Section gynecology. Hormonal drugs: list, purpose, description and prices - a complete overview List of hormonal drugs in gynecology for cancer

Hormonal drugs for women contain estrogenic and progestogen components, which are a synthetic analogue of female sex hormones such as progesterone and estrogen.

Classification of hormonal drugs

All hormonal drugs can be divided according to the organs in which they are produced:

pituitary hormones
Thyroid gland
Adrenal
Ovaries, etc.

Female hormonal contraceptives can be divided depending on the method of penetration:

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Tableted
Injectable
plasters
Rings, etc.

According to the type of hormones, these can be:

Combined funds
Monophasic
Two-phase
Three-phase
Non-combined

According to the dose of the contained hormone:

Low dose
Medium dosed
Highly dosed

What are they used for?

Due to the wide distribution of gynecological hormonal preparations, the range of their use is constantly growing.

The appointment is currently based on main goal both women and specialists:

oral contraception

Monophasic contraceptives

These are drugs that make up the group of the first generation of hormonal drugs.

They got their name from their composition. It contains two main types of hormones - estrogens and progesterone, while their concentration will remain the same throughout each day of the cycle.

That is, in each tablet of the drug, a constant concentration of the substance is maintained. Currently, drugs in this group are most widely used in women, this is primarily due to the ability to control hormonal levels.

Peculiarities:

Due to constant concentration, they help a woman cope with certain diseases. reproductive system such as endometriosis, algomenorrhea, and hyperpolymenorrhea.
In addition, skipping pills will not always be dangerous for the functioning of the ovaries and the subsequent restoration of intake, in this case it will only be possible to increase the dosage due to any other pill from the package.
In case of insufficient concentration of incoming funds, the dosage can be increased, also with the available tablets, in some cases it is simply doubled.

They include Rigevidon, Diana-35, Norkolut, Jess.

Biphasic products

This is the group of drugs that are currently not so widely used in gynecology.

Peculiarities:

A distinctive feature of these coca is that the composition of the tablets will be different. They will all have the same dosage of the estrogen component, while the amount of progesterone varies depending on the phase of the cycle.
Preference in the appointment of these funds is given to those women who have impaired sensitivity to progesterone.
In addition, one of the important indications of biphasic contraceptives is an increase in the level of male sex hormones in the blood. Hyperandrogenism can be varying degrees severity and manifestations, but with regular use, hormonal drugs are effective.

They include Synovulate, Sequilar and etc.

Three-phase contraceptives

This is one of the latest generations of medicines, which is currently prescribed to women quite widely, but due to certain characteristics, they may have certain difficulties in taking them.

Peculiarities

A distinctive feature of this group of funds is their complex composition, which contains two island types of hormones, these are progesterone and estrogens.
At the same time, the concentration of these funds in tablets will differ depending on the day of the cycle, which is why taking them for many women causes great difficulties due to the possible skipping of tablets, which turns out to be quite difficult to restore.
In addition, the undoubted advantage is the ability to fully adapt drugs to the menstrual cycle, as a result, the number side effects associated with admission is significantly reduced.

Due to the high affinity with the normal menstrual cycle, they are recommended for young girls under 18 years of age, or for women over 35, when adjusting the drug to the cycle is very important.

But it must be remembered that due to the possible skipping of tablets, as well as the complex chemical composition, the risk of an unplanned pregnancy can increase several times. In addition, the amount of intermenstrual bleeding associated with improper intake increases.

These drugs are currently Tri-regol, Tri-merci, as well as Qlaira.

Pros and cons of COC

Currently, doctors of many specialties, as well as women themselves, argue for a long time about the effectiveness, positive and negative points associated with the use of combined hormonal drugs. Most people have mixed opinions.

At the same time, combined oral contraceptives are actively used by gynecologists, and the range of application was not limited only to preventing the onset of unwanted pregnancy. But at the same time, drugs of this group cannot be prescribed en masse.

This is due to the fact that they, like other drugs, have a number of side effects and contraindications. Therefore, before taking, you should carefully talk with your doctor.

