Hormonal contraceptive. Birth control pills. Classification of hormonal contraceptives

In this article, we will look at 2 "sides of the coin" − positive sides taking oral contraceptives and potential danger for good health:

• 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 potential risk development long-term effects taking such drugs even by a healthy woman.

By doing this, we want to draw the attention of women to a longer-term prognosis of their health and reflect on the fact that any intervention in natural processes in female body 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 that 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 collection of the patient's history.

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

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 microdosed drugs, experience intermenstrual bleeding. According to manufacturers' studies, 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 directed 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 hold gynecological examination with swabs
• also a woman should visit an ophthalmologist, because long-term use 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, have a “boyish” appearance, underdeveloped mammary glands, skin and hair with increased fat content, depression on the eve of menstruation and abdominal pain, in lumbar region, menstruation is scanty, less than 5 days, the cycle is short, less than 28 days. AT 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 case of appointment medicines 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, Minisiston, 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:

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 in connection with possible side effects from their use, 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 in many developing countries regular check-ups are unlikely, and there are programs (in some countries) to distribute OCs to women who do not have access to medical care. This points to high probability that OCs will be used by high-risk groups of women. Consequently, it will be more difficult for such women to obtain medical care in the event 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.

At the end of the article there is a video of a TV show that tells in detail about the dangers of using OK by any woman, since even in the absence of the above contraindications (the woman and the doctor may not know about them), it would seem healthy woman development risk pulmonary thromboembolism, the development of oncology, is extremely high.

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 taking pills are violated (missing, irregular, in different time intake past the expiration date of the drug).
• It should also be taken into account possible vomiting in case of poisoning or co-administration with drugs that reduce contraceptive effect 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 and it happened, it is desirable, then there is no evidence 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 if they have cardiovascular pathology coupled with smoking, a high risk of cancer. 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 coition 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 for emergency cases(rape, condom damage), 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 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. Positive points use of 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 the reception contraceptive pills the menstrual cycle acquires regularity, the disappearance of pain during menstruation is possible (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 cyst (do OK healing effect- still remains a very controversial issue, since most of the research is carried out by manufacturers 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, negative consequences from taking hormonal contraceptives is much more 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, the presence 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

AT 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 cause depression, contribute to the development of osteoporosis, hair loss, and the appearance of pigmentation on the body.

The 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 each 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 a pill suppresses ovulation, the release of an egg does not occur, ovarian function is 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). gradually changing slime layer and uterine tissue, 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 with the above contraindications should never take oral contraceptives, since serious complications may develop, up to lethal outcome(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 adversely affects 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 an age of oncological tension and unimproved early diagnosis of the initial asymptomatic stages of oncology, a woman taking OCs may not be aware that she has early stages 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 factors risk - high blood pressure, smoking (especially over 35 years old), see genetic disposition;
• 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;
• an increased risk of developing inflammatory diseases cervical, 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 in the presence of many partners, women who are promiscuous sexual life(only condoms protect against sexually transmitted 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 early development 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, all over the world there is a powerful public opposition aimed at banning 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 sexually transmitted infections. Next in popularity is hormonal patch and then spiral.

After reports of harm to OK, several deaths and litigation, in some countries (USA, Germany, France) Diane-35 is prohibited, and surveys of Europeans showed that 67% of people aged 15-63 try to protect themselves with condoms, this couples and free women, 17% prefer the patch, 6% use the coil, the remaining 5-10% continue to use OC.

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 the potential and quite real threat their health.

Hormonal contraceptives have been used worldwide to prevent unwanted pregnancies for over 50 years.

The invention of these drugs has greatly expanded the ability of women to plan a pregnancy without harm to their reproductive health, and a set of non-contraceptive effects allowed doctors to use these drugs to treat a number of women's diseases.

The appointment and selection of hormonal drugs should be handled by a qualified gynecologist, because ideally, for a competent choice, a specialist will need to find out the presence of diseases in which the use of the hormonal method is strictly prohibited.

A woman will need to pass a smear on cytological examination, blood on biochemical analysis, do ultrasound procedure pelvic organs and get a consultation with a mammologist. But unfortunately, in life there are various situations when a woman does not have the opportunity to see a doctor, and the question arises of how to choose a hormonal contraceptive on her own.

So, before making your choice, carefully read the information about hormonal contraceptives and the features of their use.

What are hormonal contraceptives made of?

Modern hormonal contraceptives consist of two analogues of female sex hormones obtained by synthesis - estrogen and progestogen. The dosage of the components may vary depending on the type of contraceptive and the form of its release.

How do hormonal contraceptives work?

The mechanism of action of the drugs is based on the prevention of ovulation, due to which the egg does not leave the ovary and fertilization does not occur. Changes are being made in inner layer uterus, they reduce the ability of the egg to attach to it if fertilization does occur.

Under the influence of hormones, thickening occurs cervical mucus, which significantly reduces the likelihood of penetration into the uterine cavity of male germ cells and bacteria that can cause inflammation.

In the program "Live healthy", dedicated to the topic contraception, Elena Malysheva clearly shows the principle of action of drugs.

Who can use hormonal contraception

Hormonal contraceptive method is suitable for all women reproductive age who live a regular sexual life and want to use a reliable means to prevent unplanned pregnancy, since the effectiveness of the method is 97%.

This percentage of protection is higher than that of condoms or contraceptive suppositories, and besides, the method does not involve sexual intercourse, and you will not need to be distracted by contraception.

And also the method of contraception is suitable in such cases:

• breast-feeding;
• post-abortion protection;
• painful, profuse and irregular periods;
• premenstrual syndrome;
• acne, seborrhea;
• varicose veins;
• dysfunction thyroid gland, benign tumors ovaries and mastopathy;
• endometriosis;

When is hormonal contraception contraindicated?

