The latest birth control pills: freedom of choice. Hormonal and non-hormonal, used after the act. Which of them is better to use? Is it possible to take birth control pills constantly, for more than a year? Pharmacological effect of hormonal pills

Unwanted pregnancy is what worries many women the most. Everyone knows that abortion is injurious to health, and that is why prevention is the most topical issue. Gynecologists, in turn, are ringing the bells, because taking some of the new generation of contraceptives, unplanned pregnancies still end in abortions.

Medicine and pharmacology do not stand still. Developing and improving new modern drugs preventing pregnancy. This allows you to reduce the number of abortions and the consequences after them. Now there are not only hormonal pills, but also a whole group of topical preparations.

How do modern contraceptives work?

Vaginal contraceptives work very simply - getting into the body, Chemical substance kills sperm. Oral contraceptives prevent the development of eggs in the ovaries. They affect the uterine mucus, make it viscous and impassable for spermatozoa. Birth control pills inhibit or completely prevent the attachment of the embryo to the cervix. All this does not allow pregnancy to occur.

Topical preparations, such as suppositories, are a local and chemical method of contraception. They contain nanoxinalon or benzalkonium in their composition. Exactly these active substances affect the spermatozoa and make them immobile by violating the integrity of the membrane.

The vaginal ring is one of the methods of contraception, belongs to the group of hormonal drugs. It is made of elastic material, which contains a small dose of progesterone and estrogen. The dosage is such that the release of a mature egg is prevented. There are other contraceptives of high efficiency and safety.

Are modern contraceptives harmful?

If the contraceptive is not chosen correctly, it can harm the female body. For example, there will be side effects, weight will begin to gain, hairline will increase. This applies only to hormonal drugs that are contraindicated in diseases of cardio-vascular system, diabetes. Even with problems in the liver and kidneys, such drugs are contraindicated. Women who smoke need to choose other contraceptives, since hormonal drugs put a powerful strain on the heart. There is also an increased risk of thrombosis.

For medical reasons, if taken regularly long time hormonal drugs, then sexual activity gradually decreases. This is due to a decrease in testosterone production.

What are contraceptives?

Contraceptives are the most different types and forms: hormonal pills, intrauterine devices, condoms, topical preparations, injections.

"Jess" is a popular new generation of contraceptives. It's not only birth control pills, but also a drug that treats some disorders in the field of gynecology and hormone dependence. This remedy treats acne and other imperfections of the skin of the face. The contraceptive effect is achieved due to the estrogens and progestogens that make up the drug. They are the ones that stop ovulation.

"Jess" affects the state of health during menstruation. Its composition affects the reduction of anemia and pain symptoms. Menstruation is faster. Very often, gynecologists prescribe this remedy for severe symptoms PMS. The advantage of these tablets over similar drugs in a low concentration of active substances. The drug is prescribed to women aged before the onset of menopause.

"Jess plus" is an effective contraceptive. In addition to hormones that inhibit sperm patency and block ovulation, the drug contains folate (calcium levomefolate). This is a type of folic acid that is essential for a woman's normal health. B9 is rapidly absorbed into the bloodstream and affects the nervous system. This drug is unique in that, unlike all contraceptive drugs, it gives the biggest guarantee. In addition, the composition of the product protects a woman from all troubles if a pregnancy suddenly occurs. Her body will be prepared for this, and the active form of the drug will help eliminate shortcomings in the formation of the neural tube of the future fetus, that is, to exclude the development of a violation of the baby's nervous system. It is safe for women reproductive age. It can be used from the age of 18 until the onset of menopause.

"Marvelon" is a new generation of contraceptives after 35 years. Women who have already given birth and are of childbearing age should take low-dose hormonal drugs. Marvelon can also be taken by women who have not given birth. It has a low content of hormones. This drug belongs to the group of oral hormonal contraception. Designed for women who have an active sex life. The composition of the tablets provides high-quality and complete protection against pregnancy. Medical indicators– 99% protection. Marvelon is safe for health, easy to use, helps to eliminate the problems of women during menstruation. If a woman has a serious PMS syndrome, then gynecologists often resort to prescribing this remedy. The low-dose drug in its composition contains ethinylstradiol, gestodene, norhistimat. These hormones are great for women over 35, as they improve the condition of the skin of the face, normalize hormonal balance and reduce the growth of unwanted hair. The drug is recommended for women after 25 years and before menopause.

Depo-Provera is a new generation of contraceptives after 40 years. He appeared on the pharmacological market not so long ago. This is a synthetic means of progesterone hormones. Currently, the drug is prescribed to women for contraception, treatment of a number of gynecological pathologies and even oncological pathologies. Women over 40 can also take oral contraceptives, but doctors prefer special injections. Depo-Provera is a suspension containing medroxyprogesterone acetate. Once it is injected under the skin, it acts as a contraceptive and blocks ovulation. The injections are very effective, they are administered intramuscularly, it has a number of positive therapeutic effects. Belongs to a group safe means with minimal side effects. Recommended for use by women over 40 and before menopause.

Vaginal suppositories "Farmateks" are excellent contraceptives of a new generation after 45 years. Since it is very difficult to choose contraceptives for women at this age, as there are various difficulties, Pharmatex is a reliable and safe option.

By this age, a bouquet of acquired diseases is observed, and what could be taken in youth is not at all suitable for 45 years. Closer to the period of menopause, gynecologists prescribe barrier contraceptives to women. It could also be condoms. But for those who are sexually active, the only way not to get pregnant is to use vaginal suppositories. Pharmatex is such an effective remedy that it is compared with hormonal contraceptive ballet flats and with an intrauterine device. In addition to protecting against pregnancy, active ingredients protect a woman from various diseases, as they destroy pathogenic microflora. Candles are recommended to be used at the age of 45 and until the full onset of menopause.

"Patentex Oval" - modern contraceptive candles. It contains the chemical components nonoxynol and excipients that affect the decrease in the tension of the lipid membrane of spermatozoa. Once in the vagina, candles paralyze the ability to move sperm. A mechanical obstacle causes a spermatocidal substance, which, under the influence of body temperature, is distributed throughout the vagina. Thus, a stable barrier is formed. This prevents sperm from entering the cervix.

The drug provides good prophylaxis against various infections. These suppositories can be used at any reproductive age, including after 45 years.

Nuvaring is a modern contraceptive. This is a ring made from a smooth and elastic material; it contains hormonal components that affect the movement of spermatozoa and prevent them from moving into the uterus. The ring is inserted into the vagina. Since it is quite flexible, it accepts desired shape. This method of protection is convenient and safe. The ring does not interfere with leading a full life and having sexual intercourse. There is no discomfort. The ring contains estrogen and progestogen. The ring is valid for one menstrual cycle. An excellent and effective remedy that treats a number of gynecological diseases. It is prescribed for women aged 18 years and before the onset of menopause.

"Laktinet" is a contraceptive called mini-pill. Each tablet contains synthetic analogues of female hormones. Progestin and estrogen prevent the movement of sperm into the uterus. "Lactinent" is not more effective than combined contraceptives and has a number of contraindications, so these drugs should be prescribed only by gynecologists. Mini-pills are prescribed, as a rule, only for lactating women or when combined drugs are contraindicated. These drugs are also prescribed for women over 45 with varicose veins and diabetes. Suitable for women who smoke.

Contraceptive sponges are used more and more often. Some women do not want to be protected by contraceptives and help them escape from unwanted pregnancy barrier contraceptives. Contraceptive sponges do not allow sperm to enter the cervix due to a mechanical obstruction and the release of a special spermicidal substance.

