What are the best birth control pills to take. Pros and cons of taking oral contraceptives. Low-dose contraceptives: properties, list, list

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

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

What is hormonal contraception?

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

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

Estrogens help:

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

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

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

Application features

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

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

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

Advantages

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

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

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

Flaws

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

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

Types of COCs

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

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

Monophasic

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

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

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

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

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

Two-phase

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

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

Three-phase

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

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

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

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

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

Criterias of choice

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

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

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

A long time ago, more than one or even two children were born in Russian families. A family in which there are “seven on benches” and a mother in the process of demolition is a typical example of the way of pre-revolutionary life. A hundred years ago, a woman was in two states for almost the entire reproductive period - pregnancy and breastfeeding, and the latter smoothly flowed into the next interesting position.

Whether it's good or bad, but in modern families there are much fewer heirs. One or two children are considered normal. And in order not to exceed the upper limit, a healthy woman needs to take contraception seriously.

In the contraceptive arsenal today, there are about a dozen methods of preventing unwanted pregnancies. Almost the most popular way is the use of birth control pills.

How effective and safe is contraception using pills? Who shouldn't rely on this method? And in general, what should be understood by the term "contraceptive pills"? Every woman should own these concepts no worse than a local gynecologist - after all, health sometimes depends on this knowledge. Well, let's figure it out together.

Contraceptive pills: both orally and vaginally

The concept of "contraceptive pills" includes two completely different categories of drugs:

- hormonal contraceptives, which are based on synthetic hormones;

- local spermicides in tablets. The action of these contraceptives is based on the spermicidal effect, which is achieved with topical, vaginal application.

Of course, hormonal agents are of greatest interest from the point of view of the pharmacological effect. With them, we will begin our acquaintance with contraceptives.

Hormonal contraception: origins

Already at the end of the 19th century, it became known that the development of follicles and ovulation is completely suppressed during pregnancy, and the reason for this is the high concentration of corpus luteum hormones. In the 1920s, Ludwig Haberlandt proposed the use of such substances as contraceptives. In the next ten years, three estrogens were synthesized: estrone, estriol and estradiol, and at the end of 1929 scientists identified progesterone.

Probably, the first hormonal contraceptive pills would have appeared ten years earlier, if not for the problem with the synthesis of progesterone. It was mastered only in 1941, after which it was the turn of other progesterone drugs - norethisterone and norethindrone. It was then that these substances received the common name progestogens (or progestins), which emphasized progesterone-like properties.

In the early 50s, scientists began experimenting with hormonal drugs. The first pancake came out lumpy: the use of hormonal pills for the treatment of infertility did not give results. But it was found that in women taking these drugs, ovulation was suppressed. It took researchers another 5 years to select the right formula, and in 1957 the first hormonal contraceptive drug was released. As early as 1960, 0.5 million American women were taking these pills. The era of hormonal contraceptives has begun.

Pharmacological effect of hormonal pills

The action of contraceptive hormonal drugs does not depend on the composition and dosage. The contraceptive effect is achieved by influencing a complex reproductive chain, which includes the pituitary gland, hypothalamus, ovaries, uterus, and even fallopian tubes.

First of all, hormonal contraceptives suppress the production of releasing hormones by the hypothalamus, resulting in a decrease in the gonadotropic function of the pituitary gland. Due to this, ovulation is inhibited, and temporary sterility occurs.

Secondly, hormonal pills suppress ovarian function: estrogen synthesis is almost halved, and the ovaries even decrease in size.

Thirdly, under the influence of hormonal drugs, the properties of cervical mucus change, which becomes very difficult for spermatozoa to pass.

Fourth, the peristalsis of the fallopian tubes slows down significantly. A miraculously mature egg is unlikely to be able to get out of the long, inactive fallopian tubes and, most likely, will be doomed to death.

And fifthly, the endometrium changes, which quickly regresses and does not reach the thickness necessary for the implantation of a fertilized egg. This mechanism serves as additional protection - even if conception has occurred, the embryo simply cannot attach to the uterine wall.

The effectiveness of contraceptive drugs is evaluated using a single indicator - the Pearl index. It is equal to the number of pregnancies in one year in 100 women who used a particular method of contraception. The Pearl Index of hormonal contraceptives rarely exceeds 3-4% and fluctuates around 1%.

Hormone Dosage: Then and Now

The first hormonal contraceptives contained simply lethal doses of hormones: 150 micrograms of estrogen and 9.35 mg of progestogen. In 1964, it was possible to reduce the concentration of active substances to 100 micrograms and 2 mg, respectively. However, these dosages were far from perfect.

The next step was the release of hormonal contraceptives containing 50 micrograms of estrogen. Scientists came to the conclusion that lowering the dose of hormones does not affect the effectiveness of the drug, but it greatly reduces side effects.

In the 1970s, the upward trend in the use of hormonal contraceptives stopped. This resulted in pronounced adverse events in the form of thromboembolism (blockage of blood vessels by blood clots), especially in women who smoke. Pharmacists had no choice but to develop new low-dose drugs. And it succeeded.

Birth control pills of the new, latest generation contain less than 35 mcg of estrogen - the component that causes most of the side effects. In addition, highly active progestogens have been synthesized, including drospirenone, desogestrel, gestodene, and others. Due to these advances, low-dose hormonal drugs have a very high safety profile and a low chance of side effects. Nevertheless, when choosing a contraceptive drug, you need to be vigilant, given the many nuances. However, more on that later.

Classification of hormonal contraceptives

All hormonal drugs can be divided into three large groups:

- combined oral contraceptives (COCs).
Such tablets contain both components: both estrogen and progestogen;

- progestin preparations - mini-pill.
Monocomponent means, which include only gestagen.

