Hormonal drugs for women after 35 consequences. Birth control pills: monophasic, biphasic and triphasic

Prevention problem unwanted pregnancy has long been a concern for humanity. And today, family planning remains one of the most pressing topics. Contraception is protection against unwanted pregnancy, and therefore against negative consequences that may arise as a result of its interruption. Any method of preventing pregnancy is safer for a woman’s health than terminating it! According to the Russian Medical Academy, only 25% of married women use contraception, in last years the use of the most effective methods contraception, such as hormonal and intrauterine devices!

Over the long century of its existence, hormonal contraception has acquired myths and legends, which force women to be wary of using it. Let's try to figure it out, is this true?

How long has hormonal contraception been around?

The idea of ​​its creation arose at the beginning of the twentieth century thanks to the experiments of the Austrian doctor Haberland. The first artificially synthesized female sex hormones - estrogen and progesterone - were obtained in 1929 and 1934, and in 1960, the American scientist Pincus created the Enovid pill, which laid the foundation for the whole genus hormonal contraception.

What are they? hormonal contraceptives?

They consist of estrogen and progestogen components, artificially created twin brothers of estrogen and progesterone (natural sex hormones in women). Such drugs are called combination drugs. Sometimes drugs containing only gestagens are used.

What types of hormonal contraception are there?

Hormonal contraception is divided into oral (OK) - the drug enters the woman’s body through the mouth in the form of tablets and parenteral - hormones enter through other routes, bypassing the intestines. Another type of parenteral hormonal contraception is special ring, placed into the vagina by the woman herself once a month. There is also special kind intrauterine device, which has a contraceptive effect due to the release of hormones.

What is COC?

COCs are combined oral contraceptives(analogues of estrogen and progesterone in tablets).

Distinguish monophasic COCs (in each tablet of the drug the content and ratio of estrogen and progesterone are the same), two-phase (the estrogen content is the same in all tablets, but the dose of progesterone in the second phase of administration is higher), three-phase (different ratio of hormones in the three phases of administration).

Besides, COCs, depending on the dose of estrogen, are divided into high-dose, low-dose and micro-dose. From the first days of the invention of these drugs to improve COCs, scientists have been following the path of reducing hormone dosages: it is believed that the lower the dosage in a COC tablet, the less side effects.

Are three-phase COCs more physiological and closer to the normal menstrual cycle?

Triphasic COCs do not necessarily mimic the hormonal fluctuations of the normal menstrual cycle and are not more physiological than monophasic COCs. The advantage of the former is a lower percentage side effects than the rest. But only a few women tolerate triphasic COCs themselves well.

How do COCs work?

The hormones included in COCs affect the process of formation and release of the egg from the follicle in the ovary in such a way that ovulation simply does not occur. That is, the egg is not “born”, therefore, its meeting with the sperm is obviously impossible. It is also impossible because COCs create a kind of trap for male reproductive cells. These drugs make the cervical mucus more viscous, which is a barrier to the path of sperm into the uterus.

In addition, even if fertilization of the egg does occur, for further development it is necessary that it enter the uterine cavity at a certain moment - not earlier and not later than the due date. Under the influence of COCs, the work of the fallopian tubes, which “move” the fertilized egg towards the uterus, slows down, thereby preventing the progression of pregnancy.

Let's say that the fertilized egg managed to get into the uterus at the right moment. But for the further development of the embryo, a special condition and structure of the inner lining of the uterus (endometrium) is necessary, which provides nutrition and other conditions necessary for pregnancy. When taking COCs, changes occur in the structure of the endometrium that prevent further development fertilized egg.

What are the rules for taking COCs?

The drug should be taken on one of the first days of menstruation or within three days after an abortion. The earlier the better. If the use of COCs did not start on the first day of the cycle, it is better to use additional methods contraception during the first two weeks. Reception is continued for 21 days, after which a break of no more than 7 days is taken. Usually a woman is recommended to take COCs at the same time of day, and so that she does not forget about this, it is better if she associates taking the drug with daily ritual, for example, will put the tablets next to the toothbrush.