Modern contraceptive sponges are made of soft polyurethane. The composition contains benzalkonium chloride, nonoxynol. They are very easy to use. They are prescribed to women at any reproductive age.

The most common method of protection against unwanted pregnancy is intrauterine contraception. The material used is polyethylene, which contains barium sulfate. Modern spirals differ in their shape from those used 10 years ago. The spiral contains a sputtering (copper or silver). The most commonly used T-shaped form of the intrauterine device.

This method of preventing unwanted pregnancy is not new, but, nevertheless, some forms and types of contraceptives belong to the new generation. Some coils contain progestogen or antibiotics. Inserted deep into the cervix.

Women who are of the progesterone type, that is, have an angular figure, small breasts, who have skin problems and are accompanied by menstruation painful symptoms should give preference to drugs with an antiandrogenic effect. These are: "Jess", "Jess plus", "Yarina", etc.

If a woman has normal skin, menstruation is painless, then you can choose Mercilon, Regulon, Femoden and others.

It is also important to know that hormonal drugs are addictive, so you should take a break, otherwise side effects may appear.

The latest birth control pills: freedom of choice. Hormonal and non-hormonal, used after the act. Which of them is better to use?

Thanks

Key priorities modern medicine- concern for conservation reproductive health women, protection and ensuring safe motherhood. It is no secret that Russia is in one of the first places in terms of the number of abortions. Abortion is a real operation that often results in infertility, menstrual irregularities, miscarriages, and even maternal death. The following conclusion can be drawn - measures to prevent abortions can help maintain a woman's health and give birth to a healthy child.

No wonder they say that children are the flowers of life. But each flower opens only at a certain time by nature. A woman has the right to give birth to a child whenever she wants, at any time in her life, so that the child is desired and happy. This fact is confirmed by law.

For the prevention of unwanted pregnancy and the prevention of abortions at a certain stage in a woman's life, an important role is played by contraception.

Contraception has been used by women since ancient times. So, even in ancient Africa, intravaginal herbal remedies in the form of a cocoon, and in America they used douching with decoctions of herbs, lemon juice, decoction of mahogany bark after sexual intercourse.

Quantity contraceptives increased over time, but effective methods and reliable drugs appeared only in the 20th century.

New contraceptives appear almost every day. Science does not stand still. They are easy to use, reliable, safe for health, moreover, they have a therapeutic effect in certain diseases.

Currently, medicine offers various contraceptives, and a woman can always choose which methods and drugs to use. In our country, freedom of choice of contraceptives is ensured, but a woman cannot always decide on her own what is best for her. In deciding on the choice of a contraceptive, a consultation with the attending physician will help - only a qualified specialist can assess the state of a woman's health, determine the indications for prescribing a particular method of contraception, and offer the best drug for the patient.

Hormonal oral contraceptives

The effectiveness of contraceptives is estimated by specialists by counting the number of unplanned pregnancies per 100 women during the year. This index is called the Pearl Index.

Types and composition of birth control pills

• New contraceptive pills began to contain small doses of hormones, while at the same time their effectiveness and reliability were maintained.
• New analogues of female sex hormones were obtained: ethanyl estradiol and levonorgestrel.
• Third-generation progestogens appeared - norgestimate, desogestrel, gestodene.
• The latest contraceptives have been developed - mini-pills that do not contain progestogen.

Combined contraceptives contain two components in their composition:
1. Synthetic estrogen ethinyl estradiol, which is the estrogenic component of the drugs.
2. Progestogen component in the form of various progestogens.

All contraceptive pills, depending on the dosage of hormones, are divided into the following types:

• monophasic;
• two-phase;
• three-phase.

Biphasic drugs involve changing doses of hormones twice per course, triphasic drugs - three times. Usually such tablets for one course have a different color. Biphasic contraceptives include Anteovin, three-phase contraceptives include Tri-merci, Triquilar, Tri-regol, Triziston.

Contraceptives "mini-drank" are monophasic, and are intended for the period of breastfeeding and lactation. These include: Lactinet, Exluton, Charozetta.

The action of combined oral contraceptives (COCs) is based on blocking ovulation. This way they protect against unplanned pregnancy. Only progestogen has the ability to block the ovulation process, the dose of which is the same in all combined birth control pills. The difference between micro-dose and low-dose drugs is only in the dosage of estrogen. Estrogens affect a woman's menstrual cycle.

Depending on the dosage of the active ingredients, contraceptive pills are divided into four types:

Microdosed birth control pills
As a rule, these funds contain minimum doses the hormone ethinylestradiol. Side effects when using them are minimal. In some cases, they have the ability to eliminate violations hormonal background: acne (especially in adolescence), painful menstruation. These pills are best suited for young girls under 25 who have not given birth and are sexually active on a regular basis. Also they can be used mature women older than 35 years, and women who have never used hormonal contraception. The most popular are: Tri-Merci, Jess, Mercilon, Lindinet -20, Klaira, Novinet.

Low dose birth control pills
The preparations contain the same ethinylestradiol, but in combination with various hormones: desogestrel, gestodene, norgestimate, dienogest or levonorgestrel. These birth control pills are recommended for young women who have given birth. In addition to the contraceptive effect, these funds have a pronounced antiandrogenic effect: they help eliminate unwanted facial hair growth, prevent the appearance of acne and hair loss due to hormonal imbalance. Popular tablets: Regulon, Belara, Marvelon, Yarina, Janine, Midiana, Femoden.

Medium dose birth control pills
As a rule, they contain two hormones: ethinylestradiol and levonorgestrel. Less commonly, they may contain other combinations of hormones. Medium-dose birth control pills are intended for women who have given birth, especially over 30 years of age. They also have an antiandrogenic effect, which is important for women who have not recovered from pregnancy and childbirth. However, when choosing a drug, one condition must be observed - these drugs are not suitable for nursing. Popular tablets: Diana 35, Demulen, Tri-regol, Chloe.

High dose birth control pills
They contain ethinylestradiol and levonorgestrel, but only in higher doses. These drugs are primarily used for the treatment and prevention hormonal diseases. Contraceptives of this type can be taken by women over 35 years of age, with the ineffectiveness of drugs with a low dosage of hormones. These include: Triquilar, Tri-regol, Ovidon, Milvane, Non-Ovlon.

The latest birth control pills: how to choose?

The choice of contraceptive is difficult, it should be approached seriously.

Ideally, a specialist should deal with the selection of contraceptives, but sometimes a woman herself decides which pills to take. In these cases, it is necessary to scrupulously collect information about the remedy. Where to start?
1. Familiarize yourself with the different types of contraceptives.
2. Compare all the pros and cons.
3. Define your goal - decide what you want to get as a result of using oral contraceptives.

What you need to know for right choice? Let's figure it out.

A woman should find information about drugs and their effects on the body. It should be borne in mind that birth control pills differ in parameters, degree of reliability and side effects.

Combined contraceptives usually contain two analogues of female sex hormones, so they are in the first place in terms of reliability. Combined oral agents are used both for protection against pregnancy and for the treatment of diseases and hormonal disorders. Women who opt for hormonal birth control pills are still advised to consult with their doctor and undergo a hormonal study.

New contraceptives are the so-called "mini-pill". They contain only one hormone - in this regard, the reliability of drugs is 90%. Their advantage is the possibility of use during lactation, as well as by women who have estrogen intolerance (which are part of COCs).

The next type of contraceptive pill is represented by means for emergency contraception. These tablets are not intended for long-term use and are used immediately after intercourse. The content of hormones in them is very high, so these funds can be used only once a month.