There are a number of diseases in which the use of female sex hormones is prohibited. These include issues such as severe illness liver and biliary tract, thrombosis and thromboembolism, bleeding disorders, high blood pressure, migraine, breast cancer, autoimmune diseases, severe complications diabetes mellitus.

Disadvantages and Side Effects

The use of hormonal contraceptives does not protect against the risk of contracting sexually transmitted infections and HIV. Taking drugs in tablet form requires a woman to have good self-discipline, since the tablets must be taken daily at the same time.

The action of drugs against tuberculosis and epilepsy significantly reduces the contraceptive effectiveness of contraceptives. St. John's wort, which is part of some antidepressants, works in a similar way.

Drinking alcohol while taking hormonal contraceptives is perfectly acceptable, but try to keep the interval between the pill and alcohol at least 3-4 hours so as not to overload the liver.

As side effects, many women note nausea, vomiting, abdominal pain, changes in body weight (within 1-2 kg, both gain weight and lose weight), heaviness in the mammary glands, amenorrhea. The drugs disrupt the function of the limbic system, which manifests itself in the form of changes in mood and sexual desire. Spotting discharge when taking hormonal contraceptives is not a reason to refuse their use. As a rule, these undesirable manifestations disappear in 3-4 months.

In what forms are hormonal contraceptives produced?

Taking into account the individual preferences and capabilities of women, as well as the availability of recommendations and restrictions on the use of the method, the following types of hormonal agents have been developed:

• Tablets. The content of hormones in active tablet Distinguish between combined oral contraceptives (COCs), they contain estrogen and progestogen, as well as purely progestogen preparations or mini-pills.
• Transdermal therapeutic system (contraceptive patch).
• vaginal ring.
• progestogen injections.
• Intrauterine system with progestogen.

Combination oral contraceptives

According to their composition, COCs are divided into monophasic (the doses of estrogen and progestogen are equal in them), two-phase (one tablet contains two different combinations of active substances) and three-phase, containing three options for the ratio of hormones.

According to the dosage of available estrogens, COCs are high-dose, low-dose and micro-dose.

COCs are produced in blisters containing 21 or 28 tablets. You need to take it from the first day of the menstrual cycle, every day one tablet at the same time. If you miss even one day, you can immediately become pregnant.

At the end of the package containing 21 tablets, you will need to take a break for a week, and after that start a new one. If there are 28 tablets in the blister, then there is no need to pause. The duration of the use of drugs is not limited, and a woman can take them for several years without a break.

How to choose combined oral contraceptives

The principle of selecting oral contraceptives takes into account the age, weight and height of a woman, the presence of concomitant diseases, childbirth and the characteristics of her phenotype.

In total, there are three types of female phenotype.

1. The first, estrogen, type includes women of short or medium stature, who have a very feminine appearance, dry skin and hair, heavy menstruation lasting 5 days or more.
2. The second or mixed type includes women of average height, feminine appearance with moderate menstruation lasting 5 days.
3. The third, progesterone, type are women of a boyish appearance and tall, with oily skin and hair types, menstruation is scanty and usually lasts up to 5 days.

Consider the list of COC drugs that are included in the ranking of the best and most prescribed. However, do not forget that each organism is individual, and even the most popular drug may not suit you:

• "Jess" and "Jess Plus". Available in a pack of 28 tablets. These are new generation microdosed hormonal contraceptives. In addition to the monophasic ratio of female sex hormones, Jess tablets contain drospirenone, which has an antiandrogenic effect, which can significantly reduce the number of side effects and improve skin condition. "Jess" is recommended for women of the progesterone type. "Jess plus" differs from "Jess" in that it contains folates, and it is advised to women who want to become pregnant immediately after taking COCs.
• "Yarina" and "Yarina plus". Contains 28 tablets in a blister. They belong to the group of low-dose oral contraceptives with antiandrogenic properties, therefore they are suitable for women of the progesterone phenotype. According to most reviews, Yarina is well tolerated and makes the skin condition better. The folates contained in Yarina Plus compensate for the deficiency of this element and prepare the woman's body for future pregnancy and breastfeeding.
• Lindinet 30, Lindinet 20. Monophasic hormonal contraceptive, which is designed for 21 days of admission, after which you need to pause for 7 days. Recommended for women with a balanced phenotype.
• "Three-merci". Three-phase low-dose preparation containing 21 tablets in a blister. Recommended for balanced women.
• Rigevidon is a monophasic contraceptive. There are 21 tablets in one blister for a month. Suitable for women with estrogen type.

Progestogen contraceptives or mini pills

The composition of the mini-pill tablets contains only progestogen. They are used most often in situations where the use of COCs is contraindicated: during lactation, with estrogen intolerance, with high blood pressure, and if a woman smokes a lot. The names of drugs from the group of progestogen drugs: "Charozetta", "Lactinet", "Exluton", "Microlut".

Contraceptive patch "Evra"

Contains estrogens and progestogens that enter the body through the skin. The use of the patch is suitable for women for whom the daily use of tablets is a problem.

The patch is attached to clean, intact skin of the scapula, lower abdomen or buttocks on the first day of menstruation. You can start using the patch on any day of your menstrual cycle, but you will need to use other methods of contraception for the next week.

The patch should be changed every week and after three weeks of use, make a seven-day pause.

For the price, the cost of the patch is slightly higher than that of the tablets.

Hormonal ring "NovaRing"

This is a modern elastic intravaginal agent that releases estrogen and progestogen under the influence of body temperature. A woman can independently insert a contraceptive ring into the vagina for three weeks on the first day of menstruation, then taking a week break. The contraceptive is compactly located inside and is practically not felt by the partner during sex.

progestogen injections

The drug "Depo-Provera" contains a progestogen. It is administered intramuscularly once every three months.

