Hormonal preparations for the disease. Tablets for the treatment of gynecological diseases. The use of hormonal drugs in gynecology. Combined hormonal agents

Anti-inflammatory drugs in gynecology are used to treat candidiasis, lesions of the uterine neck, fibroids, inflammatory processes in the appendages and other purely female diseases. This group of drugs is distinguished by a wide range, allowing the specialist to choose the drug that is optimal for each specific case, taking into account the individual characteristics of the patient.

Characteristics of drugs

Anti-inflammatory drugs are a group of drugs whose action is aimed at stopping inflammatory processes with the concomitant elimination of pain, swelling and other characteristic symptoms. Efficiency lies in the ability to suppress the processes of formation and transformation of arachidonic acids, which provoke the development of inflammation.

Anti-inflammatory drugs, according to the international classification, are divided into the following pharmacological groups:

Antibiotics.
Glucocorticosteroid preparations, which are natural or synthetic hormones of the adrenal cortex (the funds are indicated exclusively for the treatment of hormonal diseases and are not used in the gynecological field).
Antimycotics.
Non-steroidal anti-inflammatory drugs.
Biostimulants.

Anti-inflammatory drugs used in the gynecological field are available in the following forms:

Injections.
Rectal suppositories.
Vaginal suppositories.
Tablets.

The most popular are rectal and. The choice of a particular drug, its form and dosage are determined by the specialist individually in each case. This takes into account factors such as the age and general health of the patient, the presence or absence of concomitant pathologies, the type of disease, its severity and the form of the course.

Indications for use

Anti-inflammatory drugs are prescribed to patients in the presence of diseases:

Colpitis.
Candidiasis.
Cervical erosion.
and fallopian tubes.
Vaginal dysbacteriosis.
Acute infectious lesions of the female genitourinary system.
Bacterial vaginosis.
Dysmenorrhea.
Gynecological diseases of a viral or fungal nature.
Diseases of the pelvic organs in a chronic form.
Disorders of sexual function.
Reproductive disorders.
Endometriosis.
Algodysmenorrhea.
Inflammation of the ovaries.
Dysplasia of the cervix.

Indications for the appointment of anti-inflammatory drugs are:

Menstrual disorders.
Painful menses.
Excessive dryness of the vagina.
Postponed surgical interventions in the gynecological field.
Pain in the lower abdomen.

Benefits and contraindications for use

In modern medicine, there are a large number of different methods used to combat gynecological diseases. Drug therapy based on the use of anti-inflammatory drugs is widely popular due to its effectiveness and high efficiency. The benefits of these funds include:

Elimination of pain associated with a number of gynecological diseases.
A high degree of effectiveness in terms of eliminating painful symptoms.
Removal and relief of the development of the inflammatory process.

Despite the widespread use of anti-inflammatory drugs in the gynecological field, in some cases it is strictly not recommended to use them, since this can cause serious damage to health. The main contraindications include:

Pregnancy.
Tendency to allergic reactions.
Individual intolerance to certain drugs or their individual components.
lactation period.
Renal failure.
Hepatic pathologies.
hemorrhagic stroke.
Ulcerative lesions of the stomach or duodenum.
The patient is under 16 years of age.
Diseases of the cardiovascular system in a chronic form.
Bronchial asthma.
Mental disorders.
Parkinson's disease.
epilepsy.
thrombocytopenia.
Hemorrhagic diathesis.
arterial hypertension.

Possible side effects

Today, drugs are characterized by minimal toxic effects, and if the treatment process is carried out under medical supervision, then the danger to the patient's health is very insignificant. But the manifestation of side effects is still possible. The most common may be:

Increased risk of intestinal bleeding.
Nausea.
Attacks of vomiting.
Dizziness.
Headache.
Painful sensations in the abdomen.
Allergic skin rashes.
Diarrhea.
Violations in the functioning of the gastrointestinal tract.

In order to avoid possible side effects and to prevent health problems, the drug, its dosage and duration of the therapeutic course should be prescribed by a qualified gynecologist. Following medical recommendations will minimize the risks.

Medicines for gynecological diseases

The following types of anti-inflammatory drugs are used for treatment:

Suspensions.
Non-steroid drugs.
Antibiotics.

Suspensions. Rectal and vaginal suppositories are one of the most popular anti-inflammatory drugs used in gynecology. This is due to their effectiveness, rapid action and a minimum of side effects. Most often, suspensions are prescribed for gynecological diseases of a bacterial or fungal nature, inflammatory processes in the uterus, appendages, ovaries and vagina. The most popular and effective in the treatment of female ailments are considered to be drugs:

Diclofenac.
Voltaren.
Movalis.
Flamax.
Hexicon.
Ginalgin.
Klion-D.
Metronidazole.
Mykozhinaks.
Terzhinan.

Possible side effects of suspensions include:

Flatulence.
Nausea.
Feeling of itching and burning.
Constipation.

The use of rectal suppositories is contraindicated in ulcerative lesions of the gastrointestinal tract, with cracks, inflammation and bleeding of the anus.

Non-steroidal drugs have analgesic, anti-inflammatory, capillary-protective and antiplatelet effects. In gynecology, these drugs are used for painful menstruation, inflammation of the genital organs, urogenital infections, adhesive lesions of the uterus and endometriosis.

Drugs of this pharmacological group are used as an anesthetic when taking a biopsy, treating uterine pathologies and establishing or removing an intrauterine device.

In most cases, gynecologists prescribe the following nonsteroidal drugs to patients:

Indomethacin.
Meloxicam.
diclofenac,
Celecoxib;
Piroxicam.
Nurofen.
Rapten.
Ketoprofen;
Rapid;
Novigan.

The use of non-steroidal drugs is contraindicated in peptic ulcer and other pathologies of the gastrointestinal tract. Disturbances in the functioning of the digestive system are among the most common side effects caused by these drugs.

Antibiotics in the gynecological field are used to treat various kinds of inflammatory processes, colpitis, erosive lesions. The drugs are prescribed after surgical interventions of a gynecological nature. Antibiotics are also prescribed for such diagnoses as gonorrhea, endometritis, tuberculosis of the uterine appendages and perimetritis.

The most common include:

Biomycin.
Penicillin.
Cephalosporin.
Streptomycin.

Antibiotic therapy has a lot of contraindications and side effects, it is used exclusively as directed by a doctor and takes place under his strict control.

Anti-inflammatory drugs in gynecology are characterized by a wide range of applications and have a high degree of effectiveness in the treatment of a number of diseases.

To achieve favorable results of the therapeutic process, the choice of the drug, its dosage and duration of administration should be carried out only by a doctor.

Most people, due to the lack of knowledge in the field of medicine, consider hormonal drugs to be something terrible, bringing a huge amount (from weight gain to significant hair growth). Such fears are unfounded. An example is hormonal pills for women. These drugs are widely available and effective in their application. What hormones are, why they are drunk, and which of them are the best, is discussed in the article.

The composition of hormonal preparations includes synthetic hormones or hormonoids (substances that have similar properties). Hormones are produced by the glands of the endocrine system. Entering the bloodstream, they are carried throughout the body and reach target cells, which have a direct effect. There are specific reactions that control the vital activity of the body.

