The best ok with estrogen 20. Choosing a hormonal contraceptive depending on the woman’s phenotype

For quotation: Tikhomirov A.L., Kholnov A.I. Choice hormonal contraceptive depending on the woman’s phenotype // Breast cancer. 2000. No. 18. P. 759

MMSU named after N.A. Semashko

AND The study and practical use of sex hormones is one of the most important achievements of modern medicine. Statistical data have shown that there is an inverse proportional relationship between the frequency of use of contraceptives and the risk of developing pregnancy complications (death of the mother and/or fetus, premature birth, etc.), as well as the frequency of impaired fertility. This is why WHO guidelines state that the prevalence of hormonal contraception is of great importance for the health of the population as a whole. Over the past 30 years, the number of married couples using contraceptives has increased from 10% in 1960 to more than 50% in 1995. In developed Western countries, the percentage of couples using contraceptives is more than 70%. Over 30 years of family planning services, more than 400 million births have been avoided worldwide (Bulatao R A., Levin A. et al., 1993).

First oral contraceptives(OC) contained high doses of both estrogens and progestogens, which is why when taking them the risk of death from thromboembolism increased by 40%. This risk is associated primarily with the dose of the estrogen component, since estrogens have a procoagulant effect. This has led to the need to reduce the dose of estrogen in drugs, and today the vast majority of modern low-dose combined OCs (COCs) contain 30-35 mcg of ethinyl estradiol.

In the working classification used, OC is divided according to the progestogen component (Serov V.N., Paukov S.V. et al., 1996). 1st generation (1962) - drugs containing: norethinodrel, ethynodiol diacetate, norethinodrone acetate; 2nd generation (1972) - drugs containing: norethisterone (trinovum, ortho 777, micronor, etc.); norgestrel, levonorgestrel (bisecurin, microgynon, rigevidon, miniziston, etc.); 3rd generation (1981) - drugs containing: gestodene (triaden, minulet, triminulet, femoden, logest, etc.); desogestrel (Marvelon, Mercilon, Regulon, Novinet, etc.); norgestimate (silest, trisilest).

The development of hormonal contraception followed the path of reducing the daily dose of the estrogen component and introducing new gestagens into the preparations. New generation progestogens deserve special attention: norgestimate, desogestrel, gestodene. Their high affinity for progesterone receptors has allowed them to be used in low doses for reliable contraception. Their main advantage is their insignificant effect on the lipid spectrum of the blood. This makes it possible to ensure almost complete safety of modern low-dose OCs, taking into account contraindications to their use. However, in our country the negative psychological attitude of the population is changing extremely slowly and medical workers on the harmful effects of hormones on female body. In Europe and the USA, one of the most common methods of contraception are OCs; they are used by 40-60% of women of childbearing age, in our country - only 0.5-5%.

Numerous studies have shown that the risk of taking OCs. for women's health is 10 or more times lower than the risk of complications during pregnancy, childbirth and abortion. Approximately 500,000 women die each year as a result of these complications . It has been established that from one quarter to a third of such deaths, as well as millions of cases of severe sexual and reproductive disorders, are the consequences of poorly performed abortions (N. Mahler, 1993). The number of abortions in Russia from 1990 to 1999 decreased from 4 to 2.5 million per year, which corresponds to an indicator of 70 abortions per 1000 reproductively capable women. More than half develop severe functional impairments 3-5 years after an abortion. As the number of abortions increases, the risk of gynecological diseases also increases: in the absence of abortions - less than 3-4%, with 2-3 abortions - 18-20%, with 6-7 - 100%. When high-dose estrogen-gestagen drugs are prescribed from the first day after an abortion, the number of complications is reduced by 5 times, since COCs block hypothalamic stress. When antibacterial therapy is used during treatment, post-abortion complications are eliminated by 100%.

Combined OCs consist of synthetic estrogens (mainly ethinyl estradiol) and progestogens. Progestogens used in OCs come in 2 classes:

Derivatives of 17a-hydroxyprogesterone. Synthetic derivatives, mainly chlormadione acetate, megestrol acetate and medroxyprogesterone acetate, block ovulation without androgenic, anabolic or estrogenic effects.

Derivatives of 19-norsteroids. The most widely used in hormonal contraception are norethisterone, norethinodrel, ethinol diacetate, and linestrenol. Metabolism in the liver reduces their biological activity by 40%. Modern 19-norsteroids (gestodene, desogestrel, norgestimate) have a longer half-life, maintaining their activity for 24 hours. They are practically not affected by metabolism in the liver, which makes them 100% biologically active. Like levonorgestrel, these steroids have residual androgenic activity. The bioavailability of desogestrel when taken orally is 76-80%. DZG not only has a greater ability to bind to progesterone receptors compared to levonorgestrel, but is also significantly less androgenic, as evidenced by changes in the blood lipid spectrum.

DZG is one of the most powerful progestogens that suppress ovarian function. A complete absence of follicular growth (by ultrasound) was found in 40% of courses, and in approximately 30% follicles of preovulatory size were noted. When measuring estrogen in blood serum, in approximately 60% of courses concentrations corresponding to the early follicular phase were found; in 25% of cases this level was even higher. The level of progesterone in the blood is higher than in the follicular phase during a normal menstrual cycle, and lower than in the luteal phase. The advantages of DZG include the lack of the ability to change glucose tolerance; the disadvantages are less pronounced control menstrual cycle. From the above it follows that OCs containing third-generation progestogens are significantly more selective and less androgenic than OCs of previous generations. The differences within the group of third-generation progestogens themselves are not so significant.

The pregnancy rate when taking COCs is 0.2-1 cases per 100 women per year.

Positive aspects of using OK

Modern OCs can have both contraceptive and positive non-contraceptive effects.

Almost 100% reliability and almost immediate effect.

Pearl index = (number of conceptions x 1200) / number of months of observation

This indicator reflects the number of pregnancies in 1000 women during the year without the use of contraceptives. In Russia, this figure is on average 67-82. The Pearl index is widely used to assess the reliability of a contraceptive method - the lower this indicator, the more reliable this method is. It is estimated that adolescents miss, on average, up to 3 tablets per month when using OCs, and at least 20% of women miss a dose once each month. Due to reception errors, the Pearl index can increase to 6.2.

Reversibility of the method and providing women with the opportunity to independently control their fertility.

Fertility in nulliparous women under 30 years of age who took combined OCs is restored within 1 to 3 months after discontinuation of the drug in 90% of cases, which corresponds to the biological level of fertility. During this time, there is a rapid rise in FSH and LH levels. Therefore, it is recommended to stop taking OCs 3 months before the onset of a planned pregnancy.

Sufficient knowledge of the method.

WHO recognizes that the optimal intergenetic interval should be at least 2 years, and the optimal interval between births is 2.5-3.5 years. This condition makes it possible to reduce maternal and child mortality by 2 times. Incidence of late gestosis, weakness and incoordination labor activity, intrauterine growth retardation and bleeding during childbirth are reduced by 2 or more times.

Low incidence of side effects.

Comparative ease of use.

Lack of influence on the course of sexual intercourse and on the partner.

Possibility of poisoning due to overdose.

Reducing the incidence of ectopic pregnancy by 90%.