pros

This is to prevent unwanted pregnancy. Many women use funds for this purpose. And with a properly selected drug, it will be absent, as well as subject to regular intake. This allows a woman to currently realize her plans and opportunities in the absence of negative impact on the sexual life and reproductive system, avoiding unwanted abortions.
Second positive moment from taking combined oral contraceptives is the ability to control the menstrual cycle. This is especially important for women who have previously had failures, as well as a tendency to delays and rhythm disturbances. You can not only be sure of the time of their onset and, therefore, carefully guess important events in life, as well as other procedures, but also, if necessary, to shift the date of the planned menstruation. Under the supervision of a doctor, a woman can delay, accelerate or even prevent the onset of menstruation in a given cycle. This is achieved by stopping or vice versa by changing the cyclical intake of active and inactive tablets.
Also, many hormonal preparations for women are used to provide a cosmetic effect. This is true in women suffering from androgenic disorders in the body, which is expressed in hormone-dependent alopecia, manifestations on skin in the form of acne, etc., as well as growth unwanted hair on the surface of the body, where normally they should not be. Already after a few months, the woman notes a positive trend in achieving a cosmetic defect. It should be remembered that drugs for this purpose should be prescribed only by a gynecologist, after a thorough hormonal study, but never by a cosmetologist or dermatovenereologist.
There is also a version that hormonal drugs for women can prolong reproductive age and delay the onset of menopause. This is achieved with a properly selected concentration of hormones, which leads to the occurrence of a lack of ovulation. Thanks to a similar mechanism, the ovarian reserve in the ovary is preserved and the woman can, after stopping taking long time do not enter the climax. But for the implementation of such an effect, you can not use low-dose drugs for a certain group of women, as well as mini-pills, since they are not able to suppress ovulation. In addition, the reception should be long and regular and be at least 5 years. This is especially important for women who have prerequisites for the onset of early menopause.

Minuses

First of all, this is the fact that hormonal preparations for women used to prevent unwanted pregnancy do not protect against sexually transmitted infections. This is true if a woman takes them in the absence of a regular sexual partner. In such situations, a condom should also be used.
Probability of development initial stages addiction to drugs, which can be very scary for a woman. This group includes headaches, pain in the mammary glands, their cutting and feeling of swelling, dizziness, the appearance of migraine and, in rare cases, disorders of the gastrointestinal tract. Such changes are usually reversible and therefore they do not pose a serious danger.
Weight gain. This is one of the most pressing questions women ask. In fact, body weight is added, but this occurs due to the development of a slight edema of internal tissues under the influence of progesterone, as well as due to increased appetite. In most cases, a similar symptom is quickly and independently eliminated after discontinuation of the drugs.
development of cellulite. This is serious cosmetic defect, which can scare a woman and prevent her from starting to receive funds. A similar action is also created due to the accumulation of excess fluid, but as a rule similar problem already exists in the body of a woman, only during the period of taking cocaine it is aggravated.
Development risk arterial hypertension as well as thrombosis and thromboembolism. These problems may occur due to the development of blood clotting, which leads to a violation of its rheological properties. Besides, similar clinic often develops against a background of pronounced varicose veins veins.
With prolonged and uncontrolled intake, especially against the background of the presence of predisposing factors or existing problems, toxic effect on the liver and bile ducts.
The risk of developing malignant tumors on the cervix or mammary glands arising at the beginning of the reception against the background of cervical erosion or fibrocystic lesions of the mammary glands with a predominantly nodular component.
In addition, it is the regularity of reception. For some women, the hormone regimen is a significant problem.

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What are mini pills?

mini pili - This is a separate group of drugs that are used to protect women from unwanted pregnancy.

They belong to the hormonal preparations of oral contraception. Currently, it is an alternative to oral contraceptives, but there are differences in their composition.

The main component of these hormonal preparations is gestagen(progestin, acting as an analogue of the progesterone type, which is produced in corpus luteum during one of the phases of the menstrual cycle).

Advantages and disadvantages

Among the shortcomings can be identified insufficient contraceptive efficacy. This is due to the fact that the contraceptive effect of this dose of hormones is much less compared to conventional means and the effect on the body is significantly reduced.
The advantage of their composition is a much lower dosage compared to conventional hormonal preparations for women. Their dosage should not exceed a third of the prescribed in standard preparations. It is thanks to this property that the likelihood of developing a side effect that occurs with the estrogen component is significantly reduced.

Preparations of this group are allowed to be taken if the main group of hormonal contraceptives is contraindicated.

Mechanism of action

Mechanism of action:

The mechanism of their action is achieved due to the fact that progesterone, which is part of the composition, is able to act on the mucus of the cervix, which leads to a change in its properties. This is manifested in the development of thickening, which will create a mechanical obstacle to the further advancement of spermatozoa.
At the same time, there is an effect on the egg, which is manifested by a decrease in the speed of its movement through the fallopian tubes in the woman's body.
It also affects the state of the endometrium. It changes its properties and becomes less differentiated and more subtle. Such its development becomes insufficient so that later, even with fertilization, attachment occurs. gestational sac to the uterine cavity.

Application features

In the body of a woman, there is a significantly greater release of a hormone that promotes the onset of ovulation. Therefore, with prolonged and systematic use, there may be a lack of ovulation.

In most cases, you can still notice the onset of the ovulatory cycle, that is, the likelihood of pregnancy is not excluded.

For the development of such contraceptive effects in these hormonal drugs, all the rules of admission should be followed. It should be regular use, as well as the duration of the intake.

