The cycle can last from 21 to 35 days, but for most women it is 28 days. Ovulation occurs in the middle of the cycle. At this time, a mature egg is released from the ovary. If it is combined with a spermatozoon, conception occurs. All these processes are regulated and. During the cycle, the ratio of these sex hormones changes several times.

How do COCs work?

The action of combined oral contraceptives is based on the effect of sex hormones on the body. Combined oral contraceptives (COCs for short) consist of synthetic analogues of the hormones estrogen and progesterone. Depending on the amount of active substances in the preparation and their ratio, such agents are divided into single-phase , two-phase And three-phase drugs. These are the best oral contraceptives for modern women, as they can be selected depending on the individual characteristics of the body.

Three-phase COCs contain an amount of hormones that is as close as possible to the natural fluctuation of estrogen and progesterone in a woman's body. In biphasic oral contraceptives, the ratio of sex hormones changes twice, and this already has a certain difference with the natural processes of the female body. But, when determining which means to choose, a woman must take into account that single-phase contraceptives are the least consistent with natural processes. But in general, all COCs affect the woman's body in the same way, preventing unwanted ones.

Therefore, when recommending a woman to take these drugs, the doctor pays special attention to the individual tolerance of such drugs. In some cases, the body, which normally perceives single-phase combined contraceptives, reacts negatively to three-phase means. But in general, modern COCs are so positively perceived by the female body that their use is allowed from the beginning of sexual life to the period. During menopause, oral contraceptives can be used as a hormone replacement treatment to prevent pathological changes in bone and cartilage tissue that occur due to calcium loss.
COCs have several routes of exposure to the body, resulting in a contraceptive effect. First of all, under their influence, ovulation is suppressed, so the egg does not mature and does not go into the fallopian tube. Also, drugs of this type change the composition cervical secretion . Under normal conditions, this secret facilitates the penetration of spermatozoa into the uterus, and due to the action of COCs, it turns into a thicker and more viscous mass. As a result, spermatozoa cannot get inside, besides, they become practically unviable, getting into the cervix. In addition, when taking such contraceptives, the structure of the uterine mucosa changes markedly: the membrane becomes noticeably thinner. Therefore, even if the fertilization process does occur, the egg with the embryo will not be able to attach to the wall of the uterus. Thus, the triple level of COC exposure guarantees a high level of protection against unwanted conception. According to statistical information, when taking oral contraceptives, 0.1 pregnancies are recorded per 100 women.

Hormonal contraceptives are also an effective prophylactic for preventing a number of gynecological diseases, hormonal imbalance . Also, taking these drugs facilitates the course of menstruation, reducing the amount of blood released.

Types of COCs

As mentioned above, hormonal contraceptives are divided into several varieties. Single phase oral contraception contains the same amount of synthetic analogues of progesterone and estrogen in all tablets of the package. This type of COC includes drugs, , Silest , Ovidon , Non-Ovolon , . Such contraceptives are an appropriate method of contraception for young nulliparous women. The fundamental difference between these drugs are the doses of hormones that they contain. Therefore, an important condition is the individual selection of such means, which necessarily takes into account the general state of the woman's health, the presence of chronic ailments and pathologies, and, finally, the ability to purchase more expensive contraceptives.

Speaking of biphasic drugs, it should be noted that this category includes fewer drugs. In the preparation Anteovin contained And . Biphasic contraceptives, in addition to the main effect, contribute to the cure for acne , . The fact is that these ailments are often provoked by too high a content androgens in the body, contraceptives allow you to balance the content of hormones. Specialists define biphasic COCs as intermediate preparations between single-phase and triphasic agents.

Three-phase hormonal contraception allows you to simulate the natural menstrual cycle, because the preparation contains hormones in a ratio as close as possible to the physiological one. This group includes drugs Trinovum , . These drugs contain hormones in different proportions. Such funds have a positive effect on the body in the presence of initial ovarian dysfunction and other diseases. Three-phase COCs are recommended for women over 27 years of age.

How to take COC?

Hormonal contraceptives from modern manufacturers are produced in plates containing 21 tablets or 28 tablets. In order for a woman to easily navigate the order of taking the drug, new three-phase and two-phase tablets have special designations on the packaging in the form of arrows or days of the week. COCs should be started on the first day of the menstrual cycle, after which the drug should be taken every day. Doctors advise, if possible, to take the tablets at the same time. The latest research shows that with such a clear intake of COCs, hormonal substances are absorbed better. If there are 21 tablets in the plate, the drug should be taken from the first day of menstruation, after which there is a break for seven days. On days when pills are not taken, the use of other methods of protection is not required, since the contraceptive effect remains. If there are 28 tablets in the plate, the drug is taken continuously. After one year of taking COCs, a woman should take a break for three months so that ovarian function can fully recover and unwanted side effects do not occur. These days, it is necessary to protect yourself from conception using other methods.