All hormonal drugs can be divided into the following types:

pituitary preparations - representatives are and, which is known to every woman;
- are used in the treatment of insufficient or excessive synthesis of hormonally active substances;
means of the pancreas (based on);
preparations of the parathyroid glands;
hormones of the adrenal cortex - glucocorticosteroids, which are used in most areas of medicine to relieve insufficiency, inflammatory and allergic processes;
preparations of sex hormones (, progestins, androgens);
anabolics.

What are hormones used for?

Hormonal drugs are used to treat and prevent a number of pathological conditions, namely:

as a contraceptive;
for replacement treatment during menopause and menopause, this also includes men with androgen deficiency;
treatment of inflammatory and allergic diseases;
replacement therapy for deficiency of certain hormones;
as a link in the complex treatment of tumor processes.

Female hormonal preparations are used for the following purposes:

violation of the menstrual cycle;
prevention and treatment of anemia;
the period after an ectopic pregnancy;
postpartum contraception (3 weeks after the end of lactation);
therapy of gynecological pathologies;
post-abortion condition.

Features of oral contraception

The history of contraception goes back to ancient times. What was not used until the structure of steroid hormonally active substances and the discovery of the overwhelming effect of high doses of sex hormones on ovulation was studied. It was interrupted sexual intercourse, various covers soaked in infusions and decoctions of herbs, fish bubbles, prolonged breastfeeding.

The use of hormones began in 1921, when the Austrian professor Haberlandt confirmed the possibility of inhibiting the process of ovulation by introducing an extract from the ovaries themselves. In 1942, it was first synthesized in the USA, and used in 1954. The negative point was that the hormones in the tablets at that time contained a significant dose of the active substance (tens of times higher than what a woman is taking now), and therefore caused a mass side effects.

Modern drugs with good tolerance were synthesized in the 90s of the XX century. How effective the drug is, evaluates the Pearl index. This indicator clarifies the possibility of pregnancy within 12 months of regular use of the drug. The index of modern hormonal drugs is in the range from 0.3% to 3%.

Contraceptives based on hormones:

combined;
mini-pills (non-combined);
preparations for urgent contraception.

Combined hormonal agents

COCs are a group of the most popular modern contraceptives. They include estrogen (ethinyl estradiol) and progestogen (norgestrel, levonorgestrel, desogestrel) - hormones similar in their action to female sex hormones.

Depending on the dosage, as well as the ratio of gestagens and estrogens, there are several groups of hormonal tablets:

Monophasic - have the same dosage of active substances in each tablet of the package.
Biphasic - the amount of estrogen is constant, and the dose of progestogen varies depending on the phase of the cycle.
Three-phase - a variable content of hormones in the composition.

The last group is considered the most physiological. It contains three types of tablets. The amount of hormones in each type depends on the phase of the menstrual cycle. The first 5 tablets correspond to the follicular phase, the next 6 pieces imitate the periovulatory, the remaining 10 - the luteal phase. The amount of estrogen in each of the tablets is maximum, and the level of progestogen increases systematically, reaching the highest levels by the third phase of the cycle.

Mechanism of action

All hormone-based contraceptives are aimed at preventing the production and release of active substances, the action of which is associated with ovulation and implantation of the ovum into the uterine cavity. The gonads decrease in size, as if "falling asleep".

The drugs have the ability to make the cervical mucus thicker, which prevents the penetration of a significant amount of sperm into the uterus. In addition, there is a change in the functional state of the endometrium, it becomes thinner, its ability to attach a fetal egg to itself decreases, if conception does occur.

Reviews of women who use the funds of this group confirm the effectiveness of the application at the age of up to 35 years. The package contains 21 tablets of the same color. There may be a strict usage pattern, but it is of little value since all tablets have the same composition. The following is a list of the most popular and effective remedies.

The drug contains 30 mcg and 2 mg of dienogest. Regular reception has the following features:

the Pearl index does not exceed 1%;
has androgenic activity - taken by women with elevated levels of male hormones;
normalizes the level of cholesterol in the blood.

Good product made in Germany. The gestagen is represented by gestodene (75 µg). Produced in the form of a dragee. It is undesirable to use with other drugs, as the risk of uterine bleeding increases.

The tool is the most popular representative of the group. Drospirenone acts as a progestogen. Properties are similar to Jeanine. In addition to lowering cholesterol and anti-adrogenic effects, Yarina has a positive effect on skin condition. This explains why dermatologists prescribe pills in the treatment of acne and acne.

It is an analogue of Logest. Significant differences are the country of origin, the color of the shell of the tablets, and the content of estrogen in the composition is slightly higher.

The name of this representative is also constantly heard. The composition includes ethinylestradiol and cyproterone acetate. The remedy is the drug of choice for those women who have an increased level of hair growth, since the progestogen, which is part of the composition, has a powerful antiandrogenic effect.

One of the well-tolerated drugs, excluding the formation of edema, weight gain, increased appetite. Drospirenone, which is part, has the following features:

softens the effect of estrogen;
relieves manifestations of premenstrual syndrome;
reduces the level of cholesterol in the blood.

Monophasic drugs do not end there. There is also a significant number of representatives:

minisiston;
Mercilon;
Silest;
Regividon;
Dimia;
Midian.

Two-phase and three-phase means

Experts prefer monophasic drugs to representatives of these groups because of fewer side effects. Biphasic drugs are rarely used, which is why among them there are tablets whose names are not familiar even to pharmacists: Femoston, Anteovin, Binovum, Neo-Eunomine, Nuvelle.

Three-phase drugs, due to their physiological composition, are more popular, however, side effects and complications when taking them are no less pronounced. The representative of the group will be called as follows: the name begins with the prefix "three". For example, Tri-regol, Tri-merci, Trister, Triziston.

Tablets are colored in different colors depending on the phase of administration. Such drugs must be taken strictly according to the scheme that is attached to the package.

Advantages and disadvantages

Modern contraceptives have a lot of positive qualities, which makes them widely used:

fast effect and high reliability;
the ability of the woman herself to control the state of her fertility;
knowledge of the means;
low frequency of side effects;
ease of use;
lack of influence on the partner;
reducing the possibility of developing an ectopic pregnancy;
a positive effect in the presence of benign tumor processes of the mammary gland;
prevention of tumor processes in the female reproductive system;
relief of manifestations of dysmenorrhea;
positive effect on the condition of the skin, gastrointestinal tract, musculoskeletal system.

The negative aspects of COCs are the need for regular use according to a certain scheme, as well as the possibility of delaying subsequent ovulation cycles after drug withdrawal.

Contraindications

Absolute contraindications for the appointment of COCs are the presence of pregnancy, malignant tumors of the reproductive system and mammary glands, pathology of the liver, heart and blood vessels, acute thrombosis or thrombophlebitis, as well as uterine bleeding of unknown etiology.

Pathological conditions that create problems during the period of drug use include:

arterial hypertension;
epileptic state;
migraine;
depression, psychosis;
diabetes mellitus of any type;
pathology of the liver of a chronic nature;
bronchial asthma;
tuberculosis;
porphyrin disease - a pathology of pigment metabolism, accompanied by a high level of porphyrins in the blood and their massive excretion with urine and feces;
benign tumors of the uterus;
upcoming immobilization or surgery.