It can cause a change in the nature of menstruation, and the ability of a woman to become pregnant can be restored only 6 months after the injection is stopped.

Intrauterine system with progestogen

The Mirena spiral is a tool that combines the properties of intrauterine and hormonal contraceptives. The system is installed only by a doctor under conditions medical institution. The duration of the contraceptive is 5 years.

Emergency or postcoital contraceptive pills

The drugs of this group - "Postinor" and "Escapel" - are characterized by the content of high doses of hormones and are not recommended for regular use. Using these drugs more than once a year can lead to a number of dangerous consequences, one of which is hormonal failure in the body.

Considering the variety of hormonal contraceptives and the peculiarities of their use, it is possible to recommend to young women and those who have not yet given birth microdosed COCs: Jess, Logest, Lindinet, NovaRing ring and Evra patch.

For women who have given birth and middle-aged women, low-dose hormonal contraceptives are suitable: Tri-merci, Yarina, Rigevidon, the Mirena intrauterine device, as well as a patch and a contraceptive ring.

Hormonal contraceptives after 40 years are microdosed COCs, mini-pills, Depo-Provera injections or the Mirena system.

How to restore hormonal levels after birth control

After using hormonal contraceptives, hormone levels can recover almost immediately or within a few months. The duration of recovery depends on the age of the woman, and the older the woman, the longer it will take for everything to return to normal.

To stabilize the hormonal background of the body, a balanced diet containing folic acid, vitamins A and C is recommended. Folk herbalists advise eating foods containing phytoestrogens, such as soy, cereals, rice, lentils, carrots and apples. However, if the process is delayed, a medical examination is necessary.

Note! Hormonal contraceptives are prescription drugs, the selection and appointment of which should only be handled by a doctor. It often happens that even the best means In practice, they can cause a lot of unpleasant and even dangerous side effects.

In addition, the very process of taking hormonal contraceptives provides for the observation of a woman by a doctor, periodic monitoring of blood pressure and blood clotting. Entrust the selection of hormonal contraceptives qualified specialist and protect yourself properly!

The prerequisites for the introduction of hormonal contraception were data on the hormonal regulation of the menstrual cycle, the duration of the phases of the uterine and ovarian cycle, the time of ovulation, etc., obtained in the early 30s of the twentieth century, as well as the development of subsequent studies of the pharmacological regulation of ovulation and industrial technology for obtaining sexual steroids.

The pattern of fertile and non-fertile periods throughout the menstrual cycle was described by Knaus (Austria) and Ogino (Japan). In 1934, Korner and Byrd isolated progesterone, and in 1937, Makepeace, in experiments on rabbits, caused the suppression of ovulation by progesterone. In the 1950s, contraceptive pills (Pinkus) were created and introduced, which in recent decades have become the most common method of preventing pregnancy. Around the world, hormonal drugs are used by up to 20% of women. In different regions of the Russian Federation, they are used by 0.5 to 5% of women of reproductive age. The highest frequency of using hormonal contraceptives is in the population of young women in Moscow and St. higher education(university students).

Hormonal contraceptives are synthetic analogues of the female sex hormones estrogen and progesterone. The actual contraceptive effect is achieved by the progestogen (progesterone-like) component. Estrogens are used to control the menstrual cycle.

The mechanism of action of various hormonal contraceptives is based on the following principles:

blockade of ovulation due to suppression of the secretion of gonadoliberin;

compaction and thickening of church mucus;

dysfunction of the corpus luteum;

violation of implantation due to changes in the morphological properties of the endometrium.

depending from the composition distinguish between: combined estrogen-progestogen preparations (COC tablets) and only progestogen-containing preparations (“pure” progestogens). The latter, in turn, are divided into tablets with microdoses of gestagens (mini-pill), tablets with large doses of gestagens (for postcoital contraception), implants and injections of prolonged action gestagens.

The most widely used combined estrogen progestogen drugs (COCs). The action of COCs is based on the reversible suppression of ovulation by inhibiting the secretion of GnRH by the hypothalamus and gonadotropic hormones by the pituitary gland, "glandular regression" of the endometrium, and thickening of the cervical mucus.

By doses of the estrogen component in one COC tablet, high-dose preparations are distinguished (the content of ethinylestradiol is more than 35 μg), low-dose (from 35 to 20 μg) and microdosed (up to 20 μg of ethinylestradiol). According to modern requirements for the safety of contraception, COCs with a dose of ethinyl estradiol of 35 mcg and below should be used for these purposes.

By the nature of the action of the progestogen component on progesterone receptors, androgenic and anabolic potential, there are three generations of hormonal contraceptives. Contraceptives containing first generation progestogens (norethisterone or norethindrone, linestrenol) - with low selectivity for progesterone receptors and high anabolic and androgenic potential, second generation (norgestrel, including levonorgestrel) - with higher selectivity for progesterone receptors and third generation - with the highest selectivity for progesterone receptors, low affinity for androgen receptors, low anabolic potential. Currently, there are two types of true (not converted into norgestrel) third-generation progestogens: desogestrel (in low-dose COC - Marvelon and micro-dosed COC Mercilon) and gestaden (in low-dose Femoden). Norgestimate is also considered as a third-generation progestogen, but its main metabolite is norgestrel.