A woman taking such pills should be clearly aware that COCs are categorically not combined with certain drugs. These are anticonvulsants, a number of antibiotic preparations, medicines for lung diseases. But even if a woman is prescribed treatment with any other drug, then she must definitely warn her doctor about taking oral contraceptives.

How to choose COC?

Contraceptives for women, like male contraceptives, must be chosen by carefully weighing all the individual pros and cons. Before you start using any drugs, you need to consult a gynecologist. For the correct selection of COCs, it is necessary to undergo a number of studies. So, initially a routine gynecological examination is performed, a smear is taken. This allows you to exclude a number of diseases, among which - oncological pathologies. Twice during the menstrual cycle, an ultrasound examination of the pelvic organs is performed. Ultrasound should be performed immediately after menstruation and before the start of the next menstruation. Such a study will allow you to learn about the growth and condition of the uterine mucosa, about the features of ovulation. A woman is also assigned a consultation with a mammologist, an ultrasound of the mammary glands. Sometimes it is also necessary to determine the level of hormones in the blood of the patient.

About three months after the woman began taking the pills regularly, she needs to visit the doctor again in order to control the effects of hormonal substances on the body.

In general, oral contraceptives for women have many visible advantages, including a high level of reliability, rapid onset of effect, ease of use, and good body tolerance. In addition, such female contraceptives provide a normal level of reversibility, that is, after stopping taking such pills, a woman can become pregnant in 1-12 months. Such pills are also suitable for young girls, as they allow you to adjust the monthly cycle, eliminate pain during menstruation, get a certain therapeutic effect in certain diseases, and reduce the manifestation of inflammatory processes.

COCs reduce the risk of cysts , oncological diseases , benign breast tumors , and also avoid iron deficiency anemia . Their use is advisable for women who have a high level of male hormones.

Due to the inhibition of ovulation, the tablets also provide protection against development. In some cases, they also allow you to eliminate some of the provoking factors. Therefore, after stopping treatment with such drugs, pregnancy occurs with a higher probability.

By the way, monophasic COCs allow, if necessary, to “postpone” the next menstruation. To achieve this effect, you should start taking pills from the next package of single-phase contraceptives immediately after the previous one has ended. In addition, COCs provide emergency contraception.

Flaws

In addition to the described number of advantages, these contraceptives have some disadvantages. First of all, this is the likelihood of a decrease in the contraceptive effect in the case of interaction with certain medications. For some women, it is quite difficult to ensure the accuracy and regularity of taking pills. At the same time, skipping pills increases the risk of unwanted pregnancy. As side effects when taking these drugs, there may be amenorrhea , intermenstrual bleeding , decreased sex drive , headache , mood swings , soreness in the chest , weight gain , vomit , nausea . However, all of these phenomena occur, as a rule, in the first months of taking the pills, and later they disappear immediately after the body has fully adapted to COCs.

A significant disadvantage when taking such drugs as contraceptives is the lack of protection during sexual intercourse, both from and from diseases that are sexually transmitted .

Contraindications

There are several absolute contraindications in which oral contraceptives are not used categorically. This is pregnancy or the suspicion that conception has already occurred; the period after childbirth, when a woman is breastfeeding, or the first six months after childbirth; diseases and tumors of the liver; pituitary tumors; cardiovascular diseases; mammary cancer; progressive forms; a number of mental disorders.

Relative contraindications are hypertension , active smoking , tendency to depression . The intake of such contraceptive pills is stopped for one month before planned surgical operations, as well as before taking some. In all these cases, women are advised to use non-hormonal contraceptives .

What if the woman did not take the pill on time?

Despite the fact that if you miss a timely pill, the risk of conception immediately increases, a woman should not panic in this case. The tablet should be taken as soon as possible. If the missed dose happened just on the days of the expected ovulation, then the best way out would be to use an additional method of contraception until the day of the next menstruation. However, modern COCs act on the body in such a way that skipping one tablet for 12 hours does not affect the contraceptive effect. If you miss two tablets, you should take two forgotten tablets as soon as possible, and two more the next day. In this case, it is important to apply an additional method of protection. Such changes can provoke the appearance of spotting, which occurs as a result of a high concentration of hormones. After a few days, this side effect disappears.

