Hormonal contraceptives: instructions for use, classification. How to choose hormonal contraceptives.
The mechanism of action of hormonal contraceptives:
- Suppression of ovulation. By the mechanism of negative feedback, the progestogen blocks follicle-stimulating and luteininizing hormones. Absence of peaks of FSH and LH excludes the possibility of ovulation. Ethinyl estradiol together with progestogens suppresses folliculogenesis in the ovaries;
- Increasing the viscosity of the cervical secretion. Progestogens change biochemical characteristics and thicken the cervical mucus, creating a barrier to the movement of spermatozoa into the uterine cavity;
- Changes in the endometrium that interfere with implantationEggs. Progestogens interfere with the reproduction of endometrial cells, provoking an inferior secretory transformation. Even if ovulation and fertilization occur, pregnancy does not progress;
- Slowing the migration of the egg and reducing the contractility of the fallopian tubes. Progestogens delay the peristalsis of the tubes.
The mechanism of action of emergency contraception (Escapel, Postinor):
More information about emergency contraception can be found here.
- Inhibition of ovulation, prevention of fertilization;
- Change in the endometrium, preventing the implantation of a fertilized egg.
Classification of hormonal contraceptives:
- On the way of the hormone's intervention into the bloodstream:
- Implantable under the skin. Flexible capsules (35X2.5 millimeters), releasing hormones that are absorbed into the blood, creating a constant concentration;
- Ampoules. The injections are performed every 45-75 days;
- By hormonal composition:
- Combined birth control pills: Single-phase (during the cycle (21 days) a certain number of gestagens and estrogens enter the female body), biphasic (in the first half of the cycle, tablets with a lower content of gestagens are used to simulate the natural oscillation of the hormonal background), three-phase (contain different amounts of hormones for sequential administration, Which allows you to accurately replicate the physiology of the female body);
- Uncombed ("mini-drank"). Contain only gestagens.
- For the daily dosage of the estrogen component:
- Microdosed (contain 20 mg / day ethinyl estradiol);
- Low-dose (30-35 μg / day ethinyl estradiol);
- High-dose (50 mcg / day ethinyl estradiol).
Hormonal contraceptives: instructions for use
For the contraceptive ring / hormonal release systems: the contraceptive patch is stuck for 7 days (3 patches per package).
For monophasic COC: 21 tablets of the same color in the blister.
For "mini-drank": 21/28 tablets of the same color in the blister.
For three-phase OK: 21/28 tablets of different colors in the blister.
The contraceptive effect is achieved byChanges in the characteristics of cervical secretion and suppression of ovulation. OK and "minipili" are taken inside, every day at a certain time, following the order stated on the package. Standard dosage: tablet once every 24 hours, for 21 days. The next package should be started after a one-week break, during which bleeding cancellation begins. Rhythm of reception: 3 weeks - reception of dragees, 1 week - a break.
Hormonal contraception: absolute contraindications
- Arterial hypertension, risk factors for cardiovascular diseases, valve apparatus abnormalities, history of a heart attack;
- Thromboembolic diseases, cerebrovascular strokes, thrombophlebitis;
- Disturbance of cerebral circulation, migraine;
- Operative intervention with prolonged immobilization;
- Diabetes, acute hepatitis, serious skin diseases;
- Liver tumors (benign / malignant), decompensated liver cirrhosis;
- Smoking (15 or more cigarettes per day) at the age of 35 years and older;
- Lactation, pregnancy, deformation of the uterine cavity, chronic constipation, prolapse of the uterus;
- Acute diseases of small pelvis organs of acute genesis;
- Malignant / hormone-dependent neoplasms of the reproductive system;
- Uterine bleeding of unknown etiology.
Clinical side effects of hormonal contraceptive:
- Deficiency of estrogen: meager menstruation, intermenstrual bleeding, amenorrhea, hypoplasia of the uterus, kraurosis of the vulva, "hot flashes", irritability;
- Excess estrogens: fluid retention, nausea, chloasma, painful menstruation, heaviness in the mammary glands, hypertension, migraine, headaches, latent diabetes syndrome;
- Progesterone deficiency: amenorrhea, intermenstrual bleeding, profuse menstruation;
- Excess progesterone: depressive episodes, headaches, alopecia, oily skin, acne, amenorrhea, weight gain / appetite, decreased libido.
The algorithm for choosing a hormonal contraceptive:
- To pass or take place inspection to exclude contraindications for reception of hormones;
- The drug of the first choice is monophasic OK with low androgenic gestagen and the content of ethinylestradiol not more than 35 μg / day (Regulon, Janine);
- Drugs of choice for patients with severe estrogenic insufficiency - three-phase OK (Diane-35, Tri-Mersey);
- In the presence of acne, hyperandrogenia monophasic tablets with antiandrogenic action are shown (Lindineth, Yarina, Logest);
- With dysfunctional uterine bleeding, dysmenorrhea shows tablets with a strong progestogen component (Jeanine, Claira);
- In the presence of endometriosis the best choice is monophasic contraceptives with dienogest, gestodene (Jeanine, Lindineth);
- For smokers, women over 35 years of age are contraindicated, up to 35 years of age are shown oral contraceptives with a minimum content of ethinyl estradiol (Jess, Lindineth).
The best hormonal contraceptives
Hormonal drugs have on the bodySystemic versatile impact, which can not be characterized in one word. OK appoint not only to prevent pregnancy, but also for therapeutic purposes. Same tablets can cause serious problems in some women, others do not provoke any discomfort. The hormonal contraceptive should be selected individually, taking into account the gynecological and somatic status, family and personal history data. Properly selected hormonal contraception is a reliable protection against unplanned pregnancy and an effective way to preserve female reproductive health.