According to the nature of the change in the (daily) dose of hormones in a tablet, monophasic, biphasic, triphasic COCs are distinguished. In monophasic preparations, the content of the estrogenic and progestogen components is the same throughout the entire cycle. The usual dosing regimen for monophasic COCs is to take the 21st tablet of the package for 21 days, followed by a 7-day break, during which “withdrawal bleeding” usually begins. It must be remembered that lengthening the 7-day interval in taking COCs up to 8-9 days or more is unacceptable, since the risk of pregnancy due to spontaneous ovulation increases, even while taking exogenous steroids. In the 70s, in order to reduce the cyclic steroid load, the concept of two- and three-phase contraception was proposed. Unlike monophasic contraception, in biphasic contraceptives, the content of the progestogen component in the 2nd phase of the cycle increases. With three-phase contraception, the increase in the dose of progestogen occurs stepwise, in 3 stages, and the dose of estrogen in the first and third phases remains unchanged. In connection with the emergence of new 3rd generation progestogens (desogestrel, gestodene, norgestimate), which have a high affinity for progesterone receptors and, as a result, high efficiency, acceptability and safety with long-term regular use, popular in the 70s. Triphasic drugs once again "gave way" to monophasic combined contraception as a more reliable and convenient method of contraception.

The use of COCs has a number of non-contraceptive beneficial effects both on the reproductive system and on the woman's body as a whole. According to long-term epidemiological studies, regular and long-term (at least two years) COC use leads to a significant reduction in the number of gynecological and some other diseases, in particular, the relative risk of developing endometrial cancer is reduced (by 60% on average), ovarian cancer (on average by 40%), cystic ovarian formations, ectopic pregnancy, uterine fibroids, endometriosis, dysmenorrhea, premenstrual syndrome, dysfunctional uterine bleeding, fibrocystic mastopathy, iron deficiency anemia, rheumatoid arthritis, thyroid disease, peptic ulcer of the stomach, postmenopausal osteoporosis.

COCs with third-generation progestogens: microdose Mercilon, and low-dose Marvelon and Femodene are most suitable for most women who require contraception. These drugs are currently the most preferred for contraception due to their high efficacy (highest contraceptive efficacy after progestin implants), minimal side effects, high safety with long-term use, and rapid restoration of fertility after contraception is discontinued.

Side effects of COCs include amenorrhea or breakthrough bleeding, nausea, headache, weight gain in the first 2-3 cycles of administration, and complications: thromboembolism, diseases of the cardiovascular system, hypertension, amenorrhea, benign liver tumors. To prevent complications, it is necessary to follow the WHO recommendations on the selection of a contraceptive method.

Microdoses of gestagens . Currently, most "mini-pills" use progestogens derived from 19-norsteroids of various generations (norethisterone, linestrenol, ethinodiol diacetate, levonorgestrel, desogestrel). Half of the pregnancies that occur while taking "mini-pills" are the result of non-compliance with the regimen, most often an increase in the interval between taking the pills. In addition, there is an inverse relationship between the effectiveness of the method and age. The effectiveness of the method at the age of 25-29 years is 3.1 per 100 women/years, in the age group of 45 years and older - 0.3 per 100 women/years. The drug should be taken on the 1st day of the menstrual cycle, daily, at the same time of day in a continuous mode, 1 tablet per day. The maximum effect is reached 3-4 hours after ingestion and lasts 16-19 hours. The mechanism of action of "mini-pills" is to suppress ovulation (in 60% of cycles), morphological changes in the endometrium that prevent egg implantation, thickening of the mucus of the cervical canal. Indications for contraception using "mini-pills" are intolerance to estrogens contained in combined tablets, smoking over the age of 35, the need for contraception during lactation, diabetes mellitus, hypertension, sickle cell anemia, focal migraine.

The disadvantages of "mini-pills" are their lower effectiveness compared to COCs, the need for a more careful intake regimen, worse cycle control (acyclic bleeding). In Russia, micronor (norethisterone 0.35 mg) and exluton (linestrenol 0.5 mg) are used as "mini-pills".

Postcoital (“emergency”) contraception is much less common. Postcoital drugs - contraceptives "single" use after intercourse close to ovulation, their intake is necessary within 24-72 hours after "unprotected" intercourse. Large doses sex steroids, taken as postcoital contraception, change the state of the endometrium. For this purpose, large doses of levonorgestrel (postinor) or COCs are used according to certain schemes:

high-dose COCs (50 micrograms of ethinyl estradiol and 250 micrograms of levonorgestrel): two tablets are taken orally no later than 7 hours after "unprotected" intercourse and two more - 12 hours after the first two;

Long-acting hormonal contraceptives. These include injections and implants of high doses of pure gestagens with a gradual and prolonged entry into the peripheral blood.

Of the injectables, medroxyprogesterone acetate (depo-prover, megestron) is the most common. Preparations long-acting, are used mainly in oncology, since the mid-60s - for the purpose of contraception as injectable contraceptives prolonged action. Injections are made intramuscularly 1 time in 3 months.

As implants, norgestrel is used - a first-generation progestogen, for example, norplant - 6 cylindrical capsules that are placed subcutaneously using a trocar or etonogestrel - a third-generation progestogen. The term of contraceptive action is 5 years. Pregnancy can occur in one in 100 women. However, the use of progestogen implants requires specially trained personnel for its administration. After the introduction, it is impossible to suspend its action at the request of the woman or if side effects appear, which include: pain in the lower abdomen, expulsion of implants, suppuration in the injection area, delayed menstruation, migraine. Reversibility - after 12-18 months. after termination of use.

Less common are vaginal rings containing levonorgestrel, norethindrone, or progesterone, which are administered for 1–6 months. The mode of action is similar to microdoses of gestagens when taken in tablets: the formation of thick cervical mucus, inhibition of ovulation, thinning of the endometrium, premature luteolysis.

Intrauterine contraception (IUD) known since ancient times. Widely used since the middle of our century. VMK forms: "loop", "umbrella", 7, T, rings, spirals; materials: copper, silver, plastic, platinum. According to the composition, inert, copper-containing, gestagen-containing IUDs are known. Inert IUDs are practically withdrawn from use.

