Femoden - official* instructions for use. Femoden: instructions for using IUD tablets or intrauterine device

One of the many drugs of modern contraception is Femoden. The instructions for use of this contraceptive describe in detail the instructions and effect of the contraceptive on the female body. If you carefully read the information and consult with a gynecologist, this remedy can provide a good service.

1 tablet contains 2 main substances: gestodene 75 mcg, ethinyl estradiol 30 mcg. The auxiliary components include: talc, montanglicol wax, calcium carbonate, starch, lactose monohydrate, sodium calcium edetate, PEG-6000, povidone 700000, povidone 25000.

Effect of the drug Femoden

When using contraceptives, certain hormonal changes occur. The mechanism works according to the principle: some hormones block the release of others, and the egg does not develop. Against the new background, the ovulation process is suppressed. The secretion of cervical mucus changes, which in turn interferes with the progress of sperm.

Femoden is an oral contraceptive for systemic use. The drug is considered a combination drug. Two active ingredients together help achieve the desired result.

1. Ethinyl estradiol– an analogue of natural estradiol. This synthetic steroid binds to estrogen receptors and has an immediate effect. It is quickly absorbed and passes through the mucous membranes. After interaction with the liver, the synthetic hormone is oxidized, resulting in the formation of metabolites. They are easily excreted from the body in urine. The positive effect of ethinyl estradiol is that it promotes the healing of the epithelium of the internal and external genital organs.
2. Gestoden– an analogue of natural progestin. Therefore, it has an active progestogenic and antiestrogenic effect. The androgenic effect is very weak due to low dosages. Thanks to this, gestodene has almost no effect on carbohydrate and lipid metabolism. It is this synthetic hormone that produces changes in the cervical mucus.

The fact that follicles will not mature and eggs will not develop in a woman’s body for some time does not mean that this will further affect reproductive abilities. Pills have a reverse effect. The fact that after discontinuation of the contraceptive, infertility was not observed, is shown by reviews of some women.

In addition to the contraceptive effect, Femoden manifests itself as a medicine. To some extent, it protects against cancer. In some women, an overly active ovulation process can trigger cancer. This is due to the fact that when there are a large number of active cells, disturbances occur. Therefore, the drug is prescribed to block this process.

Indications for use

Femoden is mainly used to prevent pregnancy. It also finds its use in cases of menstrual irregularities and excessive bleeding. In addition to the main therapeutic classification, the product is used to improve the condition of hair, nails and skin.

Contraindications

The drug Femoden is contraindicated in the following diseases: myocardial infarction, angina pectoris, cerebrovascular disorders, transient ischemic attacks, thrombosis and predisposition to it, thromboembolism, diabetes mellitus, jaundice, liver lesions and tumors, vaginal bleeding (unspecified), tumors at the hormonal level. The tablets should not be taken during pregnancy or while breastfeeding. In case of hypersensitivity, the contraceptive should be discontinued.

Instructions for use of Femoden

The contraceptive is taken for 21 days, with breaks of 7 days. There is a hint on the blister. Taking pills is scheduled according to the days of the week. This approach simplifies the course of admission and helps not to make omissions. You need to get used to drinking dragees (tablets) at the same time.

The instructions for use are convenient because they describe the features of taking Femoden in various situations.

• Initial reception. Ideally, you should take the first tablet. It is possible on other days of menstruation, but then use barrier methods of contraception for another week.
• Switching from other oral contraceptives. Femoden is taken immediately after the last dose of another drug.
• Reception after gestagens. The pill or tablet is taken any day without interruption.
• Taking the drug after injections. The next scheduled injection is canceled and the first tablet is taken instead.
• After removal of intrauterine contraceptives. Femoden is prescribed on the same day.
• After childbirth. The first tablet is taken after 21 days.
• After missing a pill. If the gap is less than 12 hours, take a pill. If you miss more than 12 hours, take 2 tablets. Then take it as usual.

In all of the above cases, the first 7 days are necessary
adhere to a barrier method of contraception.

Before taking Femoden, you need to undergo a thorough examination as prescribed by a gynecologist.

1. Rule out possible pregnancy.
2. Undergo examination of the mammary glands and cervical mucus.

Features of menstruation after taking and stopping Femoden

At first, after taking the pills, you may experience spotting or heavy bleeding. Such manifestations arise due to the body’s adaptation to the contraceptive and are considered normal.

If after a period of getting used to the drug, menstruation does not stop, then this is a signal to visit a doctor.

During the initial period of using a contraceptive, the next menstruation may not occur. If it occurs once, it's not scary. You need to continue taking the pills. If the delay in menstruation recurs, then you need to contact the clinic. The gynecologist must rule out pregnancy and only then can you continue taking Femoden.

Some people believe that in order for pregnancy to occur, you need to take special medications after using contraceptives. But, experts say that after stopping Femoden dragees (tablets), the likelihood of getting pregnant becomes even greater.

Side effects

Side effects of the drug are rare. Sometimes a woman may experience headache, nausea, negative breast changes, depression, weight gain and changes in sexual desire. In rare cases, clearly defined pigmentation (chloasma) appears on the skin.

In women who smoke, taking Femoden can cause vascular complications and even cause a stroke.