There are a number of factors that reduce the effectiveness of the means used. These include dyspeptic manifestations in the form of vomiting and diarrhea, taking laxatives, antibiotics, anticonvulsant drugs. If vomiting and diarrhea occur within 3 hours of taking the last tablet, an additional tablet should be taken.

What are progestogen oral contraceptives?

These are alternative drugs (mini-pills) that contain only gestagens. Hormones from this group are needed in the following cases:

older women;
during lactation;
those who smoke;
those for whom COCs are contraindicated;
patients with hypertension.

Progestin contraceptives have a higher Pearl index. It can reach 4%, which is a negative point for the contraceptive process. Representatives - Levonorgestrel, Charozetta, Ovret, Micronor.

Reception scheme

Tablets must be taken once a day at the same time. If a woman missed a dose, then you need to drink hormones as soon as you remember, even if you have to take two tablets at the same time.

If a woman remembers the pill no later than 12 hours after the need to take it, the contraceptive effect is preserved, after 12 hours, additional methods of protection should be used.

Urgent funds

Emergency contraception is represented by drugs used in moments of unforeseen cases. These drugs contain significant doses of hormones that prevent the process of ovulation or change the functional state of the endometrium of the uterus. The most famous are Postinor, Escapel, Ginepriston. Cases when it becomes necessary to take such drugs should be as rare as possible, since they cause a huge hormonal surge in the body.

How to choose an oral contraceptive

The specialist evaluates the hormonal balance of the patient's body and determines what is the minimum dose of the drug that will be able to show the desired effect. The dose of estrogen should not exceed 35 mg, and gestagen (in terms of levonorgestrel) - 150 mcg. The doctor also pays attention to the constitutional type of a woman. There are three main types:

with a predominance of estrogens;
balance;
with a predominance of gestagens.

Representatives of the first type are suitable for those drugs that have an increased dose of progestogens, the third - with an increased level of the estrogen component. If a woman has signs of an increased amount of male sex hormones, the ideal option would be to use drugs with an enhanced antiandrogenic effect.

The gynecologist also evaluates the condition of the patient's reproductive organs. Menstruation is profuse, having a long period, an increased size of the uterus - factors in an increased level of estrogen in the body. Menstruation of a meager nature in combination with uterine hypoplasia indicates high levels of progestogen.

Currently, combined mono- and three-phase oral contraceptives are considered the most used, having a low dose of hormonally active substances that make up the composition. These funds have the same effectiveness and safety, if you follow the rules for their use. The choice between specific representatives is made on the basis of each individual clinical case. Confirmation that the contraceptive is chosen correctly is the absence of uterine bleeding or bleeding between menstruation.

Bibliography

Obstetrics: a course of lectures. UMO certification for medical education. Strizhakov A.N., Davydov A.I., Budanov P.V., Baev O.R. 2009 Publisher: Geotar-Media.
Obstetrics. National leadership. UMO certification for medical education. Ailamazyan E.K., Radzinsky V.E., Kulakov V.I., Savelyeva G.M. 2009 Publisher: Geotar-Media.
Gestosis: theory and practice. Ailamazyan E.K., Mozgovaya E.V. 2008 Publisher: MEDpress-inform.
Intrauterine infection: Management of pregnancy, childbirth and the postpartum period. UMO certification for medical education. Sidorova I.S., Makarov I.O., Matvienko N.A. 2008 Publisher: MEDpress.
Clinical guidelines. Obstetrics and gynecology. Savelyeva G.M., Serov V.N., Sukhikh G.T. 2009 Publisher: Geotar-Media.

The main biological task of a woman, of course, is the bearing and birth of a healthy child. And for this it is necessary to protect and preserve women's health. However, the risk of gynecological diseases increases every year. The reason for this is the general acceleration, the early onset of sexual activity and the low culture of sexual behavior. Also important factors in the development of various pathologies are: viruses, fungi, bacteria, hormonal disruptions, frequent change of partners, lack of contraception.

For the proper functioning of the female reproductive system, hormones are of great importance. They are represented by estrogens (estradiol, estriol, estrone) and gestagens (they are also progestins or “pregnancy hormones”). All regulation of the female reproductive system is carried out along the line cerebral cortex - hypothalamus - pituitary gland - target reproductive organs (ovaries and uterus). Violations at any level will certainly lead to the failure of the underlying organs.

It should be noted the importance of stressful situations in the development of hormonal disorders in women. Stress affects the cerebral cortex, which is the highest regulator of sexual functions. Minimizing stress is one of the most effective methods of preventing women's diseases.

All gynecological diseases can be conditionally divided into several groups:

Menstrual disorders - amenorrhea, dysfunctional uterine bleeding, algomenorrhea and others;
Neuroendocrine diseases - pathology of the hypothalamus and / or pituitary gland, which lead to impaired production of sex hormones;
Inflammatory diseases of the female external and internal genital organs - adnexitis, vaginosis, candidiasis or thrush, trichomoniasis, gonorrhea, chlamydia, genital herpes and others;
Endometriosis - the development of the endometrium in uncharacteristic places (outside the uterus);
Benign and malignant neoplasms (tumors);
Anomalies in the development of female genital organs;
Infertility.

Treatment of gynecological diseases. Basic approaches.

For the successful treatment of gynecological diseases, one should undergo high-quality diagnostics - colposcopy, gynecological smear, hysteroscopy, hysterosalpingography, ultrasound of the pelvic organs, take blood tests for sex hormones, bacterial cultures with the determination of sensitivity to antibiotics and others. This is the only way to accurately determine the level of damage, establish the cause and begin effective therapy.

In order to preserve women's health and cure any gynecological disease, it is necessary to carry out a full diagnosis, make a correct diagnosis and use only effective, if possible, European, drugs for treatment.

Hormonal pills were invented in the middle of the last century as a cure for unwanted pregnancy. Currently, many drugs have been created that, in addition, can help get rid of inflammatory processes in the uterus, ovaries or vagina. Contraceptives are suitable for young girls who have recently begun sexual activity. There are special forms with a high content of hormones for the treatment of severe pathologies.

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Hormonal remedies for women

Hormonal preparations are used by women as a means of contraception and for the treatment of diseases of the genital organs.

In pharmacology, there are several types of drugs. First, they are divided according to the change in the amount of hormones in the composition:

Monophasic- the dosage of hormones in all tablets is the same. This group includes: Regulon, Jeanine, Logest.
Two-phase- the amount of hormones varies depending on the 1st or 2nd phase of the cycle. Representatives: Femoston, Bifosil, Binovum.
Three-phase- according to the name, the amount of hormones is changed three times during the entire period of the menstrual cycle in women. These are the following medicines: Tri-Regol, Tri-Merci, Triziston.

The hormonal cycle of a woman

The following list divides oral contraceptives into:

1. Microdosed- they are recommended for girls under 24 years of age. Example: Jess, Clayra, Zoely.
2. Low dose- assigned to older women and those who gave birth. Also, girls who, when using drugs of the 1st group, experience bleeding before menstruation, switch to low-dose COCs. These include: Diana, Yarina, Chloe.
3. Highly dosed- are used to treat diseases of the uterus and ovaries, as they contain a large amount of hormones. These drugs may cause side effects. Representatives are: Triquilar, Ovidon, Triziston.