DID YOU KNOW?

The disadvantage of most drugs are side effects. Often, drugs cause severe intoxication, subsequently causing complications in the functioning of the kidneys and liver. To prevent side effect such preparations we want to pay attention to special phytotampons.

Of the most common drugs in this group, we can distinguish Microlute, Lactinet, Norkolut other.

These hormonal preparations are taken by women after the onset of 35 years, as well as nursing mothers.

For the last group hormonal contraception remains relevant and quite controversial, since there should not be an impact of funds on the child through transfer through breast milk. In addition, mini-pills are taken by women who, among contraindications, have the use of drugs with an estrogen component.

In the presence of contraindications, in which combined oral contraceptives are contraindicated, mini-pills are allowed. This is especially true for diabetes.

Hormonal preparations for women after 40 years

Many women in modern world at the onset of this age, preference is given to the use of hormonal therapy.

The main indication for their use will be the prevention of pregnancy. Since at this age it can cause serious concern both on the part of the woman and on the part of the fetus.

After 40 years, the risk of developing a child with chromosomal pathologies increases several times.

In addition, hormonal drugs also have such positive effects as reducing the possibility of developing oncological process both in the uterus and ovaries, as well as to cope with the severity of some chronic pathologies.

At this age, preference should be given to hormonal preparations that will either contain only progesterone or low-dose estrogen in combination with progesterone.

Preference should be given to drugs with a low dosage of hormones, as they will help reduce the risk of developing hyperplastic processes in the endometrial tissue, which in some cases leads to the development of abnormal uterine bleeding.

Among the drugs are such as Jess or Jess plus, Marvelon, Janine and Diana-35. But it should be given Special attention correct selection funds, since there high risk development of complications in this period. In some cases, this can prevent the risk of early menopause.

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Hormonal preparations after 50 years

This age is rather doubtful regarding the choice of hormonal preparations by specialists. This may be due to the fact that there is still a possibility of pregnancy, since even with violations of the regularity of the cycle, ovulation can occur.

And in the absence of contraceptive methods, the risk of developing an unwanted pregnancy in this period is high. In addition, many women are already going through menopause and remedies are selected taking into account given state organism.

In this case, hormone replacement therapy is selected, aimed at preventing the development of complications associated with the development of menopause in a woman.

Among oral contraceptives, preference is given to drugs that have a fairly small dose of hormones. They allow you to prevent not only the onset of pregnancy, but also to cope with certain types of diseases. In addition, the risk of side effects is minimal.

The only point that deserves attention is a thorough study of all contraindications, since at this age most women have various kinds of pathologies from the reproductive system.

Among these drugs, it should be noted Silest, Triquilar, Marvelon and Tri-Regol.

In some cases, hormone replacement therapy is already preferred, especially if signs of the onset of menopause are already noted. In this case, they help to cope with the development of complications that occur with a lack of hormones.

These can be both synthetic hormonal drugs that are aimed at complete replacement of the hormonal background, and herbal preparations containing phytoestrogens. The last group is not strong enough hormonal influence on the body, but helps to somewhat reduce the severity of manifestations of menopausal disorders.

Hormone Replacement Therapy

Efficiency

This is currently one of the most popular groups of drugs that are used by women to maintain hormonal levels.

These drugs are prescribed exclusively by a specialist, after a complete treatment. It is recommended to start treatment with hormonal drugs from this group 1-2 years before the expected onset of menopause, when a woman can notice the appearance of precursors.

Harbingers of menopause:

disruptions in the menstrual cycle, a change in their nature;
frequent headaches;
mood changes;
jumps in blood pressure;
intermittent hot flashes or chills.

In some cases, the reception may begin after the onset of menopause, this may be with its early onset, as well as with the artificial creation of such a situation. The course of treatment with such means is long and continuous.

Hormonal drugs used to replace their own during menopause have a number of side effects, but nevertheless they help to cope with severe complications associated with the onset of menopause. The risk of developing osteoporosis, arterial hypertension, atherosclerosis decreases, in addition, the number of heart attacks and strokes associated with the onset of menopause decreases.

Such hormonal preparations for women mainly contain a combination of estrogens and progesterone, some may have only an estrogen component.

Contraindications

Has the following contraindications:

Phytohormones

These are drugs plant origin, which are analogous synthetic means. They are extracts from various plants, in particular, it can be extracts of soybeans, clover, legumes and cereals.

They are produced in various dosage forms, among which there may be drops, tablets, etc.

The main mechanism of their action is to compensate for the lack of female sex hormones in the body. Created similar effect due to estrogens, which enter the bloodstream and contribute to the partial maintenance of the concentration of hormones.

This is necessary at the moment when a woman begins to notice signs of the onset of menopause, which are expressed by violations of the cyclical nature of menstruation, deterioration in well-being, the appearance of hot flashes, as well as jumps in blood pressure and other manifestations.