- emergency contraceptives.
These contraceptives contain extremely high doses of hormones and are intended for urgent, that is, urgent contraception.

Each of the groups of hormonal pills has its own advantages and disadvantages, on the basis of which the conclusion is based on the appointment of a particular remedy.

KOC: positive aspects

Undoubtedly, the most common hormonal pills are combined contraceptives. They have a lot of positive aspects, including:

• high contraceptive effect;
• excellent tolerance;
• ease of use;
• reversibility of action;
• safety;
• therapeutic action;
• preventive action.

To understand all the advantages of contraceptive hormonal drugs, we will consider each criterion in detail.

Efficacy and tolerability of combined contraceptives

The Pearl Index KOC ranges from 0.1-5%. The average statistics state that the probability of pregnancy with the constant use of hormonal pills during the year does not exceed 1%. Thus, the effectiveness of combined contraceptive pills reaches 99%. An indispensable condition for achieving such results, of course, is compliance with the dosing regimen.

Oral combined contraceptives are generally well tolerated. Side effects develop, as a rule, in the first months of taking, and notice that they decrease on their own and completely disappear.

Types of combined hormonal pills

Depending on the qualitative composition, COCs are divided into three groups:

- monophasic drugs.
These drugs contain estrogen and progestogen in the same dosage. Regardless of the phase of the menstrual cycle, the same amount of hormones enters the body. Tablets of monophasic COCs are painted in one color.

These monophasic contraceptive drugs include most modern low-dose COCs: Logest, Silest, Janine, Microgynon, Lindinet-20 and Lindinet-30, Regulon, Diana, Yarina, Jess and others;

- biphasic drugs.
Biphasic COC tablets are divided into two groups: the first contains more estrogen, and the second - progestogen. For ease of administration, the tablets are colored in two colors. Biphasic COCs are rarely used;

- triphasic preparations.
A package of a three-phase COC contains three groups of tablets, the level of hormones in which changes approximately in the same way as in a physiological menstrual cycle. Each group of tablets is coated with its own color. Three-phase preparations are considered the most adapted to the natural cycle of a woman. Among the modern representatives of this group, we note Tri-merci, Tri-regol, Triziston.

Rules for taking birth control pills

The first and main rule, on which both the effectiveness and side effects of COCs depend, is the regularity of intake. Forgetfulness is the main enemy of any contraceptives, and hormonal ones in particular.

We list the main postulates that every woman who takes hormonal contraceptives should remember:

1. It is better to start taking contraceptive drugs on the first day of a new cycle, although it is also allowed in the first 5-7 days from the onset of menstruation. Some experts recommend starting treatment on some convenient day for counting, for example, on Sunday. If a woman needs immediate therapy, you can drink the first tablet immediately after the complete exclusion of pregnancy;

2. It is better to take medicine at the same time. Ideally, you should associate the reception with some kind of ritually repetitive action, for example, evening dress or dinner. Although there are no specific recommendations on the best time of day to take the pill, many doctors advise taking COCs at night. This is due to the fact that at the beginning of treatment there is a possibility of mild nausea, which practically does not annoy during sleep;

3. In the first cycle of taking COCs, additional contraceptive measures should be used: according to some reports, the effectiveness of hormonal contraceptive pills reaches a maximum only after 2-4 weeks of continuous use;

4. After a 21-day intake, a 7-day break follows, during which menstrual-like bleeding occurs. On the eighth day of withdrawal, you should start taking the first tablet of a new treatment cycle. If within a week after the abolition of COC menstruation has not occurred, the next package is still not canceled. However, in such a situation, it is better to seek advice from your doctor: you need to exclude pregnancy and gynecological pathologies;

5. If there was vomiting within four hours after taking the pill, the contraceptive effect is reduced. In such cases, it is better to use an additional method of contraception until the end of the cycle. Usually, the barrier method is considered the best "safety" method, which involves the use of a banal, but true condom;

6. If bleeding occurs while taking COCs, treatment should be continued. Some experts recommend that patients who bleed more than 4 days start taking an additional COC tablet (eg, morning). As a rule, 2-3 additional tablets are enough to restore the normal picture. After stopping the bleeding, you should take another 2-4 days for half the additional dose, and then switch to the standard course of treatment. If, despite the measures taken, the bleeding continues, you will have to see a gynecologist;

7. Patients who take COCs for a long time need to undergo periodic examinations by a gynecologist with monitoring of the condition of the mammary glands.

What if memory fails?

Every woman, no doubt, knows about the regularity of taking hormonal contraceptive pills. But the girl's memory is fragile: there are gaps and gaps in it. What to do with forgetful patients? Moaning: “All is lost!”? Or ... Of course, act! Depending on how many birth control pills the patient missed:

- if no more than 12 hours have passed since the last pill was taken, you need to take the next one immediately after memory recovery and calm down. The contraceptive effect will not change;

- if the interval between doses was more than 12 hours, you must take the next pill, regardless of the time of day, and then continue according to the schedule. The scheme does not change, even if you have to drink two tablets a day;

- if two doses were missed, that is, the interval between doses was more than 24 hours, you need to take two tablets at once and drink two more doses the next day. It should be borne in mind that in such cases, bleeding may occur;

- if the memory was lost for a long time, and this led to the skipping of three or more pills, the likelihood of spotting is very high. Of course, you can forget about the contraceptive effect, and it’s even better to remember where the condoms are. However, what to do with COC? Doctors recommend taking two tablets for the first three days, and then switch to the standard regimen. There is a second way out of the situation: to abandon the old packaging altogether and start from scratch, that is, with a new KOC packaging, for example, next Sunday.