Mechanism of action of VMK: decrease in activity and survival of spermatozoa; enhancement of the spermicidal effect of endometrial mucus by increasing the amount of lysozyme and its decay products due to polymorphonuclear leukocyte infiltration of the endometrium; reduction in the life of the egg; inhibition of sperm migration into the tube; acceleration of the transport of a fertilized egg to the uterus; inhibition of the fertilization process; blastocyst lysis; obstruction of implantation due to aseptic inflammation, local increase in the formation of prostaglandins.

The benefits of using an IUD include: high efficiency(98-99% for copper and hormone-containing and 92% for inert IUDs), reducing menstrual blood loss and the risk of inflammatory diseases when using hormone-containing IUDs, as well as reducing the symptoms of algomenorrhea, no side effects on metabolic processes (for copper-containing IUDs), one procedure is enough for the introduction, a quick restoration of fertility after the removal of the IUD.

Side effects for inert IUDs: perforation of the uterus, expulsion of the contraceptive into the abdominal cavity or from the uterus, bleeding, infection. For hormone-containing IUDs - a number of side effects of levonogestrenol. When pregnancy occurs: spontaneous abortion, ectopic pregnancy, premature birth.

barrier methods of contraception widely used since ancient times and at the beginning of our century. Currently, their use is of great importance as a means of preventing STIs. Their advantages over other methods of contraception are: reduced risk of STIs, AIDS, cervical cancer, low cost and a high degree of safety.

There are male (condoms) and female (spermicides, diaphragms, caps, vaginal sponges, condoms) types of barrier contraceptives.

The frequency of male condom use depends on the educational level of the partners, their age and degree of interest in contraception. Contraceptive effectiveness - 5-10 cases per 100 women per year. Latex condoms that keep out air, water, and germs can prevent the spread of STIs.

Female barrier contraceptives are divided into those that do not require individual selection (spermicides, sponges, strips) and those that require special selection (vaginal diaphragms, cervical caps). Usually spermicides are used together with other contraceptives, such as diaphragms, caps, condoms.

Spermicides consist of a spermicidal chemical and a carrier that spreads the spermicide into the vagina, enveloping the cervix. The main ingredient: nonoxylon-9 surfates, octoxylon, menfegol, benzalkonium chloride (destroys the spermatozoon) or substances that inhibit the activity of enzymes - A-gene, syn-A-gene. They quickly release the active agent, spread to the walls of the vagina and cervix, turning into a physical barrier for spermatozoa, destroying some of them and reducing their fertility. Release forms: creams, jellies, melting and foaming candles, tablets, sponges and strips impregnated with spermicides. The pregnancy rate is 5-25 per 100 women per year. You may be allergic to spermicides.

Vaginal sponges are made of polyurethane impregnated with 1 g of nonoxynol-9. The vaginal sponges secrete spermicides and block the church canal. They can be administered only for 24 hours, they are dangerous for the development of toxic shock syndrome (TSS).

Vaginal diaphragms are latex domes that are placed between the womb and the posterior wall of the vagina. The diaphragm is a barrier to spermatozoa. Most effective in combination with spermicidal gels and creams. The selection of the diaphragm is carried out by the doctor. However, further medical assistance is not required. The pregnancy rate is 5-10 per 100 women per year. Efficiency depends on the time of action: the diaphragm must be left in the vagina for 6 hours after intercourse. Due to compression of the urethra, the incidence of urinary tract infection increases.

Neck caps - metal and rubber. There are several types of cervical caps. The mode of action is a barrier to spermatozoa, especially in combination with spermicides. Caps are left in the vagina for a period of no more than three days. The disadvantages include: the inconvenience of the introduction, the need for the help of a specialist for the selection and introduction of funds, the limitation in the time spent in the vagina; danger - urinary tract infections, TSS.

Traditional methods of contraception(so-called natural methods of family planning). These include: periodic sexual abstinence (abstinence) with the definition of the so-called "dangerous" and "safe" days of the cycle calendar method, using the dynamics of cervical mucus characteristics (Billings method), basal temperature and a combination of these three methods. This group also includes the method of lactational amenorrhea and interrupted sexual intercourse. The effectiveness of these methods is the lowest, due to the influence of many factors (for example, vaginal infection, motivation for sexual abstinence, etc.).

Surgical sterilization is an irreversible method of contraception. In some cases, fertility can be restored by microsurgical operations. According to the order of the Ministry of Health of the Russian Federation No. 303 of December 28, 1993, surgical sterilization of women is carried out only if there are certain indications, and it is carried out in a gynecological hospital. Examination and preparation are the same as for any surgical procedure. Surgical sterilization of men - vasectomy - is carried out in urological hospitals.

The most effective way to prevent unwanted pregnancy in this moment recognized as hormonal contraception.

The modern pharmacological industry has developed a large number of its varieties with different combinations of doses and active ingredients. This allows you to choose birth control pills, which will be best suited for a woman, taking into account her age and hormonal cycle.

Classification of hormonal methods of contraception

All hormonal contraceptives are divided into two large groups:

1. Combined, containing in its composition synthetic analogues of estrogen and progesterone.
2. Single-component, containing only progesterone analogues.

Combined hormonal contraceptives

They consist of a synthetic estrogen component - ethinyl estradiol and various progesterone derivatives.

According to the method of application, the drugs are divided:

1. Oral - available in tablets, taken by mouth.
2. Parenteral - forms of drugs with different ways introductions:

• patches (transdermal contraceptive system Evra);
• vaginal rings (NovaRing).

In turn, combined oral contraceptives are divided according to the dosing regimen:

• single-phase (Zhdes, Novinet, Logest, Regulon, Zhanin, Yarina);
• two-phase (anteovin);
• three-phase (tri-regol, trisiston, trinovum).

