Comparison of contraceptive pills. Hormonal patches and ring. Disadvantages and serious risks of oral contraceptives

Many women prefer protection with oral contraceptives, which is due to several factors: preventing unexpected pregnancy, improving the appearance of skin, hair and nails, and normalizing hormonal levels. Among the disadvantages are bloody issues between menstruation, lack of protection from venereal diseases, difficulty of selection in accordance with individual characteristics. The latter factor is decisive in successful contraception and hormone replacement therapy.

Classification and types

Which ones are better to choose for reliable contraception? The pharmaceutical industry produces a sufficient amount oral contraceptives new generation. Contrary to prevailing opinions about the dangers of hormones for female body, modern drugs do not increase weight (in some cases even reduce body weight), do not increase hair growth in unwanted places, do not affect libido and women Health . Ease of use and benefits for the beauty of the body and face often become the determining condition for this particular type of contraception. Before choosing birth control pills, need to know existing species tablets.

Single-phase (aka monophasic) tablets

A characteristic feature of such tablets is the same ratio of estrogen and progestogen hormones. The main drugs of the group are the following tablets:

The doctor selects single-phase oral contraceptives to correct hormonal levels after abortion, in case of menstrual irregularities.

Biphasic contraceptives

One tablet of biphasic drugs includes a certain constant concentration of estrogen and a variable dose of gestagen, which changes in the first and second periods of the menstrual cycle. The following types of tablets are distinguished:

This group of drugs is prescribed to women with particular sensitivity to gestagens, as well as with a history of hyperandrogenism. Treatment is carried out in accordance with the indications of the drug.

Contraception in three phases

Three-phase drugs contain a dose of hormones that changes three times during the menstrual cycle. The main drugs in this group are:

Tablets with three-phase action are prescribed to women over 35 years of age and girls under 18 years of age. Considering that the main contraindication to the use of tablets is smoking, triphasic hormones can be taken by women who smoke. The advantage is high efficiency for obesity at any stage of development. The main disadvantage is the complex application regimen and the frequency of bleeding between menstruation.

Minipill tablets

The active component of mini-pill tablets is only progestogen. The substance affects local areas of the woman’s reproductive system, normalizes cervical mucus and its biochemical composition. Volume of mucus at natural conditions decreases in the middle of the cycle, but despite the use of the drug, the viscosity remains consistently high and interferes with the movement of sperm. Usually the choice falls on such effective tablets:

Lactinet, Charozetta (based on the drug desogestrel);

Microlut, Exluton, Orgametril (the drug is based on linestrenol).

Changes while taking the mini-pill occur at the level of biochemical processes, as well as in the endometrial layer. Implantation of a fertilized egg becomes difficult. For many women, ovulation is completely blocked. Even such pills are extremely difficult to choose without a doctor.

The basic principle of action of combined oral contraception consists of completely blocking ovulation and implantation of the fertilized egg to the wall of the uterus. Oral contraception provides a kind of glandular regression in the mucous structures of the uterus. The mucous components in the cervical canal thicken, which prevents the penetration of sperm. These changes are due to contraceptive effect from the use of tablets.

Classification by volume of hormonal components

Differences in tablet contraceptives are also due to the total concentration of hormones in one tablet. The information is presented in the following table:

Features of choosing birth control pills

It is very difficult to choose pills on your own, so doctors recommend not to practice on your own health. IN in some cases even after examinations and consultation with specialists pick up the right drug perfect the first time is impossible. Women are tormented by constant spotting between menstruation, there is no effectiveness of therapeutic effects and an increase in symptoms gynecological diseases. When prescribing a drug, a number of diagnostic criteria are taken into account:

general clinical history;

number of births and abortions;

living conditions (nutrition, bad habits, sexual contacts, the nature of menstruation);

analysis indicators (sample collection from cervical canal, urine and blood tests);

ultrasound of the peritoneal and pelvic organs;

mammological examination;

assessment of a woman’s type based on hormonal levels.

It is impossible to obtain all this data at home. Self-prescription leads not only to a decrease in contraceptive function, but also to a number of side effects.

Before appointment consultation with an endocrinologist or ophthalmologist is required. The choice of oral contraceptives is also based on other criteria for assessing general physiological parameters:

type of mammary glands;

the nature of menstruation;

the presence of chronic diseases of organs and systems, including gynecological pathologies;

general condition of the skin and hair;

type of pubic hair growth.

According to all clinical data, the woman’s phenotype is compiled, which is the main criterion for choosing suitable pills for contraception and the treatment of gynecological diseases, including infertility.