If everything is taken and canceled: the reversibility of COC action

Contraception involves deliberate family planning. And someday there comes a time when a woman would gladly start taking germ pills, if such existed. The purchase of new packs of hormonal contraceptives is postponed indefinitely. The only question that worries a woman is when can you get down to business?

The action of combined hormonal contraceptives is reversible, and this, of course, can be attributed to the important advantages of such drugs. In most cases, in the first 1-3 months after the abolition of COCs in healthy women, a full-fledged ovulatory menstrual cycle is completely restored. The maximum recovery period is 12 months.

There is information about the so-called withdrawal syndrome or rebound effect that occurs after stopping the use of hormonal contraceptives. The ovaries, which have been “resting” for quite a long time, begin to work actively and fruitfully immediately after recovery from “hibernation”. The result of such work is the maturation of the follicles and the release of an egg ready for battle, hungry for action. According to the theory based on the COC withdrawal syndrome, the probability of pregnancy in the first 1-2 months after stopping treatment with hormonal pills is much higher than in the standard cycle.

However, some experts believe that normalization of hormonal levels is still needed for a healthy pregnancy. Many gynecologists insist that conception should occur several months after hormone withdrawal.

Therapeutic effects of COCs: birth control pill therapy

In addition to the contraceptive effect, hormonal preparations also have a proven therapeutic effect, and in this capacity, COCs containing both estrogen and progestogen are mainly used. Consider the main indications for the appointment of combined contraceptives.

Dysfunctional uterine bleeding

Intermenstrual uterine bleeding, not associated with pregnancy and organic pathology, is considered to be dysfunctional. Their main cause lies in a hormonal imbalance caused by a malfunction in the complex circuit of the hypothalamus-pituitary gland-ovaries. It has been proven that long-term use of COCs contributes to the normalization of hormonal levels and the cessation of dysfunctional bleeding.

endocrine infertility

As we have already said, in some cases COCs are used for the sake of the rebound effect. Some endocrinologists believe that if endocrine infertility is suspected, it is first necessary to start treatment with combined contraceptives. If pregnancy does not occur after the abolition of COCs, then proceed to ovulation stimulants.

Premenstrual syndrome

For the treatment of PMS, modern low-dose contraceptives are prescribed, including Novinet, Median, Silhouette, Lindinet, Mercilon, Jeanine, Dimia and other drugs. Symptoms characteristic of premenstrual syndrome - irritability, weakness, swelling, pain in the back, chest, headaches - disappear after 1-2 months of treatment.

endometriosis

Endometriosis is a fairly common disease that can be one of the causes of infertility. With this pathology, a tissue similar to the endometrium (the tissue of the inner lining of the uterus) grows in the pelvis. COCs are recognized as one of the treatment options for endometriosis. As a rule, these drugs are prescribed in long courses for a period of at least 12 months.

Among the contraceptives that are most often used for the treatment of endometriosis are Marvelon, Femoden, Regulon, Microgynon, Logest and others.

Hyperandrogenism

A condition that is accompanied by an increased content of testosterone in the blood - hyperandrogenism - is manifested by a number of striking symptoms. These include excessive hair on the face and body in women, acne (acne) and seborrhea.

The drugs of choice for the treatment of mild and moderate forms of hyperandrogenism include COCs with an antiandrogenic effect. This action is inherent in the gestagen, which is part of some combined contraceptives, namely Diana, Zhanin, Yarina and some others.

Separate words deserve a drug with a powerful antiandrogenic and antimineralocorticoid effect - Yarina. As a progestogen, these tablets use drospirenone, which not only helps to reduce testosterone levels, but also reduces swelling. Therefore, the likelihood of weight gain when taking Yarina is minimal.

With acne and seborrhea in adolescents, a three-phase COC Tri-merci is prescribed, which is able to reduce testosterone levels three times.

And the last. The antiandrogenic effect is achieved after three months of constant use of COCs, so contraceptives in order to get rid of acne will have to be taken for a long time.

COC: not only treatment, but also prevention

Combined contraceptives are also an additional prevention of gynecological diseases.

Inflammatory diseases

It has been proven that regular use of COCs reduces the likelihood of developing an inflammatory process in the small pelvis. This effect is achieved through:

1. increase the viscosity of cervical mucus.
   More viscous mucus turns out to be a barrier not only for spermatozoa, but also for some bacteria;
2. decrease in the intensity of menstruation.
   Menstrual blood is an ideal environment for the growth of pathogenic microorganisms. Therefore, a decrease in monthly blood loss also reduces the likelihood of infection;
3. decrease in the strength of uterine contractions during menstruation.
   With uterine contractions, the infection easily penetrates from the uterus into the fallopian tubes, contributing to the development of dangerous diseases - salpingitis (inflammation of the fallopian tubes) and salpingo-oophoritis (simultaneous inflammation of both the ovaries and tubes). It is these processes that occupy an honorable first place among diseases that lead to the formation of adhesions in the pelvis, and as a result, infertility.

According to the recommendations of the WHO - the World Health Organization - combined contraceptive pills are used in a complex treatment regimen for already developed inflammatory processes. In such cases, COCs allow the ovaries to “rest” and recover, and the cervical mucus plug additionally protects the body from reinfection, that is, re-infection.

Functional ovarian cyst

These pathologies include follicular cyst and cyst of the corpus luteum. Monophasic COCs reduce the likelihood of formation of functional cysts by 3-4 times, and also contribute to the resorption of existing formations.