Currently, contraceptives of the second - fifth generations have appeared on the market. These newer drugs contain a small dose of hormones, have mild side effects. It should be understood that there are no good or bad contraceptives. There are remedies that are suitable or not suitable for a woman. Therefore, for the selection of contraceptives, the individual characteristics of the body of a particular woman should be taken into account.

With self-selection, it is necessary, first of all, to determine the phenotype - the body type of a woman.

There are the following types of female phenotype:
1. With a predominance of estrogen - estrogenic type.
2. With a balance of estrogens and progestogens - a balanced type.
3. With a predominance of gestagens and androgens - progestogen type.

The phenotype is determined by the following features: general appearance, volume and condition of the mammary glands, skin type, the nature of menstruation, the duration of the menstrual cycle, the presence of toxicosis during a previous pregnancy, the woman's body weight and a tendency to be overweight.

A balanced phenotype is characterized by average values ​​of these traits. In this case, it is recommended to take Marvelon, Triquilar, Microgynon, Triziston, Mercilon, Tri-merci, Regulon.

With the predominance of the estrogen phenotype, a very feminine appearance is characteristic, a very long menstrual cycle, very abundant menstruation and vaginal discharge, moderate fullness. It is advisable to take drugs such as Anteovin, Minulet, Norinil, Rigevidon, Minisiston.

With the predominance of the progestogen phenotype, all signs are less pronounced: unfeminine appearance, small volume of mammary glands, scanty menstruation, short menstrual cycle, oily skin. The following remedies are effective Bisecurin, Chloe, Non-ovlon, Yarina, Ovidon, Jess, Jeanine, Claira, Diana, Midian, Belara.

No matter how carefully the choice is made, it still happens that the drug is not suitable. The ideal selection method has not yet been invented. Often you have to act by "trial and error", but sometimes this is inevitable, because the body of each woman is unique.

It has been proven that the criterion for a successful choice of a contraceptive is the absence of menstruation for three months - i.e. period of adaptation. Then this drug can be taken for a long time.

Non-hormonal contraceptive pills

The fact is that the use of non-hormonal birth control pills is not contraindicated for women immediately after childbirth, nursing mothers, as well as women who cannot take hormones. And another important detail: non-hormonal means to prevent pregnancy not only have the ability to destroy spermatozoa, but also contribute to the formation of a protective film on the vaginal mucosa, and thickening of mucus in the cervical canal. Moreover, active substances - spermicides - reduce the speed of spermatozoa, and the resulting mucus is a barrier to their penetration into the uterus. This is a good protection against unwanted pregnancy. Non-hormonal contraceptive pills, which is important in our time, protect a woman from sexually transmitted infections, as they have both antiseptic and antimicrobial effects.

It follows from this that non-hormonal contraceptives can be used by many women at different periods of life. The use of tablets refers to the barrier chemical method contraception. They are easy to use, do not disrupt the hormonal background, can be used at any reproductive age of a woman, and are the prevention of sexually transmitted diseases.

Contraceptive pills Pharmatex

In addition to the contraceptive effect, Pharmatex birth control pills prevent the transmission of sexual infections, reduce the risk of their consequences: infertility, miscarriage, cervical disease, tumors caused by HIV infection.

A huge advantage of using Pharmatex is that it in no way affects either the hormonal background or the vaginal microflora.

Pharmatex, like other non-hormonal tablets, affects such types of microorganisms as Trichomonas, gonococci, chlamydia, Candida fungi, herpes virus. Pharmatex acts locally, which does not give side effects on the organs and systems of the whole organism.

The use of vaginal tablets is more suitable for women in postpartum period, during lactation and breastfeeding, after an abortion, with an irregular sexual life, when there is no permanent partner.

Mode of application
The manufacturer of funds, as a rule, attaches instructions for use. Mostly non-hormonal vaginal tablets are introduced into the vagina to a sufficient depth 10 minutes before sexual intercourse. For more convenient introduction of tablets and other dosage forms, in the package medicinal product includes a special applicator.

It is necessary to know that before each subsequent sexual intercourse, and in the case of sexual intercourse that occurred later than two hours after the administration of the pill, it is necessary to introduce a new tablet. Of course, to a certain extent this is inconvenient, since a woman cannot afford without reintroduction pills after casual or unexpected sex. She needs to plan the time of intercourse, which is unnatural.

It is believed that the effect of the drug lasts from 40 minutes to several hours. But it must be remembered that the use of vaginal tablets is not combined with water procedures before and after sexual contact using intimate hygiene products.

In some women, the drug may cause a burning sensation in the vagina. In this case, you should consult with your doctor about continuing or canceling Pharmatex. The reliability of Pharmatex is 80-82%.

Contraceptive suppositories and creams

In addition to tablets, manufacturers suggest using other dosage forms: suppositories, creams, ointments. The active substance in the suppositories is either nonoxynol or benzalkonium chloride.

Pharmatex is also available in various forms: in the form of vaginal suppositories, tampons, cream, capsules.

Benefits of using contraceptive suppositories
Contraceptive suppositories are easy to use, easy to insert into the vagina, and have minor side effects. Another advantage in the use of non-hormonal vaginal suppositories is the effect of additional lubrication. They are especially suitable for partners who have problems with natural lubrication and dryness in the genitals.

Vaginal suppositories protect a woman from sexually transmitted infections, are indispensable for casual sexual intercourse, with infrequent sexual intercourse, in the absence of a permanent partner.
Disadvantages in the use of contraceptive suppositories
Vaginal contraceptive suppositories can affect the microflora of the vagina, since in their composition, in addition to the active substance, they have acids. Burning and itching, allergic rashes that occur when using candles, are an indication for their cancellation.

Dosing
Candles are vaginal. The candle is inserted into the vagina 10 minutes before sexual intercourse. The drug works for 4 hours.

Tampon vaginal. The tampon is taken out of the package, with the help of a finger, it is inserted into the vagina, up to the cervix. The protection effect is immediate and lasts 24 hours. The tampon does not need to be changed during this period, which is very convenient. The tampon does not change even if there are several sexual intercourses that follow each other during the day. The tampon is removed no earlier than 2 hours after the last sexual intercourse, but no later than 24 hours after its first insertion into the vagina.

Cream vaginal. It is inserted into the vagina with a special syringe. The device should be filled to the mark without the formation of air bubbles. Then slowly insert into the vagina before intercourse. The introduction is made lying down. The action of the remedy begins immediately, and lasts about 10 hours. Before repeated sexual contact, it is necessary to introduce a portion of the cream again.

Popular drugs: Pharmatex, Nonoxynol, Patentex Oval, Contraceptin T.

Birth control pills after intercourse

Sometimes this method is simply called: emergency, fire, emergency contraception, contraception the next morning after. But still, it is correct to call it emergency, since this method is used in emergency situations.

Emergency contraception aims to prevent pregnancy at the following stages: ovulation, fertilization and fixation of a fertilized egg in the endometrium (the inner layer of the uterine lining).

• in emergencies associated with violent actions by a partner, as well as in violation of the integrity of the condom or skipping the birth control pill for a woman;
• with rare sexual contact;
• at unprotected sex when no contraceptive methods were used.

• thrombosis and thromboembolism (even in history);
• liver disease with a high degree of insufficiency;
• kidney disease;
• oncological diseases.

Estrogens for emergency contraception in recent times are not used so often, because they contain high doses of hormones, which leads to side effects - nausea and vomiting.

Combined birth control pills are used within 72 hours after sexual intercourse, twice, with a break of 12 hours. You can use any drug from this group.

The most well-known drug for emergency contraception in Russia is Postinor. It is recommended to take it twice, one tablet at a time. The first tablet is taken no later than 72 hours after sexual intercourse, the second - 12 hours after the first.