Women of this type are of medium or short stature, their hair and skin are dry. Femininity is defined. Menstruation is accompanied by severe blood loss and is prolonged. The duration of the menstrual cycle is more than 4 weeks. Such women are prescribed high-dose and normal-dose contraceptives. The main drugs are Milvane, Femoden, Tri-regol, Rigevidon, Lindinet, Microgynon, Logest, Triziston. Such remedies are not prescribed to oneself.

Balanced estrogen content

The type of woman is characterized by average height, medium-sized breasts, normal skin and hair condition. Signs of PMS are usually absent or moderate. The duration of menstruation does not exceed 5 days, and the total duration of the menstrual cycle is normal. Women can choose the following drugs:

Tri-mercy;

• Lindinet-30;

  Triquilar;

• Marvelon;

• Microgynon.

A balanced content of female hormones is accompanied by moderate femininity, normal hair growth in the pubic area and other parts of the body.

Predominance of gestrogens (aka androgens)

The women are predominantly tall and boyish in appearance. The mammary glands are poorly developed, it is noted increased fat content hair and skin. Androgenic manifestations are expressed in excess hair growth in the armpits and pubis. PMS is accompanied by depression and abdominal pain. The duration of the menstrual cycle is short, less than 28 days. The periods themselves last no more than 3-4 days. The following tablets are prescribed:

Yarina, Jess, Dimia, Jazz containing drospirenone and ethinyl estradiol;

Erica-35, Chloe and Diana-35 with ethinyl estradiol, cyproterones in the composition;

Siluet and Janine, which contain predominantly dienogest and ethinyl estradiol;

Zoely with estradiol and nomegestrol.

Each phenotype is distinguished by features and individual characteristics in clinical and life terms.

Contraception by age

Self-assess age-related changes the body is impossible without consequences for the body and ensuring normal contraceptive function. The benefits and harms of certain pills can only be assessed after adequate diagnosis. The selection of oral contraceptives is the task of professional gynecologists. The main goal is prevention unwanted pregnancy and additional therapeutic effects if necessary. Age characteristics Women are an important aspect of successful and effective prescription of drugs. Biochemical indicators of the female body change with age and are divided into several main periods:

teenage girl (from 11 to 18 years old);

early reproductive (from 19 to 33 years);

late reproductive (from 34 to 45 years);

postmenopausal (2-3 years after the cessation of menstruation).

Adequate contraception should begin during adolescence if necessary. According to statistics, the age of a woman giving birth is noticeably decreasing, and the frequency of abortions is increasing. Combined contraceptives are preferable in adolescence with small doses of hormones. The following drugs are indicated for young girls: Tri-regol, Triquilar, Triziston, Mercilon, Marvelon, Silest, Femoden. These drugs not only protect against unwanted pregnancy, but also improve appearance skin with juvenile acne, normalize menstrual cycle, prevent the development of gynecological diseases.

Appointment for women from 20 to 35 years old

At this age, all methods of protection against unwanted pregnancy are usually widely used. The use of combined oral tablets is especially effective during constant sexual contact. The main disadvantage of the drugs is the lack of complete protection against sexually transmitted diseases. Women in this age group are usually prescribed drugs with a minimum dosage of hormones or low-dose drugs that ensure stabilization of hormonal levels. Such remedies do no harm reproductive health women, normalize the menstrual cycle. The main drugs are Yarina, Regulon, Janine.

Women over 35 years old

Women over 30 years of age should be prescribed adequate contraception against unwanted pregnancy due to high perinatal risks. Usually at this age they don’t think about children; many women smoke and build a career. Often there are diseases of the female genital organs, endocrine disorders, varicose veins veins Hormones are prescribed here only after a thorough diagnosis and medical consultation.

The preferred agents are Triziston, Silest, Marvelon, Tri-regol, Triquilar. Contraceptives from the mini-pill group with a low content of hormonal components are suitable for women. After 35 years, it is important to prescribe drugs with obvious therapeutic effect, for example Femulen. The drug is suitable for many female diseases, chronic liver and kidney damage of any origin. Smoking and systemic chronic diseases greatly complicate the selection of tablet contraception for women at any age.

Appointment after 45 years

After 40 years, a woman’s reproductive function decreases significantly, and ovarian activity decreases. Many women experience menopause, and some continue to ovulate. The likelihood of pregnancy is greatly reduced, but protection is still necessary. There may be a risk of pregnancy, but full pregnancy is already problematic: existing diseases, aging of the tissues of the pelvic organs, and possible fetal pathologies have an effect. To others important aspect is raising a child - many women after 45 have their own grandchildren. When pregnancy occurs, they resort to abortion in 90% of cases, which has a particularly negative impact on the woman’s health, including the development of endometriosis and uterine cancer.