It is worth noting that triphasic birth control pills may, on the contrary, stimulate the development of cysts. This is because "floating" doses of hormones in such preparations are not able to completely suppress ovarian function.

uterine fibroids, endometriosis

Both uterine fibroids and endometriosis are estrogen-dependent diseases. A decrease in estrogen levels significantly reduces the likelihood of developing these pathologies.

Official figures sound more convincing than words: with the constant use of birth control pills for five years, the risk of fibroids decreases by 17%, seven years - by 20%, and 10 years - by 30%.

Birth control pills: simple cancer prevention

The most reliable studies in the medical world have confirmed that the regular use of COCs reduces the risk of gynecological cancer. Continuous use of birth control pills reduces the risk of developing ovarian cancer by as much as 40%, and such prevention lasts for 15 years after the elimination of COCs. In addition, the use of combined contraceptives reduces the likelihood of developing uterine cancer by exactly half, and the protective effect is also enough for 15 years.

The only condition that should not be overlooked: to obtain a serious preventive effect, birth control pills must be taken for at least two years.

Combined contraceptives: side effects

Of course, the other side of the coin cannot be ignored. COCs have both side effects and contraindications.

Let's start with the first one. The most common side effects of hormonal birth control pills include:

• headache;
• nausea, vomiting;
• discomfort in the stomach and intestines;
• irritability and mood changes;
• increased sensitivity of the mammary glands;
• change in libido;
• dryness of the vagina;
• intermenstrual bleeding: both spotting and breakthrough (many women perceive this effect as menstruation when taking contraceptives).

The intensity of COC side effects is greatest in the first 1-3 months of treatment. After this period, as a rule, taking birth control pills is not accompanied by any adverse events.

You should be aware that with prolonged use or cancellation of oral contraceptives, hormonal disorders may occur. The duration and frequency of menstruation is reduced or increased, and the discharge may become too scarce or plentiful, accompanied by pain in the lower abdomen. A complex of biologically active substances has a beneficial effect on the functions of the female reproductive system -
"Time Factor". It contains extracts of medicinal plants, vitamins B9, C, E and PP, minerals Fe, Mg and Zn - reduce muscle spasms, pain during menstruation and are involved in restoring hormonal balance, including during or after the use of contraceptives.

Important: When are COCs banned?

Combined contraceptives are absolutely contraindicated in:

• pregnancy or the slightest suspicion of it;
• breastfeeding;
• vein diseases;
• IHD - coronary heart disease;
• severe diseases of the heart and blood vessels;
• oncological diseases;
• uncontrolled diabetes mellitus;
• severe pathologies of the liver or kidneys;
• uterine bleeding, the cause of which is not established;
• over 40 years of age;
• smoking a large number of cigarettes, especially women over 35 years of age.

In the presence of one of the above contraindications, COCs should be completely forgotten. There is an additional list of diseases in which it is necessary to weigh the risks and benefits by prescribing contraceptive pills.

Such pathologies include diabetes mellitus, fibroids, age over 35, smoking, and others.

Women suffering from migraine should be especially careful when using COCs. Migraine is a relative contraindication to treatment with hormonal pills. Experts recommend prescribing low-dose contraceptive drugs containing less than 35 micrograms of ethinylestradiol, in particular, Janine, Logest, Minisiston, Mercilon, Regividon, Yarina. If severe headaches appear during COC treatment, the tablets should be discontinued, and as soon as possible.

Monocomponent birth control pills: mini pills

The second large group of hormonal contraceptive pills contains only one hormone - progestogen. Due to the low dose of the active substance, these drugs have received the sonorous name of mini-pills. Some of the most popular mini-pill birth control pills include:

• Exkluton containing 500 micrograms of linestrenol;
• Microlut, which includes 3 mg of levonorgestrel;
• Charozetta and Lactinet, which contain 75 micrograms of desogestrel.

It should be noted that Charozetta and Lactinet occupy a special place among mini-pills. The composition of these funds includes a modern gestagen, which has unique properties. In addition to contraception, desogestrel has an antiandrogenic and antimineralocorticoid effect.

The pharmacological action of the mini-pill is similar to that of COCs. By blocking the production of gonadotropic hormones of the pituitary gland, gestagens contribute to an increase in the viscosity of cervical mucus, forming a barrier to spermatozoa. In addition, mini-pills reduce the contractile activity of the fallopian tubes and cause endometrial hypotrophy, which makes implantation of a fertilized egg difficult.

Rules for taking mini-pills

Unlike combined birth control pills, mini-pills are used daily without taking a break.

The elimination half-life of the mini-pill is quite short: it is 12 hours less than that of the combined drugs and is only 22-24 hours. In this regard, monocomponent contraceptives must be taken at the same time in order to prevent a critical drop in the dose of hormones.

Charozetta and Lactinet can be attributed to a pleasant exception to the rule: their half-life occurs 36 hours after administration.

Monocomponent birth control pills: benefits

What distinguishes mini-pills from COCs? What are the advantages of monocomponent contraceptives over traditional combination drugs? The positive aspects of the mini-pill include:

- no side effects associated with the intake of estrogen.
Estrogen is responsible for most of the adverse events associated with COC use. Due to the lack of this hormone in mini-pills, they are better tolerated than combination pills;

- the possibility of appointment during lactation.
Monocomponent contraceptives are considered a means for nursing mothers. It has been proven that the gestagens used in mini-pili do not affect the qualitative composition of breast milk and do not reduce its amount. On the contrary, there is information stating that taking a mini-pill helps to improve lactation and lengthen the duration of breastfeeding. WHO recommends the use of monocomponent contraceptive pills 6 weeks after birth;

- the possibility of using mini-pills in women who are contraindicated in combination pills.
Monocomponent contraceptives are safe in patients with severe diabetes mellitus, migraine, heart and vascular diseases, varicose veins, as well as in smokers. In addition, mini-pills are birth control pills that are indicated for women of older reproductive age, including those after 40 years;

- no side effects after abrupt withdrawal of tablets.
Unlike COCs, you can stop taking monophasic contraceptives at any time during treatment.