Application Features:

It is necessary to start taking phytohormones until the moment of complete cessation of menstruation.
In some cases, it is allowed to use them after the onset of menopause.
The course of therapy is usually long and includes a daily intake.
They cannot fully compensate for the lack of hormones, but they are able to slightly maintain the level.
In addition, they cannot be used as full-fledged substitutes for therapy.
The main advantage of phytohormones is that they have minimal amount side effects. Also, they are not addictive.

This group includes tools such as Klimadinon, Qi-Klim, Menopace, Klimaksan, Remens other.

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Principleshormonaltherapy

performed

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Ulyanovsk 2010

Plan.

Etrogen

Gestagens

Progesterone

Androgens

Anabolic steroid

pituitary hormones

Corticosteroids

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

Rules for the rational use of hormonal drugs

Hormonal tests

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

Hormonal preparations are successfully used in diseases associated with a violation metabolic processes, in neurology, surgery.

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

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

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

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

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

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

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

Octestrol (Octoestrolum) is available in 1 mg tablets.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

7. Climacteric neurosis(for therapy).

8. Trophic disorders in the genitals.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

It should be noted the importance stressful situations in the development of hormonal disorders in women. Stress affects the cerebral cortex, which is the highest regulator of sexual functions. Minimizing stress is one of the prevention of female diseases.

All gynecological diseases conditionally can be divided into several groups:

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

Treatment of gynecological diseases. Basic approaches.

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

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

Very often in their practice, the gynecologist is forced to resort to hormonal drugs. Let's just say that this area of \u200b\u200bmedicine cannot do without the use of hormonal drugs. Of course, this fact frightens many, since many various information on this occasion. Below we will take a deeper look at what these hormones are, the use of hormonal drugs in gynecology, as well as the indications and contraindications of this type of treatment.

Hormonal contraception

This is an area where the use of hormonal drugs has come to the fore. high level. This is a method of preventing unwanted pregnancy by introducing sexual hormones. In this case, hormones suppress the cyclic processes that occur at the level of the hypothalamus and ovaries, which leads to the fact that ovulation (the birth of an egg) does not occur.

There are several groups of these drugs, namely:

Combined hormonal contraceptives - these can be taken orally or by injection;

Progestin hormone preparations - can also be oral (mini-pills), injectable, or in the form of implants.

Combined hormonal preparations consist of two main hormones - estrogen and progesterone. There are different concentration combinations of these substances. They can be single-phase, two-phase or three-phase. Each tablet has its own concentration of these hormones, which repeats the menstrual cycle in women, but does not allow the occurrence of ovulation.

The use of combined hormonal drugs is carried out for several reasons:

1. Broad mechanism of action:

Suppresses ovulation;

Increases the density of cervical mucus, which prevents spermatozoa from entering the uterine cavity;

Produce structural changes in the inner lining of the uterus (endometrium), which prevents the resulting embryo from implanting.

Even if the spermatozoa could enter the uterine cavity, hormones will not allow them to migrate towards the fallopian tubes.

2. Increased effect;

3. Instant effect;

4. Does not depend on sexual intercourse;

5. Has a reversible effect;

6. Reducing the duration of menstruation and the amount of menstrual hemorrhage;

7. Reducing menstrual pain;

8. Prevention of ovarian and endometrial cancer;

9. Frequency reduction benign tumors breast and ovarian cysts;

10. Protection against ectopic pregnancy;

11. Reducing the risk of genital infections.

The following contraindications are absolute in gynecology, and characterize the side effects of hormonal drugs:

Pregnancy;

The first 6-8 weeks after childbirth, if the mother is breastfeeding;

The first 3 weeks after childbirth, if the mother is not breastfeeding (risk of blood clots);

Vaginal bleeding of unknown etiology;

Pathology of the liver or biliary tract (since the liver processes these drugs, then reduced function liver increases the concentration of hormones in the blood, increasing their side effects);

Women who smoke, especially after 35 years ( increased risk thrombus formation)

Ischemic heart disease, or stroke - in the present or in the past.

Violation of blood coagulation - thrombophlebitis, pulmonary embolism;

Diabetes;

Hypertension;

Mammary cancer;

Any surgery that requires prolonged bed rest;

The use of drugs in epilepsy.

Synthetic combined preparations are used more often, among them can be distinguished such as: Regividon, Diane-35, Marvelon, Nordette. Each of these drugs has its own instructions for use, but in general, the course begins in the first days of menstruation. Each tablet on the blister is numbered, which corresponds to the day of the menstrual cycle, so you should take them in the written order. Usually women choose the morning to take the pill, it is not so important, it is important that every day the drug is taken at the same time, without delay. In one blister there are 21 tablets with the drug and there may be (not in all preparations) 7 more neutral tablets, they may be empty or consist of iron, which is simply necessary for a woman during menstruation. After 2-3 days from the last active tablet, menstruation begins.