The second drug for emergency contraception - Escapelle - is taken once within 96 hours after sexual intercourse.

Combined oral contraceptives are taken daily for 21 days. Then a break of 7 days is made, and the reception begins next package drug. The course begins with an active tablet.

"Mini-drank" are taken without interruption. Immediately after the end of the package, the reception of the next one begins.

Reception break

Menstruation while taking

If the intake of contraceptives was regular, without gaps and breaks, but the menstruation stopped, then it is necessary to continue taking them.

But if the reception was irregular, it is worth suspecting the onset of pregnancy, urgently stop using the contraceptive and contact a gynecologist to identify it.

Menstruation after cancellation

Bleeding on admission

When heavy bleeding you need to consult a doctor.

Can you get pregnant while taking birth control pills?

Another situation is that a woman vomits when taking it. Then you need to take the next pill, because the first one has not been absorbed. With repeated vomiting, it is better to switch to another type of drug. The same actions should be taken with loose stools.

The reliability of contraceptive contraceptives may decrease when taking other drugs - for example, antibiotics, St. John's wort, etc. In this case, the use of an additional method of contraception is recommended.

How long can the tablets be taken?

According to scientists, fifth-generation contraceptives have already appeared in Russia, which have a slight side effect. But the number of questions is not decreasing.

Is it possible to take birth control pills constantly, for more than a year?

Pregnancy after stopping birth control pills

Can you stop taking birth control pills?

Which is better: birth control pills or a spiral?

The best birth control pills

Jess

This tool belongs to the fourth generation of contraceptives.

It is recommended to use the drug for a long time. The package contains 28 tablets. Take the tablets daily, preferably at the same time. They begin to take Jess on the first day of menstrual bleeding, then drink continuously.

Jess is a novelty in medicine. The popularity of the drug is growing. Jess provides reliable protection, controls the menstrual cycle, is used to treat symptoms of premenstrual syndrome, acne, has a beneficial effect on hair, nails. At the same time, the weight of women using Jess remains stable. The period of adaptation to the contraceptive is 1-2 months.

No wonder the drug Jess is called the contraceptive of the twenty-first century.

Novinet

The drug has minimal side effects, does not cause pain during menstruation, does not affect the weight gain of a woman.

When taking Novinet, nausea, rarely vomiting, partial hair loss, headaches may occur.

Novinet take 1 tablet daily for 21 days. Break - 7 days, on the eighth day they start a new package.

Breastfeeding women can start taking the drug three weeks after giving birth. It should be remembered that Novinet dramatically increases the amount of breast milk.

Reviews about Novinet are mostly positive.

Janine

The active substances are dienogest and ethinylestradiol.

Janine take 1 tablet daily for three weeks. Then they take a break for a week, after which the course is repeated.

Reviews of Janine prove a really pronounced contraceptive effect.

Regulon

Regulon helps with menstrual disorders, uterine bleeding.

Reviews about Regulon
Women who took this drug, note the quality of the drug and its reliability. Regulon acts much softer than other drugs. It was often recommended by doctors for use by teenagers and young girls. At long-term use does not cause side effects, reliably protects against unwanted pregnancy and does not contribute to weight gain.

Women who used it in medicinal purposes. The drug helps with uterine bleeding, abundant vaginal discharge, improves the quality and appearance of hair, nails and skin.

Yarina

The drug is well tolerated and has few side effects. During the reception, the woman's weight remains unchanged, there is no nausea and vomiting, a therapeutic effect is expressed - a decrease in premenstrual symptoms, symptoms of seborrhea, acne.

Women taking Yarina noted the high reliability of the drug, as well as an improvement in mood, restoration of libido, and normalization of the menstrual cycle.

The minimum cost of a monthly drug intake in Russia ranges from 600 rubles.

Logest

The action of the drug is based on the inhibition of ovulation, an increase in the viscosity of the secret, which makes it difficult for the movement of spermatozoa and prevents the implantation of the egg in the uterus.

The tablets are taken on the first day of the menstrual cycle. Take 1 tablet daily for 21 days. Then they take a week break, after which the course is repeated.

With the abolition of the drug, the body's ability to conceive is fully restored.

The price of the drug ranges from 330 to 450 rubles per pack.

claira

Qlaira refers to natural oral contraceptives. For the first time, ethinylestradiol as an active substance was not included in the combined hormonal preparation for contraception. It has been successfully replaced by the milder and safer hormone estradiolavalerate, which is a hormone with a natural formula. This hormone is well studied, and is used mainly to treat the symptoms of menopause.

To enhance contraceptive functions, scientists added the active substance dienogest to estradiol valeriate, which also solved the problem of intermenstrual bleeding.

The procedure for taking the drug has also been changed. It has a unique dynamic dosing mode. Qlaira is a four-phase hormonal drug. The package contains two placebo tablets, that is, they do not contain the active ingredient, and 26 active tablets with different doses active substance. The doses of estrogen when taken are gradually reduced, and the doses of progestogen are increased. This dosing regimen increases the effectiveness of the drug several times.

At the present stage of development of contraception, Qlaira is revolutionary, providing a high degree of protection and treatment of women's diseases.

Despite a very large selection of contraceptive pills, in our country remains high percentage abortions. Women do not have sufficient information about drugs, experience panic fear before using hormonal agents, not allowing the idea that safe and reliable contraceptives have appeared at the present stage. A new generation of contraceptive pills, containing lower doses of active substances, can help women plan pregnancy without being at risk of complications and abortions.

Text: Anastasia Travkina

The use of hormonal contraception, of course, it is already difficult to surprise someone, but it is easy to get lost in the myths that surround this topic. In the US, up to 45% of women aged 15–44 prefer hormonal contraception, while in Russia only 9.5% of women have ever used it. With the help of gynecologist-endocrinologist Valentina Yavnyuk, we figured out how it works, what healing properties it has, whether it poses a danger to a woman's health, and what feminism has to do with it.

What is hormonal contraception

Distinctive feature modern world- a large-scale movement to liberate the individual from various cultural, religious and social stereotypes. A significant part of this process is related to the acquisition of reproductive freedom by women. This means that a woman is given back the right to control her own body: to live a sexual life that suits her, and to make her own decision about her readiness to become pregnant or terminate an unwanted pregnancy. In many ways, it was the emergence and development of hormonal contraception that allowed women to take control of their bodies.

Hormonal contraception is a method of preventing unwanted pregnancy that a woman can fully regulate on her own. At the same time, its effectiveness is higher than all other options for protection - subject to the rules of use, of course. So, possible pregnancy becomes something that partners can consciously choose. True, such contraceptives do not protect against genital infections - here the only way save yourself a condom.

All hormonal contraceptives work in general on the same principle: they suppress ovulation and / or prevent the egg from attaching to the surface of the uterine mucosa. This is due to the fact that the body constantly receives a small amount of synthetic sex hormones. Suppression of ovulation puts the ovaries into an artificially controlled "sleep": they decrease in size and the follicles stop releasing eggs for nothing.

How hormones work

Hormones are substances that actively influence all functions of the human body. Yes, in most cases they improve the quality of skin and hair, stabilize weight, and have many non-contraceptive benefits. Nevertheless, in no case should you take hormones on your own, without consulting a doctor. In addition, these drugs should not be prescribed by a cosmetologist or gynecologist without a referral to a consultation with a gynecologist-endocrinologist.