Depending on quantity active drug in a tablet, contraceptives are divided:

• microdosed (contraceptive pills Mercilon, Novinet, Logest);
• low-dose (contraceptive pills Yarina, Janine, Diane-35, Regulon, Marvelon);
• high-dose (contraceptive pills Non-Ovlon, Ovidon).

Single component hormonal contraceptives

Single-component hormonal contraceptives are divided according to the method of administration:

1. Oral (minipil) - hormonal contraceptive pills for oral administration (Microlut, Exluton, Charozettau).
2. Parenteral:

• injections (medroxyprogesterone);
• implants (desogestrel);
• intrauterine hormonal systems(Mirena).

It is impossible to say unequivocally which birth control pills are better and which are worse, since age, hormonal status, the presence of bad habits and chronic diseases, as well as many other factors.

Combined oral contraceptives (COCs)

Mechanism of action

The basis of the contraceptive action of COCs is the suppression of ovulation. This effect is realized due to the action of ethinylestradiol, which replaces its own estradiol and blocks the growth and maturation of the follicle.

The synthetic progestins that are part of COCs affect the mucous layer of the uterus, lead to its change and prevent the implantation of a fertilized egg (even if ovulation has occurred).

Thickening of mucus in the cervix is ​​another mechanism contraceptive action. In this case, the penetration of spermatozoa into the uterine cavity becomes extremely difficult. Also, in addition to the contraceptive effect, thickening of the cervical mucus prevents the penetration of infections into the uterine cavity.

Side effect

It should immediately be noted that by the presence or absence of side effects it is impossible to say which birth control pills are better and which are worse. Since the same drugs may or may not be suitable at different periods of a woman's life.

COCs are combined preparations, respectively, side effects are represented by the action of each component of the contraceptive.

Side effects of ethinylestradiol

• increased blood pressure;
• headache;
• dizziness;
• nausea and vomiting;
• pain and heaviness in the chest;
• hyperpigmentation on the face;
• irritability;
• weight gain.
• headache;
• low mood;
• reduction of mammary glands;
• decreased lubrication in the vagina;
• spotting in the middle of the cycle;
• decrease in sexual desire;
• scanty periods.
• headache;
• depressive states;
• reduced performance;
• increased greasiness of the skin;
• acne;
• decrease in sexual desire;
• increased varicose veins;
• dryness of the vagina;
• weight gain.
• delay in menstrual flow;
• blood smearing in the second part of the cycle;
• pronounced menstrual bleeding.

Side effects associated with the suppression of own estrogens

Side effects of synthetic progestins

Side effects associated with an insufficient dose of progestins

In the initial few months, taking birth control pills is associated with the presence of side effects in 11 - 42% of cases. In the future, the occurrence adverse reactions decreases to 4 - 9%. If, after 3-4 months of continuous use, side effects persist or increase, then the drug should be discontinued or replaced.

Also, one should make a reservation about a rare, but extremely dangerous complication of hormonal contraception - venous thromboses and embolism. The likelihood of their development directly depends on the presence of risk factors, such as smoking, age over 35 years and obesity.

The best contraceptive pills in terms of minimal risk of thrombosis are microdose COCs (Novinet, Jess, Qlaira). It has been proven that the risk of developing thromboembolic complications when taking them is lower than during pregnancy.

Contraindications

1. The presence of thrombosis of the veins of the legs or thromboembolism of the pulmonary artery. As well as diseases in which there is high risk development of thrombosis, for example, large surgical operations, fractures of bones (especially the femur) with prolonged wearing of a plaster cast.
2. Cardiac ischemia.
3. Stroke.
4. High blood pressure.
5. Diseases of the valves of the heart.
6. Diabetes mellitus for over 20 years.
7. Oncological disease of the breast.
8. Smoking in women over 35 years of age.
9. Pregnancy.
10. Diseases of the liver.
11. Breastfeeding in the first 6 weeks after childbirth.

All of the listed contraindications to taking birth control pills are absolute. That is, it is strictly forbidden to take hormonal contraceptives if there is at least one item from the above list.

How is individual selection carried out?

In order to make it most clear, let's take a step-by-step analysis of which birth control pills are best to take.

For a woman who has never taken contraceptives before, the selection scheme will consist of three stages:

1. Prescribing the drug of first choice.
2. Selection of the drug, taking into account the presence of hormonal disorders and gynecological diseases.
3. Change contraceptive with the development of side effects.

Prescribing a first choice drug

The first, as a rule, is prescribed a micro or low-dose monophasic COC containing estrogen no more than 35 mcg / day and a progestin with a minimal androgenic effect (Novinet, Logest, Mercilon, Jess).

Selection of the drug, taking into account the presence of hormonal disorders and gynecological diseases

Let's take a closer look at the main female diseases And what contraceptive pills are better to take with them.

Change of contraceptive with the development of side effects

In the event of the development of side effects while taking contraceptives, further selection and change of drugs should be carried out by the attending gynecologist. Most often, a transfer is made to three-phase drugs with the selection of the required dose of ethinyl estradiol.

How are they accepted

COCs are available in calendar blisters of 21 or 28 tablets. They start taking COCs, as a rule, on the first day of menstruation. When irregular cycle or the absence of menstruation, the reception can be started on any day, subject to the exclusion of pregnancy. Tablets are taken one daily:

• pack of 21 tablets - 21 days of taking pills, 7 days off, then a new pack begins;
• pack of 28 tablets (21 + 7) - taken continuously, at the end of the pack, the next one begins.