The presence of chronic diseases of organs and systems, sexual dysfunction, bad habits- all this can become a contraindication to the prescription of oral contraceptives. After 45 years, promising contraception is the use of hormonal pills, injectable implants, and mini-pills. At this age, oral contraception is contraindicated in case of obesity, severe forms hepatic or renal failure, diabetes mellitus. The drug Femulen with a low likelihood of side effects may be ideal.

Basic rules for taking birth control pills

Traditional birth control pills taken on the first day of onset active phase menstrual cycle, only then the pills begin to take their toll active action. For irregular periods, you can start taking the drug from the first day of the cycle, with the absolute exception of pregnancy. After childbirth, the tablets should be taken 3 weeks later (on day 21), provided there is no lactation. When saving breastfeeding taking oral contraceptives should be postponed for six months. After an abortion of any level of complexity, you should start taking contraceptives on the day of surgery.

Dosage regimen

Classic mode involves The duration of the course is 21 days, after which they take a break of 7 days. Then continue continuous reception new packaging. The appearance of spotting between menstruation occurs during the break between doses.

A complex regimen involves a special regimen where you take pills for 24 days, taking a 4-day break (24+4 regimen).

The prolonged regimen consists of continuous use of tablets with active hormones. So, 63 days of monophasic tablets with a 7-day break. With this scheme, the discharge between periods is reduced by up to 4 times.

Adequate contraception is of interest to girls from the moment of their first menstruation. Correct selection Hormonal pills not only protect against unplanned pregnancy, but also significantly improve a woman’s appearance. At the same time, when hormonal levels are normalized, the condition of hair, nails, facial skin and body improves. Modern drugs have virtually no effect on a woman’s weight, and in some cases, hormonal treatment can even reduce it.

Understand the hormonal background yourself - difficult task, therefore, it is necessary to trust specialists for comfortable contraception without consequences for health and life.

Hormonal drugs are medications containing hormones or substances that exhibit effects similar to hormonal ones. Natural hormonal medications obtained from the glands, blood and urine of animals, as well as from human blood and urine.

Synthetic hormones are produced in pharmacological workshops and laboratories. They can be either structural analogues of true hormones, or differ from them in chemical structure, but exhibit a similar effect.

Around hormonal pills for various purposes, almost the most a large number of threatening myths: patients are afraid of infertility, weight gain, excess growth body hair, loss of potency. The list of negative ones is scary and alarming.

How true are the myths, and what types of hormonal therapy are there?

Hormonal drugs are classified depending on their origin (producing gland) and purpose. Based on their origin, medications are divided into:

• adrenal hormones (cortisol, adrenaline, glucocorticoids, androgens);
• pancreatic preparations (insulin);
• pituitary hormones (TSH, human gonadotropins, oxytocin, vasopressin, etc.);
• thyroid and parathyroid hormones;
• sex hormones (estrogens, androgens, etc.).

Human hormones regulate metabolism in the body. However, if there is a malfunction of one of the organs endocrine system a perfectly adjusted mechanism of correction and interaction may fail, which will have to be eliminated by introducing synthetic analogues of hormones.

According to their intended purpose, hormonal drugs are divided into:

• synthetic substances for replacement therapy (sodium levothyroxine, insulin, estrogens);
• hormonal contraception (synthetic analogues of estrogen and progesterone);
• hormonal agents that inhibit the production of hormones (for example, therapy with pituitary hormone analogues for prostate cancer);
• symptomatic medications (anti-inflammatory, antiallergic drugs).

Hormonal drugs often also include antidiabetic and other non-hormonal drugs.

What is treated with hormonal medications?

Hormone-based medications are used for both chronic and treatable conditions. You cannot do without the help of hormonal drugs when:

• hypothyroidism;
• hyperthyroidism;
• diabetes mellitus type 1, sometimes type 2;
• hormone-dependent tumors of the reproductive system;
• prostate cancer;
• asthma and other diseases associated with the immune response to allergens (including allergic rhinitis);
• endometriosis;
• hormonal imbalances;
• menopause;
• sleep disorders;
• other diseases associated with hypofunction of the glands.

Inflammation and allergic manifestations treated with glucocorticoids. Drugs based on them - Prednisolone, Metipred, Dexamethasone - reduce inflammation and suppress leukocyte function.

They can be used both internally (if necessary systemic action), and externally (for hemorrhoids, thrombophlebitis, dermatological diseases, allergic rhinitis). When used externally, they are practically not absorbed into the main bloodstream and do not have any effect. negative impact on the body.

Even if the cause of inflammation is unknown, adrenal hormones help relieve swelling, pain and redness. Hormonal anti-inflammatory drugs are among the vital drugs.

Vasopressin and epinephrine may be administered along with anesthetics. Due to their property of constricting blood vessels, these hormones are actively used in anesthesia (including local).