Sex hormones are biologically active substances in our body responsible for the development of male or female sexual characteristics. We have two types of them: estrogens are produced by the ovaries and from the onset of puberty form the female characteristics of the body, are responsible for libido and menstruation. Progestogens are produced by the corpus luteum of the ovaries and the adrenal cortex and provide the possibility of conception and continuation of pregnancy, which is why they are called “pregnancy hormones”.

It is these two types of hormones that provide our monthly cycle, during which the egg matures in the ovary, ovulation occurs (when the egg leaves the ovary) and the uterus prepares for gestation. If fertilization does not occur, then after ovulation, the egg dies, and the endometrium, that is, the mucous membrane of the uterus, begins to be shed, which leads to the onset of menstruation. Despite the opinion that menstruation is a “broken egg”, in fact, bleeding is precisely the rejection of the mucosa. It does indeed release an unfertilized egg, but it is too small to see.

Primary estrogen female body- the hormone estradiol, produced in the ovaries. A high concentration of estradiol in the blood in the middle of the cycle leads to the fact that the pituitary gland actively “turns on” in the brain. The pituitary gland triggers ovulation and the production of the main progestogen - progesterone - in case of pregnancy. Hormonal contraceptives work like this: they suppress the ovulatory activity of the pituitary gland, which controls all this complex process "from above", and maintain a stable level of the pregnancy hormone progesterone. Thus, the pituitary gland rests from reproductive worries, and the female body experiences a state of the so-called false pregnancy: there are no monthly fluctuations in hormones, the eggs calmly “sleep” in the ovary, so fertilization becomes impossible.

There is another type of hormonal drugs. Gestagens in their composition change the quantity and quality of vaginal mucus, increasing its viscosity. So it becomes more difficult for spermatozoa to get into the uterus, and the changed thickness and quality of its coating excludes egg implantation and reduces the mobility of the fallopian tubes.

How to start using hormonal contraceptives

You can take hormonal contraceptives from late puberty, when it is established monthly cycle(on average from 16–18 years old), and until the cessation of menstruation and the onset of menopause. In the absence of complaints and with regular preventive diagnostics, women are advised to take a break in taking hormones only if necessary to become pregnant, during pregnancy and lactation. If there are no contraindications, hormonal contraception can be taken the rest of the time.

Remember that a gynecologist-endocrinologist must carefully collect information about the state of your body in order to effective selection drug and avoid unnecessary risks. This information includes a history - collecting information about thromboembolic disease, diabetes, hyperandrogenism and other diseases in your family - and examination. The examination should include a general gynecological examination, examination of the mammary glands, measurement blood pressure, taking a smear from the cervix, donating blood for clotting and sugar, and assessing risk factors based on the results.

What are the types of hormonal contraception?

There are several types of hormonal contraception: they differ in the method of use, regularity, composition and dosage of hormones. Oral contraceptives are one of the most popular. For example, in the United States it accounts for about 23% of all methods of contraception. These are tablets that are taken every day with a break, depending on the properties of a particular drug. There are two types of tablets in composition: mini-pills contain only synthetic progestogen (they can be used by nursing mothers), and combined oral contraceptives (COCs) contain synthetic estrogen and one of the types of synthetic progestogens - depending on the indications and the condition of the body, you may need certain substances.

Oral contraceptives have the lowest dosages of hormones with high protection against unwanted pregnancy. Recently, a natural analogue of estrogen, estradiol valerate, has been found. The drug based on it has the lowest concentration of the hormone to date, while maintaining contraceptive effect. The only disadvantage of the tablets is the need to take them every day at the same time. If this condition seems difficult, then it is worth choosing a method that requires less care, since violation of the rules of admission leads to an increased risk of pregnancy and possible complications.

The lifestyle of a modern woman often not only does not imply a permanent pregnancy, but also requires her to withstand a large social load.

Mechanical contraceptives are placed on or under the skin, or inside the vagina or uterus. They constantly release a small concentration of hormones, and they need to be changed periodically. The patch is fixed on any part of the body and is changed once a week. The ring is made of elastic transparent material and is inserted into the vagina for a month, almost like a tampon. There is also a hormonal intrauterine system or a spiral, which is inserted only by a doctor - but it lasts up to five years. Hormonal implants are installed under the skin - and they can also work out for almost five years.

There are also hormonal injections, which are also administered for a long time, but in Russia they are practically not used: they are mainly popular in poor countries, where women do not have access to other methods - injections are highly effective and not too expensive. The disadvantage of this method is that it cannot be canceled: the patch can be removed, the ring removed, the spiral removed, and the pills stopped drinking - but it is impossible to stop the effect of the injection. At the same time, implants and spirals are also inferior to rings, tablets and patches in terms of mobility, since they can only be removed with the help of a doctor.

What is treated with hormonal contraceptives

It is precisely due to the fact that hormonal contraceptives help stabilize the hormonal background of the female body, they have not only contraceptive, but also. that modern women suffer from an ecological-social reproductive dissonance - in other words, from a dramatic difference between the way we live and how our ancient biological mechanism works. The lifestyle of a modern woman often not only does not imply a permanent pregnancy, but also requires her to withstand a large social load. Since the advent of contraception, the number of monthly cycles of a woman in her life has increased significantly. Monthly hormonal changes are associated with more than just monthly risk of symptoms. premenstrual syndrome or dysphoric disorder, but also exhausts the forces of the body as a whole. These energetic resources a woman has the right to spend at her discretion on any other kind of constructive activity - and hormonal contraceptives help with this.

Due to the action described above, hormonal contraceptives treat the symptoms of premenstrual syndrome and are even able to cope with the manifestation of its more severe form - premenstrual dysphoric disorder. And due to combined estrogen-progestin contraceptives, endocrinologists correct hyperandrogenism - an excess of male hormones in a woman's body. This excess can lead to cycle disorders, infertility, heavy periods and their absence, obesity, psycho-emotional problems and others. severe conditions. Due to hyperandrogenism, we may be disturbed by other problems: hirsutism ( increased growth male pattern hair), acne (inflammation sebaceous glands, acne) and many cases of alopecia (hair loss). The effectiveness of COCs in the treatment of these diseases is quite high.

After consulting with your doctor, some pills can be taken in such a mode that even withdrawal bleeding will not occur.

Hormonal contraceptives treat abnormal uterine bleeding - this is a general term for any deviations of the menstrual cycle from the norm: change in frequency, irregularity, too heavy or too long bleeding, and so on. The causes of such failures and the severity of the condition may be different, but often hormonal contraceptives are prescribed as part of complex treatment. In the absence of contraindications, they will most likely choose a spiral: it daily releases a progestogen into the uterine cavity, which effectively causes changes in the lining of the uterus, due to which it corrects severe menstrual bleeding. The risk of developing ovarian cancer and cancer of the lining of the uterus with hormonal contraceptives is reduced, as the ovaries decrease in size and "rest", as during pregnancy. Moreover, the longer the reception lasts, the lower the risk.

Hormonal drugs are mainly designed to mimic the monthly cycle, so there is monthly withdrawal bleeding - "menstruation" against the background of a break between cycles of taking the drug for several days. Good news for those who can't stand their periods: with the advice of a doctor, some pills can be taken in such a way that there will be no bleeding.

Who should not take hormonal contraceptives

According to the WHO, there is an impressive list of contraindications that cannot be ignored. Combined contraceptives should not be taken by pregnant women, non-nursing mothers earlier than three weeks after childbirth and lactating mothers - earlier than six months after childbirth, smokers after thirty-five years of age, hypertensive patients with thromboembolic diseases or their risk, diabetics with vascular disorders or more than twenty years of experience, and also in breast cancer, gallbladder diseases, coronary disease heart or complications with the valvular apparatus, with hepatitis, liver tumors.