If a woman still forgets to take another pill (most common mistake while taking COCs), it is recommended to take it as soon as possible and continue taking subsequent normal mode. But in this case, additional contraception for 2 weeks is desirable.

How many months (years) in a row can you use COCs?

There is no clear opinion on this matter. Some gynecologists believe that when correct selection The duration of use of the drug does not increase the risk of complications. Therefore, you can use this method of contraception as long as necessary, until the onset of menopause. Taking breaks from taking medications is not only unnecessary, but also risky, since during this period the likelihood of an unwanted pregnancy increases.

Other scientists take a different point of view, insisting on small, but mandatory breaks at 3-6 months. So, some recommend imitating natural pregnancy, that is, take COCs for 9 months, and then stop the drug for 3 months, using other methods of contraception. The body is given a kind of rest from the “rhythm and doses of hormones imposed on it.” There is evidence that with continuous use of COCs for a number of years, the ovaries seem to become exhausted, in other words, they “forget” how to work independently.

How effective are COCs?

This method of contraception is highly reliable in preventing unwanted pregnancy. According to statistics, within twelve months of their use, 1000 women experience 60-80 pregnancies, but only one is the result of insufficient contraceptive effect of the drug, and the rest are due to errors in the use of COCs. For comparison: with interrupted sexual intercourse during the year, there are 190 cases of unplanned pregnancy per 1000 women, of which 40 are due to the unreliability of the method itself.

How long after stopping taking COCs can a woman become pregnant?

At correct use With COCs, the ability to conceive is restored immediately after COCs are discontinued. After 3-6 months it reaches 85%: the same as in women who did not use hormonal contraception.

How does OK affect libido?

There is no definite answer, everything is individual. But most women note an increase in sexual desire, since there is no fear of an unwanted pregnancy when taking OCs. If there is a decrease in sexual desire when using COCs, then this problem can sometimes be solved by changing the contraceptive used to another one with less progesterone.

Do OCs actually make you fat?

Fear of gaining weight hormonal pills has existed since ancient times. Weight gain (usually plus 2-3 kg) occurs in the first three months of taking the drug, mainly due to fluid retention in the body. OCs can increase appetite, which also contributes to weight gain. However, in other women, taking OCs, on the contrary, causes the loss of extra pounds or does not affect weight at all.

Can young nulliparous girls take OK?

In some cases, even teenage girls are prescribed OK by gynecologists, since these drugs, in addition to preventing unwanted pregnancy, have a number of medicinal properties.

When are OCs prescribed as treatment?

For various disorders menstrual cycle, with some uterine bleeding, for polycystic ovary syndrome, as well as for the treatment of severe forms premenstrual syndrome, endometriosis, etc. There is also evidence that COCs have positive influence on the course of stomach ulcers and rheumatoid arthritis.

Are COCs really prescribed for the treatment of infertility?

Hormonal contraceptives: truth and myths

For some forms of endocrine infertility, “intermittent use” of OCs is used. For example, taking some of these drugs for 3 months followed by a break of 2 months in certain cases restores ovulation.

Who are these drugs prescribed to?

In the absence of contraindications to taking hormones, COCs are recommended for women of any age who want to protect themselves from unwanted pregnancy.

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 who is about to give birth is a typical example of the way of pre-revolutionary life. A hundred years ago, a woman spent almost the entire reproductive period in two states - pregnancy and breastfeeding, and the latter smoothly flowed into the next interesting position.

Whether it’s good or bad, there are far fewer heirs in modern families. One or two children are considered the norm. And in order not to exceed the upper limit, healthy woman contraception must be taken seriously.

Today, the contraceptive arsenal includes about a dozen methods of preventing unwanted pregnancy. Perhaps the most popular method is the use of birth control pills.

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

Birth control pills: both orally and vaginally

The concept of “contraceptive pills” includes two absolutely different categories medicines:

- hormonal contraceptives, the basis of which are synthetic hormones;

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

Of course, the greatest interest from the point of view pharmacological effect constitute precisely hormonal agents. This is where we begin our acquaintance with contraceptive drugs.