Reducing the incidence of inflammatory diseases of the pelvic organs.

Their frequency decreases by 50-70% after 1 year of use due to a decrease in the amount of lost menstrual blood, which is an ideal substrate for the proliferation of pathogens, as well as less dilatation of the cervical canal during menstruation due to this reduction in blood loss. Reducing the intensity of uterine contractions and peristaltic activity of the fallopian tubes reduces the likelihood of developing an ascending infection. The progestogen component of OC has a specific effect on the consistency of cervical mucus, making it difficult to pass not only for sperm, but also for pathogenic pathogens.

Prevention of the development of benign neoplasms of the ovaries and uterus.

EM. Kaunitz, in a review of the literature from the 80s, showed that using COCs for less than 1 year reduces the risk of developing ovarian cancer by 40%. The putative protection against ovarian cancer associated with OCs persists 10 years or more after discontinuation of OC use. For those who have used OCs for more than 10 years, this figure decreases by 80%.

Positive effect in benign breast diseases.

Fibrocystic mastopathy is reduced by 50-75%, this is due to the gestagenic component of COCs. An unresolved question is whether COCs cause an increased risk of developing breast cancer in young women (up to 35-40 years of age). Some studies claim that COCs may only accelerate the development of clinical breast cancer, but overall the data seems encouraging for most women.

Reduced incidence of endometrial cancer with long-term use of OCs.

The risk decreases by 20% per year after 2 years of use. The National Institutes of Health Study of Cancer and Steroid Hormones found a 50% reduction in the risk of endometrial cancer associated with at least 12 months of OC use. The protective effect lasts up to 15 years after stopping OC use.

Relief of dysmenorrhea symptoms.

Dysmenorrhea and premenstrual syndrome occur less frequently (40%).

Reducing premenstrual tension.

Positive effect (up to 50% when taken for 1 year) in iron deficiency anemia by reducing menstrual blood loss.

Positive effect on endometriosis.

The positive effect is associated with pronounced decidual necrosis of the hyperplastic endometrium. The use of OCs in intermittent courses can significantly improve the condition of patients suffering from this pathology.

Reducing the risk of developing uterine fibroids by 17% for every 5 years of use.

Reduced incidence of ovarian retention formations (up to 90% when using modern hormonal combinations).

Positive effect on peptic ulcer of the stomach, duodenal ulcer, rheumatoid arthritis, idiopathic thrombocytopenic purpura.

Therapeutic effects on the skin for acne, hirsutism and seborrhea (third generation drugs).

Preservation of higher bone density in those who used OCs in the last decade of childbearing age (Baird D.T., Glasier A.F., 1993).

A large number of studies have been devoted to the relationship between COCs and cervical cancer.

The conclusions from these studies cannot be considered unambiguous. Thus, Brsinton J. (1991) believes that the risk of developing cervical cancer increases in women who have taken COCs for a long time (more than 10 years).

According to the degree of risk of hormonal contraception, there are three categories of women:

1. Having diseases for which the use of OCs is contraindicated:

Malignant tumors of the breast and genital organs

Severe diseases of the cardiovascular system

Acute illnesses, severe dysfunction, liver tumors

Acute thrombophlebitis, thrombosis or thromboembolism, or a history of them associated with estrogen use

Bleeding from the genital tract of unknown origin

Pregnancy.

2. Having diseases or conditions that create special problems when using OCs:

Arterial hypertension

Migraine

Epilepsy

Depression

Diabetes

Gallstone disease, chronic liver disease, itching and jaundice during pregnancy

Bronchial asthma, heart and kidney failure

Uterine fibroids

Hyperlipidemia, hypercalcemia

Porphyria

Tuberculosis

Upcoming surgery or immobilization

Intolerance to estrogens or gestagens

Obesity, smoking more than 15 cigarettes per day.

3. Practically healthy women who do not have problematic conditions for prescribing OCs.

Factors that reduce the effectiveness of OCs

The most significant of them: vomiting, diarrhea, simultaneous use of certain medications (antibacterial, anticonvulsants, laxatives). In case of vomiting or diarrhea that interferes with the absorption of OCs, within 3 hours after taking the drug, you must take an additional tablet. If you experience repeated bouts of vomiting or diarrhea after taking an additional tablet, you should return to your usual dosing regimen when possible, but no longer count this cycle reliably protected.

Classification OK

Depending on the composition, OKs are distinguished:

Combined oral

Gestagenic

Progesterone antagonists.

Combined oral contraceptives

There are monophasic, two- and three-phase COCs.

Monophasic contraceptives contain a constant dose of estrogen and progestogen components in each tablet. They differ in dose, type of estrogens and progestogens. Monophasic oral contraceptives are highly effective in the prevention and treatment of some forms of endometriosis. So, according to Pshenichnikova T.Ya. (1993), the effectiveness of treatment for minor forms of endometriosis and grade 1 adenomyosis was 58%. In addition, they help restore generative function in many patients. These drugs include: ovidon, rigevidon, regulon, novinet. They provide the highest level of contraception (Pearl index = 0.06-0.07). A simple method of daily use (from 5 to 25 days of the menstrual cycle at night), the possibility of doubling the daily dose in case of missing 1 tablet makes them most acceptable and suitable for girls and young women. In older age groups, their advantages also include the possibility of using them for contraception and simultaneous treatment of minor forms of genital endometriosis, as well as after widespread intrauterine interventions to inhibit hypothalamic-pituitary stress. Regulon, among other things, has a positive effect on the course of the menstrual cycle, regulating the duration of the cycle and the intensity of bleeding during a break in taking the drug, even in women with long and/or heavy bleeding. Cases of intermenstrual bleeding when taking the described drugs are extremely rare.

Combined two-phase OK contain a constant dose of estrogen and a varying dose of gestagen in different phases of the menstrual cycle. They are indicated for women with hypersensitivity to gestagens. Drugs of this type include Anteovin. Anteovin increases HDL content by 43% and therefore does not have an atherogenic effect (Dubnitskaya L.V., 1988). For women with clinical manifestations of hyperandrogenism, biphasic OCs may be recommended.

Combined three-phase OK characterized by variable steroid content according to the phases of the menstrual cycle. Providing a more physiological effect on menstrual cycle parameters has increased the acceptability of triphasic formulations. They are especially indicated for women over 35-40 years of age and under 18 years of age, as well as for smokers and those who are obese. The positive side of the use of three-phase drugs is the reduction in the risk of side effects of progestins. Their disadvantages are the more frequent occurrence of intermenstrual bleeding or spotting, as well as the relative difficulty of taking them correctly, and finally, the lower possibility of doubling the daily dose if a pill is missed. Based on this, in young women, preference is initially given not to triphasic, but to monophasic drugs. There are indications in the literature about possible cystic changes in the ovaries, which indicates insufficient blockade of gonadotropin secretion. The use of three-phase combinations is also not recommended for women with neuroendocrine diseases due to dysfunction of regulatory systems - endometriosis, mastopathy, etc. For such patients, it is preferable to prescribe monophasic OCs.

A more “physiological” change in the hormonal profile during the menstrual cycle when taking a three-phase drug leads to a decrease in the adverse effects of the contraceptive on the development of the endometrium. Three-phase drugs have a positive effect on the regularity of the menstrual cycle. After childbirth or abortion, it is recommended to take the three-phase drug no earlier than the first menstrual cycle.