There are fewer restrictions on taking progestogen contraceptives. They should not be taken again by pregnant women, breastfeeding earlier than six weeks after childbirth, who have cancer mammary gland, hepatitis, tumors or cirrhosis of the liver. The combination of certain antibiotics, sleeping pills, anticonvulsants with hormonal contraception may also be undesirable: tell your doctor if you are taking other drugs.

Are hormonal contraceptives dangerous?

Hormones have an impact not only on the reproductive system, but on the whole organism as a whole: they change some metabolic processes. Therefore, there are contraindications for taking hormones based on possible side effects. Ever since the first and second generations of high-dose hormonal contraceptives, there have been many horror stories about weight gain, "hair growth", strokes, chemical addiction and other sad consequences of taking a high concentration of hormones. In new generations of products, the concentration of hormones is reduced tenfold and other substances are often used than before. This allows them to be used even for non-contraceptive medicinal purposes - therefore, it is incorrect to transfer stories about the first generations of drugs to them.

The most common side effect of hormonal contraception is increased blood clotting, which can lead to a risk of thromboembolic disease. At risk are women who smoke and women whose relatives had any thromboembolic complications. Since smoking itself increases the risk of thrombosis, most doctors will refuse to prescribe hormonal contraceptives to smokers after thirty-five years of age. The risk of thrombosis is usually higher in the first year of taking and in the first six months after hormone withdrawal, which is why, contrary to popular belief, frequent breaks in taking hormones should not be taken: it is not recommended to take them for less than a year and return to them earlier than after a year's break, so as not to damage your own health. health. Prevention of thrombosis, in addition to quitting smoking, is a mobile lifestyle, the consumption of a sufficient amount of fluid and an annual blood test for homocysteine ​​and a coagulogram.

Against the background of taking hormones, other types of intoxication can also give a negative effect: the use of alcohol and various psychoactive substances, including marijuana, psychedelics and amphetamines, can provoke problems with pressure, blood vessels of the heart and brain. If you are not going to cut back toxic substances while taking hormonal contraception, you should inform your endocrinologist about your habits in order to avoid unnecessary risks.

The risk of cervical cancer while taking contraceptives increases when a woman has human papillomavirus, chlamydia, or high risk contracting sexually transmitted infections - that is, neglect barrier contraception with unstable partners. The pregnancy hormone progesterone suppresses the immune response of the body, so women who fall into this risk group can take hormonal contraceptives, but it is necessary to undergo a cytological examination more often - in the absence of complaints, once every six months. There is no convincing evidence that modern contraceptives increase the risk of liver cancer, although the first generation of drugs had a bad effect on her health due to the high dosage. Many women are afraid that taking drugs will provoke breast cancer. Most studies have failed to establish a reliable link between the use of hormonal contraceptives and the occurrence of breast cancer. Statistics show that at risk are women with a history of breast cancer, with late menopause, childbirth after forty or who have not given birth. In the first year of GC use, these risks increase, but disappear as they are taken.

There is no evidence that a woman taking hormonal contraceptives has a reduced egg supply.

There is an opinion that taking hormonal contraceptives can lead to depressive states. This can happen if the progestogen that is part of the combined contraceptive is not suitable for you: with this problem, you need to consult a doctor in order to change the combined drug - most likely, this will help. But in general, depression and even observation by a psychiatrist is not a contraindication for taking contraceptives. However, both doctors must be informed about the drugs that you use, because some of them can weaken the effect of each other.

There is a myth that hormonal contraceptives, due to inhibition of the reproductive system, lead to infertility, subsequent miscarriage and fetal pathologies. This is not true . The so-called ovarian sleep, or hyperinhibition syndrome, is reversible. At this time, the ovaries are resting, and the whole body is in a hormonally even state of “false pregnancy”. There is no data that would prove that a woman taking hormonal contraceptives has a reduced supply of eggs. Furthermore, hormone therapy used to treat infertility, because after drug withdrawal and recovery, the ovaries work more actively. Taking hormonal contraceptives in the past does not affect the course of pregnancy and fetal development. In most cases, the risks and side effects from taking hormonal contraceptives are much lower than from terminating an unwanted pregnancy.

Also, hormonal contraceptives do not cause amenorrhea, the pathological cessation of menstruation. After discontinuation of the drug, it often takes at least three months for the menstruation to return (if it has not been for more than six months, it is better to see a doctor). Hormonal contraceptive withdrawal syndrome is a condition that occurs after the cessation of hormones, when the body returns to a constant monthly hormonal adjustment. In the first six months after the cancellation, the body can storm, and therefore during this period it is better to be observed by an endocrinologist. Without medical necessity, hormones should not be interrupted in the middle of the cycle: sudden interruptions contribute to uterine bleeding and cycle disorders.

In the endocrinological environment, there is a poetic phraseological unit that characterizes the status of "balanced" women's health: hormone harmony. Modern hormonal contraceptives still have contraindications and side effects, but with proper selection, compliance with the rules of admission and healthy lifestyle life, they can not only eliminate the risk of unwanted pregnancy, but also significantly improve the quality of life of a modern woman - freeing her strength for the desired activity.

The era of hormonal contraception begins in the middle of the last century, when the first contraceptive pill was invented by the American scientist Gregory Pincus. Since then, millions of women around the world have been using hormonal contraceptives for family planning and effective protection against unwanted pregnancies.

Of course, during this period, more advanced and convenient forms were invented that allow you to choose hormonal contraception for almost any healthy woman.

What is hormonal contraception?

Regardless of the route of administration, hormonal contraceptives consist of synthetic analogues of one or both of the female sex hormones: estrogen and progesterone. Therefore, hormonal contraceptives (HC) can be combined (containing both hormones) or single-component.

Ethinyl estradiol (EE) is used as the estrogen component in most GCs. AT last years an estrogenic component was synthesized, which is similar in structure to the natural hormone of a woman - estradiol valeriate. The first contraceptives contained a huge dose of estrogen (about 150 micrograms / day). However, low- and micro-dose preparations have now been developed that contain much lower daily concentrations of estrogen - 30, 20, and even 15 micrograms.

Progesterone analog (synonyms: progestogen, progestin, gestagen) in modern GCs is represented by a large variety of compounds that can be divided into four groups or generations:

• The first is norethinodrel, ethyndiol acetate, norethinodrone acetate.
• The second is norethisterone, norgestrel, levonorgestrel.
• The third is gestodene, desogestrel, norgestimate.
• The fourth is drospirenone.

It is the progestogen component that determines the whole variety of hormonal contraceptives.

How GCs work:

• Suppress the maturation of the egg (ovulation).
• They thicken the cervical mucus, preventing the passage of spermatozoa.
• Modify the structure of the mucous membrane of the uterus (the probability of attaching a fertilized egg decreases).
• Reduce the speed of movement of sperm in the fallopian tubes.

As a rule, hormonal contraceptives simultaneously have all of the above properties that prevent conception and pregnancy. This determines their high contraceptive effectiveness.

Classification

All hormonal contraceptives can be classified according to several criteria. The most popular is their division along the way of introduction into the body of a woman:

• oral
• Injectable.
• Implants.
• Plasters.
• vaginal rings.
• Intrauterine hormonal system with progestin.

According to the species composition of hormones, all GCs are divided into two categories:

• Combined (contain both an estrogen component and a progestogen).
• One-component - progestagenic.

Each type of hormonal contraception has its own indications and contraindications. The selection of the form and composition of the hormonal contraceptive should be carried out exclusively by a gynecologist!