Melatonin also belongs to hormonal drugs. This substance, produced in, has an anti-stress effect, regulates circadian rhythms, affects metabolism, slows down the processes of aging and weight gain, and also stimulates the production of antibodies to infectious agents and tumor cells.

What is hormone replacement therapy?

For chronic conditions associated with dysfunction of the glands or their partial removal, drugs with synthetic and natural hormones ensure high quality and longevity of the patient's life.

There are several types of hormone replacement therapy:

• treatment with synthetic thyroid hormones;
• insulin therapy;
• taking analogues of sex hormones.

Deficiency and excess of thyroxine and triiodothyronine are fraught with disturbances in mood, sleep, dry skin, problems with memory and performance, proliferation of glandular tissue and other unpleasant symptoms.

Clinical hypothyroidism is most often associated with diseases and tumors thyroid gland, That's why replacement therapy analogues of iodine-containing hormones are prescribed for life.

Substitution therapy uses drugs such as:

• "Euthirox";
• “L-thyroxine” (one of the Russian or German brands).

Treatment of hyperthyroidism has a somewhat more complex scheme: to reduce the synthesis of one’s own iodine-containing hormones, thyreostatics are used, and in particularly difficult cases, removal of part of the gland or radioiodine therapy is justified. Then normal level triiodothyronine and is restored using their synthetic analogues.

Insulin is a hormone of β-cells of the pancreas, the main task of which is to reduce blood glucose levels by regulating its entry into cells and stimulating the conversion of monosaccharides into glycogen.

Impaired functionality of the cells secreting this hormone is called diabetes mellitus 1st type. Patients with such pathology are necessarily prescribed replacement therapy with the drugs “Humodar”, “Apidra”, “Novorapid”, “Actrapid”, “Humulin”, “Insulin Lente”, etc.

For type 2 diabetes, which is associated with impaired tissue sensitivity to insulin, hormone administration may also be prescribed.

Finally, female hormonal replacement therapy (HRT) is a pharmacological replacement of the function of the sex glands (ovaries) lost during their removal or menopause. The most commonly used drugs are:

• "Climodien";
• "Divina";
• "Ovestin";
• "Trisquence";
• "Femoston";
• "Estrofem" and others.

During treatment, androgens, estrogens and gestagens can be used (mainly the last two subtypes of hormones are used in the drugs).

Oral contraception

Oral contraceptives - the most famous hormonal pills for women. The action of OCs is based on their ability to prevent ovulation (the maturation of the egg and its release from the follicle). Synthetic hormones thicken the mucus on the cervix, which complicates the movement of sperm, and also thin the uterine lining (endometrium), which prevents the fertilized egg from firmly attaching.

The triple mechanism of action of hormones reliably protects the patient from unwanted pregnancy: the Pearl index for oral contraceptives (the percentage of pregnancies that occur while taking OCs) does not exceed 1%.

When using oral contraceptives, menstrual bleeding does not stop, but becomes more regular, less heavy and painful. A certain regimen of hormones allows, if necessary, to delay the onset of menstruation.

Modern contraceptives are classified into three categories:

• Single-component preparations (Continuin, Micronor, Charozetta, Exluton).
• Combined oral contraceptives (COCs). COCs are the most reliable means. They contain synthetic estrogen () and progestogen (levonorgestrel, desogestrel, norgestrel, etc.).
• Postcoital (emergency) hormonal tablets (Postinor, Escapelle). Emergency contraceptives contain an increased dose of hormones, but have lower efficiency.

Dosages of active hormones in modern contraceptives much lower than in drugs of the last century, so the side effects of taking estrogen do not appear or appear slightly.

Combined hormonal contraceptives

COCs are divided into mono-, two- and three-phase. Single-phase COC tablets contain a strictly defined amount of hormones, which does not change during the cycle. Multiphase products are designed to be more physiological: the dosages of the active ingredients in tablets are not the same for different days of the cycle.

Three-phase COCs (with three types of tablets changing per cycle) are often recommended by doctors, but two-phase drugs are practically not used.

Combined contraceptives:

Different dosages of the active substance (levonorgestrel) allow you to adapt to hormonal fluctuations during the menstrual cycle and ensure high degree protection against unplanned pregnancy at low concentrations.

Hormonal products for men

Male hormonal drugs are classified into recruiting agents muscle mass, directly drugs for oppression pathological process and hormone replacement therapy.

In practice, hormones from the adrenal glands (in particular testosterone), pancreas (insulin) and the anterior pituitary gland (somatropin or growth hormone) are actively used. They are used to form muscle relief, accelerate weight gain and burn fat. Reception hormonal drugs without a doctor's prescription has a number of negative consequences, including damage to the excretory system and possible gynecomastia (swelling mammary glands) due to the conversion of excess testosterone into female hormone estrogen.