Studies have shown that the reliability of triphasic drugs is inferior to monophasic drugs. The Pearl index for monophasic drugs is 0.05-0.18, while for triphasic levonorgestrel-containing drugs it is up to 0.34; for norgestimate-containing ones - 0.19 and 0.68, respectively (Speroff L., 1993).

Today, it is three-phase drugs containing second-generation progestogens that have been tested over many years of practical use (triquilar, triziston, tri-regol) that are the first choice drugs for the treatment of ovarian dysfunction and algodysmenorrhea in young, nulliparous women, as well as post-castration syndrome. According to a number of domestic researchers, the effectiveness of the above three-phase hormonal combinations in the treatment of menstrual irregularities is 95-97%.

The effect of the three-phase drug tri-regol on the condition of the cervix in young nulliparous women with ectopia was studied. An increase in metaplastic processes in areas of ectopia was revealed, which contributed to the epithelization of ectopia of varying severity in 47.5% of women.

An alternative to the use of combined OCs is to take drugs containing only one progestogen component - pure progestins (PP). In the UK and USA, about 8% of women use this method of birth control. PE is indicated for older women, lactating women, smokers, and those for whom combined OCs are contraindicated for one reason or another. Emergency procedures do not affect blood clotting or the ability of aggregation of its formed elements and are the method of choice for women with hypertension.

An alternative to the use of combined OCs is to take drugs containing only one progestogen component - pure progestins (PP). In the UK and USA, about 8% of women use this method of birth control. PE is indicated for older women, lactating women, smokers, and those for whom combined OCs are contraindicated for one reason or another. Emergency procedures do not affect blood clotting or the ability of aggregation of its formed elements and are the method of choice for women with hypertension.

Recently, it was announced the creation of a tablet emergency (mini-pill) containing a 3rd generation progestogen - desogestrel at a dose of 75 mcg (Boen P., Hickling D.J. et al., 1992). The contraceptive reliability of this group of drugs is significantly lower than that of combined OCs (Pearl index ranges from 0.6 to 4), so today the only absolute indication for emergency is contraception during lactation. It is recommended to start taking it 21-28 days after birth.

Choosing an oral contraceptive

The basic principle when prescribing OCs is the use of the lowest dose of steroids that would be able to provide reliable protection against unwanted pregnancy. The dose of the estrogenic component in OCs should not exceed 30-35 mcg of ethinyl estradiol, the dose of the progestogen component (modern OCs include norethisterone, levonorgestrel, desogestrel, gestodene and norgestimate) should not exceed that equivalent to 150 mcg of levonorgestrel or 1 mg of norethisterone (IPPS Materials, 1993). In addition to the purely quantitative characteristics of the recommended OCs, when choosing drugs in some cases, differences in women’s constitutional and biological character (phenotype) should also be taken into account. In the 70s, a whole group of researchers (Hirschler, Gimes, Dekov, Vilics, etc.) developed criteria for assessing the female phenotype depending on hormonal dominance. In this regard, 3 types of female constitutional-biological character were proposed (Table 1):

Estrogen-dominant type

Balanced type

Type with a predominance of gestagens (androgens).

For women of the estrogenic type, drugs with an enhanced gestagenic component (rigevidon, ovidon) are indicated, and for the gestagenic type - with an enhanced estrogen component (anteovin); if there are signs of androgenization, it will be useful to use drugs with an additional antiandrogenic effect, containing cyproterone acetate (Diane-35) as a progestogen component, or a 3rd generation progestogen: norgestimate, desogestrel or gestodene (Novinet, Regulon, Logest, etc.).

When prescribing OCs, the quality of menstruation and the size of the uterus should be taken into account. The condition of the uterus and the nature of menstruation reflect the woman’s hormonal background better than a simple assessment of external signs:

Long and heavy menstruation, especially in combination with an increased size of the uterus, indicates a predominance of estrogen activity,

Short and scanty menstruation in combination with uterine hypoplasia indicates the predominance of progesterone activity.

Currently, the first choice drugs are combined oral contraceptives with the minimum effective dose of the included components. Low-dose single-phase and three-phase drugs are not opposed to each other; they are considered to be equally effective and safe when used correctly. We can only talk about the advantage of a single- or three-phase drug in a specific clinical situation (Smetnik V.P., Tumilovich L.G., 1994). Criterion the right choice- absence of breakthrough bleeding or recurring intermenstrual bleeding.

The list of references can be found on the website http://www.site

Desogestrel + ethinyl estradiol -

Novinet (trade name)

(Gedeon Richter)

Worldwide, approximately 60 million women used oral contraceptive pills. In developed countries, oral contraceptive use among married women aged 15–44 years ranges from 4% in Japan (where the pill was approved for use only in 1987) to 40% in the Netherlands.

Young women of reproductive age are more likely to use birth control pills.

In most countries, women can obtain birth control pills from regular pharmacies without a prescription.

The main advantage of using combined oral contraceptives is their high efficiency. With the exception of Norplant (a contraceptive implant) and Depo-Provera (an injectable hormonal contraceptive), oral contraception is an effective, reversible method of contraception. Birth control pills containing less than 50 mg of hormones (usually 30 to 35 mg) are as effective as combination pills containing 50 mg of hormones.

The pregnancy rate after using oral contraceptives (“contraceptive failure”) during the first year is 0.1%. The occurrence of an unwanted pregnancy is probably more associated with irregular use OK when a woman forgets to take a pill at the appointed time, especially at the beginning of a new cycle, as the so-called. "pill-free interval" The same phenomena are observed when missing one of the last active tablets from the package. To improve the efficiency of modern oral contraception (birth control pills containing less than 50 mg of hormones) it is recommended to reduce the “pill-free interval” from 7 to 4 or 5 days.

The use of oral contraceptives does absolutely no harm to a woman if she has no contraindications to their use.

Indications for the use of combined contraceptives

• Sexually active young women.
• Married couples using birth control to ensure appropriate spacing of children.
• Nulliparous women.
• Sexually active teenagers.
• Non-breastfeeding women in the postpartum period.
• Need for short-term or long-term reversible birth control.
• Emergency contraception after unprotected intercourse.
• Desire for birth control immediately after an abortion.
• Acne ().
• Painful menstruation.
• Recurrent functional ovarian cysts.
• Ovarian cancer in close relatives.

Primary contraindications to the use of combined oral contraceptives

Combined oral contraceptives should not be used by women with a known or suspected pregnancy, although available data do not indicate an increased risk of birth defects among infants born to women who inadvertently took OCs during pregnancy.

In general, OCs should not be used by women:

• over 35 years of age and smokers. All women who smoke should be advised to quit smoking;
• who have had or have thromboembolic or cardiovascular disorders, including pulmonary embolism (pulmonary thrombosis), or acute heart disease (or heart failure);
• who have had or are suffering from breast cancer; have severe active liver disease, a benign or malignant liver tumor, or a history of pregnancy-induced jaundice;
• who had unexplained abnormal uterine bleeding in the last 3 months, between menstruation or after sexual intercourse;
• in whom a change in cycle may be a sign of cancer, ectopic pregnancy or pelvic infections.