Hormonal contraception: origins

Already in late XIX 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 hormones corpus luteum. In the 20s of the 20th century, Ludwig Haberlandt proposed the use of such substances as contraceptives. Over the next ten years, three estrogens were synthesized: estrone, estriol and estradiol, and at the end of 1929, scientists also identified progesterone.

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

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

Pharmacological effect of hormonal tablets

The effect of contraceptive hormonal drugs does not depend on the composition and dosage. The contraceptive effect is achieved by influencing the 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, as a result of which the gonadotropic function of the pituitary gland decreases. Due to this, ovulation is inhibited and temporary sterility occurs.

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

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

Fourthly, peristalsis of the fallopian tubes slows down significantly. A miraculously mature egg will hardly be able to escape from the long, slow-moving 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 implantation of a fertilized egg. This mechanism serves as additional protection - even if conception has occurred, the embryo simply will not be able to attach to the wall of the uterus.

The effectiveness of contraceptive drugs is assessed using a single indicator - the Pearl index. It is equal to the number of pregnancies occurring during 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 contraceptives hormonal drugs contained simply killer doses of hormones: 150 mcg of estrogen and 9.35 mg of gestagen. In 1964, it was possible to reduce the concentration of active substances to 100 mcg and 2 mg, respectively. However, these dosages were far from perfect.

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

In the 1970s, the upward trend in the use of hormonal contraceptives stalled. This was led to severe adverse events in the form of thromboembolism (blockage of blood vessels with blood clots), especially in smoking women. Pharmacists had no choice but to develop new low-dose drugs. And it was a success.

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

Classification of hormonal contraceptives

All hormonal drugs can be divided into three large groups:

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

- progestin preparations - mini-pills.
Monocomponent products that contain only gestagen.

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

Modern hormonal contraceptive pills can be divided into several groups, each of which is suitable for a specific category of women. This takes into account age, whether the woman has given birth or not, and whether she suffers from any hormonal or other disorders of the body.

1. Combined birth control pills

Contraception for women who have given birth or women of late reproductive age who have regular sex life, in case of contraindications to the use of combined oral contraceptives (estrogens). These drugs have fewer side effects and are slightly less reliable.

Sikirina Olga Iosifovna.

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 used hormonal contraceptives for family planning and effective protection against unwanted pregnancy.

Of course, during this period, more advanced and easy-to-use forms were invented, which make it possible to select hormonal contraception for almost any healthy woman.

What is hormonal contraception?

Regardless of the route of administration, hormonal contraceptives consist of synthetic analogs of one or both of the female sex hormones: estrogen and progesterone. Consequently, hormonal contraceptives (HCs) can be combined (contain both hormones) or single-component.

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

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

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

It is the gestagenic component that determines all the variety of hormonal contraceptives.

How do GCs work:

• Suppresses egg maturation (ovulation).
• They thicken cervical mucus, preventing the passage of sperm.
• Modify the structure of the uterine mucosa (the likelihood of attachment of a fertilized egg decreases).
• Reduce the speed of sperm movement 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 according to the route of introduction into the woman’s body:

• 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 - progestogen.

Each type of hormonal contraception has its own indications and contraindications. The selection of the form and composition of a 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:

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

In addition, combined hormonal contraceptives (due to negative influence estrogen component) are contraindicated for the following categories of women:

• The entire lactation period.
• Bleeding disorders, thrombosis (current or in history).
• Some somatic diseases in which there is increased risk 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 HAs should be used with caution.

Also available certain contraindications to the use of a specific 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, receiving greatest distribution. They are used in the form of tablets that must be consumed in strict order.

Oral contraceptives are either combined oral contraceptives (COCs) or progestin-only pills (PPOCs, “mini-pills”).

Combined

Traditionally, based on the combination of estrogen/progesterone components, 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).
• Multiphase - the content of estrogen and progesterone in active tablets can have three or more combinations (Tri-Regol, Triquilar, Tri-Mercy, Qlaira, etc.).