There is an additional group of substances (oral contraceptives), which contains only 1 type of hormone - progestogen. It leads to violations of the movement of sperm to the egg, therefore, it only affects pregnancy. These are the following medicines: Charozetta, Exluton.

Microdosed COCs

Preparations from this list are most often prescribed to young girls who have just begun sexual activity and have not been pregnant. They are not harmful to the female body.

The hormonal agent Jess includes a synthetic analogue of estradiol and drospirenone. The medicine stops the onset of ovulation and prevents the fusion of the egg with the sperm. It has an antiandrogenic effect on the body, reducing the production of male hormones in the blood, so it can be used to treat acne, alopecia, seborrhea and other endocrine diseases. It normalizes the cycle of nulliparous girls, contributes to the appearance of regular bleeding and prevents the development of cancer.

Drospirenone has a positive effect on the synthesis of mineral corticoids in the body, so even prolonged use of Jess tablets does not lead to the appearance of extra pounds and psycho-emotional disorders.

Qlaira is also a combined contraceptive. Contains both gestagenic and estrogen components. The drug suppresses the onset of pregnancy by thickening the contents of the cervical canal. Prevents hyperplasia of the mucous membranes of the uterus. An indication for the appointment of this medicinal composition is the situation when young girls have long periods of menstruation and a lot of blood is lost.

Zoely includes nomegestrol and estradiol. The medicine should be used only for contraception - the drug is not suitable for the treatment of dysmenorrhea.

It is not recommended to drink microdose COCs for girls with diseases of the pancreas, kidneys and liver. You should also limit the use of these drugs in severe endocrine pathology, pituitary tumors and severe hypertension.

With prolonged use, some women develop side effects, in particular, edema appears and weight increases, as well as dryness of the mucous membranes of the eyes and mouth.

Low dose tablets

These drugs are not dangerous and do not harm the health of a woman. They are prescribed for middle-aged patients who have already given birth and need contraception. The drugs contain an increased dose of hormones.

Diane is a monophasic contraceptive that contains estrogen and cyproterone acetate. The drug inhibits the release of mature eggs for subsequent fusion, reduces the activity of testosterone in the woman's body and blocks androgen receptors, as a result of which the voice is restored in patients with androgen-dependent pathologies and the condition of the facial skin improves.

The drug is intended for the treatment of endocrine disorders (alopecia, hirsutism, androgenization), polycystic ovaries.

Yarina contains drospirenone and an estrogen derivative. It has an effective contraceptive effect, blocks ovulation and disrupts the movement of spermatozoa. Prevents the appearance of anemic syndrome, cancer and hyperplasia of the mucous membranes. The medicine is used only for contraceptive purposes.

Chloe also belongs to monophasic oral contraceptives with pronounced antiandrogenic activity. The tablets contain cyproterone and estradiol.

Chloe is used in the treatment of seborrhea, androgenism, alopecia, hirsutism and acne vulgaris.

Contraindications are:

pathology of the heart and liver;
vascular thrombosis;
pregnancy and lactation.

High-dose COCs

This group of tablets is used mainly for the treatment of certain diseases.

Triquilar is a three-phase agent containing a combination of hormones. The main effect of the drug is considered to be a change in the deep layers of the endometrium of the uterus, which leads to a violation of egg implantation. Also, the drug disrupts ovulation.

As a rule, Triquilar is not used to prevent pregnancy due to frequent adverse reactions. The drug is used to treat endometriosis, heavy bleeding, and the establishment of a regular menstrual cycle.

Complications include severe suppression of libido, migraine, visual disturbances, vomiting, rash, diarrhea, thromboembolism, and increased blood pressure.

Ovidon tablets contain levonorgestrel and ethinylestradiol. The drug is used to prevent bleeding from the fallopian tubes and cervix, to treat pain during menstruation. Also, the tool helps to restore a regular cycle.

Contraindications for the use of this group of drugs are:

pregnancy;
violation of the psyche and emotions (depression, nervous excitement, schizophrenia, parkinsonism);
hereditary anemia;
breast tumors.

One-component products

Charozetta and Exluton contain only desogestrel, a progestogen derivative that disrupts the movement of spermatozoa to the egg due to the thickening of mucus in the uterus. Both drugs have the same properties.

Medicines are used to prevent unwanted pregnancies, unlike other COCs, they have fewer side effects and are more expensive.

Side effects are represented by moderate headache, urticaria, dyspepsia and libido disorders, but they develop extremely rarely.

The package contains 21 tablets, designed for 28 days of the cycle. If the patient missed taking the medicine, the next day you need to drink both tablets at the same time.

Overview of the most popular drugs

There is a list of hormonal drugs that are prescribed by gynecologists most often.

Regulon

Contains ethinylestradiol and desogestrel.

The drug is used to prevent pregnancy and as a source of additional female hormones. The mechanism of action is based on the suppression of the pituitary function, which is associated with the synthesis of follicle-stimulating and luteinizing hormones. As a result, ovulation is disturbed, mucus thickens in the lumen of the vagina and cervix, which creates unfavorable conditions for the fusion of the egg with spermatozoa.

Estradiol begins to be synthesized independently in the body of a woman - this is the hormone of the 1st phase of the menstrual cycle. With its help, the ovaries develop and the egg is released. Ethinylestradiol blocks the release of a mature egg into the lumen of the fallopian tubes, reduces the amount of blood secretions and reduces pain.

Desogestrel is an analogue of progesterone, therefore it has an antiandrogenic effect. In women, facial hair stops growing (as in men), acne disappears and the condition of the skin improves.

Regulon is used to treat dysmenorrhea, uterine bleeding, premenstrual syndrome and to prevent pregnancy. The drug reduces pain in the lower abdomen in women, treats aching pain in the chest and reduces the size of uterine fibroids.

Contraindications include: current pregnancy, liver disease, jaundice, high blood pressure, migraine headaches, herpes, estrogen-dependent tumors and itching. In some women, while taking COCs, arterial hypertension develops, hearing decreases. 1% of patients develop systemic connective tissue diseases, such as systemic lupus erythematosus.

Regulon must be drunk from the 1st day of the cycle - this is the first day after the end of blood discharge. The package contains 21 tablets, after taking the last one, you need to stop using the medicine for 1 week. At this time, the woman begins to bleed, during which you need to start taking a new package.

In case of overdose, there is a risk of developing convulsions or vomiting. In such cases, it is necessary to do a gastric lavage and consult a doctor.

Janine

Jeanine contains dienogest and ethinylestradiol. The drug inhibits the maturation of follicles in the ovaries and suppresses the release of pituitary hormones. After using the product, the structure of cervical mucus is disturbed, and spermatozoa cannot penetrate inside.

Jeanine reduces the risk of developing anemic syndrome, since the severity of bleeding decreases during the use of tablets.