Secondary contraindications to the use of combined oral contraceptives

Particular attention should be paid to prescribing OCs to women who are breastfeeding a child less than 6 months old.
If any two of the following risk factors for developing heart disease exist:
age over 35 years;
high blood pressure;
;
the presence of heart disease or a young family member.
Presence of suspected breast carcinoma. If cancer is suspected, it is necessary to conduct an examination.
If women are taking rifampin, rifampicin, or anticonvulsants (except valproic acid), which cause the liver to metabolize the progestin more quickly. These drugs may decrease the effectiveness of the smallest dose of combination tablets.

Choosing a combined oral contraceptive

Modern oral contraceptive drugs contain much less estrogens and progestins than previous generations of OCs. Currently, the third generation of birth control pills is in use - combined estrogen-progestin preparations with a low content of estrogen (30 mcg or less ethinyl estradiol) and progestin components. When prescribing OCs in specific cases, the following must be taken into account:
OCs have a number of non-contraceptive effects:
Birth control pills are used for hormone replacement therapy and the treatment of dysfunctional bleeding, dysmenorrhea, endometriosis, acne (), hirsutism, benign breast diseases, functional ovarian cysts and many other diseases. The use of OCs also prevents the development and aggravation of anemia, the development of ovarian and endometrial cancer, uterine fibroids and inflammatory diseases of the pelvic organs.
In women with certain medical problems, the use of OCs is assessed according to different criteria from the usual use of birth control pills.
Most of the noncontraceptive properties of combined OCs apply to birth control pills containing less than 50 mcg of estrogen.
When prescribing oral contraception, all possible side effects OK.
A. The estrogen component of OCs is associated with a number of side effects:
;
soreness of the mammary glands;
enlargement of the mammary glands (due to milk ducts and adipose tissue);
fluid retention;
cyclical weight gain due to fluid retention;
vaginal mucous discharge ();
cervical ectropia;
headache;
thromboembolic complications;
pulmonary embolism;
cerebrovascular complications;
liver adenomas;
hepatocellular carcinoma;
growth of uterine fibroids;
telangiectasia, etc.
B. The progestin component of the OC may be associated with the following side effects:
increased appetite and weight gain;
depression, increased fatigue and tiredness;
decreased libido and sexual pleasure;
acne, increased skin greasiness;
headache;
enlargement of the mammary glands (alveolar tissue);
increased levels of low-density lipoproteins (LDL);
decreased levels of high-density lipoproteins (HDL);
decreased tolerance to carbohydrates, diabetogenic effect;
.
B. Both estrogen and progestin components of OCs can lead to the development of the following side effects:
headache;
hypertension;
;
dysplastic diseases of the cervix.
The estrogenic, progestin and androgenic effects of OCs affect a number of organs and tissues of the whole body (skin, uterus, ovaries, brain, mammary glands, arteries, veins, etc.). Birth control pills may affect the functioning of these organs differently than the endogenous hormones (the body's own hormones) that were produced before the use of oral contraceptives.
The potency of the estrogen and progestin components of OCs cannot be matched to the dosing of these tablets on a milligram-to-milligram basis.
Smoking increases a woman's risk of developing the most serious complications, especially from the cardiovascular system.
If well tolerated and without any side effects or complications when using OCs containing less than 35 mcg of estrogen, the woman is recommended to continue using this drug

Oral contraceptives containing 80 or 1000 mg estrogen

Combined contraceptive pills containing 80 or 100 mcg of estrogen (combined OCs with the highest dosage). In all cases, the use of oral contraception should be started with birth control pills containing no more than 35 mcg of estrogen, since the development of the most serious side effects is associated precisely with the activity and content of the estrogenic component of the OC. Even with good tolerability of OCs containing 80 or 100 mcg of estrogens, switching to the use of low-dose OCs is recommended. Birth control pills containing high doses of estrogen are no longer used in most countries around the world. But there are a number of situations in which it is recommended to prescribe OCs containing 80 or 100 mcg of estrogens:
The development of bleeding or the absence of a menstrual-like “drug withdrawal” reaction when using OCs containing low doses of hormonal components can sometimes be uncontrollable. In these cases, it is sometimes recommended to prescribe OCs containing 80 or 100 mcg of estrogens, although there are more rational treatment approaches for the development of spotting, severe uterine bleeding or the absence of “menstrual” bleeding by prescribing OCs containing no more than 50 mcg of estrogens.

Treatment of acne (), dysfunctional uterine bleeding, polycystic ovary syndrome and endometriosis sometimes includes OCs containing more than 50 mcg of estrogens. For dysfunctional uterine bleeding, treatment is carried out with various oral contraceptives in the following regimen: one tablet 4 times a day for 5-7 days, and for ovarian cysts (less than 6 cm in diameter), women of reproductive age are often prescribed combined high-dose OCs, one tablet for 42 days.

When using OCs containing 35 or 50 mcg of estrogens, phenomena associated with low estrogen levels (so-called menopausal symptoms) rarely develop, although if they are severe, birth control pills containing 80 or 100 mcg can be prescribed.
The onset of pregnancy while using OCs containing 30 or 50 mcg of estrogens may lead to the prescription of OCs containing high doses of estrogens (80 or 100 mcg). The second approach is to reduce the “pill-free interval” from 7 to 5-6 days, i.e., after taking 21 active tablets, take one inactive tablet orally for 4-5 days before starting a new OK cycle. This approach is especially recommended if ovulation is observed during the usual use of OCs or if a woman is using medications that cause stimulation of the liver enzyme system and, thus, a decrease in the activity of hormonal components of OCs occurs. Such drugs include anticonvulsants, rifampicin, etc. When using these drugs, the “pill-free interval” should be reduced to 4 days. Rifampicin and Dilantin (phenotoin) affect mainly the activity of the estrogenic component of OCs. When using these drugs, switching to high estrogen OCs or another method of contraception is sometimes recommended.

Combined oral contraceptives containing less than 30 mcg of estrogens

Combined contraceptive pills containing less than 30 mcg of estrogens (combined OCs with minimal estrogen content) are not very popular, which is associated with the high incidence of intermenstrual bleeding during the use of these OCs, as well as ovulation and/or spotting when taking birth control pills. Development of nausea, breast tenderness, swelling, pain in lower limbs(not associated with thrombophlebitis) and weight gain may cause a switch to taking OCs containing 20 mcg ethinyl estradiol; if these symptoms are not relieved, the use of birth control pills containing microdoses of progestins (“mini-pills”) is recommended.

Combined oral contraceptives containing 30, 35 and 50 mg of estrogens

Most experts recommend prescribing OCs containing 30 or 35 mcg ethinyl estradiol.
One of the main disadvantages of OCs containing 30 or 35 mcg of estrogen is the high incidence of intermenstrual bleeding and amenorrhea, which forces patients to be warned about the risk of severe uterine bleeding, spotting or the development of amenorrhea when prescribing these drugs. However, from a medical point of view, for most women, spotting is not a dangerous sign and usually a wait-and-see approach can be chosen for several months.