IN medical purposes hormonal agents are used for hormone-dependent tumors (for example, prostate cancer). Injections with pituitary hormone analogues sharply reduce the production of testosterone, which accelerates growth malignant neoplasm. This procedure is called "medical castration." The introduction of hormones makes it possible to slow down the development of the tumor and resort to more radical methods treatment. Despite the threatening name, patients should not fear that the procedure is irreversible: some time after the end of treatment, erectile function and normal testosterone levels are restored.

Replacement therapy male hormones can be used both when completely removing the gland that produces them, and when reducing its functionality. After 40-45 years, the level of testosterone in a man’s blood begins to decline, which leads to problems in the sexual sphere. To restore potency, the following drugs are used:

• “Testosterone Undecanoate” and “Andriol” (tablets with one active ingredient – ​​testosterone undecanoate);
• "Sustanon" (injection solution with four active ingredients - esters - decanoate, isocaproate, phenylpropionate and);
• "Nebido" (injection oil solution testosterone undecanoate);
• “Androgel” (a product for external use, the active ingredient is testosterone).

After complete removal of the testicles (due to a tumor of the prostate or gonad), replacement therapy is mandatory.

Attitudes towards hormonal drugs among people who are unfamiliar with medical reference books, predictably biased. Many drugs in this group have strong and whole line contraindications - for example, with long-term use of Prednisolone, rapid weight gain occurs, the face of a patient receiving premedication with this drug swells.

However, this is not a reason to refuse any product containing hormones, including effective birth control pills. By following a few simple rules, the risk of complications from taking hormonal drugs is minimized.

Rules for taking hormonal drugs (GP):

• You cannot take GP without a prescription from your attending physician (endocrinologist or gynecologist). Particularly dangerous when self-prescribed are drugs that are classified as synthetic analogues of adrenal hormones.
• Before prescribing hormonal treatment to a patient or patient, the specialist must carefully study the medical history, the results of blood tests for the concentration of sex hormones and biochemical parameters, the results of pelvic ultrasound, mammography, and cytological smear. It is necessary to inform your doctor about existing chronic diseases: some of them are contraindications to taking COCs and other synthetic drugs.
• You should inform your doctor about any changes in your health status.
• Having missed a dose of the drug, it is strictly forbidden to “compensate” for negligence with a double dose of the drug at the next dose.
• It is necessary to take hormone tablets strictly at the same time with minimal errors. Some medications (for example, L-thyroxine) are taken in the morning, on an empty stomach.
• The duration of the course and dosage (including its changes during treatment) are determined by the attending physician.

The effectiveness and safety of hormonal treatment depends on the competence of the endocrinologist, the interaction of the doctor with the patient and strict adherence to the rules for taking medications.

A long time ago, more than one or even two children were born in Russian families. A family in which there are “seven on the benches” and the mother is about to give birth - typical example way of pre-revolutionary life. A hundred years ago, almost all women reproductive period was 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, a healthy woman needs to take contraception 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 “birth control pills” includes two completely different categories medicines:

— hormonal contraceptives, which are based on synthetic hormones;

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

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

Hormonal contraception: origins

Already at the end of the 19th century, it became known that the development of follicles and ovulation is completely suppressed during pregnancy, and the reason for this is high concentration 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 of cervical mucus change, which becomes very difficult for sperm to pass through.

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.

Efficiency contraceptive medications 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 hormonal contraceptive drugs contained simply lethal doses of hormones: 150 mcg of estrogen and 9.35 mg of gestagen. In 1964, it was possible to reduce the concentration active ingredients up 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 a very high safety profile and a 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 a little 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 hormones, and are intended for urgent, that is, urgent contraception.

Means for preventing pregnancy can rightfully be considered one of the oldest. After all, they were used in ancient times. For example, women of the indigenous population of America used douching for this purpose with a remedy prepared from lemon and a decoction of red tree bark. IN Ancient Egypt tampons soaked in honey and acacia decoction were used. Even condoms aren't modern method protection against unexpected pregnancy.

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

What is hormonal contraception?

The mechanism of action of birth control pills is based on the ability of substances that are synthetic analogues of sex hormones produced by the female body to influence hormonal background. At the same time, the brain receives a signal that there are enough hormones in the blood and the command to the ovaries to produce their own does not go through.

Hormones entering the body, depending on the type, trigger several mechanisms at once. All of them lead to the fact that pregnancy, even if ovulation has occurred and the egg has been fertilized, does not occur.

Estrogens contribute to:

• The next egg does not mature in the ovaries and ovulation does not occur.
• There is a disturbance in the uterus secretory processes, which cause the development of swelling of the mucous membrane - the endometrium, which, in turn, makes implantation of a fertilized egg impossible.
• A process called luteolysis begins - that is, reverse development the corpus luteum, which is normally formed after ovulation and serves to synthesize the hormone progesterone, which prepares the body for a possible pregnancy.