If a this species drugs are in the form of injections, then one injection per month is carried out (Cyclofem, Mesigina). Their effectiveness is the same as in the tablet form.

The use of hormonal drugs in gynecology is also very large for bleeding from the genital tract. This method of stopping bleeding is prescribed in several situations:

Girls - dysfunctional juvenile hemorrhage;

Stop bleeding early after surgery if it is histologically determined that the bleeding is dysfunctional.

Presence of contraindications for surgical hemostasis.

There are several options for hemostasis with the help of various hormones, namely:

estrogen;

progesterone;

Androgens;

Combined hormonal drugs.

Regardless of the type of drug, hemostasis is based on the use of large doses of hormones that can eliminate hormonal dysfunction in the body. If the bleeding is stopped, the drug should in no case be stopped, but the dose should be reduced within 5-7 days after which the administration of the drugs should be continued for another 14 days.

Also in gynecology, hormonal preparations are used in the diagnosis various diseases. Hormonal tests are used to determine the function of the endocrine glands, and for the differential diagnosis of diseases similar in clinic to diseases of the genital organs, but associated with other organs (such as the hypothalamus, adrenal glands, thyroid, pituitary). These types of tests are used in the diagnosis of diseases such as: amenorrhea; infertility; tumors of the ovaries, uterus.

AT tablets: herb ortilia lopsided ( upland uterus) 90 mg, ortilia lopsided herb extract 30 mg, yarrow herb extract 20 mg. Calcium stearate, MCC, aerosil - as excipients.

AT drops: water-alcohol extract of red brush rhizomes, boron uterus grass and ant tree bark.

Release form

Drops for oral administration 30, 50, 100 ml.

Capsules 230 mg.

Coated tablets 240 mg.

pharmachologic effect

Normalizes the function of the genitourinary system in women.

Pharmacodynamics and pharmacokinetics

Pharmacodynamics

Biologically active additive , source flavonoids , arbutin(in one tablet of flavonoids 1.5 mg, arbutin 2.5 mg). These are active substances that contribute to the elimination of inflammatory processes. genitourinary system accelerate tissue regeneration. Reception Gynekol prevents the development of infections, contributes to the reproductive health of women and prepares the body for future motherhood.

upland uterus . The aerial part of this plant is used. Main active substances are flavonoids and phenolic compounds ( methylarbutin , hydroquinone , arbutin ). They have anti-inflammatory, diuretic and disinfectant effects. In obstetrics and gynecology, preparations from plant materials of the boron uterus are used for salpingitis , fibroids , menstrual irregularities, uterine bleeding , whites. Boron uterus grass contains phytohormones that increase the ability to conceive, so it is used for infertility . Used in urology to treat cystitis and pyelonephritis .

Yarrow . It has a complex chemical composition, which causes its numerous effects. Use grass plants and inflorescences. It has a pronounced anti-inflammatory, bactericidal and hemostatic effect. It has a regenerating, antispasmodic diuretic effect. Improves blood circulation, normalizes metabolism. Proved it anti-candidiasis action, so it is often used in the treatment colpitis and vaginitis .

In Ginekol drops, in addition to the extract of the boron uterus, there are additionally extracts of the rhizomes of the red brush and the bark of the ant tree.

red brush (Rhodiola quadruple ). medicinal plant with a unique chemical composition, high content anthocyanins and betaines . In folk medicine, it is used to treat uterine fibroids , endometriosis , cervical erosion , mastopathy , hormonal disorders, painful and irregular periods, inflammation of the ovaries. Possesses adaptogenic properties .

Pharmacokinetics

Not provided.

Indications for use

Urological diseases (, jade ,).
Gynecological diseases ( salpingitis , fibroids , uterine bleeding, menstrual irregularities, leucorrhea,).

Contraindications

Pregnancy .
lactation period.
Individual intolerance.

For many of us, the term "hormonal drugs" sounds threatening. In the concept of most people who are not related to medicine and pharmaceuticals, hormones are pills of monstrous power that bring a lot of the same monstrous side effects.

What are these fears based on? And if hormones are so harmful, why are they so widely used? Let's try to figure out together what they really are hormonal pills.

Classification

Hormonal medicines contain hormones or substances that have properties similar to hormones (hormonoids). Hormones are produced in endocrine glands person and spread with the bloodstream in various bodies and systems, regulating vital important features organism.