Combined triphasic contraceptive pills

Triphasic OCs are drugs containing a significantly reduced dose of progestins. The positive side of using triphasic OCs is the reduction in the risk of side effects of progestins. At the same time, the disadvantages of three-phase drugs are the development of intermenstrual bleeding or spotting, as well as the relative difficulty of correct administration and the lower possibility of doubling the daily dose of tablets if a dose is missed on the corresponding day of taking OK.

Individual selection of oral contraceptives depending on the duration of the menstrual cycle

Scheme of use of oral contraceptives depending on the duration of the menstrual cycle

Monophasic combined OCs are available in 21 tablets. They are also used for 21 days by each patient, regardless of the duration of the menstrual cycle. Meanwhile, the duration of a normal menstrual cycle ranges from 21 to 36 days if menstruation is regular.
In all cases, the drugs are prescribed from the 5th day of the cycle and are finished 2 days before the expected menstruation, i.e. The 21-day drug intake is designed only for a 28-day cycle.
If your menstrual cycle lasts 30 days, then you must take the drug from the 5th day of the cycle for 23 days. If you have a 32-day cycle, then within 25 days. With a 25-day cycle, the duration of taking combined monophasic OCs is 19 days, etc. All other principles of using OKs, their indications and warnings for use remain unchanged.
A woman's menstrual cycle tends to remain unchanged by selecting the right type of pill and using it according to the woman's physical condition; at the same time, this method of taking CMOC does not disrupt the patient’s sexual cycle.

Prescribing oral contraceptives after childbirth and abortion

For non-breastfeeding women, combined OCs are recommended to be prescribed immediately after an abortion or 2-3 weeks after childbirth. It is generally accepted that combined contraceptive pills are not best choice for nursing mothers. Combined OCs with a low content of hormonal components have little effect on the nutritional status of infants, the transition and the content of OC hormones in breast milk. However, during lactation, the use of drugs containing microdoses of progestins (“mini-pills”) is recommended, since they do not affect the protein content and quantity breast milk.

Postcoital use of oral contraceptives

Currently, OCs are quite widely used in the form of postcoital drugs; in many cases, after unprotected sexual intercourse in the periovulatory period (especially during the ovulation period), a woman who does not want to have a child is offered two methods of pregnancy protection - inserting an IUD or taking combined OCs. In the latter case, the recommended regimen is to take two contraceptive pills containing 50 mcg of norgestrel and ethinyl estradiol (oval, ovanol, euginone) within 72 hours after intercourse and again 12 hours after the last dose of contraceptive pills.

Ways to start using birth control pills

There are several ways to start using birth control pills, but no one method should be considered the best.
You should start taking OCs as directed by your doctor or other medical personnel.
The first way to take OK: start taking pills from the first day of menstruation.
The second way to take OK: start taking the pills the next Sunday after your menstruation stops. Some authors recommend starting OC use on Monday (since Monday is a working day and patients can go to family planning clinics to purchase birth control pills).
The third way to take OK: start taking pills from the fifth day after the start of menstruation.
The fourth method of taking OK: start taking the pills immediately if pregnancy is completely excluded. Talk to your doctor about how long you should use an additional method of contraception while taking birth control pills.

Rules for using birth control pills (oral contraceptives)

There is no evidence to suggest the need for periodic breaks from taking birth control pills for one or two cycles. In fact, on the contrary, many women became pregnant after such interruptions.

• The use of OCs alone does not protect against the transmission of pathogens or other sexually transmitted diseases; prevention is the use of condoms and spermicides when there is an increased risk of contracting STDs, especially AIDS.
• Remember that birth control pills primarily work by inhibiting ovulation (the release of an egg from a mature follicle). Pregnancy cannot occur if the sperm fails to fertilize the egg. Women who regularly and consistently use OCs are reliably protected from pregnancy.
• Choose an additional method of birth control (for example, a contraceptive sponge or foam, etc.) during the first cycle of taking birth control pills, since in some cases OCs cannot completely protect against pregnancy when you start using birth control pills.

Learn to use these methods of contraception, which is especially important if:

• You've run out of birth control pills;
• forgot your birth control pills somewhere else;
• with the development of complications or side effects associated with the action of birth control pills;
• to protect against sexually transmitted diseases, especially AIDS (in this case, the most reliable preventive measure is the use of condoms).

Take birth control pills regularly, one tablet a day until the pack runs out.

If you are using 28-day packs, start taking the tablets of the new cycle immediately after taking the last tablet of the previous pack.

If using 21-day packs, stop taking the medications for a week (7 days), then start taking the tablets again from a new pack.

Try to associate taking your birth control pill with a specific activity that you normally do at the time you take the pill, such as before bed, eating, brushing your teeth, etc. It makes using oral contraception much easier when you establish your own routine for taking birth control pills. The contraceptive effect and stability of the hormonal components of the OC increases if the tablets are taken at the same time of the day.

Try to check your birth control pill blister every morning to make sure you took the right pill the day before.

If you develop intermenstrual bleeding, try to take the pills at the same time of day. If spotting continues for several cycles (months), you should contact your doctor. In most cases, spotting is associated with the use of OCs with low hormone content. Because spotting is not a dangerous symptom, your clinician may choose a wait-and-see approach if you are not concerned or uncomfortable.

If intermenstrual bleeding develops in the case of regular and consistent use of birth control pills, inflammatory disease of the genital organs or insufficient effectiveness of prescribed OCs should be excluded; Some experts recommend the use of an additional method of birth control while taking birth control pills (especially if a woman is taking another drug that interacts with birth control pills and thus reduces their effectiveness).

The effectiveness of birth control pills may be slightly reduced. medicines that affect the absorption of drugs from the gastrointestinal tract or liver function. Such drugs include rifampicin, Dilantin (phenytoin), carbamazepine, ampicillin, tetracycline, etc.

What to do if you miss a pill

If you forget to take your birth control pills for a day or two, follow these guidelines:

• If you miss one birth control pill, take that pill immediately and the next pill at the scheduled time the next day. Despite the fact that the likelihood of pregnancy in this case is insignificant, you should resort to an additional method of birth control until the onset of your next menstruation.
• If you miss two birth control pills, take two pills at once immediately and the remaining two the next day. For example, if you forget to take your prescribed pills on Saturday and Sunday evenings, you should take two pills on Monday morning and two on Tuesday. In this case, spotting may appear, which in some cases continues until the next menstruation. Use additional birth control methods until your next period.

If you miss three or more birth control pills, you may be more likely to ovulate, become pregnant, or experience uterine bleeding or spotting. An additional method of contraception should be started immediately. In this case, it is recommended to think about using another method of birth control, since subsequently skipping pills again can lead to adverse consequences.

If you want to continue using birth control pills, you can
Take two birth control pills for three days while using an additional method of birth control until your next menstrual period. The use of an alternative method of contraception is most preferable when three or more birth control pills are missed or when the patient misses more than one pill each month.

Another option is to stop taking birth control pills from the old one and start taking them from the next pack (preferably from the next Sunday). The use of an additional method of birth control is necessary before and during the first two weeks after starting a new cycle of birth control pills (new packaging).

If you have strong (loose stools) or lasting several days, use an additional method of birth control until your next menstrual period from the onset of these symptoms.

Delayed menstruation while taking OK

Scanty menstruation is one of the characteristic symptoms when using birth control pills; the appearance of bloody discharge in the form of spots (or spots) indicates the onset of menstruation.