Analogs

Femoden analogues are divided into groups. This takes into account the composition, indications, method of application and ATC code (classification medicines). Each drug has its own pharmacological effect. Success depends on the right product. The instructions for use clearly indicate which therapeutic group the medicine belongs to.

• Preparations similar to Femoden, according to its composition: Lindinet, Logest, Milanda, Difenda, Artitia, Modell Tin.
• According to indication and method of use: Janine, Regulon, Novinet, Marvelon, Yarina, Jazz, Belara, Rigevidon, Mercilon.

Prices

If there is a need to switch from taking Femoden to another
contraceptive, this does not mean that you just need to go to the pharmacy and buy any analogue. Instructions for use indicate contraindications and side effects. After reading it, a woman will only be able to partially understand whether this medication is suitable for her. The final word should be with the gynecologist.

Latin name: Femoden
ATX code: G03A A10
Active substance: Ethinylestradiol,
gestodene
Manufacturer: BAYER PHARMA (Germany)
Conditions for dispensing from a pharmacy: On prescription

Femoden is a low-dose contraceptive OK.

Indications for use

Prevention of unplanned pregnancy.

Composition of the drug

• Active ingredients: ethinyl estradiol - 30 mcg, gestodene - 75 mcg
• Additional components of the structure and shell: lactose (in the form of monohydrate), corn starch, sodium calcium edetate, E572, sucrose, povidone, macrogol, calcium (in the form of carbonate), talc, mountain wax (glycolic).

Medicinal properties

Femoden belongs to the group of combined OCs containing low doses of two active ingredients. Pregnancy prevention is achieved through several mechanisms that complement each other. The most important of them is blocking ovulation and changing the structure of the cervical secretion by increasing its density, as a result of which sperm lose the ability to pass into the uterine cavity.

In addition, OK has a beneficial effect on the state of the reproductive system by streamlining the monthly cycle, shortening its duration and reducing the intensity of blood loss. The latter effect is especially important, since a woman’s risk of iron deficiency anemia is eliminated. It has also been noted that Femoden protects against the occurrence of oncology: epithelial and ovarian cancer.

Ethinyl estradiol is an artificial substance, an analogue of natural estrogen. After oral administration, it is quickly absorbed and absorbed in full. Peak concentration values ​​are formed after one and a half hours. Then the content gradually decreases, the half-life takes 1-2 hours, complete exit from the body takes 20. The rate of excretion depends on the condition of the body (age, pregnancy, MC, etc.).

The substance is transformed in the liver into inactive metabolites, which, after the end of action, are excreted along with feces and urine.

Repeated intake of tablets replenishes the content of the substance, increasing it by 30-40% compared to a single dose.

After penetrating into target cells, the synthetic hormone acts on the present receptors that are sensitive to the substance, and thereby increases the susceptibility of the tissues of the muscles of the uterus and tubes to substances that affect their motility. It also promotes the growth of beta lipoproteins in the blood, glucose tolerance and its utilization. In a large dosage it can retain water in the body, in a small dosage it blocks too active formation of red blood cells.

Gestodene is a synthesized analogue of natural progesterone, similar in structure to levonorgestrel. It has a gestogenic property, and in small doses has unexpressed antiandrogenic and antimineralocorticoid effects. Forcibly transfers the state of the epithelium to the secretory phase from the proliferative phase. Slows down the production of LH by the pituitary gland, thereby eliminating the possibility of ovulation.

After penetration into the body, it is instantly absorbed and absorbed in full. After a single dose, serum concentration reaches a maximum within an hour.

The metabolism of gestodene follows the same scenario that is inherent in steroids. The resulting compounds are not pharmacologically active. A significant amount is excreted from the body in urine, the rest in feces.

Release forms

The contraceptive is produced in the form of pills. The contents of the pills are enclosed in a white film coating. The product is placed in blisters with a calendar indicator. There are 21 pieces in one plate. The pharmacy chain comes in packages with 1 or 3 blisters and accompanying instructions.

Mode of application

Average cost: (21 pieces) - 753 rubles, (63 pieces) - about 1391 rubles.

Like all monophasic OCs, Femoden tablets should be taken in a 21-day course: once a day, 1 pill at one time. After this, a week-long break is observed, during which bleeding similar to menstruation should begin. The next pill intake is resumed after the end of the interval.

• If the patient had never used such OCs before Femoden or had taken them but completed the course a month earlier, then she should start taking the contraceptive on the first day of her period. If this is done later - on days 2-5 of the MC, then in the next week you will need to additionally use barrier agents.

• If before Femoden the patient was protected using other OCs, then the tablets should be started immediately after the end of the placebo course of the previous OCs or a mandatory break. If before this protection was carried out using a vaginal ring or transdermal patch, then OK pills are started immediately after the end of the break.

• When switching from monoprogestogen OCs or IUDs with progestogen, Femoden should be taken on any convenient day after the end of the course or on the day the device is removed. After starting OK, it is advisable to additionally use condoms.

Features of the use of Femoden after termination of pregnancy, depending on the period at which pregnancy ceased:

1st trimester: OK tablets are started immediately after an abortion (medical or miscarriage). There is no need for additional means of protection.