Hormonal drugs can be conditionally divided into hormone preparations:

pituitary.
These include chorionic gonadotropin and known, probably, to every woman oxytocin;

thyroid gland.
These drugs are used to treat underproduction own hormones (for example, with hypothyroidism) and the opposite state - excessive production of hormones;

pancreas.
Most known remedies this group - insulin preparations;

parathyroid glands;

adrenal cortex.
This group includes glucocorticosteroids, which are widely used in many branches of medicine as anti-inflammatory, anti-allergic and analgesic agents;

sex hormones: estrogens, gestagens, androgens;

anabolic agents.

What is treated with hormonal pills?

Despite the very wary attitude towards hormonal drugs on the part of patients, we can safely say that these drugs are extremely necessary and important. Often only hormonal agents able to provide a chronically ill person with a decent quality of life, and sometimes save life itself.

Therapy with hormonal pills is necessary for:

- oral contraception;

- hormone replacement therapy in postmenopausal women and in older men suffering from a lack of testosterone;

- treatment of inflammation and allergic diseases;

- treatment of hormonal deficiency.
These conditions include hypothyroidism, diabetes the first type, Addison's disease and other diseases;

- treatment of many oncological diseases.

Oral contraception. Achievements of modern medicine

The first studies that initiated the development of hormonal contraceptives were carried out as early as 1921. Ten years later, scientists have already accurately figured out the structure of steroid hormones and found that high doses of sex hormones inhibit, that is, block ovulation.

The first combined hormonal contraceptive was released in 1960 by American pharmacists. It contained really high doses of hormones, and therefore had not only a contraceptive, but also a lot of side effects.

Over time, the situation has changed dramatically. In the 90s of the last century, hormoneoids were synthesized, which, along with high activity, have excellent tolerance. So modern women may not worry about extra pounds, recruited as a result of taking hormonal birth control pills. This side effect is a thing of the past along with shock doses active ingredients contained in the first contraceptives.

The effectiveness of all contraceptives is assessed using the Pearl Index, which determines the likelihood of pregnancy within one year when constant use drugs. On average, the Pearl Index of hormonal contraceptives ranges from 0.3% to 2-3%. The maximum value of this indicator reaches 8%.

If a woman is of average fertility and does not get pregnant from her husband's toothbrushes, the chance of pregnancy rarely exceeds 1%. Of course, subject to the daily use of tablets.

But let's get back to classifications. Modern hormonal contraceptives can be:

1. combined;

2. non-combined (mini-drank);

3. pills for emergency contraception.

Let's try to figure out how these groups differ.

1. Combined hormonal contraceptives: COC

Behind the funny abbreviation COC are very serious drugs that are the most popular modern contraceptives. All COCs include two active ingredients - estrogen and progestogen. Ethinyl estradiol is used as an estrogen, and levonorgestrel, norgestrel, desogestrel and other synthetic hormones can act as a progestogen.

The dose of ethinylestradiol in modern COCs is much lower than in the first "killer" pills. Because of this, when taking new drugs, the side effects of estrogen are rarely developed: weight gain, breast tenderness, and nausea.

Monophasic COCs have a constant dose of estrogen and progestin in each of the tablets. Despite the fact that during the menstrual cycle the concentration of hormones in the body of a woman is unstable, monophasic contraceptives- This is a strictly defined dose that comes daily.

Biphasic contraceptives contain two types of pills in one package. The main difference between tablets of the second type is increased content gestogen, characteristic of the physiological cycle.

However, three-phase COCs are traditionally considered the most adapted to the menstrual cycle. They include three groups of tablets. The concentration of active substances in each group approaches the content of estrogens and progestogens in a certain phase of the menstrual cycle. The first group of tablets mimics follicular phase, which lasts 5 days, the second - periovulatory, the duration of which is 6 days and the last - luteal, the longest 10-day phase. At the same time, the concentration of estrogen in three-phase COCs, as well as in the menstrual cycle, is maximum, and the level of progestogen increases from the first phase to the third.

Pharmacology: how do hormonal birth control pills work?

The contraceptive effect of all hormonal contraceptive pills, regardless of composition and dosage, is based on blocking the release of hormones responsible for ovulation and implantation. The ovaries practically “fall asleep”, decreasing in size. Ultimately hormonal pills:

suppress ovulation;
change properties cervical mucus. As a result of this effect cervical canal becomes a real barrier for nimble sperm;
change the state of the endometrium, as a result of which the "lining" of the inner surface of the uterus does not allow the implantation of the egg, if fertilization does occur.

How to take hormonal birth control pills?

The answer to the question of how to take hormonal pills that protect against pregnancy can be expressed in one single word: regularly. Depending on the period for which the course is designed - 21 or 28 days - the tablets should be used once a day during the entire period of treatment, and preferably at the same time.

An important question that worries most women taking COCs is what to do if the patient forgot to take the pill on time. First, don't panic. The situation is solvable and, in general, very commonplace.