Disadvantages of minipill

Along with a significant list of advantages, monocomponent tablets are not without some disadvantages, including:

• high probability of menstrual irregularities while taking drugs: intermenstrual bleeding, shortening of the cycle, etc.;
• relative low efficiency compared to COCs. The Pearl mini-peel index ranges from 0.5 to 3%. The higher probability of conception is due to the fact that low doses of progestogens in mini-pills cannot completely suppress ovulation. The only monocomponent tablets that guarantee this effect by 96% are Charozetta (Lactinet).
• increased risk of ectopic pregnancy If ovulation and conception still occur while taking the mini-pill, the fertilized egg will not be able to implant in the uterus. Therefore, the embryo is attached to the fallopian tubes or ovaries, as a result of which an ectopic pregnancy develops.

In addition, mini-pills also have side effects, including:

• increased appetite;
• decreased libido;
• nausea, rarely - vomiting;
• headache;
• increased sensitivity of the breast.

And the last. After the abolition of the mini-pill, a full menstrual cycle is restored within 1-3 months. At the same time, the rebound effect that combined contraceptives are famous for should not be expected.

Emergency contraception: contraceptives in haste

Along with planned contraception, every woman should remember that there is a second, emergency option of contraceptive pills. They are intended primarily for patients who rarely have sexual intercourse, as well as in unforeseen cases when, for some reason, planned contraceptive measures were not taken.

Preparations for emergency contraception are called postcoital, used already post factum, that is, after. If sexual intercourse occurred before ovulation, high doses of birth control pill hormones ensure that it does not occur. If conception does occur, emergency contraceptives provide endometrial hypotrophy, as a result of which the embryo cannot attach to the walls of the uterus. In addition, a low concentration of progesterone guarantees the impossibility of pregnancy.

To quickly achieve the desired effect, it is necessary to administer the highest possible doses of hormones. Therefore, postcoital contraception preparations are high-dose hormonal agents that are recommended to be used as rarely as possible. The effectiveness of urgent drugs reaches 97–99%.

Medicines for emergency contraception

There are several means of postcoital contraception:

- combined tablets.
Conventional combined COCs at a certain concentration can provide emergency contraception. This method of contraception is called the Yuzpe method. Among the contraceptives used according to the Yuzpe method are Microgynon, Minisiston, Femoden, Regividon, Regulon and others;

gestagens.
This group is represented by the contraceptive Postinor and its analogues - Microlut, Escapel and Eskinor-F;

antigonadotropic drugs.
These include Danazol, which is a treatment for endometriosis;

antiprogesterone agents.
A modern drug that suppresses the synthesis of progesterone - Mifepristone - is used as both an emergency contraceptive and in medical abortion.

Rules for taking postcoital contraceptive pills

There are strict rules for the use of hormonal emergency contraception, and deviation from them can lead to the most disappointing consequences.

Almost all emergency birth control pills must be taken within 72 hours of intercourse. Dosages of drugs depend on the pharmacological group.

Combined hormonal pills

At the same time take 4 tablets of both colors twice a day with an interval of 12 hours.

Gestagens

Postinor and its generics are prescribed one tablet twice a day after 12 hours.

Antigonadotropic and antiprogesterone drugs

Danazol for the purpose of emergency contraception is used at 400-600 mg twice or three times after 12 hours. An alternative regimen involves the appointment of 200 mg per day for five days in a row.

Mifepristone is used once at a dosage of 600 mg. Perhaps the appointment of 200 mg of mifepristone once a day from the 23rd to the 27th day of the cycle.

Note that according to some data, Mifepristone contributes to abortion up to a period of 5 obstetric weeks.

Emergency contraception side effects

The possible consequences of taking high-dose birth control pills cannot be overlooked.

In the vast majority of cases, taking hormonal pills for emergency contraception is accompanied by menstrual irregularities. Therefore, some experts recommend starting taking COCs to restore hormonal levels next to the “emergency” cycle.

In addition, taking high doses of estrogen is associated with nausea and even vomiting. To reduce these side effects, it is best to take the medication with or after meals. If vomiting could not be avoided, it is necessary to drink another, extraordinary dose.

Local contraceptive pills: alternative contraception

The contraceptive effect of local, that is, vaginal, contraceptives is based on the spermicidal action of the components of the drug. Most spermicides come in the form of suppositories, but pharmaceutical companies have mastered the technology for the production of both contraceptive cream and foam and, of course, vaginal tablets.

In Russia, only one spermicidal vaginal tablet is registered - Pharmatex. The active substance of the drug is an antiseptic and spermicide benzalkonium chloride. Pharmatex has a complex effect:

• spermicidal.
  The Pearl Pharmatex Index, when used correctly, is about 1%. Benzalkonium chloride contributes to the destruction of the flagella and the head of the sperm;
• bactericidal.
  Pharmatex also provides protection against sexually transmitted diseases, including chlamydia, gonorrhea, trichomoniasis, HIV infection, herpes simplex virus type 2.

Rules for the use of Pharmatex

To achieve a contraceptive effect, it is necessary to strictly follow the rules for the use of Pharmatex:

• the tablet must be inserted into the vagina 10-15 minutes before sexual intercourse.
  It is this period of time that is needed for a solid tablet to disintegrate and start working. The duration of action is about three hours. Before each subsequent sexual intercourse, it is necessary to use an additional tablet, even if the previous one has not yet expired;
• it is strictly forbidden to use soap and other alkaline detergents for the toilet of the external genitalia two hours before and after the use of birth control pills. This is due to the fact that soap contributes to the rapid and complete destruction of benzalkonium chloride.