General contraindications to GC

There are conditions in which hormonal contraceptives are contraindicated in any case. These include:

• Suspected or existing pregnancy.
• Hypersensitivity (allergy) to HA components.
• Bleeding from the genital tract of unknown etiology (until the cause is clarified).
• Cancer of the breast or structures of the genital tract (currently or in history).
• Neoplasm or serious impairment of liver function.
• Increased risk of STI infection (additional use of barrier methods of protection is required).

In addition, combined hormonal contraceptives (due to the negative effect of the estrogen component) are contraindicated in this category of women:

• the entire period of lactation.
• Blood clotting disorders, thrombosis (currently or in history).
• Some somatic diseases in which there is an increased risk of thrombosis: complicated course of diabetes mellitus, severe arterial hypertension, hereditary dyslipoproteinemia and some others.
• Migraine, focal neurological symptoms.
• Estrogen-dependent tumors: suspected or confirmed.
• Women over 35 who smoke. Combined GCs should be used with caution.

There are also certain contraindications to the use of a particular type of hormonal contraception, which will be discussed in the relevant sections of this article.

Oral contraceptives

This is the most famous type of hormonal contraception, which has received the greatest distribution. They are used in the form of tablets, which must be consumed in strict sequence.

Oral contraceptives are combined (COC) or progestin-only (PPOC, "mini-drank").

Combined

Traditionally, according to the combination of the estrogen / progesterone component, COCs are divided into three groups:

• Monophasic - the dose of hormones is the same in all active tablets (most modern COCs: Logest, Marvelon, Jess, Janine, Yarina and many others).
• Biphasic - active tablets contain two different combinations of estrogen and progesterone (Anteovin).
• Multiphasic - the content of estrogen and progesterone in active tablets can have three or more combinations (Tri-Regol, Triquilar, Tri-Merci, Qlaira, etc.).

There is also a different mode of taking such contraceptives. The most popular is the 21+7 mode. In this case, the blister contains 21 active tablets, after which a break is taken strictly for 7 days. For ease of use of such COCs, often seven inactive tablets (“dummy” or iron-containing) are added to the blister. In this case (28 tablets in a blister), there is no need to take a break.

There are other schemes for taking pills: 24 + 4, 26 + 2, etc.

Admission rules

The most important requirement is the daily intake of tablets. It is necessary to take one COC tablet every day, preferably at the same time of day. It is also necessary to obtain precise instructions from the doctor regarding the regimen of taking the tablets and strictly adhere to it.

Start of application:

• It is recommended to take the first tablet within five days of starting next menstruation. Most doctors recommend starting COCs on the first day of your period.
• After childbirth: in the absence of lactation, it is possible to start taking COCs as early as three weeks after the birth of the child. When breastfeeding, taking COCs is contraindicated.
• After an abortion: it is advisable to start taking COCs on the day of the procedure or within a week after it.

If for some reason the next pill was not taken, then it is urgent to consult a doctor.

COC advantages:

• At correct application- This is one of the most reliable contraceptive methods.
• Convenience and ease of the method.
• A woman can stop taking COCs on her own.
• Menstruation usually becomes less abundant and shorter, which contributes to the normalization of hemoglobin levels (with its decrease).
• Reduced menstrual pain.
• Reducing the risk of benign tumors and cancer of the ovaries and endometrium.
• Some types of gestagens in COCs have an antiandrogenic effect and can be used with an additional therapeutic effect (in addition to contraception).

Disadvantages and contraindications to COCs:

• The need for strict daily pills.
• Unpleasant side effects are possible in the first few cycles of administration: nausea, dizziness, headache, spotting, etc.
• Decreased effectiveness when used concomitantly with some medications(anticonvulsant, antituberculous, antibacterial and other drugs).
• Temporary changes in the psycho-emotional background, decreased libido, etc. are possible.
• Some change in body weight, etc.

You should immediately consult a doctor if there is no menstrual flow during the 7-day break (to exclude pregnancy).

Pure progestin

These pills contain only one type of hormone - progestin. Currently, on the pharmaceutical market, you can find PPOC preparations with the following composition (in one tablet):

• 0.5 mg linestrenol (Exluton).
• 75 micrograms of desogestrel (Lactinet, Charozetta, Desirette, etc.).

The blister usually contains 28 tablets, which must be taken every day at exactly the same time of day. When using such drugs, there is no need to take breaks: at the end of one blister, the tablets begin from the next.

This type of oral GC has much fewer contraindications and can be used by women who are contraindicated in COCs, for example:

• When smoking.
• With lactation.
• With some somatic diseases (diabetes mellitus, hypertension, etc.).

However, these contraceptives also have disadvantages, which include:

• The need to take pills strictly at the same time.
• Changes in the nature of the menstrual cycle (irregularity, spotting).
• They do not have preventive and therapeutic properties of COCs.
• Decreased contraceptive effect when used simultaneously with certain other medications.

It is necessary to start taking POCs in the same way as COCs: within five days from the beginning of menstruation (preferably on the first day). After childbirth, if a woman wishes, you can start taking such a drug already one and a half months after the birth of a child and in the presence of lactation. If a woman is not breastfeeding, then taking PPOC can be started in the very first days after childbirth.

The contraceptive effect when taking PPOC occurs already during the first day from the start of taking the drug.

Injectable contraceptives

Means the introduction of the drug by injection (usually - intramuscular). These drugs have a prolonged action and to maintain the contraceptive effect, it is enough to administer the drug once every few months.

Injectable contraceptives can also be combined (CIC) or progestogen (PIC).

Combined

Currently, CECs are represented by two drugs: Cyclofem and Mesigyna, which have not yet found wide distribution in the CIS countries.

These drugs must be administered intramuscularly once every 28 days. Their main advantages and disadvantages are practically the same as those of COCs. In addition, there is a more frequent violation of the menstrual cycle (irregularity, spotting) at the beginning of the intake.

The first injection should be performed within seven days from the start of the next menstruation. The recommended interval between subsequent injections is 28 days (with a tolerance of 1-7 days).

Progestogenic

Among injectable contraceptives containing a monocomponent (progestin), the most famous drugs are:

• Depo-Provera (150 mg depo-medroxyprogesterone acetate).
• Noristerate (200 mg norethindrone enanthate or NET-EN).

Depo-Provera (150 mg) is the most popular among PICs. It is administered intramuscularly once every three months (deviation in terms of injection is allowed up to 2-4 weeks earlier or later than the appointed time).

Noristerate is administered every two months (with a tolerance of 1–2 weeks).

These drugs have most of the advantages and disadvantages of POCs. Undoubtedly, a big plus is long-term and reversible contraception with high efficiency. They can be used by women of almost any age, as well as nursing mothers. Majority somatic diseases, in which the use of estrogens is contraindicated, are also not an obstacle to the use of PIK.

• Frequent occurrence of menstrual irregularities (from amenorrhea to bleeding).
• Weight gain (usually temporary).
• Relatively long recovery ability to conceive (from 6-12 months or more).
• Increased glucose tolerance (this should be considered in women with diabetes).

The first injection of the drug is performed for seven days from the beginning of the next menstruation. After childbirth, it is permissible to use PIK already after three weeks in the absence of lactation or after a month and a half if it is present.

Subsequent injections are performed two (Noristerat) or three months later (Depo-Provera).

Implants

They are one or more progestin capsules that are implanted (“implanted”) under the skin of the forearm. The operation is performed by a doctor under local anesthesia.

This is a prolonged method of contraception (from three to five years).

Currently, the most commonly used types of implants are:

• Norplant - consists of six thin flexible capsules filled with levonorgestrel. The validity period of the implant is 5 years.
• Norplant-2. Represents two capsules with levonorgestrel, which prevent the onset of pregnancy for three years.
• Implanon. Presented as a single capsule filled with etonogestrel (a metabolite of desogestrel), the validity of which is 3 years.