2nd trimester: OK contraception begins 21-28 days after childbirth/abortion and condoms are used for a week. If unprotected PA occurred before this time, then before taking Femoden you will need to make sure that there is no new pregnancy. To do this, check with a doctor or postpone the appointment until the onset of menstruation.

What to do if you miss tablets OK

A delay of less than 12 hours does not affect the contraceptive effect of the drug. To make up for the omission, a woman should take a pill at the first opportunity, and the next one in accordance with the schedule.

If you miss the pill for more than 12 hours, the contraceptive effect of Femoden, as indicated in the instructions for use, weakens. In this case, we must remember that the contraceptive effect develops over 7 days of use. During this period, the areas of the brain responsible for the mechanism of ovarian function are suppressed. Therefore, long intervals between taking OCs should not be allowed.

• If the omission occurred in the first week of the OK course, then the forgotten pill is drunk as soon as possible (if the time coincides with the personal schedule, they drink two pieces). Plus you will need to use condoms for a week. If there was PA, first confirm the absence of pregnancy or delay taking Femoden until the next menstruation.
• Week 2: do the same.
• Week 3: do the same. But if in the previous period OCs were taken regularly, then you don’t have to use condoms. If omissions have also happened before, then you can do one of two things:

1. Make up for the “shortfall”, finish the entire blister and immediately start a new one. In this case, the break is not observed. Bleeding may not occur or may appear while taking the second blister in the form of spotting.
2. After a forgotten pill, take a 7-day break and after it ends, start the 21-day course, trying to avoid intervals. If withdrawal bleeding does not appear during this time, you will need to undergo an examination to ensure that there is no pregnancy.

What to do if there was vomiting or diarrhea during the course

If this happens within 3-4 hours after the next OK pill, you need to drink another pill to restore the concentration of Femoden in the blood.

How to use pills to change the onset of MC

When there is a need to delay menstruation, then Femoden is taken without intervals. Tablets from a new pack are taken for as long as the woman needs it. But at the same time, she needs to be prepared that during the next blister, withdrawal bleeding or the so-called may occur. "daub". After the goal is achieved, take a week's break and after it ends, resume taking Femoden.

If you just need to move the start of the MC to another date, then shorten the weekly break by the required number of days. But we should not forget that the shorter the interval, the greater the chance that bleeding will be transferred to the course from the new pack.

During pregnancy and pregnancy

OK is prohibited for use by pregnant women. If pregnancy occurs after Femoden, it should be canceled immediately and immediately visit a gynecologist.

OC is also extremely undesirable for breastfeeding women. It has been established that the active components of the contraceptive can influence lactogenesis: reduce milk production and change its composition. It is also assumed that metabolites can penetrate into mother’s milk and be passed on to the baby.

If you are going to take Femoden after a long break, then you must not forget that in the postpartum period the risk of VTE increases.

Contraindications

Femoden birth control pills can be harmful if you do not take into account their contraindications. It is prohibited to use contraception if a woman has at least one of the following factors:

• VTE: present at the time of prescription or in the past, predisposition to it (congenital or acquired), risk factors in the present or past
• Extensive surgical interventions, prolonged bed rest
• PE: currently diagnosed or in the past, predisposition regardless of origin, risk factors for it
• Migraines with focal neurological manifestations (present and in medical history)
• Severe liver pathologies (prescription is possible only if the condition is stabilized)
• Liver tumors, regardless of nature
• Nicotine addiction
• Pancreatitis due to severe hypertriglyceridemia
• Severe hypertension
• Bleeding from the uterus that cannot be diagnosed
• Existing or suspected cancerous tumors of the genital organs
• Individual hypersensitivity to the components of OK
• Pregnancy, GW
• Diabetes mellitus with vascular disorders.

The question of the possibility of taking Femoden should be considered on a personal basis if serious risk factors for deterioration of health are discovered.

Precautionary measures

The appointment of Femoden should occur after a thorough examination and analysis of laboratory tests. This is especially true for women with a high risk of pulmonary embolism or VTE, or a predisposition to vascular or cardiac pathologies.

To prevent a sharp deterioration in well-being and the development of fatal consequences, the patient should be familiar with the symptoms of stroke or MI, as well as thromboembolic conditions.

Symptoms that require emergency withdrawal of Femoden:

• The onset of migraines (if there were none before), inexplicably severe headaches
• Sudden loss of hearing/vision or other senses
• Severe pain and swelling in the legs
• Pain when breathing, heaviness in the chest
• Jaundice
• Strong increase in blood pressure
• Severe pain in the upper abdomen or in the liver area (or enlargement of the organ)
• Pregnancy (diagnosed or possible)
• Exacerbation of diabetes mellitus.

Cross-drug interactions

When taking Femoden in combination with other medications, it is possible that the properties of OCs or other medications may be distorted:

• Drugs that increase the clearance of sex hormones can cause breakthrough bleeding or a decrease in the effect of the contraceptive. It has been precisely established that barbiturates, drugs with glycolyl urea, antiepileptics (Carbamazepine, Primidon), and anti-tuberculosis drugs (Rifampicin) have this property. It is assumed that Oxcarbazepine, Felbamate, Griseofulvin have the same effect, so if prescribed, you should check with your doctor about the specifics of combining them with OK.

• HIV protease inhibitors and NNRTIs (separately and in combination) can enhance metabolic processes in the liver.