Also, there is a method of continuous intake, when the drug is taken in the same dose, regardless of the cycle. the main objective this method- medical delay of menstruation. Most often, the continuous method of admission is used for medical purposes, for example, for the treatment of endometriosis. But it can also be used for a short-term delay in menstruation at significant events in life, for example, a wedding, Honeymoon, vacation.

What to do if a drug is missed?

1. One tablet not taken

• less than 12 hours have passed - take the drug, continue further administration as before;
• more than 12 hours have passed - take a forgotten pill:
• if the reception is missed in the first week of the cycle - use barrier methods of protection for 7 days;
• if an appointment is missed in the second or third week, the use of additional contraception is not required.

2. If 2 or more tablets are missed, take 2 tablets per day until the intake returns to normal. And also within 7 days to use additional methods of protection. If, after the missed pills, menstruation begins, the drug should be stopped and after 7 days a new pack should be started.

Combined parenteral contraceptives

At the moment, there are only two parenteral combined contraceptives:

• transdermal contraceptive system Evra;
• vaginal contraceptive ring NovaRing.

The Evra transdermal contraceptive system is a beige patch containing 0.6 mg ethinyl estradiol and 6 mg norelgestromin. Moreover, the dose that is absorbed per day corresponds to the intake of microdosed COCs.

The patch is glued for 7 days, three transdermal systems are needed for one cycle. As well as when taking birth control pills, after 21 days (3 patches) a break is made for 7 days.

The vaginal contraceptive ring NovaRing is a hormonal combined contraceptive with the vaginal route of administration. Doses absorbed per day are lower than in microdose COCs (0.015 mg ethinylestradiol, 0.12 mg etonogestrel), which allows you to get a good contraceptive effect with fewer adverse reactions.

NuvaRing is inserted into the vagina by a woman from the 1st to the 5th day of the menstrual cycle for 21 days, then it is removed and a break is made for 7 days.

The advantages of the parenteral method of administration are:

• ease of use;
• lower doses of hormones;
• fewer side effects.

Of course, the advantages of parenteral drugs are undeniable, but there are some disadvantages that somewhat limit their popularity:

• the patch can peel off and go unnoticed;
• not all parts of the body can be glued;
• may develop local reaction for drugs.

Given all these shortcomings, hormonal birth control pills remain best solution to prevent unwanted pregnancy.

Gestagen oral contraceptives (minipils)

These preparations contain very low doses of synthetic progestins, approximately 15-30% less than COCs. Accordingly, the contraceptive effect of their intake is much lower.

Indications

Taking the minipill is justified only in women who are breastfeeding (6 weeks after childbirth) and in case of contraindications to other methods of contraception. In other cases, they are not the best birth control pills.

Contraindications

The same as in the appointment of combined contraceptive drugs.

Side effect

• violation of the menstrual cycle;
• headaches and dizziness;
• nausea and vomiting;
• low mood;
• weight gain;
• decreased sex drive.

Parenteral progestogen contraceptives

Parenteral forms of gestagen contraceptives are much wider than combined ones:

• injection - medroxyprogesterone (Depo-provera);
• implants - desogestrel (Implanon);
• intrauterine hormonal spiral(Mirena).

The drug is available in tablets, aerosol, suspension.

For injectable contraception, a suspension is used that contains 0.15 g of medroxyprogesterone.

The mechanism of action of the drug is to suppress ovulation, thicken the cervical mucus and change the inner lining of the uterus. The effectiveness of contraception when using injectable medroxyprogesterone is very high (more than 99%).

Side effects the same as for oral progestins.

The drug is administered intramuscularly once every three months. The first introduction on the 5th day from the onset of menstruation.

The disadvantages of the drug are:

• long-term recovery of the ability to become pregnant;
• it is impossible to stop contraception at will;
• should be contacted regularly medical Center for repeated injections.

It should be noted that after the last injection of medroxyprogesterone, to restore normal ovulation and the menstrual cycle may take up to a year and a half. Therefore, birth control pills are better because they give you the choice to continue contraception or not to continue.

Implants

Implanon is the only contraceptive implant registered in the Russian Federation. The drug is a polymer rod, 4 cm long and 2 mm wide. Using a special needle, it is injected subcutaneously into the inner surface of the shoulder for a period of 3 years.

The mechanism of action, contraceptive efficacy and disadvantages are the same as those of injectable forms.

The drug is an intrauterine device containing levonorgestrel at a very low dose (52 mg).

The main effect of the drug is local, since the released daily dose levonorgestrel is very small to have a systemic effect on the body. This is the reason minimal amount side effects when using Mirena. Levonorgestrel, acting on receptors in the endometrium, leads to its transformation and prevents the implantation of the egg. Just like other progestins, Mirena causes cervical mucus to thicken, preventing sperm from moving into the uterine cavity.

Therefore, it is not surprising that more than 70 million women worldwide use hormonal contraceptives.

The mechanism of action of any hormonal drug is as follows:

• suppress ovulation (maturation and release of the egg);
• contributes to the thickening of mucus in the cervix, making it impassable for sperm.

Choice of hormonal contraceptives

Before you start taking hormonal contraceptives, it is advisable to pass gynecological examination and consult with your doctor. It is also necessary to warn the doctor about the use of hormonal contraception when prescribing any other medications.

When choosing a contraceptive, lifestyle also plays an important role. If you have irregular sex, or if you have many partners, birth control pills may not work. the best option. It would be preferable to use a method that you can use as needed, or a method that will provide protection against sexually transmitted diseases - AIDS, syphilis, chlomidia, herpes and others ( barrier method: condoms). If you do choose hormonal contraceptives, you should use condoms to protect against sexually transmitted diseases. But if you are married and do not want to have children for a while, then oral contraceptives are just what you need. But still, the choice is yours.