It is impossible to do without hormonal pills containing HA in the treatment of allergic diseases, including bronchial asthma. Glucocorticoids can reduce inflammatory response and counteract the activity of immune cells that are involved in pathological process. Most often, HA is administered by inhalation, but in some severe cases, hormonal preparations are used in tablets and ampoules.

Glucocorticoids are certainly included in the treatment of oncological diseases. Their main purpose is to reduce side effects chemotherapy. In addition, hormonal pills can help in the destruction cancer cells with lymphoblastic leukemia, Hodgkin's lymphoma, non-Hodgkin's lymphoma and multiple myeloma.

Glucocorticoid tablets

Most often, several tableted glucocorticoids are used.

The drug effectively reduces inflammation by suppressing the function of leukocytes. Interestingly, the anti-inflammatory effect of Dexamethasone is 30 times higher than the activity of another HA - hydrocortisone.

Dexamethasone tablets are indicated for the hormonal treatment of Addison's disease, hypothyroidism, bronchial asthma, rheumatoid arthritis, nonspecific ulcerative colitis, eczema, malignant tumors in advanced stages.

The dosage of Dexamethasone is selected individually.

The drug is an analogue of hydrocortisone. Prednisolone is able to influence all stages of the inflammatory process and have a pronounced anti-inflammatory effect.

There are really a lot of indications for the use of Prednisolone tablets - hormonal treatment is prescribed for systemic lupus erythematosus, multiple sclerosis, joint diseases, bronchial asthma, oncological diseases, adrenal insufficiency, allergies, autoimmune pathologies and many others.

The drug produced by the Polish plant Polfa contains triamcinolone HA at a dose of 4 mg. The main indications of Polcortolone include diseases of the joints, allergic pathologies, which are difficult to treat, rheumatic, dermatological, hematological, oncological and other diseases.

Side effects of glucocorticoids

HAs have truly unique qualities. Therefore, glucocorticoids could be called healing drugs, if not for the side effects. Because of a large number adverse effects due to treatment long-term use of these drugs can even be dangerous.

We list the most common side effects of hormonal tablets of the glucocorticoid group:

decreased immunity;
increase in blood sugar levels. With long-term treatment with GC, the development of diabetes mellitus is possible;
decreased calcium absorption, which can lead to osteoporosis, a dangerous bone disease;
amyotrophy;
increased levels of cholesterol and triglycerides in the blood;
mood changes, depression, memory impairment, in severe cases - psychosis;
gastritis and peptic ulcer;
violation of the menstrual cycle, decreased libido;
slow wound healing;
weight gain.

Another extremely unpleasant side of corticosteroids is the withdrawal syndrome: after stopping long-term use of hormonal pills, there is a possibility of severe side effects. To avoid such a development of events, drugs should be canceled smoothly, gradually reducing the dose over a certain period of time.

Hormonal deficiency: when you can not do without pills?

The most common pathologies that require constant use of hormonal drugs include thyroid diseases.

Thyroid deficiency - hypothyroidism - a common disease in which the production of hormones is reduced. Treatment is based primarily on compensation for the lack of hormones. To do this, prescribe hormonal tablets, which include levothyroxine sodium.

Levothyroxine sodium is the levorotatory isomer of thyroxine. It is a synthetic analog of the thyroid hormone. Thyroxine is the first-line drug for hypothyroidism, euthyroid goiter, and after removal or resection of the thyroid gland.

Although thyroxine is hormonal medicine, when prescribing the correct dosage according to indications, there are practically no side effects.

Hormones in oncology: when drugs save lives

Hormone therapy in oncology, along with chemotherapy, is one of the main medical methods cancer treatment. Hormone treatment is used for several types of hormonally sensitive tumors, including breast, prostate, endometrial (uterine cancer), and adrenal cortex.

Most drugs that are used to treat hormone-dependent tumors inhibit, that is, block the release of hormones. These drugs include one of the most known medicines for the treatment of breast cancer - Tamoxifen.

Many drugs can reduce the production of other hormones that are responsible for growth. malignancy. Often, hormonal treatment is almost the only way to fight the tumor and prolong the life of the patient.

Hormonal pills are a whole pharmaceutical world in which there is a place for efficiency, uniqueness, and side effects. And only doctors can untie this tangled tangle of complex concepts, indications and contraindications. Then a properly prescribed remedy turns out to be the right path to a fulfilling life.

The human body, for all its perfection, is made carelessly. Viruses, microbes, inflammatory diseases try to put a person in a hospital bed for a long time.

The health of the future peanut depends on the state of the female reproductive system.

Even if the baby is not included in your plans yet, then follow correct operation genitals - not just useful, but extremely important for any girl.

From inflammatory diseases no woman is immune. Of course, the disease is easier to prevent than to cure. But if you are already ill, then you need to scrupulously follow all the doctor's prescriptions.