• Drugs of the ampicillin and tetracycline groups weaken the effect of Femoden.

• Some drugs of the penicillin and tetracycline groups are able to reduce the content of estrogens by reducing their circulation in the gastrointestinal tract.

If a short course of these drugs is prescribed, patients are advised to protect themselves using barrier contraceptives throughout the course of treatment and for a week after the end of the course. For Rifampicin, more stringent recommendations apply: you must use condoms during the entire course of treatment, and after completion, continue to use protection for at least 28 days.

Side effects

Taking the contraceptive Femoden can provoke a negative reaction from the body. The most typical symptoms of deterioration in the functioning of organs and internal systems:

• Immune system: urticaria, allergies
• Vascular system: risk of pulmonary embolism, myocardial infarction, stroke,
• Mental health: mood lability, depression, decreased sexual desire
• NS: headaches, migraine attacks (sometimes)
• Eyes: sensitivity to contact lenses
• Gastrointestinal tract: abdominal pain, nausea, vomiting, diarrhea
• Skin: rash, chloasma (women with chloasma during a previous pregnancy are especially susceptible), erythema nodosum or erythema multiforme
• Reproductive system: bleeding between periods, spotting, pain and sensitivity of the mammary glands, increase in their size, discharge from the nipples/vagina
• Other disorders: accumulation of fluid in the body, weight gain (less commonly, weight loss).

In patients with a high susceptibility threshold, OC may increase the risk of angioedema. After completing the course of Femoden, liver dysfunction, increased chorea, decreased intensity of menstruation, amenorrhea, and breakthrough bleeding may be observed.

If these or other uncharacteristic conditions occur, you must notify your gynecologist.

Overdose

There are no known cases of serious intoxication after accidental or deliberate use of high doses of Femoden. An overdose can manifest itself in the form of nausea, bouts of vomiting, and in girls who are not yet fully formed - spotting bleeding from the vagina or megrorrhagia.

To eliminate intoxication, symptomatic therapy should be used, since no special antidote has been developed.

Conditions and shelf life

OK must be protected from light and moisture penetration. The storage temperature is below 25 °C. If all conditions are met, the validity period of the OK is 5 years.

Analogs

To select another contraceptive, you need to consult a doctor.

ZENTIVA, k.s. (Czech Republic)

Average cost:(21 tables) – 336 rubles, (63 tables) – 945 rubles.

The contraceptive contains a similar composition of active hormones. They prevent unnecessary pregnancy by suppressing ovarian function, thickening cervical secretions, and suppressing ovulation.

The course of treatment is designed for 28 days: continuous use for 21 days with a week break.

The product is available in film-coated tablets. Packs are equipped for 1 or 3 courses of administration.

Pros:

• Helps
• Affordable price.

Flaws:

• Side effects.

Gedeon Richter (Hungary)

Average cost:(21 pcs.) – 740 rub., (63 pcs.) – 1770 rub.

OK based on ethinyl estradiol and drospirenone. Prevents pregnancy by blocking ovulation and changing the condition of the endometrium.

The course of treatment is designed for 21 days, after which a week-long break is observed.

The product is available in the form of white pills.

Pros:

• Good effect
• Relieves PMS.

Flaws:

• Side effects
• Doesn't let you lose weight.

The contraceptive effect of combined oral contraceptives (hereinafter referred to as COCs) is based on the interaction of various factors, the most important of which are suppression of ovulation and changes in cervical secretion. In addition to preventing pregnancy, PDAs have a number of positive properties that can be used when choosing a method of contraception. The menstrual cycle becomes regular, menstruation is less painful, and blood loss decreases. The latter helps reduce the incidence of iron deficiency anemia. Proven to reduce the risk of endometrial and ovarian cancer. In addition, it has been found that when using COCs in high doses (50 mcg ethinyl estradiol), the risk of ovarian cysts, inflammatory diseases of the pelvic organs, benign breast diseases and ectopic pregnancy. Whether this applies to low-dose COCs has not been definitively established.
Gestoden
After oral administration, gestodene is quickly and completely absorbed. The maximum serum concentration of 4 ng/ml is achieved 1 hour after a single dose. Bioavailability is about 99%.
Gestodene binds to serum albumin and sex hormone binding globulin (SHBG). Only 1-2% of the total concentration of the substance in the blood serum is contained in the form of a free steroid, and 50-70% is specifically associated with SHPS. An increase in the level of SHPS induced by ethinyl estradiol determines an increase in the fraction of gestodene associated with SHPS and a decrease in the fraction associated with albumin.
The metabolism of gestodene is similar to that of steroids. Serum clearance is 0.8 ml/min/kg.
The level of gestodene in the blood serum decreases in two phases. When distributed in the final phase, the half-life is 12-15 hours. Gestodene is not excreted unchanged. Its metabolites are excreted from the body in urine and bile in a ratio of approximately 6:4. The half-life of metabolites is 1 day.
The pharmacokinetics of gestodene is affected by the level of GSPS, which increases 3 times with simultaneous administration of ethinyl estradiol. After daily administration, the level of gestodene in the blood serum increases approximately 4 times, reaching an equilibrium concentration in the second half of the course of taking the pill.
Ethinyl estradiol
When taken orally, ethinyl estradiol is rapidly and completely absorbed. The peak serum concentration, which is approximately 80 pg/ml, is achieved within 1-2 hours.
Ethinyl estradiol binds strongly but not specifically to serum albumin (approximately 98%) and increases serum concentrations of SHBG.
Ethinyl estradiol is metabolized mainly by aromatic hydroxylation, however, a large number of hydroxylated and methylated metabolites are additionally formed, including both free metabolites and conjugates with glucuronides and sulfates. Clearance is 2.3-7 ml/min/kg.
The level of ethinyl estradiol in the blood serum decreases in two phases with half-lives of about 1 and 10-20 hours, respectively. The substance is not excreted from the body unchanged; ethinyl estradiol metabolites are excreted in urine and bile in a ratio of 4:6. The half-life of metabolites is approximately 1 day.
Based on variable serum half-life and daily dosing, steady-state serum concentrations of ethinyl estradiol are achieved in approximately one week.