If menstruation is delayed while using birth control pills, you should consult a doctor.

Pregnancy is unlikely if your period is late, there are no signs of pregnancy and you are taking birth control pills regularly (as long as you have not missed any pills during your cycle). It should be recalled that this is observed in many cases of the use of birth control pills. Start taking the new cycle of pills on the appointed day.

To monitor the onset of pregnancy if menstruation is delayed, measurements should be taken within a few days of taking the last contraceptive pills or the first 3 days of the “pill-free interval”. basal temperature; if the basal body temperature does not exceed 37°C for 3 days, pregnancy can be excluded and you can start taking birth control pills in a new package.

If you miss 1 or more birth control pills and your period is late, you should stop taking the pills and start using another method of birth control. Consult your doctor for a gynecological examination and laboratory testing to rule out pregnancy.

Call your doctor immediately if you miss your period while taking two cycles of birth control pills. Submit your morning urine for laboratory testing to determine if you are pregnant.

If pregnancy occurs while using birth control pills, it is necessary to decide whether to maintain or terminate the pregnancy. The likelihood of developing intrauterine abnormalities in the fetus increases, although slightly, when using birth control pills during the first two months of pregnancy.
If you want to become pregnant, you should immediately stop taking birth control pills. You can use another method of birth control until normal menstruation is completely restored (this usually takes 2-3 months); in this case, it is easier to determine the duration of pregnancy and the approximate date of future birth.

• Indicate the use of birth control pills every time you see any doctor, especially for inpatient care.
• Consult your doctor if you develop depression, irritability or other mood changes, or decreased libido (sex drive).

Complications when taking OK

Learn to recognize early signs complications OK. Any of the following symptoms may indicate serious consequences from using birth control pills. Particular attention should be paid to early signs of the effects of OC use in women who smoke and consume more than 14 cigarettes per day; in this case, it is recommended to stop taking birth control pills after reaching the age of 35; The best solution is to stop smoking.
Don't ignore these problems and don't wait for them to go away. See your doctor right away and tell him about your concerns. Only in this case is the reliable use of oral contraceptives possible.

Early warning signs:

• Severe pain in the abdominal area;
• severe pain in the chest area;
• severe headaches, general weakness, feeling of numbness in the limbs;
• visual or speech disturbances;
• severe pain in the lower extremities (in the calf muscles or thighs).

Contact your doctor if you experience depression, jaundice, or a lump in the breast area.

Complications from taking birth control pills (oral contraceptives)

Amenorrhea

The use of modern OCs with low hormone content often leads to spotting after stopping a certain cycle of taking the pills.

But you need to know that prolonged exposure to small amounts of progestin contained in combined contraceptives reduces the thickness of the inner layer of the uterus - the endometrium, which causes a decrease in menstrual bleeding, and in some women - its complete absence.

In the absence of menstruation, it is necessary to undergo an examination to exclude pregnancy.

What you need to know and do in the absence of menstruation

Before starting to take OCs with a low content of hormonal components, you should be warned about the possibility of scanty menstruation or its delay. If you take OCs regularly and consistently and there is a delay in “menstruation” (withdrawal bleeding) due to the use of birth control pills, you need to start a new cycle of use. If menstruation is delayed again, you should be examined for pregnancy:

• Measure your basal body temperature for three consecutive days during the “pill-free interval.” A temperature below 37°C indicates the absence of pregnancy and ovulation.
• Determine human chorionic gonadotropin hCG in urine using a pregnancy test and serum - exclusion of pregnancy is the most important part of the diagnosis when two or more withdrawal bleedings are delayed.
• Ask your doctor to prescribe you a different type of OC that contains low hormones. Your doctor may prescribe a different OC containing a more active progestin, or birth control pills with a higher estrogen content.
• If “menstruation” is delayed for 8-16 months and there is no change in the clinical picture, despite the prescription of another type of OC, conduct a more in-depth examination after agreement with the doctor.

Bloody discharge or heavy intermenstrual bleeding

A decrease in estrogen levels can lead to uterine bleeding. The development of spotting or intermenstrual bleeding is more common when using low-dose tablets than when taking OCs with a high content of hormonal components. Such bleeding can be regarded as normal if it occurs in the first 3 months from the start of taking contraceptives.

You need to know that such intermenstrual bleeding is not harmful to health.

If bleeding or intermenstrual discharge occurs, it is necessary to exclude ectopic or intrauterine pregnancy, pelvic inflammatory disease, uterine fibroids, cervical fibroids and endometriosis.

What you need to know and do if bleeding or intermenstrual spotting occurs

You should be warned that such a complication is possible in the first 3 months from the start of taking the contraceptive. You need to know that reducing the OC dosage increases the safety of oral contraception, but increases the intensity of bleeding.

If bleeding develops before the expected “menstrual” period, you should continue taking the OC as usual or stop taking the OC for 7 days, and then continue using birth control pills from a new package.

• The doctor may recommend taking additional OCs with a high content of progestins or containing more active progestins in the second phase of the menstrual cycle. Sometimes a more effective treatment method is to prescribe OCs with an increased content of progestins without changing the dose of estrogen at any period of the menstrual cycle.
• Your doctor may recommend OCs with a high estrogen content without changing the dose of progestins. If there is heavy bleeding, take a blood test to determine your hemoglobin level. If you are anemic, start taking iron supplements.

Depression

Are you in a low mood, can't control yourself, don't want to go to work, do you constantly feel tired?

In most cases, the development of depression is not associated with the use of OCs. But sometimes a depressive state can be caused by the presence of a progestin component in combined contraceptives and the direct influence of OC hormones on the emotional sphere or on the metabolism of pyridoxine (vitamin B6), which leads to its deficiency.

With a pronounced picture of depression, the intervention of a psychiatrist is required.

What you need to know and do if depression occurs

• If depression is severe, you should consult a psychiatrist.
• If depression is associated with taking OCs, you should stop using birth control pills. In this case, the doctor may suggest another method of birth control and, if possible, resumption of taking OCs after 3-6 months.
• Your doctor may recommend switching to a combined contraceptive that contains a smaller amount of the progestin component.
• Take vitamin B6 20 mg per day.

Visual impairment

You may be bothered by a feeling of tension in the eye area, darkening, decreased visual acuity, sometimes accompanied by headaches, and general weakness.

In rare cases, the use of OCs can lead to inflammation of the optic nerve with loss or double vision, as well as pain or swelling of the eyes. When using oral contraception, the risk of developing retinal artery and vein thrombosis and corneal edema increases, which leads to an increased likelihood of discomfort or even corneal damage in women wearing contact lenses, although the use of modern improved lens models reduces the risk of such consequences. There is no evidence of worsening or development of glaucoma with OC use.

What you need to know and do if visual disturbances occur

Immediately stop taking OCs and consult a neurologist and ophthalmologist. You should also stop taking OCs if concomitant migraine occurs.

Headache

It has been found that in some cases, when using birth control pills, severe, recurring or persistent headaches occur or migraines become worse. Headaches are sometimes associated with blurred or loss of vision, nausea, vomiting, or a feeling of weakness in the limbs. Severe headaches in rare cases are prerequisites for the development of seizures, which requires careful monitoring and special intervention.