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

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

Admission rules

The most important requirement is to take the pills daily. It is necessary to take one COC tablet every day, preferably at the same time of day. You should also get it from your doctor exact instructions regarding the regimen of taking pills and strictly adhere to it.

Start of use:

• It is recommended to take the first tablet within five days of starting next menstruation. Most doctors advise starting to take 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 for a week after it.

If for some reason the next pill is not taken, you should urgently consult a doctor.

Advantages of COC:

• At correct use- 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 helps normalize hemoglobin levels (if they decrease).
• Menstrual pain is reduced.
• Risk reduction benign tumors and ovarian and endometrial cancer.
• Some types of gestagens in COCs have an antiandrogenic effect and can be used with additional therapeutic effect(in addition to contraceptive).

Disadvantages and contraindications to COCs:

• The need for strict daily intake tablets.
• Unpleasant side effects are possible in the first few cycles of use: nausea, dizziness, headache, spotting, etc.
• Decrease in efficiency when simultaneous use with some medications(anticonvulsants, antituberculosis, 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 are no menstrual flows during a 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 POC drugs with the following composition (in one tablet):

• 0.5 mg linestrenol (Exluton).
• 75 mcg desogestrel (Laktinet, 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: after finishing one blister, you begin taking tablets with the next one.

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

• When smoking.
• During 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).
• COCs do not have prophylactic or therapeutic properties.
• Reduced 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 start of menstruation (preferably on the first day). After childbirth, if the woman wishes, she can start taking this drug already one and a half months after the birth of the child and if lactation is present. If a woman is not breastfeeding, then POC can be started in the first days after birth.

The contraceptive effect when taking POC occurs within the first day from the start of taking the drug.

Injectable contraceptives

This involves administering the drug by injection (usually intramuscular). These drugs have a prolonged effect 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-based (PIC).

Combined

Currently, CICs 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 almost the same as those of COCs. In addition, there is a more frequent disturbance of the menstrual cycle (irregularity, spotting) at the beginning of treatment.

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 permissible deviation 1–7 days).

Progestogenic

Among injectable contraceptives containing a monocomponent (progestin), the most well-known drugs are:

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

The most popular among ICPs is Depo-Provera (150 mg). It is administered intramuscularly once every three months (deviation in the timing of injection is allowed up to 2-4 weeks earlier or later than the prescribed date).

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 advantage is long-term and reversible contraception with high efficiency. They can be used by women of almost any age, as well as by nursing mothers. Majority somatic diseases conditions in which the use of estrogens is contraindicated are also not an obstacle to the use of ICP.

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

The first administration of the drug is carried out within seven days from the beginning of the next menstruation. After childbirth, it is permissible to use PIC as early as three weeks in the absence of lactation or after a month and a half if it is present.

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

Implants

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

This is a long-term 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. It consists of two capsules with levonorgestrel, which prevent pregnancy for three years.
• Implanon. It is presented in one capsule filled with etonogestrel (a metabolite of desogestrel), the validity of which is 3 years.

The implants do not contain an estrogen component, which allows them to be used by women for whom estrogen-containing hormonal contraceptives are contraindicated.

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, bleeding during the first 6–12 months of using the method.
• Some women sometimes experience weight gain, discomfort and tension in the mammary glands, mild headaches and some others unpleasant symptoms, which usually disappear over time.

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

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

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

New combined HAs

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

Hormonal patch

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

The hormonal contraceptive Evra is a 20 square meter patch. cm, which is attached by the woman independently to dry, intact skin. The patch releases approximately 150 mcg of norelgestromin and 20 mcg 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 applied on the first day of menstruation and is regularly replaced every seven days of use. Then it is removed and a seven-day break is taken. Therefore, the full contraceptive cycle is 28 days. A new cycle with the application of a patch begins the next day after the end of such a break.

• Buttocks.
• Stomach.
• Outer surface of the shoulder.
• Upper body.

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

It is necessary to regularly and carefully inspect the place where the patch is attached to ensure that it is firmly attached.