Anti-inflammatory drugs - general information

Anti-inflammatory drugs are substances that suppress the inflammatory process. From the point of view of biochemistry, these substances prevent the formation or transformation of arachidonic acid.

Classification of anti-inflammatory drugs:

glucocorticosteroids are natural or synthetic hormones of the adrenal cortex;
non-steroidal anti-inflammatory drugs;
antibiotics and antimycotics.

All anti-inflammatory drugs are available as injection forms, and in the form of tablets, suppositories.

What is used in gynecology?

Glucocorticosteroids are prescribed only for hormonal disorders. As anti-inflammatory drugs, they are not used in gynecology. For treatment female diseases drugs of the second and third groups are used.

Medicines are prescribed for colpitis of various origins, vaginal dysbacteriosis, inflammatory processes in the uterus, appendages, fallopian tubes.

The form of administration and dosage is prescribed exclusively by the attending physician based on the diagnosis and history of the patient. Do not self-medicate!

Anti-inflammatory suppositories

Suppositories are the most common type of drug administration in gynecology.

Consider the most popular drugs, we take the main active ingredient as the basis for the classification.

Broad-spectrum antibiotics:

hexicon;
betadine;
polygynax;
mycogynax;
terzhinan.

Candles with metronidazole:

ginalgin;
terzhinan;
metronidazole;
klion-d.

Antimycotics - antifungal drugs:

candida;
pimafucin;
clotrimazole;
nystatin.

Antifungal agents are usually prescribed simultaneously in the form of suppositories and tablets. Currently, in gynecology, they are trying to use multicomponent anti-inflammatory drugs. This increases the effectiveness of the treatment.

Non-steroidal anti-inflammatory drugs

Any gynecological disease can be accompanied pain syndrome. Non-steroidal anti-inflammatory drugs are prescribed for pain relief.

This group medicinal substances blocks the synthesis of prostaglandins, normalizes capillary permeability and the blood circulation process in general.

In addition, all drugs in this group reduce body temperature, eliminate pain, relieve swelling. Anti-inflammatory drugs are prescribed for endometriosis, adhesions, urogenital infections.

Medicines of the NSAID group are also used in everyday gynecological practice. They are used for anesthesia during installation intrauterine contraceptives, endometrial biopsy, medical procedures on the cervix.

What doctors prescribe to patients:

Preparations of phenylacetic acid - various diclofenac sodium, potassium in different forms;
Derivatives of propionic acids - nurofen, naproxen, ibuprofen, ketoprofen;
Indomethacin is a drug based on indolacetic acid;
Coxibs - celecoxib, roferocoxib, denebol;
Enolic acid preparations - meloxicam, rheumoxicam, movalis.

In pharmacies, NSAIDs are presented in various forms- tablets, suppositories, solution for injections.

Medicines of this group have a lot of contraindications and side effects. The main side effect is an aggressive effect on the mucous membrane of the stomach and intestines. If a woman has a history of an ulcer or other erosive processes in the gastrointestinal tract, these substances should be prescribed with great care.

Antibiotics in gynecology

Antibiotics are substances derived from fungi mold and bacteria. They are able to suppress other microorganisms.

Each type of antibiotic has a specific antimicrobial spectrum actions. Although at present, doctors prefer broad-spectrum drugs. But in some cases, a narrowly targeted antibiotic may be required.

It should be understood that not every antibacterial drug is an antibiotic.

In gynecology, the means of this group are treated inflammatory processes, erosion, colpitis of various etiologies, they are prescribed after surgery.

The main drugs in this group:

Penicillin - is indicated in the treatment of endometritis, inflammation of the appendages, perimetritis, parametritis, cervicitis, bartholinitis, gonorrhea. Medicines penicillin series do not act on tubercle bacillus. Penicillin - toxic drug Therefore, it should be used only as prescribed by a doctor.
Streptomycin - used if penicillin treatment fails. The drug is used to treat tuberculosis of the uterine appendages, is prescribed for cystitis in pregnant women.
Biomycin - prescribed for the treatment of gonorrhea.
II-IV generation cephalosporins are broad-spectrum antibiotics. Shown in the treatment of many diseases, including gynecological.

Important! All antibiotics have a lot of side effects. Therefore, self-medication is unacceptable!

Anti-Inflammatory Herbs

Herbal medicines are often included in complex treatment various diseases. Decoctions, herbal extracts are also used in gynecology.

The most commonly used chamomile, oak bark, sage, calendula. It is important to understand that herbs are drug. They have indications, contraindications and side effects.

Many gynecological diseases are not treated with herbs. Therefore, you should not self-medicate, even with the help of herbs. First you need to contact a gynecologist, undergo an examination, take tests, and only after that the doctor can determine the course of treatment.

Conclusions on anti-inflammatory therapy