Indications for use of the drug Femoden

Contraception.

Use of the drug Femoden

The pills should be taken daily according to the order indicated on the blister, at approximately the same time, with a small amount of liquid. The drug is taken 1 tablet per day for 21 days. Taking the pill from each subsequent package must begin after the end of the 7-day break in taking the drug, during which, as a rule, menstrual-like bleeding occurs, which usually begins on the 3rd day after taking the last pill and may not end by the time you start taking the pill from next package.
How to start taking Femoden
If hormonal contraceptives were not used in the previous period (last month)
Taking the pills should start on the 1st day of the menstrual cycle. You can start taking it from the 2-5th day, but in this case, during the first cycle, it is recommended to additionally use a barrier method of contraception in the first 7 days of taking the drug.
Transfer from another PDA
It is advisable to start taking Femoden the day after taking the last active tablet of the previous COC, at least no later than the next day after a break in taking tablets or after taking placebo tablets of the previous COC.
Switching from a progestogen-only method (mini-pills, injections, implants) or a progestogen-containing intrauterine system
You can start taking Femoden any day after you stop taking the mini-pill (in the case of an implant or intrauterine system - on the day of their removal; in the case of an injection - instead of the next injection). However, in all cases it is recommended to additionally use a barrier method of contraception in the first 7 days of taking the pill.
After an abortion in the first trimester of pregnancy
You can start using Femoden immediately. In this case, there is no need to use additional contraception.
After childbirth or abortion in the second trimester of pregnancy
If breastfeeding, see subsection Pregnancy and breastfeeding.
It is necessary to start taking Femoden from the 21st to 28th day after childbirth or abortion in the second trimester of pregnancy. If you start taking the pill later, you should additionally use a barrier method of contraception in the first 7 days of taking the drug. However, if sexual intercourse has already taken place, then before starting to use the PDA it is necessary to exclude the possibility of pregnancy or wait until menstruation.
What to do if you miss a pill dose
If the delay in taking the pill does not exceed 12 hours, the contraceptive effect of the drug is not reduced. The missed pill should be taken as soon as possible. The next pill from this package should be taken at the usual time.
If the delay in taking the forgotten pill exceeds 12 hours, contraceptive protection may decrease. In this case, you should be guided by two basic rules: a break in taking pills can never exceed 7 days; adequate suppression of the hypothalamic system - pituitary- ovaries are achieved by continuously taking the pills for 7 days.
According to this, in everyday life it is necessary to adhere to the following recommendations:
1st week
It is necessary to take the last missed pill as soon as possible, even if you have to take two pills at the same time. After this, you should continue taking the pills at the usual time. In addition, over the next 7 days you need to use a barrier method of contraception, such as a condom. If sexual intercourse took place in the previous 7 days, the possibility of pregnancy should be taken into account. The more pills you miss and the closer the break in taking the drug, the higher the likelihood of pregnancy.
2nd week
You should take the last missed pill as soon as possible, even if you have to take two pills at the same time. After this, you must continue taking the pills at the usual time. If you take the tablets correctly for 7 days before the first missed period, there is no need to use additional contraceptives. Otherwise, or if you miss more than one tablet, it is recommended to additionally use a barrier method of contraception for 7 days.
3rd week
The risk of decreased reliability increases as the break in taking the pill approaches. However, if you follow the regimen for taking pills, you can avoid a decrease in contraceptive protection. If you adhere to one of the options below, there will be no need to use additional contraceptives, provided you take the tablets correctly for 7 days before the missed period. If this is not the case, you should stick to the first option below and use additional methods of contraception for the next 7 days.
It is necessary to take the last missed pill as soon as possible, even if you have to take two pills at the same time. After this, you should continue taking the pills at the usual time. It is necessary to start taking pills from the next package immediately after finishing the previous one. It is unlikely that menstrual bleeding will begin by the end of the second pack, although spotting or breakthrough bleeding may occur while taking the pills.
The woman may also be advised to stop taking pills from the current package. In this case, the break in taking the drug should be up to 7 days, including days of missing pills; You must start taking the pills from the next package.
If you miss taking a pill and there is no menstrual bleeding during the first regular break in taking the pill, you should exclude the possibility of pregnancy.
Recommendations in case of gastrointestinal disorders
In case of severe gastrointestinal disorders, incomplete absorption of the drug is possible; in this case, additional contraception should be used.
If vomiting occurs within 3-4 hours after taking the pills, it is advisable to use the recommendations regarding skipping pills. If the patient does not want to change the usual regimen of taking the drug, she needs to take additional pill(s) from a different package.
How to change the timing of your period or how to delay your period
To delay the appearance of menstruation, you should continue taking Femoden tablets from a new package and not take a break from taking the drug. If desired, the period of administration can be continued until the end of the second package. In this case, breakthrough bleeding or spotting cannot be ruled out. Regular use of the drug Femoden is restored after a 7-day break.
To shift the onset of menstruation to another day of the week, it is recommended to shorten the break in taking pills by the desired number of days. It should be noted that the shorter the break, the more often there will be no menstrual-like and breakthrough bleeding or spotting while taking the pills from the second package (as in the case of a delay in the onset of menstruation).