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

What you need to know:

• If you are overweight (90 kg or more), you should not use this product. contraceptive method due to its reduced effectiveness in such women.
• Do not use more than one patch at a time.
• If the skin is irritated, you can re-stick the patch to another area.
• Sometimes during the adaptation period, side effects may occur: nausea, vomiting, menstrual irregularities (even before bleeding). If such 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 releases approximately 15 mcg of ethinyl estradiol and 120 mcg of etonogestrel, the secretion of which is activated by body temperature. They then enter the bloodstream through the vaginal mucosa, thereby minimizing their systemic influence. One vaginal ring is designed to be used for one cycle.

The contraceptive is inserted by the woman herself 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 the ring falls out during stress, defecation, sexual intercourse or other conditions, it must be rinsed in running warm water and reinserted.

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

Other advantages and contraindications for use hormonal patch and vaginal ring are the same as for all combined GCs.

Intrauterine system

It is a variety intrauterine contraceptive device(“spirals”) containing progestin – levonorgestrel (LNG). Currently used under the following trade names:

• Mirena (abroad – Levonova). Contains 52 mg LNG. Established for five years.
• Jaydess. Contains 13.5 mg LNG. The recommended period of use is three years.

Each intrauterine system releases approximately 20 mcg of progestin daily. How longer term use of the system, the lower the daily volume of levonorgestrel excretion.

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

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

You should know 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 inserted by a doctor during the next menstruation or on any day of the cycle if there is confidence in the absence of pregnancy. After childbirth, it is possible to use this method as early as four weeks.

Main contraindications for use this method are (in addition to the general ones):

• Infectious and inflammatory pathology of the genital tract (including recurrent ones).
• Cervical dysplasia.
• Anomalies in the structure of the uterus (including fibroids that deform the uterine cavity).
• Increased risk of genital infection (eg frequent change sexual partners).

Before inserting an intrauterine hormonal system Some preparation and examination of the woman is necessary, the extent of which is determined by the doctor.

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

There comes a time in every woman’s life when she thinks about protecting herself from unwanted pregnancy. Currently, pharmacy shelves offer a wide range of hormonal tablets that are highly effective. However, in consciousness Russian women the memory of their side effects associated with the set is still alive excess weight.

In this regard, many representatives of the fair half of humanity prefer to use contraceptives that do not contain hormones, despite their low effectiveness. What non-hormonal contraceptive pills do pharmacists offer women, and what new generation hormonal contraceptives do not have side effects on the female body?

Currently women reproductive age Increasingly, people are resorting to chemical protection against pregnancy provided by non-hormonal pills. However, they justify their name only by their form, although they are not tablets as such. These drugs are not taken orally, like traditional hormonal contraceptives, but are inserted into the vagina.

The composition of such drugs includes spermicides - substances that, within a short period of time, destroy spermatozoa, preventing their penetration into the body. fallopian tube. Their active substance is benzalkonium chloride or nonoxynol.

How exactly do non-hormonal contraceptives work?

• Coming into contact with a sperm, spermicides destroy the flagellum, interfering with its further movement.
• When interacting with the head of the sperm, the membrane is damaged, which leads to its death.
• Causes thickening of mucus in cervical canal cervix, which becomes a reliable obstacle to the advancement of weakened sperm.

Preparations based on spermicides are also available in other substances, which include the following forms:

• vaginal suppositories;
• vaginal creams and gels;
• tampons;
• diaphragms are soft, dome-shaped caps that cover the cervix.

Regardless of the form of release, the use of non-hormonal contraceptives allows you to create a reliable protective barrier against fungi and other diseases transmitted during unprotected sexual intercourse. This is facilitated by substances included in the preparations that have bactericidal and antimicrobial effects.

Distinctive feature non-hormonal methods contraception is that they must be used immediately before intimacy. At the same time, they retain their effectiveness for several hours.

Degree of reliability

The effectiveness of certain contraceptive drugs is assessed using the Pearl scale. The study is conducted among 100 women using this particular method of contraception. This indicator is based on information about how many women among the subjects managed to become pregnant despite protection. And the lower the indicator, the higher the effectiveness of the group of drugs being evaluated.

In this case, this indicator is 8-36. This means that from 8 to 36 women out of 100 become pregnant even with protection from unwanted pregnancy.