If three or more pills were missed, then in this case, you should switch to additional methods of contraception, and start taking COCs again, from the first day of menstruation. Therefore, every woman, before starting to take such contraceptives, should carefully analyze whether she can ensure regular intake of the drug, since the irregular and indiscriminate use of such pills can adversely affect the woman's health.

Today, perhaps, one can hardly meet such a person in developed countries who, regardless of his occupation, would not be familiar with the term “family planning”. According to the modern definition, family planning is a set of social, medical, information and educational activities aimed at maintaining the reproductive health of the population, preventing sexually transmitted diseases, protecting the first pregnancy, reducing the number of abortions and developing safe sexual behavior. The most important element of this complex is contraception.

According to the terminology generally accepted in science, contraception is a set of measures and means used to prevent conception and prevent unwanted pregnancy.

There are several methods of contraception:

1. Physiological - involves determining the period of egg maturation and abstinence during this period from sexual intercourse or the use of contraceptives.

2. Biological - implies a hormonal effect on ovulation.

3. Chemical - involves the use of substances that have a detrimental effect on spermatozoa.

4. Mechanical - characterized by the use of means that create a mechanical barrier to the penetration of spermatozoa into the cervix.

The most widely used method of contraception today is the biological method. It is he who implies the use of hormonal contraceptives, and therefore the problem of the medical use of these drugs needs the proper level of awareness of both doctors and pharmacists.

The history of the use of hormonal contraceptives (GCS) dates back to 1960, when the American scientist G.Pincus synthesized progesterone from the roots of Mexican grapes and demonstrated its contraceptive properties in mice and rats. This event is rightfully considered one of the most important medical discoveries of the 20th century. Since then, the intensity of research

The number of studies in this area is only growing every year, more and more new drugs appear, schemes for their use are improved, and the list of therapeutic and side effects is expanding. All this significantly increases the level of requirements for the qualifications of medical workers, but at the same time significantly increases their capabilities.

Discussion of the problems of hormonal contraception must begin with fundamental points. It should be clearly understood that hormonal contraception involves the use of drugs primarily by a woman, therefore, synthetic analogues of female sex hormones - estrogens and gestagens (progesterone) are used as medicines, the structure of which is close to natural, but the activity is much higher due to their lower ability to oxidize in the body. For example, the activity of synthetic gestagens is higher than natural analogues from 80 to 300 times. Looking ahead a little, we note that in practice this made it possible to reduce the dose of estrogens that make up the GCS by 3-5 times, and gestagens by 5-20 times.

For a better understanding of the features of the mechanisms of action of GCS, it is necessary to briefly recall the physiology of the menstrual cycle. The menstrual cycle (MC) is a complex physiological process, the main task of which is to ensure the development of the egg necessary for pregnancy. Ideally, the MC lasts 28 days, but these terms may vary somewhat depending on the individual characteristics of the female body. The menstrual cycle has two phases, which are called the follicle and the new (or proliferative) and luteal (or secretory). The follicular phase begins on the 1st day of the MC and lasts 13-15 days. In this phase, the maturation of the follicle containing the egg occurs. Note that the growth of the follicle is controlled by estrogens produced in the ovaries. Then the mature follicle ruptures, and an egg ready for fertilization comes out of it. This process is called ovulation and usually occurs between 13 and 15 days. Subsequently, a corpus luteum forms at the site of the burst follicle, and from that moment the luteal phase of the MC begins. The corpus luteum actively produces the progestogen hormone - progesterone, and the synthesis of estrogen during this period is significantly weakened. Under the influence of progesterone, the structure of the uterine mucosa changes, which becomes prepared for the implantation of a fertilized egg. If pregnancy does not occur, the functional layer of the endometrium is rejected, menstruation occurs.

All modern corticosteroids contain ethinyl stradiol as an estrogen component (EC), and the progestogen component (GC) can be represented by various means, but levonorgestrel is most often used. In addition to levonorgestrel, the progestogen component can be represented by the following means.

1) Norgestimate - in the liver turns into levonorgestrel, has a less pronounced progestogenic effect.

2) Desogestrel - has a bioavailability of 76%. It is metabolized in the liver to 3-keto-desogestrel. It has a weak androgenic effect and does not change glucose tolerance, and therefore is more indicated for young women.

3) Gestodene - bioavailability is 100%, is the most effective contraceptive substance.

Currently, there are more than 50 types of combinations of estrogenic and progestogen components, which, depending on the type of combination and dose, can have predominantly estrogenic, progestogenic, androgenic and anabolic effects on a woman's body, and therefore GCS are used not only as contraceptives, but also as a means for the treatment of certain hormonal diseases.