Contraindications to the use of Femoden

The PDA should not be used if you have any of the following conditions or diseases. If any of these conditions or diseases occurs for the first time while using COCs, use of the drug should be stopped immediately.
Venous or arterial thrombotic/thromboembolic events (eg, deep vein thrombosis, pulmonary embolism, myocardial infarction) or cerebrovascular disorders, current or history.
Current or history of prodromal symptoms of thrombosis (eg, transient cerebrovascular accident, angina).
History of migraine with focal neurological symptoms.
Diabetes mellitus with vascular damage.
The presence of severe or multiple risk factors for venous or arterial thrombosis may also be a contraindication (see).
Current or history of pancreatitis if associated with severe hypertriglyceridemia.
The presence or history of severe liver disease before normalization of liver function indicators.
Presence of diagnosed or history of liver tumors (benign or malignant).
Diagnosed or suspected malignant tumors (for example, genital or mammary glands), dependent on sex hormones.
Vaginal bleeding of unknown etiology.
Diagnosed or suspected pregnancy.
Hypersensitivity to the active substances or to any of the components of the drug.

Side effects of the drug Femoden

The most serious side effects associated with the use of COCs are described in the section.
Other undesirable effects have been reported with the use of COCs, but their connection with the use of COCs has been neither confirmed nor refuted:

Special instructions for the use of Femoden

If any of the following conditions/risk factors are present, it is necessary to weigh the benefits of using COCs against the possible risks, taking into account the individual characteristics of the patient, and discuss this before making a decision to take COCs. If any of the following conditions or risk factors become worse, worse, or occur for the first time, you should consult your doctor. The doctor must decide whether to stop using the COC.
Circulatory disorders
The results of epidemiological studies suggest a connection between the use of COCs and an increased risk of venous and arterial thrombotic and thromboembolic diseases, such as myocardial infarction, stroke, deep vein thrombosis and pulmonary embolism. The listed conditions occur rarely. Venous thromboembolism (VTE), manifested as venous thrombosis and/or pulmonary embolism, can occur with the use of any COC. The risk of developing VTE is highest during the first year of COC use. The incidence of VTE in patients taking oral contraceptives with low doses of estrogens (≤0.05 mg ethinyl estradiol) is up to 4 cases per 10,000 women/year compared with 0.5-3 cases per 10,000 women/year in women not using oral contraceptives. The incidence of VTE associated with pregnancy is 6 cases per 10,000 women/year.
It is extremely rare to note the occurrence of thrombosis of other blood vessels, for example, arteries and veins of the liver, kidneys, mesenteric vessels, cerebral vessels or retina for those using PDAs. There is no consensus regarding the connection between these complications and the use of PDAs.
Symptoms of venous or arterial thrombotic/thromboembolic events or stroke may be: unilateral pain in the lower extremities or swelling; sudden severe chest pain radiating to the left arm; sudden shortness of breath; sudden onset of cough; any unusual, strong, prolonged headache; sudden decrease or complete vision loss; diplopia; speech impairment or aphasia; vertigo; collapse with or without partial epileptic seizure; weakness or very severe sudden numbness of one side or one part of the body; motor impairment; acute stomach
Factors that increase the risk of venous or arterial thrombotic/thromboembolic events or stroke :

• age;
• smoking (in combination with heavy smoking and with age, the risk increases, especially over the age of 35);
• family history (for example, cases of venous or arterial thromboembolism in siblings or parents at a relatively early age). If a hereditary predisposition is suspected, the patient should be referred for consultation to an appropriate specialist before making a decision on the use of any PDA;
• obesity (body mass index more than 30 kg/m2);
• dyslipoproteinemia;
• hypertension;
• heart valve pathologies;
• atrial fibrillation;
• prolonged immobilization, radical surgical interventions, any surgical operations on the lower extremities, serious injuries. In these cases, it is recommended to stop using the PDA (for planned operations at least 4 weeks before they are performed) and not restore it earlier than 2 weeks after complete remobilization.