Dienogest is a member of the progestogen group, which is an analogue of nortestosterone. The effect of taking the substance is to reduce testosterone activity, so the acne on the face disappears in the patients, the hair on the chest falls out, and so on. Ethinylestradiol blocks the development of healthy eggs.

The tool is used to treat acne vulgaris, androgenetic alopecia, seborrhea, hirsutism and prevent pregnancy.

Do not drink the drug to patients with vein thrombosis, heart attack, angina pectoris, paroxysmal tachycardia, diabetes mellitus, liver failure and liver tumors.

Side effects after taking a contraceptive:

headache;
an increase in the size of the mammary glands;
decreased libido;
nausea and vomiting;
skin rashes;
jaundice;
small fluctuations in weight;
water retention in the body;
allergy.

The package contains 21 tablets, which must be drunk 1 for 3 weeks. This is followed by a break of 7 days, during which bleeding should appear.

If you miss taking any COC, the next day you need to drink 2 tablets: the missed one and the current one. It is recommended to take them at the same time so that the concentration of hormones in the blood is maintained for 24 hours.

Logest

Logest is a combined agent containing gestodene and ethinyl estradiol. The drug increases the viscosity of the vaginal mucus and disrupts the processes of ovulation, prevents the release of a mature egg from the tubes and inhibits the speed of movement of male sex cells inside the uterus.

Gestodene is a synthetic analogue of a woman's gestagens, it actively acts on the ovaries and inhibits the growth of follicles. The medicine is prescribed only for contraception.

You can not use this remedy for heart rhythm disturbances, high blood pressure, diabetes, pancreatitis, mastitis, during an existing pregnancy, with thrombosis of the veins of the lower extremities.

Undesirable side effects:

the appearance of acne;
stomach ache;
depression;
swelling;
jaundice;
rash;
vaginal discharge.

Tablets should be taken every day for 3 weeks. It is correct to do this starting from the 1st day of the cycle. If the patient takes Logest from the 2nd or 3rd day of the cycle, it is necessary to prevent sexual contact, as the concentration of hormones will be insufficient, or use a condom in addition.

In case of an overdose, vomiting and nausea occur. You can not take antibiotics at the same time, as the therapeutic activity of the latter decreases.

Femoston

Femoston contains estradiol and dydrogesterone. There are several types of this drug, differing in concentration. The drug has anti-menopausal activity.

Estradiol is an analogue of natural estrogen, which is necessary for women during menopause. Estrogen has a positive effect on the autonomic nervous system and normalizes a woman's mental activity, eliminates excessive sweating, mood disorders and insomnia.

Dydrogesterone has a progestogenic effect, but does not affect androgen function and does not have an anabolic effect. It provides replacement therapy for the lack of gestagens, which is noted during menopause.

Femoston is used in the postmenopausal period to eliminate hormone deficiency. Taking the drug prevents the development of bone fractures, hair loss, caries.

Contraindications include:

hormone-dependent tumors;
mammary cancer;
bleeding from the vagina;
hyperplasia of the endometrium of the uterus;
inflammation in the wall of blood vessels.

Femoston is contraindicated in girls under 18 and pregnant women.

With prolonged use of tablets, sexual desire decreases, edema appears on the legs, gastritis develops, and nervous excitement increases.

Tri-Regol

Tri-Regol contains ethinylestradiol and levonorgestrel. The latter is an inhibitor of the production of gonadotropins - pituitary hormones that regulate the production of eggs. As a result, after using Tri-Regol, healthy eggs are not released and pregnancy does not develop. Ethinylestradiol acts on the vaginal mucus - thickens its contents and prevents the free penetration of spermatozoa.

Also, the drug normalizes the menstrual cycle, promotes the onset of bleeding after a long delay due to a lack of hormones in a woman.

Contraindications:

jaundice;
age over 39 years;
diabetes;
vascular sclerosis;
cystic skid;
colitis;
phlebitis;
vaginal bleeding of unknown origin.

In some women, the effect on the body is expressed by the following undesirable effects:

depressive states;
amenorrhea;
acne;
Crohn's disease;
lupus and other connective tissue diseases.

The package contains 21 tablets - this is enough for 3 weeks. 6 pink tablets should be taken during the first six days, then the next 5 days you should drink white tablets, after which - 10 yellow pills. The order of use in the package is indicated by numbers and arrows.

In case of an overdose, vomiting is noted, uterine bleeding may develop. With these symptoms, you should immediately consult a doctor.

Tri Mercy

Tri-Merci is a three-phase agent with ethinyl estradiol and desogestrel. The tablets differ in color, the concentration and ratio of hormonal components in them changes.

The mechanism of action of Tri-Merci is associated with the suppression of the activity of female sex hormones. This leads to a decrease in the size of the ovaries, a change in the structure of the uterine mucosa, which prevents the implantation of spermatozoa. These effects are provided by the gestagen, which is part of the tablets. Dihydrotestosterone also helps to get rid of acne caused by excess male hormones in women. Estradiol regulates the cycle and relieves pain during bleeding.

The drug is intended to prevent the development of pregnancy in women of reproductive age. You can not drink this remedy for arterial hypertension, diabetes mellitus, vascular atherosclerosis, endometriosis, pregnancy, breastfeeding, Gilbert and Rotor syndrome. With caution, Tri-Merci is prescribed to patients with thrombosis of the veins of the lower extremities and with hypertrophy of the heart muscle.

The package contains 7 tablets of different colors. First of all, they drink yellow, then red and white tablets. After 21 days, a week break follows, and a new cycle begins.

Symptoms of overdose are repeated vomiting and abdominal pain. It is necessary to use activated carbon or other sorbents.

Triziston

Triziston is available in the form of tablets that contain levonorgestrel and ethinyl estradiol.

Levonorgestrel is an analogue of nortestosterone, which has progestogenic activity: it binds to receptors in the uterus and disrupts the maturation of the endometrium, follicles in the ovary and prevents ovulation. Estradiols disrupt the movement of spermatozoa.

Triziston is used for contraception and for the treatment of various functional disorders (absence of menstruation for 2 months or more, with pain during menstruation, and so on).

Principleshormonaltherapy

performed

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Ulyanovsk 2010

Plan.

Etrogen

Gestagens

Progesterone

Androgens

Anabolic steroid

pituitary hormones

Corticosteroids

Indications and contraindications for the use of hormone therapy in gynecology.

Rules for the rational use of hormonal drugs

Hormonal tests

Currently, hormone therapy is widely used (I. A. Manuylova, 1972; V. M. Dilman, 1983; R. Harrison, J. Bonnar, 1980; H. Judd et al., 1981, etc.). A large number of steroid and protein hormonal drugs have been synthesized, which are used to treat menstrual disorders, infertility, for contraception, etc.

Hormonal preparations are successfully used in diseases associated with metabolic disorders, in neurology, and surgery.

Some hormonal drugs used in gynecology. Therapy with hormonal drugs has a strong effect, but it depends to a greater extent than with many other types of therapy on the correctness of the chosen method and method of using the hormone. Before recommending this or that method, the doctor must establish the hormonal saturation of the woman's body by means of functional diagnostics, as well as evaluate the indications, contraindications and restrictions for the use of the chosen hormonal drug. It should be remembered that hormone therapy can lead to some undesirable complications associated with the biological effect of the hormone on the body, as well as side effects.