• They stimulate the thickening of cervical mucus, which clogs the cervix and makes it impenetrable to sperm.
• They inhibit the activity of enzymes that help sperm penetrate the egg.
• They reduce the contractile activity of the fallopian tubes and the uterus itself and prevent the movement of the egg through them.
• They thin the endometrium, making it unsuitable for egg implantation.
• Block the release of hormones that are responsible for ovulation in the middle of the cycle.

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

Features of application

Any hormonal pills should be taken strictly according to the schedule, preferably at the same time of day. You cannot skip the next appointment. Depending on the composition and type of drug, if missed, the contraceptive effect will last on average only up to 12 hours. After this time, the effectiveness of the drug decreases.

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

All hormonal contraceptive pills are prescription drugs and are used only as prescribed by a doctor. Before you start taking the drug, carefully read the instructions and rules of administration.

Advantages

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

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

• High efficiency, even for three-phase drugs the reliability indicator does not exceed 0.6%. In other words, out of one thousand women using this method of protection for one year, pregnancy occurred in only one case.
• Safety. Despite the fact that all birth control pills interfere with hormonal levels, their effects are much less harmful than the consequences of abortion.
• Normalization of the menstrual cycle, which becomes regular while taking the pills, and the menstruation itself is not so painful, long and heavy.
• By improving the barrier properties of cervical mucus, the incidence of inflammatory diseases or exacerbation of chronic pathologies almost twice.
• The use of hormonal contraceptives for a year reduces the risk of endometrial cancer by 50%, ovarian cancer by 30%, and the risk of developing mastopathy becomes less by 70%.

Flaws

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

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

Types of COCs

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

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

Monophasic

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

Despite the fact that this generation of drugs is not new and has existed for quite a long time, in terms of their effectiveness they are practically in no way inferior to multiphase drugs.

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

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

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

Two-phase

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

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

Three-phase

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

Typically, this group of drugs is prescribed to women over 35 years of age or under 18, as well as those who smoke or are obese. Such drugs include, for example, Tri-regol, Triziston or Tri-Mercy.

Basics positive quality This group of drugs reduces the risk of side effects from progestins. The main disadvantage is the higher frequency of bleeding between menstruation compared to monophasic drugs. A more complex dosage regimen and not always possible to double the dose if you miss another pill.

Research has shown that three-phase contraceptives In terms of reliability of protection against unplanned pregnancy, they are inferior to monophasic ones.

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

Criterias of choice

If a woman has no previous experience of taking hormonal contraceptives, then the doctor usually gives preference to monophasic drugs containing minimal doses of hormones. But only after receiving the results of all the necessary tests. Such as: cytology smear, hormone analysis, general and biochemical analysis blood, ultrasound of the pelvic organs. In some cases, an additional consultation with a mammologist may be necessary. In addition, the doctor must take into account the characteristics of the menstrual cycle and the woman’s phenotype.

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

Today, combined oral contraceptives are considered one of the most reliable methods of protection against pregnancy. However, they require a woman to pay close attention to her condition and strictly follow the dosage regimen.

There are a lot of contraceptives. To navigate their choice, it is necessary to consider in detail the types of this assortment.

Main groups of contraceptives:

• hormonal contraceptives;
• spirals;
• candles;
• barrier agents;
• natural methods.

Hormonal drugs are considered the most effective.

Hormonal contraceptives are divided into the following types:

• vaginal ring;
• patch;
• injections;
• pills.

All hormonal preparations contain sex hormones: estrogens and gestagens. These hormones suppress the ovulation process and thicken the natural fluid that the cervix secretes. As a result, it is difficult for sperm to penetrate into the uterine cavity.

In addition, the entry of new sex hormones into the body slows down the production of its own. Because of this, the egg does not mature, which means pregnancy will not occur.

Under no circumstances should you take these medications on your own. Hormonal drugs contain many contraindications. Only after medical examination, the doctor will prescribe this or that remedy.

The Nova Ring vaginal ring is a modern contraceptive for women. It is a transparent elastic ring that is inserted into the vagina.

You should start using the ring from the first day of your menstrual cycle. The contraceptive releases a certain amount of hormones for 3 weeks. After this, the woman must remove the contraceptive without the help of a gynecologist. After 7 days, the ring is reinstalled as intended.

Side effects: migraines, nausea, vaginal discharge. If such manifestations become frequent, you should consult a doctor.

This tool it looks like a regular patch. It is glued to any area of ​​the skin except the chest. The principle of its action is that the patch actively releases hormones that are absorbed through the skin.

Hormones inhibit the maturation of the egg and increase the viscosity of the fluid that accumulates at the cervix.