What you need to know and do if you have headaches

• If headaches are associated with OC use, stop taking birth control pills.
• Ask your doctor to prescribe a different method of contraception or a different type of OC with a lower estrogen and/or progestin content.
• If you have severe headaches, you should remember the risk of developing serious cerebrovascular complications.
• Get examined and consult a neurologist.

Arterial hypertension

The possibility of starting to take OK should be treated with caution if you:

• You notice episodes of increased blood pressure earlier, including those associated with the use of birth control pills, during pregnancy;
• notice periodic headaches;

• notice visual impairment;
• know about the presence of arterial hypertension in your parents;
• use caffeine, diuretics, antihistamines or vasoconstrictors, appetite suppressants, amphetamines;
• smoke.

What you need to know and do if your blood pressure is high

Arterial hypertension is considered above 140/90 mmHg. on three or more follow-up visits. At the same time, according to the WHO definition, hypertension should be considered an increase in systolic pressure to 160 mm or more, and diastolic pressure to 95 mmHg. and more.

It is necessary to stop using OCs if diastolic pressure increases to 90 mmHg or more. (when determined during several visits). With diastolic pressure from 60-70 to 80-90 mmHg. The physician should reduce the content of progestins and estrogens or temporarily stop taking contraceptives for the purpose of clinical observation.

The doctor may prescribe “mini-pills” or combined OCs with minimal estrogen content. In most cases, blood pressure normalizes within 1-3 months after stopping OC use and requires repeated monitoring.

• It is necessary to quit smoking or reduce the number of cigarettes smoked, exercise regularly, lose weight, reduce salt, caffeine intake, etc.
• Constantly monitor blood pressure, especially during pregnancy, since in the case of development of blood pressure associated with the use of OCs, blood pressure in most cases increases during subsequent pregnancy.
• Initiate appropriate treatment in a timely manner to prevent the development of serious consequences.
• Ask your doctor to prescribe you a different method of contraception.

Nausea

Complaints of nausea in women using oral contraception are more common during the period of taking the first cycle of OCs or the first pills of each new cycle. develops extremely rarely. If nausea develops after months or years of starting OC use, you need to think about the possibility of pregnancy, or rule out an infectious disease.

What you need to know and do if you experience nausea

• Switch to another type of combination OC with low hormone content or “mini-pill”. Birth control pills containing 20 mcg of estrogen significantly reduce the intensity of nausea, but at the same time increase the risk of intermenstrual bleeding, spotting and amenorrhea.
• Spontaneous disappearance or reduction in the intensity of nausea is possible during the first months of taking the drugs.
• Take birth control pills at night or before bed.
• Be sure to take an additional contraceptive pill if vomiting occurs immediately after taking the previous one.
• Rule out pregnancy by testing human chorionic gonadotropin in urine (using a pregnancy test) or in the blood.

Weight gain

Although women may notice weight gain while using OCs, in most cases the direct cause of these changes is not the birth control pill. Changes in body weight are influenced by factors such as physical and emotional stress, exercise exercise, any lifestyle changes, etc. Some women usually gain weight up to 2.5-4.5 kg during the winter period, which is in some way associated with a sedentary lifestyle.

Weight gain may be associated with:

• Side effects of the progestin and/or estrogen components of OCs include fluid retention. In this case, body weight increases during the first month after starting to take birth control pills;
• side effects of the estrogenic component of the OC, which is revealed by an increase in the subcutaneous fat layer with a predominant location in the hips and chest. This type of weight gain occurs within several months after starting OC use;
• increased appetite and large meals, which is often associated with the anabolic effect of the progestin component of birth control pills. In this case, weight gain occurs gradually over several years after the start of oral contraception;
• an increase in insulin levels in the blood, which in most cases is explained by the side effect of the progestin component of the OC on insulin secretion;
• depression, which often leads to increased food intake or calorie intake;
• changing your diet, increasing the caloric content of food intake, reducing physical activity or playing sports or physical education;
• pregnancy.

What you need to know and do when gaining weight

• Stop taking birth control pills or reduce the content of estrogens and/or progestins in OCs if cyclical weight gain is associated with fluid retention.
• Switch to OCs with a reduced content or less active estrogen component in case of weight gain due to subcutaneous tissue and/or adipose tissue of the mammary glands.
• Stop taking birth control pills or switch to taking OCs with reduced androgenic activity if you observe the anabolic effect of the progestin component of the OC and weight gain over a long period (several months or years).
• Limit the number of calories you consume and increase physical activity.

It is possible to take OK for women with. In this case, the use of OCs with a reduced hormone content is indicated.

The preventive effect of OCs against endometrial cancer is one of the positive aspects of using birth control pills for excess weight, which is a predisposing factor for the development of endometrial cancer.

Enlarged or tender breasts

In some cases, when using birth control, a feeling of fullness or pain in the mammary glands (mastalgia) may occur during the normal menstrual cycle, which is associated with the effect of the estrogen component of the OC and is less common when using birth control pills with low estrogen content.

Safety of birth control pills (oral contraceptives)

Once you stop taking combined contraceptive pills, fertility returns without additional intervention much more quickly than with other methods of contraception.
Advice for women who want to become pregnant after stopping birth control:
Birth control pills are the best choice for women who want to become pregnant in the future.
By preventing diseases such as pelvic inflammatory disease, ovarian cysts, endometrial cancer and endometriosis, OCs can significantly increase the likelihood of pregnancy.
If your menstrual cycle was irregular before you started using birth control pills, your menstrual cycle will become equally irregular once you stop taking them.
Fertility recovery will not be accelerated if you take periodic breaks from taking birth control pills.
After stopping taking the pills, pregnancy may occur on average 2-3 months later than expected (compared to what would be required during unprotected sexual activity), so if you are planning a pregnancy, you should stop taking OCs at least 3 months in advance.
In 1-2% of women it is observed during the use of birth control pills.
Since in most cases pregnancy occurs immediately after stopping taking birth control pills, if you do not want to have a child, you should immediately resort to another method of birth control.