When is the use of non-hormonal drugs indicated?

Despite the rather low efficiency, non-hormonal contraceptive pills have a number of advantages compared to hormonal methods contraception.

• They can be used for various gynecological diseases, for example, uterine fibroids, as well as in the presence of hormone-dependent tumors.
• These drugs do not enter the stomach and are not absorbed into the blood, and therefore are not able to affect the liver, blood vessels and other body systems.
• They can be used for rare sexual contacts.
• They have a bactericidal and antimicrobial effect, which hormonal agents lack.

Non-hormonal contraception will provide reliable protection for women breastfeeding babies. They are used if women are contraindicated to use COCs or other types of contraceptives.

These drugs will help prevent pregnancy in women of Balzac age (40-45 years). At this age, the menstrual cycle is no longer regular. However, the possibility of pregnancy has not yet been ruled out.

Disadvantages and contraindications

Such drugs are inserted into the vagina. Moreover, this must be done at least 10 minutes before the intended sexual contact. This means the absence of any unpredictability in sex and the need to discuss with your partner the time of each coitus. When using these drugs, it is not recommended to shower immediately before or after sexual intercourse. The time you need to wait is specified in the instructions for each drug.

Non-hormonal medications contain acid, which can irritate the mucous membrane, causing itching and burning in the vagina. However, these products are not recommended to be used regularly, since they long-term use can lead to disruption of the microflora in the vagina, causing the development of dysbacteriosis. There are no contraindications for the use of these contraceptives. The only exception is individual intolerance to their components.

Review of popular contraceptives

All non-hormonal tablets are divided into groups based on which of the active substances is included in their composition.

Names of contraceptives based on benzalkonium chloride:

• Pharmatex is most popular due to its low cost combined with high efficiency. It is available as vaginal tablets, and in the form of cream, suppositories and even tampons. Regardless dosage form, the drug begins to act 10 minutes after ingestion, without losing its properties for 3-4 hours.
• Ginotex are ring-shaped tablets. It is recommended to administer them no later than 5 minutes before contact. The effect of the tablet lasts for 4 hours.
• Genotex are tablets whose action is identical to previous drugs.
• Erotex - non-hormonal contraceptive suppositories, the effect of which begins after 10 minutes and ends after 3 hours.
• Contratex are candles that begin to perform their functions after 10 minutes and end after 4 hours.

Names of contraceptives based on nonoxenol:

• Patentex Oval are highly effective suppositories that are inserted into the vagina 10 minutes before expected intimacy. They retain their effect for up to 10 hours.
• Nonoxenol is a contraceptive suppository that has the same characteristics as the previous drug.

It should be remembered that before each subsequent sexual intercourse, non-hormonal contraceptives must be reintroduced.

Features of choice

How to determine which non-hormonal birth control pills are better? Considering their low cost, price is not a decisive factor when choosing. However, as the experience of women who have already experienced everything existing forms non-hormonal contraceptives, suppositories are suitable for ladies suffering from vaginal dryness. When using them, there is no need to use lubricants.

There are also unpleasant phenomena associated with the fact that when the tablet dissolves, a characteristic hissing sound is heard and foam is released from the vagina. In addition, even using the most good drugs, it is possible that irritation, itching and burning may occur not only in women, but also in their partners. Each woman’s body reacts differently to certain substances. Therefore, determining which non-hormonal contraceptives are better will have to be done through trial and error.

Hormonal contraceptives

Every year all larger number women prefer the use of hormonal oral contraceptives, which is explained by their high efficiency. They not only reliably protect against unwanted pregnancy, but also have beneficial influence for women's reproductive system. Among other contraceptives, new generation contraceptives took pride of place on the pedestal.

All modern hormonal preparations for oral administration are divided into four types, based on the amount of hormones they contain.