The first patch should be applied from the beginning of the menstrual cycle. The effect of one patch is 1 week. Therefore, in one menstrual cycle it is necessary to use 3 patches, and then take a break for 7 days.

Navy – intrauterine device, which has proven itself to be a highly effective contraceptive. It is not recommended to use this method for girls under 23 years of age. Despite its effectiveness (99%), the IUD can cause complications, including infertility.

The spiral is inserted into the uterus itself. This is done by a gynecologist after a thorough medical examination. The validity period of this device is up to 5 years.

There is a hormonal device (Mirena) and a non-hormonal device - made of plastic and copper. The copper spiral is an effective remedy and has far fewer contraindications. It can be used even during lactation. However, a copper IUD cannot be used if you have chronic diseases reproductive system and inflammation.

The hormonal uterine device is the most popular among women. This drug releases certain doses of the hormone levonorgesterol into the uterine cavity, which prevents pregnancy.

Benefits of the hormonal IUD:

• reduces discharge during menstruation;
• long-term effect – up to 5 years;
• efficiency 99%.

Disadvantages of the spiral:

• age limit (from 25 years);
• menstruation disorders;
• contraindications for liver and heart diseases.

Contraceptive injections

This method involves injecting a woman intramuscularly with a special substance that stops the ovulation process and also changes the composition of the mucus in the uterus. As a result, it is almost impossible to get pregnant. The duration of the injection is 3 months.

However, not all so simple. This contraceptive can cause bleeding, headaches, and decreased libido. Long-term use of this method can negatively affect the integrity of bone tissue.

So, hormonal contraceptives are quite effective, but they have a number of side effects on the body. How to be? If a woman has health problems and the doctor does not recommend taking hormonal medications, then you can use non-hormonal contraceptives in the form of suppositories.

Birth control suppositories are chemical preparations of spermicide. The candle is inserted into the vagina before sexual intercourse and, under the influence of body temperature, melts there, creating a protective membrane inside. Thus, sperm are retained by this substance and do not penetrate into the uterus.

The candle is valid for up to 5 hours. This remedy protects not only from pregnancy, but also from the penetration of infections and sexually transmitted viruses. The main disadvantage of suppositories is their regular administration before each sexual intercourse. Long-term use of suppositories is also undesirable, since spermicide can disrupt the internal microflora of the vagina.

After sexual intercourse using a candle, you should not wash with soap, as the alkali will neutralize the chemical substance that makes up the candle. Therefore, it is better to wash with just warm water.

Safe contraceptives

Thus, having studied the listed methods of contraception, we can conclude that they have side effects because they contain hormones or chemical substances. Are there really no other methods that are safer for health? This issue is especially relevant for young girls who have not given birth, who find it difficult to get pregnant after taking contraceptives.

Alternative methods of contraception:

• interrupted sexual intercourse;
• condom;
• calendar method;
• temperature method;
• douching.

Alternative methods are not harmful to health, but their effectiveness is low.

Coitus interruptus- a fairly popular method among married couples. However, its effectiveness is 70-75%. It involves the man removing the penis from the vagina before ejaculation. The effectiveness of the method is reduced by the fact that during sexual intercourse a small amount of sperm is still released along with natural lubrication. And not every man can control himself during sex.

Condom– the most reliable means not only from unwanted pregnancy, but also from sexually transmitted diseases. This is especially true for those who do not have a permanent partner.

Calendar method- simplest. It involves calculating the ovulation phase according to the calendar. To do this, you need to know the length of a woman’s cycle and the first and mark the first day of menstruation on the calendar. Count 10-11 days from this day - the beginning of ovulation. Ovulation lasts approximately 7-9 days. During this period, you should abstain from sexual relations, since it is at this time that the risk of becoming pregnant is greatest.

Temperature method involves measurement basal temperature in women in different days cycle. After ovulation, it rises by 0.2°C, which indicates that it is safe to get pregnant. This method is quite painstaking - it requires daily recording of the temperature.

Douching consists of washing the vagina with various solutions immediately after sexual intercourse. For this you can prepare weak solution sea ​​salt or herbal decoction. But this method is also very dubious - after all, there will always be “there” active sperm, which “have time” to penetrate the uterine cavity.

Which birth control pills are best to choose?

Oral contraceptives are divided into two groups:

1. Combined, containing estrogen and gestagen.
2. Mini-pills that contain only one hormone - gestagen.

How to take contraceptives? There is no single regimen for taking oral contraceptives, since each of them contains a different dose of hormones and is prescribed individually.

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Contraindications to taking oral contraceptives:

• diabetes;
• varicose veins;
• hypertension;
• heart diseases;
• migraine;
• metabolic disease;
• excess weight;
• malignant tumors;
• high cholesterol;
• pregnancy and breastfeeding;
• age over 40 years.