Positive non-contraceptive effects of birth control pills

Birth control pills have a number of non-contraceptive properties that may significantly outweigh their side effects and complications.
Effect on the menstrual cycle. When using birth control pills, the intensity of menstrual and intermenstrual (ovulatory) pain, the duration and intensity of menstrual bleeding are significantly reduced, the menstrual cycle is regulated and the number of functional ovarian cysts is reduced. The use of combined contraceptive pills also has a beneficial effect on the course of iron deficiency anemia and premenstrual syndrome.
Protection from acute inflammatory diseases of the pelvic organs. The use of oral contraception significantly reduces the risk of developing acute inflammatory diseases of the internal genital organs, which is the main cause of female infertility. When using birth control pills, you are significantly less likely to develop severe forms of pelvic inflammatory disease than women who do not take contraceptives. The above can be explained as follows:
When using birth control pills, the average amount of monthly lost menstrual blood decreases (menstrual flow, as is known, is an excellent breeding ground for pathogens of inflammatory diseases of the genital organs).
A change occurs in the cervical mucus in the form of its thickening, which prevents the penetration of sperm and, thus, ascending potential pathogenic pathogens of infectious diseases into the uterine cavity.
The use of oral contraceptives leads to less dilation of the cervical canal, mainly due to a decrease in the amount of cervical secretion and the volume of menstrual blood loss.
When using combined contraceptive pills, the intensity of uterine contractions is reduced, which leads to a reduced risk of spread inflammatory process from the uterine cavity into the fallopian tubes.
Protection against the development of ovarian and endometrial cancer. The use of oral contraceptives (OCs) reduces the risk of developing malignant tumors, including ovarian and endometrial cancer by almost 50%. The degree of reduction in the likelihood of developing cancer depends on the duration of OC use. This pattern was identified when they were used for more than 12 months and persists for a long period after stopping the use of birth control pills.
Recurrence of ovarian cysts. Because OCs suppress ovulation, the incidence of functional ovarian cysts among women using combined contraceptive pills is reduced by more than 90%.
Benign tumors (cyst and fibroadenoma) of the mammary glands. When using OCs, the likelihood of developing benign tumors, in particular, cysts and fibroadenoma of the mammary glands, decreases. Unfortunately, birth control pills do not have a protective effect against benign changes in the mammary glands associated with atypical processes of the excretory ducts, which are considered precancerous diseases.
. By inhibiting ovulation, OCs prevent the development of ectopic pregnancy, which is the cause of a significant portion of maternal mortality.
Other non-contraceptive properties. The use of OK has a beneficial effect on skin rashes in the form. In addition, some women experience breast enlargement and weight gain, which can be considered both positive and negative aspects of using birth control pills.
Some women and men experience increased sexual satisfaction during intercourse because the fear of unwanted pregnancy is reduced.
Additionally, women can delay the onset of menstruation until the time they want by taking additional birth control pills. For example, it is possible to lengthen the menstrual cycle to 90 days by taking 84 tablets, i.e. 4 packs of 21 tablets, and creating a “pill-free interval” for 6 days.
In addition, OCs are used in the treatment of diseases such as endometriosis and idiopathic thrombocytopenic purpura. The incidence of rheumatoid arthritis is reduced.

Prevention of tumor processes and birth control pills

There was an increased risk of developing liver adenoma, which is considered a benign tumor. Women who take birth control pills for a long time (8 years or more) are more likely to develop liver cancer (hepatocellular carcinoma).
There is no increased risk of breast cancer when using OCs. At the same time, the risk of developing breast cancer increases in young, nulliparous women using OCs with a high content of active progestin. The use of OC reduces the risk of developing malignant tumors such as ovarian and endometrial cancer.
The extent to which the risk of developing ovarian cancer is reduced depends on how long you use birth control pills. When used for more than 5 years, the risk is reduced by approximately 60%.
Reducing the likelihood of developing endometrial cancer with regular use of combined OCs is reduced by at least 50%. A significant decrease was observed in nulliparous women. The protective effect of OCs persists for at least 10 years after discontinuation of the drug.
OCs also help reduce the likelihood of developing benign tumors, such as benign breast tumors.

Doctor of Medical Sciences, Professor Kuznetsova I.V., Department of Obstetrics and Gynecology No. 1, Faculty of Medicine, MMA named after. THEM. Sechenov

Summary:

The report examines the requirements for contraceptives, the advantages and disadvantages of combined (estrogen-gestagen) oral contraceptives from today's perspective, and provides a rationale for the use of purely progestogen contraceptives.

Keywords: contraception, progestins, COCs, Charozetta

The ideal contraception of the 21st century should ensure high safety, effectiveness, and also have additional positive effects. Today, hormonal contraceptives can be divided into two large groups: combined (estrogen-progestogen) and pure progestogen contraceptives. Moreover, in both groups there are both oral and parenteral forms.

The basis of hormonal contraception are progestins - these are all substances, natural and synthetic, that have a characteristic antiproliferative and secretory-transforming effect on the endometrium. Progestins are synthetic gestagens, that is, part of a large group of gestagens (progestogens), which includes progesterone. They have the main antigonadotropic effect, thereby providing a contraceptive effect. The dose of ethinyl estradiol (EE), included in modern COCs, is not sufficient to suppress ovulation, so EE is included in COCs solely for the purpose of cycle control.

On the other hand, the estrogenic component, influencing various organs and systems, can, in a dose-dependent manner, cause the occurrence of a whole range of side effects that prevent the use of drugs in certain groups of women.
The main concern is the association between COC use and the development of venous thrombosis. For example, women over 35 who smoke have a slightly increased risk of developing myocardial infarction, and women with hypertension have a slightly increased risk of stroke. Moreover, the risk of developing myocardial infarction increases with the number of cigarettes smoked in one day. According to WHO (2004), the use of COCs in women with disorders of the hemostatic system increases the risk of thrombosis. Studies have shown that overweight women (more than 30 kg/m2) using contraceptive COCs were at increased risk of thromboembolic complications compared with women who did not use COCs. However, the absolute risk of such a complication remains quite low. Therefore, COCs are not recommended or undesirable for women who have high risk factors for the development of arterial and venous thrombosis. According to the Ministry of Health of the Russian Federation, the level of diseases of the cardiovascular system and metabolic disorders in our country is growing every year. Accordingly, the number of women who do not want to take combined contraceptives is growing.
Even in women who have no contraindications to the use of OCs, estrogens can cause side effects such as nausea, headache, and breast engorgement, which are the main reasons for discontinuation of OC use. Estrogens contained in COCs can affect the amount of breast milk in nursing women and the duration of lactation.

Based on this, prescribing COCs is impossible or less preferable compared to prescribing pure progestin drugs for many common diseases and syndromes.

A representative of progestogen-containing contraceptives is the drug Charozetta. Each Charozetta tablet contains 75 mcg of the highly selective progestogen desogestrel. Charozetta is taken continuously.
One of the main advantages of Charozette is its mechanism of action. Unlike the mini-pill, the main mechanism of action of Charozetta is the suppression of ovulation, which is observed in 99% of cycles. Thanks to this, if you miss taking a pill for less than 12 hours, the contraceptive effectiveness is not reduced.

Numerous studies have proven that side effects are rare when using the drug. Charozetta does not have a clinically significant effect on body weight, blood pressure, hemostasis, lipid and carbohydrate metabolism.

Clinical experience with the use of progestin-only contraceptives has shown that they have additional non-contraceptive effects, which is manifested by a decrease in menstrual flow and the incidence of anemia. Progestogen-containing contraceptives can be used to treat heavy bleeding, treatment of pain syndrome in endometriosis, prevention of acute episodes of inflammatory diseases of the pelvic organs, prevention of endometriosis, hyperplastic processes and endometrial cancer. Due to the fact that ovulation is effectively suppressed during the continuous use of gestagen-containing contraceptives (except for the mini-pill), it seems justified to use this effect for the treatment of diseases that depend on changes in the level of female sex hormones.
Contraindications to gestagen contraception include confirmed or suspected pregnancy, bleeding from the genital tract of unknown etiology, breast cancer (including a history), migraine with focal symptoms, cerebrovascular accident, severe liver disease (active phase of viral hepatitis, cirrhosis of the liver) .

Thus, estrogen-free contraception is highly effective and acceptable, safe and has additional beneficial effects. Progestogen-containing drugs are relevant in the 21st century.