• Microdosed contraceptives contain minimal amount hormones, which practically eliminates their side effects. Active ingredient in such preparations it is a synthetic analogue of estradiol. Due to this, they are used to treat acne and painful menstruation arising due to imbalance of hormones. Such drugs can be used by very young nulliparous girls, and mature women who have never taken hormonal contraceptives.
• Low-dose contraceptives also contain synthetic in combination with. Such drugs will be an ideal means of preventing unwanted pregnancy for young women who have already given birth. In addition to the contraceptive effect, data medicines help eliminate manifestations caused by excessive levels of male sex hormones in the body. These include hair growing in inappropriate places, acne and male pattern baldness.

• Medium-dose contraceptives contain synthetic analogues of estradiol with progesterone. They are intended for mature women who have given birth. Like the previous option, these drugs are intended to normalize hormonal levels. However, they cannot be used during breastfeeding.
• High-dose contraceptives contain higher doses estradiol and progesterone. These drugs are most often used in medicinal purposes to restore hormonal levels. To protect against unwanted pregnancy, new generation birth control pills are recommended for women who have given birth after 35 years of age.

Emergency contraception

These drugs are used in emergency situations and help prevent pregnancy after unprotected sexual intercourse. They are recommended for use in the following cases:

• in case of violent acts or if the condom is damaged;
• with infrequent sexual intercourse.

Contraindications to their use include bleeding disorders, heart and vascular diseases, hepatic and renal failure, malignant tumors and smoking.

Features of taking pills

How long can you take oral contraceptives, and do you need to change them? They must be taken daily and preferably at the same time. It is recommended to start taking them on the first day of menstruation. These drugs are intended for long-term use. However, women taking hormonal contraceptives should visit their gynecologist annually. If there are no contraindications, you can continue taking contraceptives.

With long-term use of COCs, menstruation may stop altogether, and this is not a pathology. However, if a woman forgot to take her birth control pill and the last day of her period is long past, this may be a sign of pregnancy. After discontinuation of contraceptives, the menstrual cycle is completely restored within 1-2 months. In this case, pregnancy can occur immediately or after a short period of time. You can take birth control pills for several years. If they do not cause any side effects in a woman, they should not be changed. Otherwise, the body will experience stress.

Natural methods of contraception

Methods of preventing unwanted pregnancy without hormones have been used for a long time. Despite wide range modern contraceptives offered by pharmacists, they still remain relevant today.

One of them is based on counting the days of ovulation. On average, the duration of the menstrual cycle is from 28 to 30 days. In its first half, the follicle matures. And ovulation occurs in the second half of the cycle. The ability to fertilize a mature egg remains for 2-3 days. In this case, sperm can take a wait-and-see position for 4 days. Therefore, special care only needs to be taken for about a week in the middle of the cycle.

In some cases, measuring the days of ovulation allows you to determine basal temperature, which is the most dangerous days rises. However, the reliability of calculations and temperature measurements in the rectum cannot guarantee full protection.

Some couples practice coitus interruptus. However, even in this case, pregnancy cannot be ruled out, since a small amount of sperm may be contained in the lubricant secreted by the partner’s penis. In this case, the likelihood of pregnancy increases depending on how many sexual acts have been performed.

Bibliography

1. Venereal diseases. Directory. Ed. N. 3. Yagovdika. -Minsk: “Belarusskaya Navuka”, 1998. - 342 p.
2. Emergency conditions in obstetrics. Sukhikh V.N., G.T.Sukhikh, I.I.Baranov et al., Publisher: Geotar-Media, 2011.
3. Pregnancy and childbirth with extragenital diseases. UMO stamp medical education, Apresyan S.V., Radzinsky V.E. 2009 Publisher: Geotar-Media.
4. Rakovskaya I.V., Vulfovich Yu.V. Mycoplasma infections of the urogenital tract. - M.: Medicine, 1995.
5. Diseases of the cervix, vagina and vulva / Ed. V.N. Prilep-

Graduated from Kirov State University medical academy in 2006 In 2007 she worked in the Tikhvin central district hospital on the base therapeutic department. From 2007 to 2008 - employee of a mining company hospital in the Republic of Guinea (West Africa). From 2009 to the present day he has been working in the field of information marketing. medical services. We work with many popular portals, such as Sterilno.net, Med.ru, website