Implants do not contain an estrogen component, which allows them to be used by those women who are contraindicated in estrogen-containing hormonal contraceptives.

The advantage of this contraceptive method is that there is no need to take pills, regular injections, etc. But for the procedure for inserting and removing the implant, the participation of a specially trained medical specialist, which is, in general, the main problem.

Among the disadvantages of this method of hormonal contraception, the following should be especially noted:

• Risk of suppuration and bleeding at the implant site.
• Irregularity of the menstrual cycle, spotting during the first 6-12 months of using the method.
• Some women sometimes experience weight gain, discomfort and tension in the mammary glands, unexpressed headaches, and some other unpleasant symptoms that usually disappear with time.

The remaining disadvantages and advantages are the same as for other progestogen-based GCs.

The introduction of the implant is usually carried out in the first seven days from the start of the next menstruation or the abortion procedure. After childbirth, the implant can be inserted already after 3 weeks, and in the case of lactation - after a month and a half.

When the implant expires, it must be removed and, if desired, a new one inserted.

New combination GCs

A kind of analogue of monophasic combined oral contraceptives are the latest developments - the Evra hormonal patch and the NovaRing vaginal ring. The mechanism of action of these contraceptives does not differ significantly from COCs. The only difference is in the route of administration of hormones - transdermal (transdermal) or through the vaginal bloodstream. This somewhat reduces the risk of those side effects that are associated with the metabolism of hormones in the liver. In addition, there is no need for daily pills.

Hormonal patch

The method is based on the gradual release of estrogen and progesterone from a special patch pasted on skin women (transdermal route of administration).

Hormonal contraceptive Evra (Evra) is a 20 sq. cm, which is attached by a woman on her own to dry, intact skin. The patch releases approximately 150 micrograms of norelgestromin and 20 micrograms of ethinyl estradiol each day. One package contains three transdermal patches designed for one cycle. The package may contain one or three such packages.

The patch is glued on the first day of menstruation with regular replacement every seven days of use. Then they take it off and take a seven-day break. Therefore, a full contraceptive cycle is 28 days. A new cycle with gluing the patch begins the day after the end of such a break.

• Buttocks.
• Stomach.
• The outer surface of the shoulder.
• Upper body.

Do not stick the patch on the skin of the mammary glands, on the mucous membranes.

It is necessary to regularly and carefully inspect the place of attachment of the patch to ensure that it is tightly attached.

If it is partially or completely peeled off, it should be glued again or replaced with a new one. If the adhesive properties of the contraceptive are lost, there is no need to additionally use adhesive tapes and other fixing devices. In such cases, a new patch is applied. If in doubt, you should seek the advice of your doctor.

What you need to know:

• With excessive body weight (90 kg or more), this contraceptive method should not be used due to its reduced effectiveness in such women.
• More than one patch must not be used at the same time.
• If the skin is irritated, you can re-glue the patch to another area.
• Sometimes during the adaptation period there may be side effects: nausea, vomiting, menstrual irregularities (even before bleeding). If these symptoms are pronounced, you should consult a doctor.

vaginal ring

NuvaRing is a flexible and elastic ring made of hypoallergenic material. During the day, it secretes approximately 15 micrograms of ethinyl estradiol and 120 micrograms of etonogestrel, the secretion of which is activated by body temperature. Then they enter the bloodstream through the vaginal mucosa, which minimizes their systemic effect. One vaginal ring is designed to be used for one cycle.

The contraceptive is inserted by a woman on her own deep into the vagina on the first day of menstruation. A correctly inserted ring does not cause discomfort. After three weeks of use, the ring is removed and, after a seven-day break, a new one is inserted.

If during stress, defecation, sexual intercourse and other conditions there is a loss of the ring, it must be washed in a flowing warm water and enter again.

The use of the method may be limited to women with existing vaginal prolapse.

The remaining benefits and contraindications for the use of the hormone patch and vaginal ring are the same as for all combination HAs.

intrauterine system

Represents a variety intrauterine contraceptive(“spirals”) containing progestin - levonorgestrel (LNG). Currently used under the following trade names:

• Mirena (abroad - Levonova). Contains 52 mg of LNG. Set for five years.
• Jaydes. Contains 13.5 mg of LNG. The recommended period of use is three years.

Each intrauterine system releases approximately 20 micrograms of progestin daily. The longer the period of use of the system, the lower the daily volume of levonorgestrel excretion.

In addition to contraceptive action, intrauterine hormonal systems have a pronounced therapeutic effect and can be used under the following conditions:

• Some types of uterine leiomyoma.
• Non-atypical endometrial hyperplasia in women of childbearing age.
• Adenomyosis.
• idiopathic uterine bleeding.
• Hyperpolymenorrhea, algomenorrhea, etc.

You should be aware that when using this method, there is often a significant decrease in the amount of blood released during menstruation, up to its complete absence.

The intrauterine hormonal system is administered by a doctor during the next menstruation or on any day of the cycle if there is no pregnancy. After childbirth, it is possible to use this method after four weeks.

The main contraindications to the use of this method are (in addition to the general ones):

• Infectious and inflammatory pathology of the genital tract (including recurrent).
• cervical dysplasia.
• Anomalies in the structure of the uterus (including fibroids that deform the uterine cavity).
• Increased risk of infection of the genitals (for example, frequent change of sexual partners).

Before the introduction of the intrauterine hormonal system, some preparation and examination of the woman is necessary, the volume of which is determined by the doctor.

In conclusion, it should be noted: there is no need to be afraid of “hormones”. Properly selected hormonal contraceptives by a doctor have a high contraceptive effect and a minimum of side effects.

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.

Is it good or bad, but modern families far 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 absolutely different categories medicines:

- 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 suggested using similar substances as a contraceptive. 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. That's when these substances got 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: application hormonal pills for the treatment of infertility has not yielded 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 contraceptives 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, which becomes very difficult for spermatozoa.

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. Triphasic preparations are considered the most adapted to natural cycle women. 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 - main enemy any contraceptives, and hormonal 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 pill 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 mild nausea, which practically does not annoy during sleep;

3. In the first cycle of taking COCs, it is worth using additional measures contraception: 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 there may be spotting;

- 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, then switch to standard scheme. 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. Maximum period recovery 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 healthy pregnancy Still need normalization of hormonal levels. 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 PMS treatment prescribe modern low-dose contraceptives, 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 a corpus luteum cyst. 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

Most credible research in the medical world have confirmed that the regular use of COCs reduces the risk of gynecological cancer. Permanent reception birth control pills reduces the risk of developing ovarian cancer by as much as 40%, and such prevention lasts for 15 years after the abolition 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, there may be hormonal disorders. 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 participate in the recovery 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 low dose 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.

Note that Charosetta and Lactinet occupy special place in a row of 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? To positive aspects mini-pills 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 absence of this hormone in minipills, they are better tolerated than combined tablets;

- the possibility of appointment during lactation.
Monocomponent contraceptives are considered a means for nursing mothers. It has been proven that the gestagens used in the mini-pill do not affect the qualitative composition breast milk and do not reduce its quantity. 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 violations of the menstrual cycle 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 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 fallopian tubes or ovaries, resulting in an ectopic pregnancy.

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. Besides, low concentration 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

Exist strict rules use of hormonal emergency contraceptives, 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

Can't be overlooked possible consequences taking high-dose birth control pills.

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 spermatozoon;
• 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 break up 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 genital organs 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 for purchase hormonal agent you need to consult a doctor, 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.