It should be emphasized that the contraceptive effect is determined primarily by gestagens, and estrogens are included in the GCS mainly to maintain a normal hormonal background in a woman's body. The principal mechanism of contraceptive action can be represented as follows. In the process of taking GCS in the blood, the concentration of ethinylestradiol and levonorgestrel increases sharply, i.e. substances with hormonal activity. Further, levonorgestrel, getting into the hypothalamus with the blood flow, stimulates specific progestin receptors there, the principle of "negative feedback" works, and the production of gonadotropic hormones (luteinizing and follicle-stimulating hormones) is weakened in the hypothalamic-pituitary system, as a result of which ovulation is suppressed. Against this background, the following changes occur in the body of a woman:

The ovaries decrease in size, the secretion of estrogens is reduced by 2 times;

The endometrium undergoes regression, which prevents the implantation of the egg;

The content of sialic acid in the mucus of the cervical canal decreases, which reduces the motor activity of spermatozoa;

The structure of the epithelium of the vaginal mucosa changes, which can lead to infectious lesions.

As a result of the described changes, reproductive function is suppressed, and pregnancy does not occur.

The most used GCS at the present stage of development of medicine are the following drugs:

I. Combined estrogen-gestagen preparations (have a ratio of EC and HA 1:50; 1:25; 1:20; 1:10).

In turn, this group is divided into several subgroups:

1) Monophasic preparations - contain certain, constant doses of estrogens and progestogens in one tablet (represented by one type of tablet).

These drugs are taken orally 1 tablet daily, starting on the 5th day of the menstrual cycle, for 21 days. The effect occurs most often after taking 14 tablets. Tablets should be taken at the same time (preferably in the evening after meals), and the intervals between doses should not exceed 30 hours. After taking all the tablets, a seven-day break is necessary, after which the intake continues according to the same scheme. We add that in addition to the main purpose of the application, these funds are also used to treat amenorrhea, menopausal syndrome and other hormonal disorders.

Despite the rather high efficiency of monophasic corticosteroids, their use is currently limited, because. they have some pretty serious side effects. These include:

Increased blood pressure;

Violation of lipid metabolism;

Impaired liver function;

thromboembolic complications;

Latent diabetes mellitus.

These side effects are determined primarily by the relatively high content of estrogens in these preparations.

Thus, monophasic corticosteroids can be considered somewhat outdated, although their production and marketing on the pharmaceutical market are still at a high level.

More modern corticosteroids are two-phase and three-phase preparations.

2) Two-phase corticosteroids - contain different amounts of EC and HA in one tablet (represented by two types of tablets).

The principal idea of biphasicity is that in the first stage of taking the drug, which corresponds to the proliferative phase of the menstrual cycle, I tin tablets containing large amounts of estrogens and smaller doses of gestagens are used. In the second stage, which already corresponds to the secretory phase of the menstrual cycle, type II tablets are taken, in which the ratio of EG and HA changes exactly the opposite - more gestagens and less estrogens. This is done so that the intake of corticosteroids, which can last several months and even years, is as close as possible to the physiological fluctuations in the production of hormones in a woman's body during the menstrual cycle. As mentioned above, more estrogens are produced in the proliferative phase of the cycle, and progestogens are produced in the secretory phase.

Currently on farm. There is only one drug from this group on the market - Anteovin. Anteovine type I tablets are usually presented in an amount of 10 pieces and are white in color. They contain 50 mg of ethinyl estradiol and 50 mg of levonorgestrel. Type II tablets already contain 50 mg of ethinyl estradiol and 125 mg of levonorgestrel. These tablets are pink in color, and their number in the package is 11 pieces.

3) Three-phase corticosteroids - contain different amounts of EC and HA, the ratio of which changes during the course of therapy already three times (represented by three types of tablets).

Type 1 tablets are purple in color, are presented in a package in the amount of 6 pieces, contain 30 micrograms of ethinyl estradiol and 50 micrograms of levonorgestrel. They provide the necessary level of estrogens and progestogens in the folliculin stage.

Type II tablets are pink in color, there are 5 of them in a package. They increase the amount of estrogens and progestogens, thereby suppressing the peak of ovulation, but at the same time supporting the growth of the endometrium. Contains 40 micrograms of ethinylestradiol and 75 micrograms of levonorgestrel.

Type III orange tablets, their number is 10 pieces. Stimulate the secretion of estradiol and progesterone into the luteal

phase, which is achieved by the presence in each tablet of 30 mki ethinylestradiol and 125 mcg of levonorgestrel.