As contraindications to the use of Pharmatex, only individual intolerance to the active substance and ulceration of the vaginal mucosa appear. In other cases, benzalkonium chloride preparations are completely safe.

Among all the contraceptive pills on the market, Pharmatex occupies a special place. If you need to consult a doctor to buy a hormonal drug, then Pharmatex tablets can be purchased at any pharmacy in the world without a prescription.

In conclusion, it is worth recognizing that the choice of birth control pills for a modern woman is great. It's a matter of small things: responsibility.

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;
• - 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) - hormoneoids 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:

1. Monophasic - have the same dosage of active substances in each tablet of the package.
2. Biphasic - the amount of estrogen is constant, and the dose of progestogen varies depending on the phase of the cycle.
3. 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 gestagens, 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

1. 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.
2. Obstetrics. National leadership. UMO certification for medical education. Ailamazyan E.K., Radzinsky V.E., Kulakov V.I., Savelyeva G.M. 2009 Publisher: Geotar-Media.
3. Gestosis: theory and practice. Ailamazyan E.K., Mozgovaya E.V. 2008 Publisher: MEDpress-inform.
4. 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.
5. Clinical guidelines. Obstetrics and gynecology. Savelyeva G.M., Serov V.N., Sukhikh G.T. 2009 Publisher: Geotar-Media.

It is difficult to say how barbaric modern methods of contraception will be considered by our descendants, because the most progressive and safe contraceptives of two hundred years ago look today as an instrument of torture. It is known, for example, that in the Middle Ages, women put iron caps on the cervix, lubricated it with a solution of mercury and lead, and inserted pessaries made of steel wire into it and caused infection and bedsores of the reproductive organs. At different times and in different countries, contraceptives were repeatedly banned either by the authorities or by the church, so devices such as a vaginal syringe or vaginal douche periodically appeared on the market, which were used to cleanse the internal female organs.

Current contraceptives promote the principle of safety and guaranteed protection against unwanted pregnancy. Three types of contraceptives are justified and approved by official medicine: physiological, barrier and drug.

• Barrier. Prevent sperm from entering the uterus. The most famous barrier contraceptive is the condom (both male and female). Other barrier contraceptives are intrauterine devices, contraceptive sponges, cervical caps, and spermicides.
• Physiological. Assume sexual intercourse on certain days of the female cycle, when the risk of becoming pregnant is minimal. Another method of physiological control is the method of PPA (coitus interruptus).
• Medical. Presented by pills, as well as vaginal rings and spirals that release hormones that block the onset of ovulation.

When prescribing a certain method of contraception to a woman, gynecologists often provide her with the opportunity to independently choose the appropriate remedy from a number of similar ones. But how to do this if the same drug has dozens of analogues that are identical in composition and mode of action? The rating of the best contraceptives takes into account the opinion of other women, the cost of drugs, the correspondence between the expected effect and the real one, as well as the presence of additional benefits and side effects.

Please note that the information below is not a buying guide. Consultation needed with a specialist!

There are contraindications. Check with your doctor.

The best birth control pills

It has long been proven that a prolonged absence of pregnancy can disrupt a woman's health, provoking hormonal failure, as well as mental and organ diseases associated with it. The Frenchman Verne Bullo, a historian by profession, said this back in the 19th century: "If a woman is not regularly pregnant, she will suffer from hysteria and from a whole category of somatic symptoms that stimulate almost any kind of physical illness or mental condition." At the same time, unwanted pregnancy and abortion can cause no less harm to a woman than a prolonged absence of pregnancy.

Hormonal contraceptives are chosen by millions of women around the world as the preferred method of contraception. They do not affect the sensations during intercourse and are guaranteed to protect against unwanted pregnancy and the consequences of its absence. The action of hormonal contraceptives is based on the prevention of ovulation. Scientists have calculated that at the time of birth, the girl's ovaries contain about 1 million follicles that can become eggs, and by the age of 37 there are only 25,000 of them. Hormonal drugs do not allow the body to ovulate, so the woman's ovarian reserve remains full. Meanwhile, hormonal pills have not only advantages, but also an impressive list of side effects, often life-threatening.

3 Lactinet

The best contraceptive for adult women
Country: Hungary
Average price: 675 rubles.
Rating (2018): 4.6

Unlike Jess and Marvelon, Lactinet contains the only active ingredient - desogestrel. Belongs to the category of mini-pills (drugs containing a minimum amount of hormones). Lactinet mini-pills are often prescribed for lactating women with an active menstrual cycle, as well as for those women who are contraindicated in combined OK. Lactinet is one of the few oral contraceptives prescribed for women who smoke, as well as women over 45 years of age.

Another feature of the Hungarian OK is that its protective effect against unwanted pregnancy is somewhat lower than that of modern COCs. For this reason, the drug is not recommended for use by women in active reproductive age (up to 30 years). Otherwise, this is a fairly effective contraceptive that has a smaller list of contraindications and side effects than modern pills.

Advantages:

• allowed during lactation;
• does not affect weight gain;
• suitable for those who are intolerant to synthetic estrogens.

Flaws:

• provokes the occurrence of mastopathy;
• violates the menstrual cycle during the reception;
• causes depression;
• causes nausea at the beginning of the course.