Types of birth control pills

One of the most popular contraceptives of our time is Yarina birth control pills. They stabilize the cycle well, do not cause weight gain, and perfectly fulfill their intended purpose - to protect against pregnancy.

But this drug has a side effect: long-term use causes frequent headaches.

If such diseases are present, then these tablets should not be taken. In addition, “Yarina” gives a number of other complications: vegetative-vascular dystonia and headaches.

Jess contraceptive pills are combination drug antiandrogenic effects. This drug has good contraceptive effect, treats acne and eliminates premenstrual syndrome.

The package contains 28 tablets, which should be taken 1 per day. In addition, the pack contains a special calendar in which it is convenient to mark the days of taking the pills.

Side effects of the drug:

• nausea;
• vomit;
• bleeding;
• headache.

The drug is contraindicated during breastfeeding.

Contraceptive Regulon has several areas of application:

• protects against unwanted pregnancy;
• treats dysfunction of uterine bleeding;
• stabilizes the cycle;
• treats dimenorrhea;
• eliminates pain during menstruation;
• treats uterine fibroids;
• resolves ovarian cysts.

Thus, Regulon - excellent medicine from women's diseases. Unlike previous drugs, Regulon is usually prescribed to women over 40. It helps prevent abortion and its negative consequences.

Birth control Lindinet is a hormonal pill that helps prevent pregnancy and also stabilizes the menstrual cycle. The tablets also prevent the occurrence of ectopic pregnancies and reduce the risk of tumors in the mammary glands. Lindinet perfectly treats acne on the skin.

Contraindications:

• hepatitis;
• pancreatitis;
• otosclerosis;
• smoking;
• pregnancy and lactation;
• thrombosis;
• tumors of the genital organs.

There are post-coital birth control pills that are emergency contraception. This method is an “ambulance” for unprotected sexual intercourse. They are hormonal and should be taken immediately after sex.

The most popular drugs in this series: Miniziston, Femoden, Marvelon. These contraceptives are widely available and are available in pharmacies without prescriptions.

Oral contraceptives are available in monophasic, biphasic and triphasic forms. The doses of hormones in each drug are different. However, the rules for taking pills are, in most cases, the same.

Rules for taking birth control pills:

1. Before you start taking pills, you must consult your doctor.
2. You should take the tablets at the same time every day (preferably at night or with meals).
3. As a rule, 1 pack contains 21 tablets, which should be taken every day from the beginning of the cycle, and then take a break for 1 week.
4. After the end of the break, on the 8th day you should resume taking the pills with a new package, if pregnancy is not planned.
5. If one tablet was missed in weeks 1 and 2, then it should be taken immediately, and then the next one after 12 hours. The next day - according to the usual schedule.
6. If you missed 1-3 tablets in the third week, it is better to stop taking it before your period. And after menstruation - resume the course.

When to stop taking the pills:

1. Onset of pregnancy.
2. Frequent headaches.
3. A sharp increase in body weight.
4. Increased pressure.
5. Visual impairment.
6. Voice change.
7. The occurrence of gynecological diseases.
8. 3 weeks before surgery.

Pregnancy after birth control

Many women are concerned about the question: is it possible to get pregnant after long-term use contraceptive drugs?

The answer is simple: you can! Any instructions on contraceptives indicate that pregnancy can occur in next cycle after discontinuation of the contraceptive.

But is everything so clear?

After all, if a woman took contraceptives for a long time, then all functions of the reproductive system were suppressed. After stopping the pills, the female organs gradually begin to return to their previous function, sometimes even with enhanced effect. It is this fact that gynecologists often use in the treatment of infertility. A woman who cannot get pregnant is prescribed contraceptives for 2-4 months, and then discontinued in order to “stimulate” the reproductive system to work twice as well. In most cases, this method helps. But sometimes you have to undergo 2-3 courses of such therapy.

Menstruation when taking birth control pills is quite scanty. This is due to the fact that hormonal drugs suppress biological processes female body. However, this case has its advantages. Firstly: menstruation passes very quickly while taking contraceptives and they are practically painless. Secondly, a clear monthly cycle— 28 days.

There are times when a woman wants to artificially “delay” her period. For example, when traveling to the sea. In this case, she does not take a week's break from taking the pills, but continues to take them. Then your period does not come. But this cannot be abused! After all, the menstrual cycle may be disrupted or intermenstrual bleeding may appear.

Good contraceptives are those that are suitable for a woman in individually. This means that a contraceptive should be selected by a gynecologist, taking into account all the characteristics of the body. individual person. And whether or not to take contraceptives is a personal matter for everyone.

The main thing to remember: Children should be wanted and born on time. After all, there is nothing worse than an unloved and abandoned child.