Two- and three-phase corticosteroids are used from the 1st day of the MC for 21 days, followed by a 7-day break. This break is necessary so that the level of estradiol in the blood decreases, the endometrium is rejected, and a menstrual-like reaction occurs.

Phase corticosteroids are indicated primarily for people over 35-40 years old, for whom the use of monophasic drugs is undesirable due to the occurrence of adverse reactions, and at the age of up to 18 years, when the parameters of the menstrual cycle are still not stable enough.

Advantages of two- and three-phase GKS:

Mild effect on the hypothalamic-pituitary system due to small doses of estrogens and gestagens;

Less likely to develop adverse reactions (in particular, they have less effect on lipid metabolism and blood clotting);

Provide the level of estrogens and gestagens in the blood, corresponding to normal physiological fluctuations throughout the MC;

The gestagenic component levonorgestrel has a direct effect on the ovaries and inhibits the synthesis of progesterone, changes the composition of cervical mucus and the structure of the endometrium, thereby enhancing contraception.

Phase corticosteroids provide almost 100% contraception, but after their cancellation, the reproductive function is completely restored. The recovery period depends on the duration of use and can be several months.

However, despite the benefits, these drugs can cause side effects, especially in the first 1-2 months of use.

The most typical adverse reactions:

Increase in body weight (no more than 3 kg);

Roughening of the mammary glands;

Thromboembolism;

Increased blood clotting;

Arterial hypertension (approximately 2.5-6% of patients);

Latent diabetes mellitus;

Cholestatic jaundice and cholelithiasis;

Changes in the urodynamics of the upper urinary tract (which in about 10% of cases leads to the development of nephritis);

Bacterial and fungal colpitis (because steroids lower the pH of the vaginal contents).

Due to the high likelihood of side effects, the duration of taking GCS should not exceed more than two years.

Absolute contraindications for taking combined GCS are:

Thrombophlebitis;

Thromboembolism;

Acute hepatitis;

Chronic diseases of the liver and biliary tract;

Hypertonic disease;

Diabetes.

II. Combined estrogen-antiandrogenic agents.

The mechanism of contraceptive action is based on two factors. First, ethinyl estradiol keeps cervical mucus highly viscous, making it difficult for sperm to enter the uterine cavity. And secondly, cyproterone, by blocking androgen receptors in the hypothalamus, suppresses the secretion of gonadotropic hormones, thereby preventing the occurrence of ovulation. An important feature of cyproterone is the fact that it competitively binds to the androgen receptors of the sebaceous glands and hair follicles and reduces the production of fat, which reduces the manifestations of acne. In connection with these features, Diane-35 is indicated for contraception in women with manifestations of androgenization, as well as for the treatment of androgen-dependent hyperandrogenic diseases in women, such as hirsutism, acne, etc.

The method of dosing the drug "Diana-35": inside, 1 tablet per day, starting from the first day of the cycle, for 21 days, after which a break of 7 days. In women with hirsutism, this drug can be combined with the antiandrogenic agent "Androkur".

Of the other features of the drug, incompatibility with barbiturates should be highlighted, tk. the latter increase the metabolism of the active components of "Diana-35" in the liver, and, consequently, the effectiveness of contraception decreases.

Sh. Preparations containing microdoses of gestagens (pure gestagens). They are also called Mini-pills.

These preparations contain only gestagens as an active ingredient, the dose of which varies from 300 to 500 mcg. Reception is carried out starting from the 1st day of the cycle, continuously for 6-12 months. The interval between doses should not exceed 24 hours, otherwise the reliability of contraception decreases. After discontinuation of the drug, reproductive function is restored after 3 months.

Minipill mechanisms of action:

Change the composition and amount of cervical mucus, while increasing its viscosity, which prevents the penetration of spermatozoa into the uterus;

Delay the transport of the egg through the fallopian tubes;

They prevent the implantation of the egg in the endometrium.

The drugs in this group are intended for women who

the appointment of combined contraceptives is contraindicated due to the fact that the estrogen component present in the latter can cause thromboembolic complications and other undesirable phenomena. Side effects of mini-pill are less significant, the most unpleasant of them is frequent intermenstrual spotting, which limits their use.

IV. Postcoital means.

These drugs are used in the first 24-48 hours after sexual intercourse. They contain high doses of estrogens or gestagens (more often), which exceed the doses of these substances in combined corticosteroids by almost 50 times and average 2-5 mg.