Estrogens. Estrogen preparations used in gynecology can be divided into three groups: 1) natural estrogens having a steroid structure; 2) derivatives of natural estrogens; 3) non-steroidal synthetic estrogens (stilbenes).

The first group of estrogens includes estrone (folliculin) - Oestronum. It is available as an oily solution in ampoules of 10,000 IU (1 mg), applied intramuscularly. The second group includes estradiol derivatives - estradiol dipropionate, ethinyl estradiol, as well as menopause containing estradiol benzoate and a non-hormonal component.

Estradiol dipropionate (Oestradioli dipropionas) is a long-acting drug, available in 1 ml ampoules of 0.1% (1 mg) oil solution. Ethinylestradiol (Aethynilo-estradiolum) is available in the form of the drug "Mnc-rofollin" (Microfollinurn) in Hungary. The drug is active when taken orally; dosed in tablets of 0.05 mg. Menopause (KJimakterin) is produced in Czechoslovakia, contains in one tablet 25 units of estradiol benzoate, 30 mg of dry ovarian powder, 0.025 g of theobromine and caffeine, 0.0002 tons of nitroglycerin, 0.006 g of phenolphthalein.

The third group includes a large group of substances that have an estrogenic effect, but are not steroids in their structure. In the body, such hormones are not synthesized and do not go through an inactivation cycle, being excreted unchanged in the urine. The estrogenic effect of these drugs is significantly superior to that of estrone and estradiol derivatives, but they are more toxic than natural hormones.

Sinestrol (Synoestrolum) is available in 0.1% ampoules of 1 ml (1 mg) and 2% (20 mg) of an oil solution in 1 ml (the latter is used only for the treatment of patients with malignant neoplasms, with prostate adenoma), as well as in the form tablets of 0.05 g and 0.001 g.

Diethylstilbestrol (Diaethylstilboestrolum) is available in ampoules of 1 ml of 3% (30 mg) May-"Lyan solution. The drug has a high estrogenic activity and is used exclusively (if indicated) for the treatment of breast cancer in women over 60 years old.

Octestrol (Octoestrolum) is available in 1 mg tablets.

Dimestrol (Dimoestrolum) - a drug of prolonged action, gives a slowly developing (3-6 days) and long-term (up to 30 days) effect, is available in ampoules in the form of an oily solution of 0.6%, 2 ml each (12 mg per ampoule).

Sigetin (Sygethinum) has a weak estrogenic effect (antiestrogen), is available in tablets of 0.05 and 0.1 g and in ampoules of 2 ml of a 1% aqueous solution. This drug is soluble in warm water, so it can be administered intravenously (preferably in 20-40 ml of 40% glucose solution), which is used in obstetrics to prevent intrauterine fetal asphyxia.

Recently, a drug, a trinisyl derivative, clostilbegyt (clomiphene citrate) (Clostilbegyt), used to stimulate ovulation, as well as in galactorrhea syndrome - amenorrhea, has become widespread in gynecological endocrinology. Clomiphene citrate is available as 50 mg tablets in Hungary and the USSR.

Gestagens. All progestogen drugs are steroid hormones or their derivatives, which can serve as progesterone, testosterone and 19-nortestosterone.

Progesterone(Progesteronum) is a hormone of the corpus luteum, it is obtained synthetically, produced in ampoules of 1 ml of 1% and 2.5% oil solution (10 and 25 mg).

A derivative of progesterone is oxyprogesterone capronate (Oxyprogesteroni caproas), containing a caproic acid residue, which causes a longer action of the drug. Oxyprogesterone capronate is available in 1 ml ampoules of 12.5% (125 mg) and 25% (250 mg) oil solution.

Pregnin (Pregninum) - less active than progesterone (5-6 times), but has a gestagenic effect when applied sublingually; Available in the form of tablets of 5 mg.

Turinal (Turinal) - a synthetic derivative of progesterone, available in Hungary, has an effect similar to progesterone. During pregnancy, turinal promotes the secretory activity of the trophoblast. Release form - tablets of 50 mg.

Norkolut (Norkolut) is a synthetic progestogen drug that, in addition to the progestogen, has a contraceptive effect, is produced in Hungary in the form of tablets of 50 mg in a package of 21 pcs.

Androgens, like gestagens, are preparations of a steroid structure, are derivatives of male sex hormones.

Testosterone propionate (Testosteroni propio-nas) is available in the form of 1% and 5% (10 and 50 mg) oil solutions.

Methyltestosterone (Methyltestosteronum) has androgenic activity when used sublingually, but is 3-4 times weaker than testosterone propionate used intramuscularly, and is available in the form of tablets of 5 and 10 mg.

Testenat (Testoenatum) is a combined androgenic drug consisting of 80% testosterone enanthate and 20% testosterone propionate. Such a mixture provides a rapid onset of the effect due to faster absorption of the first component and the duration of the effect due to the prolonged action of the second component. Testenat is available in ampoules of 1 ml of a 10% oil solution (100 mg).

Sustanon-250 (Omnadren-250) (Sustanon-250) is also a combined androgenic drug, 1 ml of an oil solution of which contains 0.03 g of testosterone propionate, 0.06 g of testosterone phenyl propionate and testosterone isocaproate and 0.1 g of testosterone decanoate (in total, the ampoule contains 0.25 g of testosterone esters). It is a hormone of prolonged action with a duration of 1 month

Anabolic steroid. This type of compounds includes androgen derivatives (testosterone, androstenediol, 19-nortestosterone), which have a significantly reduced androgenic and enhanced anabolic activity.

Methandrostenolone (nerobol, Methandrosteno-lonum) is produced in the form of tablets of 1 mg and 5 mg.

Methylandrostenediol (Methylandrostendiolum) has a high anabolic activity with relatively low androgenic activity. The release form is tablets of 10 and 25 mg; applied sublingually.

Nerobolil (Nerobolil) is an anabolic steroid drug of prolonged action, produced in Hungary in the form of ampoules of 1 ml of a 2.5% (25 mg) oil solution.

Retabolil (Retabolil) - a drug of strong anabolic action with a long-term effect (2-3 weeks), is available in Hungary in ampoules of 1 ml of 5% (50 mg) oil solution. In addition to the listed drugs of estrogenic, androgenic, gestagenic and anabolic action, there are a number of drugs that include estrogens and progestogens or estrogens and androgens, as well as hormones in combination with other medicinal substances.

The combination of estrogens and gestagens is very widely used for hormonal contraception. In addition, such drugs are used in the treatment of menstrual disorders.

Bisecurin (Bisecurin) consists of ethinodiol diacetate (1 mg) and ethinyl estradiol (0.05 mg), is available in Hungary, the release form is tablets in a package of 21 pcs.

Nonovlon (Non-ovlon) contains norethisteron acetate 1 mg and ethinylestradiol 0.05 mg, is available in the GDR as a dragee in a pack of 21 pcs.