There is no consensus regarding the possible role of varicose veins and superficial thrombophlebitis in the development of VTE.
It is necessary to take into account the increased risk of thromboembolism in the postpartum period.
Other diseases that may be associated with serious circulatory disorders include: diabetes mellitus; systemic lupus erythematosus; hemolytic uremic syndrome; chronic inflammatory bowel disease (Crohn's disease or ulcerative colitis) and sickle cell anemia.
With an increase in the incidence of migraine or its exacerbation during the use of COCs (which may be a harbinger cerebrovascular accidents) may require immediate cessation of use of the PDA.
Biochemical indicators characteristic of hereditary or acquired susceptibility to venous or arterial thrombosis include resistance to CRP, hyperhomocysteinemia, antithrombin III deficiency, protein C deficiency, protein S deficiency, antiphospholipid antibodies (anticardiolipin antibodies).
When analyzing the risk/benefit ratio, the physician should take into account the fact that adequate treatment for the conditions mentioned above may reduce the associated risk of thrombosis, and also that the risk of thrombosis associated with pregnancy is higher than with the use of COCs in low dose (≤0.05 mg ethinyl estradiol).
Tumors
The most important risk factor for the development of cervical cancer is the persistence of papillomavirus. Some epidemiological studies suggest that this risk may be further increased with long-term COC use, but this is controversial because the extent to which the studies take into account confounding risk factors such as cervical smears and sexual behavior, including the use of barrier methods of contraception, is unclear. .
Data from a meta-analysis of 54 epidemiological studies indicate a slight increase in the relative risk (RR = 1.24) of developing breast cancer in women using COCs. The risk gradually decreases over 10 years after stopping taking COCs. Because the mammary cancer in women under 40 years of age is rare, an increase in the number of cases of diagnosis breast cancer in patients currently using or recently using COCs, is insignificant relative to the overall risk breast cancer. The results of these studies do not provide evidence for a causal relationship. The increased risk may be due to earlier diagnosis breast cancer in women using COCs, and the biological effect of COCs or a combination of two factors. There is a tendency that mammary cancer, detected in patients who have ever taken COCs, is clinically less pronounced than in those who have not used them.
In isolated cases, patients using COCs were diagnosed with benign, and even less often, malignant liver tumors, which rarely led to life-threatening intra-abdominal bleeding. In case of complaints of severe pain in the epigastric region, liver enlargement or signs of intra-abdominal bleeding, the differential diagnosis should take into account the possibility of a liver tumor in women taking COCs.
Other conditions
With hypertriglyceridemia or the presence of this disorder in the family history, patients using COCs are at risk of developing pancreatitis.
Although a slight increase in blood pressure has been reported in users of COCs, a clinically significant increase in blood pressure has been reported in isolated cases. However, if prolonged clinically significant hypertension occurs while taking a COC, it may sometimes be more appropriate to discontinue the COC and treat the hypertension (arterial hypertension).
When using COCs, the occurrence or exacerbation of the following diseases during pregnancy was noted, but their relationship with the use of COCs is not conclusively established: jaundice and/or itching associated with cholestasis, gallstone formation, porphyria, systemic lupus erythematosus, hemolytic-uremic syndrome, Sydenham's chorea, gestational herpes, hearing loss associated with otosclerosis.
In acute or chronic liver dysfunction, it may be necessary to stop taking COCs until liver function tests return to normal. If cholestatic jaundice relapses, which first occurred during pregnancy or previous use of sex hormones, taking COCs should be discontinued.
Although COCs may affect peripheral insulin resistance and glucose tolerance, there are no data regarding the need to change the therapeutic regimen in patients with diabetes mellitus taking low-dose COCs (containing ≤0.05 mg ethinyl estradiol). However, such patients should be closely monitored while taking COCs.
Crohn's disease and ulcerative colitis may be associated with COC use.
Chloasma can sometimes occur, especially in patients with a history of chloasma during pregnancy. Women with a predisposition to chloasma should avoid exposure to direct sunlight or ultraviolet radiation while taking COCs.
Medical examination
Before starting or resuming taking Femoden, it is necessary to conduct a full medical examination and study the patient’s medical history in detail, taking into account contraindications (see) and warnings (see). When using COCs, it is necessary to conduct periodic examinations, which is very important, since contraindications (for example, transient circulatory disorders, etc.) or risk factors (for example, venous or arterial thrombosis in a family history) may first appear while taking COCs. The frequency and nature of these examinations should be based on existing standards of medical practice, taking into account the individual characteristics of each patient, however, special attention should be paid to examination of the pelvic organs, including standard cytology of the cervix, abdominal organs, mammary glands, determination of blood pressure.
The patient must be warned that oral contraceptives do not protect against HIV infection (AIDS) and other sexually transmitted diseases.
Reduced efficiency
The effectiveness of COCs may be reduced if you miss a pill, if you have gastrointestinal dysfunction, or if you use other medications.
Cycle control
When taking oral contraceptives, intermenstrual bleeding (spotting or breakthrough bleeding) may occur, especially in the first few months of treatment. Taking this into account, examination for the appearance of any intermenstrual bleeding should be carried out only after a period of adaptation of the body to the drug, which is approximately three cycles.
If cycle irregularities continue or recur after several normal cycles, non-hormonal causes of bleeding should be considered and appropriate investigations should be carried out to exclude the presence of tumors and pregnancy. Diagnostic measures can include curettage.
Some patients may not experience menstrual bleeding during a break in taking the drug. If you take the COC as directed, pregnancy is unlikely. However, if the use of the contraceptive was irregular or in the absence of menstrual-like bleeding for two cycles, pregnancy must be excluded before continuing to take the COC.
During pregnancy and breastfeeding. The drug is not recommended for use during pregnancy. If pregnancy occurs while using Femoden, it should be discontinued. However, research results do not indicate an increased risk of congenital pathologies in children born to women who took COCs during pregnancy, nor do they indicate the existence of a teratogenic effect when unintentionally taking COCs in early pregnancy.
Under the influence of CCP, the amount of breast milk may decrease and its composition may also change. Given this, they are not recommended to be taken during breastfeeding.
The active substances included in the drug and/or their metabolites are excreted in small quantities in breast milk, but there is no data on their negative impact on the health of infants.
Impact on the ability to drive a car and operate machinery. There was no effect on the ability to drive a car or operate machinery.