The mechanism of action for postcoital drugs is similar to that for Mini-pill, but changes in the genital organs and ovaries due to a very high dose of hormones are much more pronounced, so they are intended for women who have sex no more than 1 time per week.

Side effects in drugs of this group usually occur 2-3 days after administration and consist in the appearance of nausea, uterine bleeding, amenorrhea.

V. Prolonged (deposited) funds.

These funds are also called depot preparations, they include;

Subcutaneous implants;

Intramuscular injections;

intrauterine contraceptives.

The preparations of this group consist of gestagens and some other substances that cause their slow resorption into the body. They are introduced in the form of implants, as well as in the form of special vaginal rings and high-molecular compounds containing long-acting progestogens.

The mechanism of contraceptive action of prolonged preparations is the same as that of combined GCS, i.e. it is based on the suppression of the secretion of gonadotropic hormones.

1) Depo-prover - suspension for intramuscular injection containing 0.15 mg of hydroxyprogesterone in 1 ml.

2) Mirena - is a T-shaped polyethylene rod containing 52 mg of levonorgestrel, the release rate of which is 20 mcg per day. Levonorgestrel, being released, enters the uterus, where it exerts its effects: it prevents the proliferation of the endometrium, prevents the implantation of the egg, is partially absorbed, and suppresses ovulation. The spiral is introduced into the uterine cavity on the 4th-6th day of the menstrual cycle for up to 5 years.

3) Norplung - Silastic capsules for subcutaneous implantation containing levonorgestrel as an active ingredient. Entered for up to 5 years.

In addition to the above material, it is necessary to briefly characterize the chemical method of contraception, which has a number of distinctive features compared to the biological one.

The chemical method of contraception involves the use of spermicides, i.e. chemicals that inactivate sperm in the vagina before they can reach the upper genital tract.

Spermicidal substances by chemical nature are surfactants - surface-active substances (surfactants) that destroy the cell membranes of spermatozoa. An exception in this series is A-dep-53, which contains an enzyme inhibitor as a spermicide. True, this drug has not yet been found on the pharmaceutical market of the Russian Federation, however, given its effectiveness, it is necessary to know the features of its action.

Combined estrogen-gestagenic corticosteroids

Mii-drank

Fast-

coital

Extended forms and IUDs

Combined esgrogen-antiandrogenic agents

Mono different

Two-phase

Three-phase

Microgenon

minisiston

Rigevidon

Non-Owlon

Marvelon

Mereilon

Rigevidon

Anteovin

Triquilar

Triziston

Tri-regol

Trinovum

Continuin

Microlute

Exclusion

Primolyu-nor

Micronor

Micro shaft

Postinor

Norplung

Depo Provera

Diana-35

-396-

The most common spermicidal substances are: nonoxynol-9, octoxynol-9, menfegol, which are widely represented in various preparations.

All spermicidal preparations can be used in the form of 8 vaginal dosage forms:

Foams (aerosols);

Soluble candles;

as well as means for lubricating condoms.

Some drugs in this group:

1) Pharmatex is a contraceptive drug for local (vaginal) use. It has a spermicidal and antiseptic effect. The spermicidal effect is due to the presence of benzalkonium in the composition of the active substance, which damages the membranes of spermatozoa, resulting in the detachment of the spermatozoon head from the flagellum and further destruction, causing the inability of the spermatozoon to fertilize. Pharmatex is available in the form of vaginal tablets (administered 10 minutes before sexual intercourse, valid for 3 hours), vaginal suppositories (administered 5 minutes before sexual intercourse, valid for 4 hours), vaginal cream (administered immediately after sexual intercourse, valid for 10 hours), vaginal tampon (inserted immediately after intercourse, valid for 24 hours, after which it must be removed).

2) Zhinofilm is an intravaginal film containing nonoxysinol. Nonoxynol reduces the surface tension of the lipid membrane of the sperm and irreversibly paralyzes its movements. The drug also has an antiseptic effect. The film is inserted into the vagina 10-15 minutes before sexual intercourse, the action begins after 15 minutes and lasts 2 hours. It does not have a resorptive effect.

3) Patentex-oval - vaginal suppositories containing nonoxynol. Enter into the vagina 10 minutes before sexual intercourse.

We add that spermicidal agents have an important positive property, not associated with a contraceptive effect - they have the ability to suppress the sexual transmission of a number of infectious diseases.

Every woman who has a regular sex life thinks about how to prevent unwanted pregnancy. Today, there are many methods of contraception, but one of the most popular is taking birth control pills. How combined oral contraceptives work and how they should be taken so as not to harm the body is a question that worries many young ladies.