Types of hormonal contraceptives

1. Combined estrogen-gestagen preparations.
2. Mini-drank.
3. Injectable drugs.
4. subcutaneous implants.
5. Hormone ring for vaginal use.
6. Contraceptive patch.
7. Postcoital drugs.

Combined drugs

Combined drugs- These are birth control pills containing substances similar to female hormones that are produced by the ovaries - estrogens and gestagens (progestins). Depending on the proportion of these substances are:

• monophasic: contain 21 tablets with the same amount of estrogen and progestogen.
• biphasic: contain 21 tablets with two different combinations of estrogen and progestogen.
• triphasic: contain 21 tablets with three different combinations of estrogen and progestogen and differ in color. Their reception completely mimics the secretion female hormones during a woman's normal menstrual cycle.

Tablets should be taken daily, preferably at the same time for 21 or 28 days (depending on the drug).

Side effects:

• amenorrhea (absence of menstrual-like bleeding at the end of the cycle);
• intermenstrual bleeding and bloody issues;
• depression (mood changes or loss of sex drive);
• headaches (possible in combination with visual impairment);
• increased blood pressure;
• soreness of the mammary glands;
• weight gain;
• decreased sex drive.

Combined contraceptives not recommended to take smoking women older than 35 years, hypertensive patients ( high blood pressure), women with cardiovascular disease, liver disease, breast cancer and lactation.

mini pili

mini pili contain only microdoses of progestogens (300 - 500 mcg), which is 15-30% of the progestogen dose in combined estrogen-progestogen preparations.

Changes in the liver when taking a mini-pill are extremely minor. Based on the characteristics of mini-pills, they can be recommended as a method of contraception for women with extragenital diseases (liver diseases, hypertension, thrombophlebitis, obesity).

• women who complain of frequent headaches or increased blood pressure when using combined oral contraceptives;
• during lactation 6-8 weeks after birth;
• with diabetes;
• with varicose veins;
• with liver diseases;
• women over 35 years of age.

Mini-pills are taken continuously, starting from the 1st day of the cycle daily, for 6-12 months. As a rule, at the beginning of the use of the mini-pill, spotting is noted, the frequency of which gradually decreases and completely stops by the 3rd month of use.

Injectable drugs

Hormonal injectable contraceptives is a highly effective long-acting method containing one hormone - progestogen. It is administered intramuscularly with a syringe. One injection provides contraception for 3 months.

The question of the use of hormonal injectable contraceptives must be decided with the doctor.

• if any malignant diseases female genital organs or mammary glands;
• earlier than six weeks after childbirth;
• with liver diseases;
• with diabetes.

In our country, this type of contraception is not widely used.

Subdermal implants

Subdermal implants are silicone capsules containing hormones - gestagens. Six capsules are injected under the skin inner surface forearms through a small incision under local anesthesia. Capsules are released every day a small amount of hormone, and it, gradually absorbed into the blood, creates a reliable contraceptive effect for 5 years.

The implant can be inserted:

in the first 7 days of the menstrual cycle;

immediately after an abortion;

after childbirth after 4 weeks, if the woman is not going to breastfeed;

after 6 weeks for nursing mothers.

The subcutaneous implant may be removed at any time and before the expiration of the five year period.

The advantages of this method include high efficiency (comparable to sterilization, but reversible) and great convenience (the drug does not require any attention, it is only necessary to visit a gynecologist 2 times a year).

In addition, implantable contraception can be used by women with diseases in which taking pills is contraindicated (migraine, varicose veins veins, heart defects, diabetes mellitus without vascular complications, high blood pressure, severe obesity), as well as smoking women over 35 years of age.

This method of contraception, like injection contraception, has not received proper distribution in our country.

Hormone ring for vaginal use

Hormone ring for vaginal use(elastic ring) is a flexible contraceptive ring made of hypoallergenic material that contains microscopic doses of hormones and is applied topically, taking the shape of a woman's body and comfortably placed in the vagina.

One ring is designed for one menstrual cycle: a woman inserts it into the vagina from the 1st to the 5th day of the menstrual cycle. NuvaRing fits comfortably inside and stays in the vagina for three weeks, releasing the microscopic dose of hormones needed to protect against unwanted pregnancies.

There are contraindications, so you can start using the ring only after consulting a doctor.

Because of hormone ring applied topically, it has a number of advantages. First, the ring contains the bare minimum of hormones - just 15 micrograms of estrogen - less than any other drug. Secondly, there is no unnecessary burden on the liver and gastrointestinal tract. Thus, the effect of NovaRing on the body is minimal.

Contraceptive patch

Contraceptive patch - contraceptive for transdermal application, the most advanced and one of the most effective methods hormonal contraception. Refers to microdosed contraceptives, combining efficiency and maximum safety in use. Securely attached to the skin, does not peel off water procedures, nor under the influence of the sun.

The transdermal patch is very simple and comfortable to use. The patch is applied to dry clean skin(in the buttocks, abdomen, outer surface of the upper shoulder or upper body) once a week for 3 weeks (21 days), with a week break. Contraception with the Evra contraceptive patch begins on the first day of menstruation. The patch is applied and removed on the same day of the week. During the 4th week, from the 22nd to the 28th day of the cycle, the patch is not used. A new contraceptive cycle begins the next day after the end of the 4th week; the next patch should be pasted, even if there was no menstruation or it did not end.

It is unacceptable to use a contraceptive patch on the area of ​​​​the mammary glands, as well as on hyperemic, irritated or damaged areas of the skin.

There are contraindications, so you can start using a contraceptive patch only after consulting your doctor.

Postcoital drugs

Postcoital drugs- this is contraception that cannot be used constantly, but only in emergency cases, within 72 hours after sexual intercourse. These are, as a rule, combined hormonal preparations or gestagens. But the main thing for emergency contraception - high content hormones to achieve the desired effect.