Interactions of the drug Femoden

Interactions between oral contraceptives and other drugs may result in breakthrough bleeding and/or decreased contraceptive effectiveness.
Hepatic metabolism: may experience interactions with drugs that induce microsomal enzymes, which may cause an increase in the clearance of sex hormones (for example, phenytoin, barbiturates, primidone, carbamazepine, rifampicin and possibly also oxcarbazepine, topiramate, felbamate, ritonavir, griseofulvin and drugs that contain Hypericum perforatum L.
Interaction with the enterohepatic circulation: Some clinical studies suggest that enterohepatic circulation of estrogens may be reduced by certain antibiotics that reduce ethinyl estradiol concentrations (eg, penicillin and tetracycline antibiotics).
When using any of the above drugs, a woman should temporarily use a barrier method in addition to taking COCs or choose another method of contraception. When treating with drugs that induce microsomal enzymes, the barrier method should be used throughout the entire period of treatment with the corresponding drug and for another 28 days after stopping its use. When taking antibiotics (with the exception of rifampicin and griseofulvin), the barrier method must be used for another 7 days after their discontinuation. If the barrier method is still being used, and the tablets in the PDA package have already run out, taking the tablets from the next package should be started without the usual break.
Oral contraceptives may affect the metabolism of other drugs. Taking this into account, the concentrations of active substances in blood plasma and tissues (for example, cyclosporine) may change.
Note. To determine the potential for interaction with drugs that are prescribed concomitantly with COCs, it is necessary to read the instructions for the medical use of these drugs.
Impact on laboratory results. Taking contraceptives may affect the results of certain laboratory tests, including biochemical parameters of liver, thyroid, adrenal and kidney function, parameters contained in blood plasma proteins (carriers), such as SHBG and lipid/lipoprotein fractions, parameters of carbohydrate metabolism, as well as coagulation and fibrinolysis parameters.

Overdose of Femoden, symptoms and treatment

No serious negative effects due to overdose were noted. The following symptoms of overdose can be detected: nausea, vomiting, and in young girls - slight bleeding from the vagina. There are no specific antidotes; treatment should be symptomatic.

Storage conditions for the drug Femoden

At a temperature not exceeding 30 °C.

List of pharmacies where you can buy Femoden:

• Saint Petersburg

Diagnosis - anovulation, NMC, uterine retroflexion (bending). Normally, menstruation was extremely rare and was scanty (1 pad), but long (10-14 days). I am taking Femoden for the 5th cycle. While taking pills (the purpose was contraception, and the side effect was regulation of the cycle), menstruation became too abundant (5-10 pads), although the duration remained almost the same (5-8 days), and became painful (spasms and contractions of the uterus). In addition, at the slightest physical exertion on the abs, intermenstrual spotting begins. They are scanty, like my normal periods, but they bother me. There are no other side effects to Femoden, except for minor swelling, but I move so little (due to the discharge). .. But there remains a strong emotional burden due to copious and unpredictable discharge. I cannot refuse protection, condoms and spermicides are nonsense, they cause rejection in both me and my partner, and even reliability. . What do you recommend? Maybe it's worth changing the drug? But I’m not ready to take higher-dose medications. I'm thinking about three-phase - Tri-Regol, or mini-pill type drugs. In theory, the latter should not affect my natural cycle, but only slow down ovulation. That is, when taking the mini-pill, your periods will come as before - once every 3-6-9 months, and their character will become the same? Or am I missing something in the mechanism of progestogen tablets? I’m ready to give a damn about regulating the cycle - it’s still not life if there is no risk of discharge or bleeding only in the last week of the cycle. And one more question. What if you take 2 packs of combined tablets like Femoden at once, thereby lengthening the cycle and reducing the proportion of bleeding in its duration? After all, the duration of 28 days is a pure convention when applied to a cycle without ovulation; the duration can be any. .. in theory. For example, if we take 21 tablets twice, we get 42 days between bleedings. Even if the blood flows for 6-7 days, as now, menstruation, another 10 is a period of increased risk of discharge. .. It turns out 16-18 days of _disability_, that is, 33% of the duration of the 50-day cycle. The interval of normal condition will increase to 30-40 days. .. It's real? And in general, make the cycle longer, ignoring the 28 days imposed by the pills? I just don’t have time to recover. as my new period begins. ..Yes, I forgot to clarify: I’m 27, I haven’t given birth, I don’t plan to have 5 children in the next few years, there are no pathologies, I was examined and had an ultrasound a month ago. And please. There’s no need to send me to a gynecologist - I’ll go to him tomorrow. But I roughly know her point of view, and I need an independent view.