2 Marvelon

The cheapest tool
Country: Netherlands
Average price: 1,425 rubles.
Rating (2018): 4.8

Combined contraceptive drug from the Dutch company Organon. Approved for use by women over 35 years of age, as it contains a reduced amount of active ingredients. In addition to the contraceptive effect, it normalizes the volume of secretions and eliminates pain during menstruation. It can be used as a means of emergency contraception, but not more than 1 time in 6 months. The effectiveness of Marvelon as a postcoital agent does not exceed 80%.

According to women who took Marvelon, the drug has a negative effect on the ability to get pregnant if it has been used for many years, so it is recommended to drink these pills in courses. Given the increased risk of thrombosis, it is recommended to be examined by a hematologist, hepatologist and vascular surgeon before taking the drug.

Advantages:

• is inexpensive;
• normalizes the cycle;
• increases libido.

Flaws:

• causes acne;
• thickens the blood;
• increases appetite.

1 Jess

The best birth control pills
Country: Germany
Average price: 922 rubles.
Rating (2018): 4.9

Jess is a combined oral contraceptive from the German pharmaceutical company Bayer. The active ingredients are drospirenone and ethinylestradiol. It is used to protect against unwanted pregnancy, with severe forms of PMS, as well as for the treatment of acne. The contraceptive effect of the pills is based on blocking ovulation and changing the quality of cervical mucus, which becomes too thick for sperm to move.

Unlike other COCs with the same active ingredient, the Jess formula has been improved: it uses the latest (4th) generation drospirone, and each tablet contains 1.5 times less ethinylestradiol than other COCs. For this reason, Jess is less likely than other drugs to cause swelling, mastopathy and weight gain.

Advantages:

• eliminates menstrual pain;
• improves skin condition.

Flaws:

• the cycle is restored for a long time after the completion of the Jess course;
• addictive;
• reduces libido;
• causes migraines.

The best birth control candles

Contraceptive suppositories belong to the category of spermicidal contraceptives. The principle of action of chemical spermicides is to destroy the membrane of spermatozoa: interacting with spermatozoa, the components of the drug destroy their membrane, separate the head from the tail, depriving them of the ability to move. Especially strong spermatozoa, however, are still able to get to the egg and fertilize it. This can be fraught with the birth of a child with certain physical deformities. Such a relationship has not been proven, but many women testify to this. It is not recommended to use such contraceptives regularly, because the acids contained in the candles can have a negative effect on the condition of the mucous membrane in the vagina, as well as on the cervix. Candles are not distinguished by the highest contraceptive ability. According to statistics, 15 out of 100 women who use birth control candles become pregnant within a year.

Thus, contraceptive suppositories are a convenient contraceptive option for women who have infrequent sex. Candles are ideal as an additional contraceptive - when the pill regimen has been violated or during the completion of lactation. The undoubted advantages of this method of contraception are the absence of a systemic effect on the body and the safety of intimate sensations.

3 Gynecotex

The best cost contraceptive candles
Country Russia
Average price: 140 rubles
Rating (2018): 4.7

Gynecotex suppositories use the same active ingredient as Pharmatex suppositories - benzalkonium chloride, so these products are similar. The fundamental difference between Gynekotex and Pharmatex is in cost: Russian candles are about 3 times cheaper than German ones. Some women note that these suppositories dissolve somewhat worse in the vagina and give more foam.

Advantages:

• are inexpensive;
• do not cause burning;
• protect against infections.

Flaws:

• dissolve for a long time.

2 Patentex Oval

Most popular remedy
Country: Germany
Average price: 370 rubles.
Rating (2018): 4.5

The main active ingredient in Pantex Oval is nonoxynol. Included in many contraceptives as a lubricant: thanks to its spermicidal properties, it enhances the contraceptive effect of cervical caps, condoms, sponges and vaginal films. When interacting with a sperm cell, it damages its membrane, thereby depriving it of the ability to dissolve the egg cell membrane. The time required for the destruction of the spermatozoon is 40 seconds (10 times more than that of Pharmatex). The drug does not have bactericidal and antiviral properties, therefore it cannot be used as protection against STIs. There are studies proving that nonoxynol contributes to human morbidity with certain types of human papillomavirus.

Advantages:

• effective;
• quickly dissolve;
• have a stimulating effect.

Flaws:

• have an unpleasant odor;
• cause itching;
• foam excessively.

1 Pharmatex

The best birth control candles
Country: France
Average price: 349 rubles.
Rating (2018): 4.8

The main component of the drug is benzalkonium chloride. This drug has been used in medicine since 1935. It has not only a contraceptive effect, but also antiviral (protects against infection with herpes simplex viruses), antifungal and antiprotozoal. The substance has an instant effect on the sperm: its shell is completely destroyed within 10 seconds after contact with benzalkonium chloride. The rest of the drugs in this group require at least 30 seconds. Due to irritation of the mucous membrane of the vagina and cervix, the drug is able to increase the amount of secreted mucus, which has an additional contraceptive effect.

Advantages:

• have a pleasant smell;
• dissolve in 5 minutes;
• protect against infections.

Flaws:

• cause irritation;
• poorly open;
• provoking too much mucus.

The best intrauterine contraceptive coils

The intrauterine device is a contraceptive well known since ancient China. In the past, coils were made from aluminum wire and wood, but today they are made from hypoallergenic plastic impregnated with anti-inflammatory compounds. According to its action, the spiral refers to barrier, abortive and spermicidal agents at the same time.