Ambosex (Ambosex) consists of androgens and estrogens, is produced in Hungary. The tablet contains 4 mg of methyltestosterone and 0.004 mg of ethinylestradiol, applied sublingually. Ambosex ampoules contain 1 ml of an oil solution of 20 mg of testosterone propionate, 40 mg of testosterone phenyl propionate, 40 mg of testosterone isocaproate, 4 mg of estradiol phenylpropionate and 1 mg of estradiol benzoate. When administered intramuscularly, Ambosex has a prolonged effect (3-4 weeks).

pituitary hormones. To date, there are no drugs that have a "pure" follicle-stimulating or luteinizing effect. As a drug of predominantly luteinizing action, the gonadotropic hormone, choriogonadotropin, isolated from the urine of pregnant women, is widely distributed. In terms of its physicochemical and biological properties, it is close to the luteinizing hormone of the anterior pituitary gland.

Hornonic gonadotropin (Gonadotropinum chorionicum) isolated from the urine of pregnant women. - It is available as a lyophilized preparation in vials complete with a solvent of 500 and 1000 units. 1 unit corresponds to the activity of 0.1 mg of a standard gonadotropin preparation.

Menopausal gonadotropin (Gonadotropinum menopausticum) isolated from the urine of postmenopausal women, has a predominantly follicle-stimulating effect; similar to Pergonal-500. It is available in vials as a sterile lyophilized powder of 75 U, complete with a solvent.

Mammophysin (Mammophysinum) contains pituitrin and lactating cow mammary gland extract. It is available in ampoules of 1 ml.

Pituitrin (Pituitrinum) - a drug from the posterior pituitary gland of cattle, contains oxytocin and vasopressin, is available in 1 ml ampoules (5 units).

Corticosteroids. This group of drugs includes hormones of the adrenal cortex and their analogues.

Hydrocortisone (Hydrocorfisonum) - a synthetic analogue of the main hormone of the human adrenal cortex, is available in 0.025 g ampoules of hydrocortisone hemisuccinate for intravenous administration and in 5 ml vials (0.125 g) as a suspension for intramuscular injection.

Dexamethasone (Dexamethasonum) is a synthetic drug of glucocorticoid action, to a greater extent than hydrocortisone, which suppresses the secretion of ACTH.

Prednisolone (Prednisolonum) - a dehydrated analogue of hydrocortisone, is available in the form of tablets of 0.005 g, as well as 1 ml ampoules containing 30 mg of the drug. Cortisone acetate (Cortisoni acetas) is available in the form of tablets of 0.025 and 0.05 g and in the form of suspensions in 10 ml vials; 1 ml corresponds to 0.025 g.

Indications and contraindications for the use of hormone therapy in gynecology. Hormone therapy, prescribed without proper justification and necessary control, can lead to undesirable consequences, therefore, hormonal treatment should be carried out only with clear clinical indications for its administration. Indications for the use of hormone therapy are as follows:

1. Hypofunction and loss of ovarian function (replacement therapy with sex steroid hormones or their analogues is required).

2. The need to normalize the disturbed neurohormonal relationships that underlie the regulation of ovarian activity (stimulating therapy).

3. Inhibition of ovulation for contraceptive purposes, with endometriosis.

4. Changing the timing of the onset of menstruation - anteponation and postponation of menstruation (most often before surgical interventions).

5. Suppression of proliferative processes in the uterus and mammary glands.

6. Dysfunctional uterine bleeding (for the treatment of the restoration of a normal menstrual cycle).

7. Menopausal neurosis (for therapy).

8. Trophic disorders in the genitals.

As mentioned above, the effect of estrogens depends on the chosen dose: small and medium doses stimulate ovarian function, while large ones suppress it. The influence of estrogens on the pituitary gland should also be taken into account - in large doses, especially with long courses of therapy, they inhibit the gonadotropic function of the pituitary gland. At the same time, the production of all other hormones of the anterior lobe is also inhibited, the so-called hormonal hypophysectomy is observed.

There are a number of contraindications for estrogen treatment. So, they are not prescribed for suspected malignant neoplasms, for fibromyomas, ovarian cystomas. Currently, there is no direct evidence of the carcinogenic properties of estrogens, but no data have been obtained that categorically deny this (V. N. Serov, V. A. Golubev, 1974; V. M. Dilman, 1983).

So, the participation of the liver in the exchange of estrogens does not allow them to be prescribed for diseases of this organ. Estrogens are antagonists of somatotropic hormone, therefore, their effect on the body of a teenager should be taken into account and estrogenic drugs should be used during puberty with great care (N.V. Kobozeva et al., 1981).

Although the direction of action, the corresponding estrogenic activity and dosage are the same for natural and synthetic hormones, when prescribing drugs, it is necessary to proceed from their differences. Synthetic estrogens, compared to natural ones, have a weaker stimulating effect on the pituitary gland and a stronger toxic effect on the body, they are not inactivated by the liver. Side effects (nausea, vomiting, etc.) are more pronounced with the use of synthetic estrogens. Therefore, it is advisable to prescribe a course of treatment with stilbenes after determining their tolerance to the patient.

Gestagens have fewer contraindications for use. The following are restrictions on their use. Large doses of progesterone inhibit the gonadotropic function of the pituitary gland, causing disorders of water-salt metabolism. This must be taken into account when treating women with metabolic disorders. Important is the fact that gestagens have a pronounced effect on the blood coagulation system.

Therefore, women with a history of thromboembolic disease, increased blood clotting and extensive varicose veins are not prescribed these drugs. The same applies to the use of hormonal contraceptives, which include a progestogen preparation as an obligatory component.

The use of androgens in women also requires great caution. Thus, androgenic drugs, especially those used in combination with estrogens, successfully eliminate the neurovegetative manifestations of climacteric neurosis and neurotic symptoms, but increase blood pressure, apparently due to fluid retention. In addition, androgenic drugs have anabolic effects, causing weight gain. Significant amounts of androgenic hormones cause the virilization of the female body. After discontinuation of treatment, despite the fact that hypertrichosis, pigmentation of the perineum, changes in the skin surface (acne, hyperproduction of sebaceous and sweat glands) undergo regression, an increase in the cartilage of the larynx, clitoris, coarsening of the voice are irreversible. Gonadotropic hormones, being protein substances, can cause various allergic reactions and the formation of antibodies to gonadotropins, which reduce the effectiveness of appropriate therapy.

Prolonged administration of chorionic gonadotropin can cause the formation of luteal ovarian cysts.

Given the indications and contraindications for the use of hormonal drugs in gynecology, we can recommend the following rules for their rational use:

1. Prescribe hormones only after a thorough clinical and laboratory examination of the patient.

2. If a hormonal drug is used by a patient for the first time, individual tolerance must be checked, for which a skin allergy test is performed or the patient is examined after several days of hormonal therapy.

3. Do not start hormonal therapy with long-acting drugs, since if some complications occur, it is impossible to cancel the administered drug, and to mitigate its effect, it is often necessary to prescribe massive therapy.

4. Consider the mechanism of action of a particular hormone, paying special attention to the principle of direct and feedback in the relationship between sex and gonadotropic hormones. This means, for example, that in order to stop uterine bleeding, it is necessary to administer large doses of estrogens, which block the release of FSH by the pituitary gland. In cases where it is necessary to stimulate the function of the pituitary gland (in some forms of menstrual irregularities), estrogenic drugs are prescribed in small or medium doses.