In contact with

Contraceptives (OCs) refer to the oral method of contraception. Regardless of the type of hormonal contraceptives, these pills are based on female sex hormones that regulate estrogen levels and block ovulation, as a result of which the fertilization of the egg becomes impossible.

The contraceptive effect is also achieved due to the specific effect on the mucous membrane of the uterus, it begins to produce more thick mucus, which prevents the penetration of spermatozoa into the fallopian tube. If you take COC for a long time, the ovaries begin to work in a different mode, an artificial feeling of pregnancy is created.

Many girls are afraid to take such contraceptives, since there is an opinion that they often provoke side effects and give multiple complications. It should be noted right away that modern drugs have a mild effect on the body, if they are chosen correctly, the risk of side effects will be minimized.

The undoubted advantage of oral contraceptives is that they help to normalize the hormonal background, which improves the condition of the skin (fighting), hair and nails. Currently, physicians around the world prescribe COCs not only as a contraceptive, but also as a means to help regulate hormone production and normalize the menstrual cycle. Also, numerous clinical studies have confirmed that taking birth control reduces the likelihood of cancerous tumors of the ovaries and cervix.

It is important to know! It is impossible to select a means of this pharmaceutical category on your own. They should be prescribed by a gynecologist after the delivery of hormones and a physical examination. If the drug is selected properly, taking into account the individual characteristics of the body, it will not only not provoke the occurrence of complications, but, on the contrary, will positively affect the activity of the female body.

Many girls mistakenly believe that COCs are taken only to prevent pregnancy, but in fact, the range of use of these pills is much wider. The main indications for their use:

Both microdosed COCs and high hormone birth control pills help women get rid of many diseases. If the drug was prescribed by a gynecologist to combat the above pathologies after passing the tests, you should not be afraid to drink it, the risk of complications will be minimized.

According to statistics, birth control pills give a 99% guarantee of preventing unwanted pregnancy, but, unfortunately, not everyone can take them. You should refuse to take COCs in such cases:

the formation of neoplasms of a benign or malignant nature on the reproductive organs;
kidney and liver diseases;
childbearing and lactation;
the presence of cardiovascular diseases;
migraine;
high blood pressure;
tendency to form blood clots;
diabetes;
3 and 4 degree of obesity.

Take note! With a minimal likelihood of complications, birth control pills should be abandoned, since their use can provoke irreversible reactions and cause irreparable harm to health.

Instructions for taking COC tablets

Regardless of the type, drugs of this pharmaceutical category begin to be taken on the first day of menstruation. Experts advise taking multi-phase drugs in a certain sequence, which is indicated on the package, and after that take a week break. On the days of the break (or when taking inactive pills), menstruation begins, after which they begin to drink a new pack. It should be noted that some COCs contain 28 tablets (active and dummy) in a package, and there is no need to take breaks when taking them. The next package is started to drink after the last tablet in the previous pack is over.

Attention! Before taking OK, in any case, you must fully read the attached instructions (each drug has its own characteristics and specifics of administration).

Most gynecologists advise you to drink OK at night, so the restructuring of the body will be less noticeable. Within 7 days after taking the first pill from the first pack, it is recommended to use a barrier method of contraception, since the effect of the drug has not yet come into full force.

Hormonal contraceptives are today considered the most effective and highly reliable in preventing unwanted pregnancy. This group of contraceptives allows you not only to plan the birth of the desired baby, but also liberate in relations between partners in terms of sex, besides, they simultaneously cure some diseases of the female genital area.

Hormonal contraception is a contraceptive method based on hormonal suppression of ovulation, in which synthetic analogues of female sex hormones are used. Hormonal contraceptives are divided into oral (OC or hormonal birth control pills) and prolonged (implants and injections). Over the past few years, interest in this method of protection against the onset of an unplanned pregnancy has grown significantly around the world, including in Russia.

The level of efficiency and reliability of these contraceptives is ensured directly by strict observance of the rules for their use. In practice, often the necessary rules are not always followed, which is why pregnancy still happens when using hormonal contraception. Moreover, the reasons for this can be very different - this is skipping the pill, confidence in the long-term preservation of the contraceptive effect, interaction with certain medications.

Classification of hormonal contraceptives.
Along the path of hormone penetration into the blood, hormonal contraceptives exist in the form of tablets, ampoules (injections are made every 45-70 days) and implants that are implanted under the skin (capsules gradually release hormones, maintaining the required level of their content in the blood).