• Decreased fertility. The presence of an inflammatory process in the uterus contributes to the production of proteins that inhibit the maturation of the egg. As a result, ovulation is inhibited and fertilization does not occur.
• abortive effect. Located inside the uterus, the spiral negatively affects the endometrium, inhibiting its growth and ability to accept a fertilized egg. In fact, the spiral provokes a miscarriage in the early stages of pregnancy.
• spermicidal effect. In response to the located spiral, superficial inflammation occurs inside the uterus. As a result of inflammation, the alkaline environment in the uterus is replaced by an acidic environment that is detrimental to spermatozoa and contributes to their destruction. To increase the acidity of the intrauterine space, copper is additionally used in the spirals, which stimulates the release of an acid secret.
• Barrier contraceptive effect. The inflammatory process causes irritation of the cervical canal, which, in turn, produces an increased amount of thick cervical mucus that prevents sperm from entering the uterus.

Intrauterine devices (IUDs) are a reliable and effective way to prevent unwanted pregnancy, which, however, is associated with the creation of a focus of chronic infection in the body.

3 Spiral Nova T

The most affordable non-hormonal spiral
Country: Germany (made in Finland)
Average price: 800 rubles.
Rating (2018): 4.6

Nova T is a non-hormonal coil shaped like the letter T. Its base is made of hypoallergenic plastic, which is wrapped with copper wire. Barium sulfate has been added to the plastic in order to enhance the radiotransmittance - it allows you to determine the position of the helix during an x-ray examination, if necessary.

Advantages:

• not felt by partners during sex;
• has an affordable price.

Flaws:

• provokes copious discharge during menstruation;
• increases pain during menstruation;
• reduces sex drive.

2 Mirena

The best hormonal spiral
Country: Finland
Average price: 11500 rubles.
Rating (2018): 4.7

Mirena belongs to the category of hormone-containing spirals, therefore, the principle of its action is similar to that of hormonal pills. The fundamental difference is only in the way hormones are delivered to the body. True, according to some women, the hormonal spiral, unlike OK, does not cause increased appetite, does not provoke swelling and does not cause irritation of the digestive system. Like Multiload, Mirena is installed for 5 years.

Advantages:

• normalizes the hormonal background;
• inexpensive hormonal contraceptive;
• reliably protects against pregnancy.

Flaws:

• requires large one-time costs;
• causes back pain
• contraindicated in the presence of benign tumors.

1 Multiload

The best intrauterine device
Country: Ireland
Average price: 2800 rubles.
Rating (2018): 4.8

Multiload is a spiral made of plastic and copper. It looks like a rounded T with uneven surfaces that prevent the spiral from slipping out of the uterus. Aseptic inflammation in the uterus is provoked by a copper wire wrapped around a plastic carrier. Interacting with an alkaline environment, copper wire releases about 30 micrograms of copper oxide daily. The contraceptive effect of Multiload lasts for 5 years.

Advantages:

• reliably protects against pregnancy;
• economical;
• does not fall out.

Flaws:

• provokes inflammation;
• increases the duration of menstruation;
• causes discomfort after installation.

The best barrier contraceptives

Barrier contraception is the oldest, cheapest, most versatile and common method of contraception. A typical representative of this category is the condom. Less well known are contraceptive sponges and rings, cervical caps, vaginal films and diaphragms, as well as chemical barrier agents (candles, aerosols, gels). There are practically no contraindications to the use of these drugs, so they are ideal for those who have intolerance to OK or IUDs. Some of the barrier contraceptives are able to prevent premature ejaculation in men, protect against STIs and allergic reactions to ejaculate in women. The main disadvantage of barrier agents is that they only work when they are used. Our rating includes the best barrier contraceptives - the Nuvaring ring and Pharmatex sponges.

2 Contraceptive sponges Pharmatex

The best spermicide
Country: France
Average price: 65 rubles.
Rating (2018): 4.7

Contraceptive sponges have been used by women for many centuries as a barrier method: in ancient times they were sea sponges soaked in oils, and today they are polyurethane foam soaked in chemical spermicidal compounds. Pharmatex sponges use benzalkonium chloride as a spermicide. Unlike contraceptive suppositories, the sponge has not only a spermicidal effect, but also a mechanical one - it physically prevents the penetration of spermatozoa into the cervix. After installing the sponge, the partners can immediately begin the PA, and in the case of repeated sexual intercourse, they do not need to insert a new sponge into the vagina, as it retains its effect during the day.

Advantages:

• does not flow;
• convenient to enter;
• long-term;
• has a pleasant smell.

Flaws:

• inconveniently removed;
• hard to find in pharmacies.

1 Contraceptive ring Novaring

The best hormonal contraceptive
Country: Netherlands
Average price: 1050 rubles.
Rating (2018): 4.8

Novaring is one of the methods of hormonal contraception, which, however, uses a fundamentally different method of administering hormones - vaginal. Due to this, the hormone does not pass through the liver and organs of the gastrointestinal tract, therefore it does not have a negative effect on them. The ring releases the minimum required amount of the hormone throughout the day, which eliminates hormonal surges during the day (as is the case with oral contraceptives) and creates an even hormonal background. Another advantage of the tool is the confidentiality of its use: the ring is easy to install on your own, it is not felt during intercourse and does not require removal after. Duration of action - 3 weeks. After 21 days, the ring is removed, and after 7 days it is installed again.

Advantages:

• set once a month;
• does not cause nausea;
• has less pronounced side effects compared to OK.

Flaws:

• sometimes falls out when straining;
• causes headache;
• provokes the development of vaginitis;
• allergic;
• enhances appetite.

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

Combined oral contraceptives (COCs)

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

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

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

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

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

Combined oral contraceptives (COCs) list: types and names

Mechanism of action

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

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

Advantages

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

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

Flaws

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

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

Contraindications for the use of combined oral contraceptives

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

COCs and breast cancer

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

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

Transdermal Therapeutic System (TTS)

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

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

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

vaginal ring

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

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

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

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

Subtleties of application

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

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

List of sources

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