5. Gonadotropic hormones should be prescribed only after making sure that the ovaries are functional, that is, the pituitary hormone must have a substrate for its action.

6. Take into account the role of the liver both in the clinical examination of women with menstrual disorders, and in the appointment of hormone therapy. So, a violation of the metabolism and inactivation of estrogens in liver diseases (hepatitis, cirrhosis) leads to an increase in the content in the body of free forms of hormones with high biological activity, which can cause hyperestrogenic conditions that cause dysfunctional uterine bleeding. Therefore, therapeutic measures aimed at normalizing liver function are especially important.

7. Conduct hormone therapy based on the minimum amounts of drugs needed to achieve an effect in each patient. In case of ovarian insufficiency, when the endometrial cycle is reproduced for replacement therapy with estrogens and gestagens and such tactics continue for several months or even years, it is especially important to reduce the doses of hormones used to the effective minimum.

8. Take into account that the magnitude of the action of the hormone is not related to its concentration in the body in a linear relationship. As a rule, the effect of hormonal drugs varies in proportion to the logarithm of the dose. With an excessive increase in the dose, a "plateau effect" occurs, i.e., the maximum reaction of the effector system, in which a further increase in the dose of the hormone does not cause an increase in the effect

Any hormonal therapy should end with a gradual decrease in the dose of the drug used, and not be interrupted abruptly. Apply hormonal tests before prescribing hormonal therapy to determine individual sensitivity to hormonal drugs, select hormone doses, and also to diagnose ovarian and endometrial reactivity.

Carry out hormonal therapy only if it is possible to control both its effectiveness and the general health of the woman.

Hormonal tests are of great importance in the diagnosis of ovarian dysfunction and the pituitary-hypothalamus system. They are easy to use not only in a hospital, but also on an outpatient basis. Hormonal tests make it possible to carry out a differential diagnosis of a violation of one or another endocrine gland, which is important for the pathogenetic treatment of menstrual disorders.

In addition, small amounts of hormones are used for hormonal tests, and the doctor can draw a conclusion about the tolerability of a particular drug, possible side effects, and, most importantly, the effectiveness of the chosen hormonal therapy: a positive test indicates the rationality of further use of the drug, and a negative one makes it possible to avoid prescribing hormones which would later prove to be ineffective.

Most often, obstetrician-gynecologists use tests that allow diagnosing dysfunctions of the ovaries and pituitary gland, although sometimes (with virile syndrome, ovarian sclerocystic degeneration syndrome, tumors of the adrenal cortex with menstrual irregularities), tests are recommended that determine the function of the adrenal cortex.

1. A test with progesterone is recommended for amenorrhea of any etiology to judge the presence of estrogen deficiency, it consists in administering 10-20 mg per day intramuscularly of progesterone for 3-5 days. The appearance of bleeding after discontinuation of the drug (positive test) indicates sufficient estrogen saturation and insufficient production of progesterone, since the latter causes secretory transformation of the endometrium with subsequent bleeding only if the endometrium is prepared by estrogens. A positive test with progesterone excludes the uterine test of amenorrhea. A negative test (no bleeding after progesterone withdrawal) may be due to estrogen deficiency and uterine amenorrhea. 2. A test with estrogen and progesterone is used to exclude the uterine form of amenorrhea, as well as for differential diagnosis in dysfunctional bleeding, consists in the introduction of estrogens daily for 10-14 days (estrone 20,000 IU) or sinestrol 2 tablets, after which they are prescribed for 3-5 days daily, 10-20 mg of progesterone. The onset of bleeding (positive test) in amenorrhea excludes the uterine origin of the disease and indicates hypofunction of the ovaries. A negative test (no bleeding) confirms the uterine form of amenorrhea.

With dysfunctional uterine bleeding, this test is used for the differential diagnosis of the endocrine and non-endocrine genesis of the disease. In this case, estrogens and progestogens in a ratio of 1: 10 are administered simultaneously 3-4 times a day. It is allowed to use both oily solutions of steroids (intramuscularly) and their synthetic analogues (per os) in the same proportion. A positive test - stopping bleeding - during or immediately after the end of taking the drugs indicates progesterone deficiency as a cause of bleeding, the absence of an effect - a negative test - is observed with non-endocrine causes of pathology. 3. An estrogen test is used for amenorrhea, it consists in the administration of estrogen daily for 8 days (estroia 20,000 IU or sinestrol or microfollin 2 tablets each). If bleeding occurs a few days after the end of estrogen intake (a positive test), then this indicates estrogen deficiency while maintaining the sensitivity of the endometrium.

4. A test with two-component hormonal contraceptives and prednisolone is used in sclerocystic ovary syndrome to determine the source of androgenism, it consists in prescribing one of the two-component hormonal contraceptives (or nonovlon or bisekurn) 2 tablets per day for 10 days. In the next 5 days, while taking drugs in the same dosage, prednisone is prescribed at 20 mg daily. Before the start, after 10 days and after the end of the test, the excretion of 17-KS in the daily urine is examined. A sharp (by 50% or more) decrease in the excretion of 17-KS after a ten-day intake of a hormonal contraceptive drug (positive test) indicates the ovarian genesis of hyperandrogenism. The absence of changes or a sharp decrease in the excretion of 17-KS only after the action of prednisolone (negative test) indicates the adrenal genesis of hyperandrogenism. 5. Tests with gonadotropic hormones are used for violations of ovarian function, accompanied by amenorrhea and bleeding to establish the genesis of the disease. 6. A test with FSH is used in case of severe ovarian hypofunction, confirmed by laboratory tests (decrease in estrogen excretion, change in the cellular composition of the smear), to determine the pituitary or peripheral genesis of the disease. For the test, a domestic drug is used - menopausal gonadotropin or foreign - Pergonal-500 (both have a predominantly follicle-stimulating effect). Gonadotropi and menopause are prescribed 75 IU, pergonal - 1 ampoule daily for 3 days. If, after the end of the test, the estrogen saturation of the body increases, which is confirmed by tests of functional diagnostics or the appearance of bleeding (positive test), then this indicates the pituitary genesis of the disease and functionally active ovaries.

A negative test (no reaction after drug administration) indicates a primary ovarian lesion.

A test with chorionic gonadotropin is used for high or moderate estrogen saturation with bleeding and amenorrhea for the differential diagnosis of damage to the hypothalamic-pituitary system or ovaries. The choice of the drug is based on the fact that human chorionic gonadotropin is close in biological action to LH of the pituitary gland. Chorionic gonadotropin is administered 1500 IU intramuscularly for 4-5 days daily. With amenorrhea or opsomenorrhea, this drug is prescribed on any days, with a preserved menstrual cycle - after the 14th day of the cycle. A positive reaction (an increase in the excretion of pregnandiol, a decrease in the excretion of estrogens to values characteristic of the luteal phase of the menstrual cycle, a decrease in CI and EI, an increase in basal temperature) indicates insufficiency of the hypothalamic-pituitary system. If the test is used for amenorrhea, then the occurrence of uterine bleeding is considered a positive result. The absence of changes after the administration of the drug (negative test) indicates primary ovarian failure.