Hormonal contraceptives differ in the type and content of hormones. They are divided into combined (estrogens and progestogens are present in the composition) and non-combined (contains only progestogens, hence the second name is progestogen contraceptives).

Combined contraceptives that enter the body of a woman with birth control pills or injections during the entire menstrual cycle interfere with the regulation of the functions of the reproductive system, imitating natural changes in the content of hormones in the blood. Hormones coming from outside suppress ovulation, as a result of which the release of the egg does not occur, and, therefore, the onset of pregnancy cannot be in principle, even if hundreds of spermatozoa have entered the fallopian tubes.

Combined hormonal contraceptive pills can be single-phase (monophasic), biphasic and triphasic.

Single-phase (or monophasic) birth control pills. These first generation oral contraceptives contained a huge dose of the hormone. During the twenty-one days of the menstrual cycle, a constant amount of estrogens and progestogens is "thrown" into the body, and meanwhile, the level of natural hormones in the blood during the cycle is subject to significant fluctuations. The tablets of this group of contraceptives have one color.

Biphasic oral contraceptives, unlike single-phase drugs, contain tablets of two colors in one package. Tablets of one color are taken in the first half of the cycle, and the other - in the second, and in the latter the level of gestagens is much higher, which is necessary to "copy" the natural changes in the content of hormones in the woman's blood.

Three-phase preparations in the package contain tablets of three colors, while tablets of one color are taken during the first few days of the cycle, then tablets of the second and third colors are taken in sequence. Due to the different content of hormones, the secretion of sex hormones during the entire cycle is successfully imitated. When purchasing funds from this group, you should carefully read the composition. The content of estrogens (ethinyl estradiol) in the preparation is very important, the optimal level is 30-35 mcg per tablet.

Non-combined contraceptives consist only of gestagens (mini-pills). Typically, drugs in this group are prescribed to women who have had side effects when using combined contraceptives. This type of contraception can also be used during lactation. Drugs in this group are also prescribed for the treatment of fibroids, endometriosis and some other diseases of the female genital area.

Hormonal contraceptives are also divided into micro-dose, low-dose, medium-dose and high-dose.

Microdosed preparations are suitable as contraception for young nulliparous women who have regular sex life (once a week or more), as well as for those who have not yet used hormonal contraceptives.

Low-dose hormonal agents are also ideal for young nulliparous women who have an active sex life, and also if microdosed drugs have not been able to block ovulation. Also, this species is suitable for women who have given birth and women in the late reproductive period.

Medium-dose hormonal preparations are ideal for women who have given birth or women in the late reproductive period who have regular sex life).

High-dose hormonal drugs are prescribed for the treatment of hormonal diseases, but are also used as contraception by women who have given birth or women in the late reproductive period who have regular sex life (once a week or more) if low- and medium-dose drugs have not prevented ovulation.

Indications for use:

preventing an unplanned pregnancy,
insufficient synthesis of sex hormones in a woman's body,
menstrual irregularities.

Mechanism of action of hormonal contraceptives.
Hormonal agents prevent pregnancy by suppressing ovulation and thickening the mucus secreted by the cervix, which further prevents the penetration of sperm into the uterus and, accordingly, the fertilization process.

When using hormonal drugs, the female body does not synthesize its own sex hormones, but with even a short interruption of the drug (missing a pill), a strong release of hormones occurs, which can cause ovulation in a few hours.

Modern hormonal contraceptives are produced in the form of tablets (oral contraceptives), contraceptive patches, hormonal implants, vaginal rings, as well as special injections.

With long-term use, as well as with a sharp abolition of oral contraceptives, cases of hormonal failures are not uncommon. This is expressed in violation of the frequency of menstruation and their duration, as well as the amount of discharge. Menstruation becomes excessively scarce or, on the contrary, abundant. Some women experience pain in the lower abdomen. The complex of biologically active substances "Time Factor" has a beneficial effect on the functioning of the reproductive system. Reducing the pain of menstruation is achieved due to the unique composition of the drug, which includes extracts from medicinal herbs, vitamins C, E, B9 and PP, minerals (magnesium, iron, zinc). The components help relieve muscle spasms, restore the balance of hormones, which is quite common during the use of contraceptives or after refusing them.

It is important to remember that hormonal contraceptives cannot protect against STDs, therefore, in the absence of confidence in a sexual partner or in case of casual relationships, barrier methods of contraception (condom) should be used.

Only a gynecologist together with a woman can choose one or another hormonal contraceptive, taking into account many factors and the results of an analysis for hormones (FSH, estradiol and testosterone), which is carried out in the middle of the menstrual cycle.