What contraceptives? Types of hormonal drugs for women

Oral contraceptives are one of the most effective methods of birth control for women. You can buy any of the dozens of drugs presented without a prescription, but birth control pills should be selected by a gynecologist after a thorough examination of the patient’s hormonal status.

Types of birth control pills

Tablet contraceptives differ in composition and mechanism of action. From this point of view, they can be classified into 2 large groups: “mini-pills” and combined pills (COCs).

Mini-pill

These birth control pills contain only one hormonal component - progestin. Its task is to create unfavorable conditions for conception and implantation at the uterine and cervical level. Namely:

1. Due to the influence on the consistency of cervical mucus. Despite the fact that the production of cervical secretion is subject to the cycle and decreases towards its middle, the mucus under the influence of the hormone continues to remain thick enough to prevent sperm from penetrating into the uterus.
2. Through intervention in the process of endometrial formation. A synthetic analogue of progesterone causes changes in the mucous layer of the uterus, preventing it from “ripening” to receive a fertilized egg.
3. Due to decreased peristalsis of the fallopian tubes. Progestin slows down the movement of the fallopian tubes, which prevents the egg from moving into the uterine cavity.

Hormones - linesterol or desogestrel - are contained in mini-mils in the lowest concentration (300 - 500 mcg), which, on the one hand, makes their effect as mild and harmless as possible, and on the other hand, reduces their effectiveness in comparison with COCs: 95 versus 99 %. Progestin-only tablets are approved for use by women for whom combination drugs are contraindicated, but require strict adherence to the dosage regimen.

The list of the most popular mini-pills includes:

• Exluton (1250 rubles);
• Lactinet (800 rubles);
• Charozetta (1500 rubles).

Contraceptive pills COC - list with names

Combined oral contraceptives are based on a combination of two active ingredients in different dosages and variations:

• an analogue of the female hormone estrogen – ethinyl estradiol;
• synthetic progestogen (desogestrel, norgestrel, norethisterone and other forms).

The essence of such birth control pills is to block ovulation by affecting the pituitary gland, which produces the gonadotropic hormones LH and FSH. It is these substances that are responsible for the growth of follicles in the ovaries and the release of eggs for fertilization. In parallel with the suppression of ovulation, contraceptives cause glandular regression of the endometrium and thickening of the mucus of the cervical canal, that is, the same processes that occur when taking the mini-pill.

COCs have a rather complex classification depending on the ratio of hormonal components and their concentration levels. According to the first criterion, drugs are divided into:

1. Single-phase. All tablets in one package have the same composition, the proportions of ethinyl estradiol and gestagen do not change. Monophasic drugs include Rigevidon, Regulon, Janine, Siluet, Logest, Lindinet, Femoden.
2. Two-phase. This group of OCs contains a fixed dose of estrogen and different concentrations of progestogen for the first and second half of the cycle. The drugs Femoston with dydrogesterone, Binovum with norestirone, Anteovin and analogues with levonorgestrel in the composition have a certain sequence of administration.
3. Three-phase. The ratio of hormones in these tablets changes in accordance with the phases of the menstrual cycle, and there are 3 of them, which is reflected in the names of the drugs: Triziston, Tri-regol, Tri Mercy.

According to the quantitative indicator of active substances, birth control pills are:

• microdosed (Jess, Logest, Novinet, Mercilon, Miniziston) - recommended as the first means of oral contraception for girls under 25 years of age;
• low-dose (Zhanine, Yarina, Chloe, Diane, Femoden, Rigevidon, Regulon) - prescribed to older women who have given birth, and also those who have elevated levels of male hormones - many of these tablets have an antiandrogenic effect. For those who are not suitable for microdosing drugs, which is manifested by intermenstrual bleeding, products with a higher hormone content are preferable;
• high-dose (Tri-regol, Triziston, Non-Ovlon) - medicinal drugs with a contraceptive effect, used for hormonal disorders and in the treatment of certain female diseases.

Postcoital remedies

A separate category of hormonal drugs is postcoital - birth control pills taken after intercourse for 72 hours. This is a means of emergency contraception in case of unprotected sex with a high risk of pregnancy.

Tablets of this group - Postinor, Escapel, Plan B - contain a loading dose of levonorgestrel, and Ginepristone, Zhenale, Mifepristone consist of mifepristone, an antagonist of the progesterone hormone. Both of them sharply suppress ovulation and cause endometrial rejection (menstrual-like bleeding) along with a likely fertilized cell, essentially having an abortifacient effect.

These drugs are extremely harmful to the body, they can cause cycle disorders, ectopic pregnancy, and if abused, lead to serious hormonal imbalance, including infertility. In addition, they do not provide a 100% guarantee. Postcoital pills should be used only in desperate situations: rape, condom rupture - as an exceptional measure, but not as a regular method of contraception.

How to choose birth control pills?

To buy good birth control pills, you should not follow the advice of friends and pharmacists. All modern drugs are quite effective and harmless, but women of different ages, lifestyles, medical histories, and with particularities of general and reproductive health need different medications. Taking unsuitable contraceptives can cause problems such as uterine bleeding, hormonal imbalance and serious side effects.

It is impossible to choose the right OC without a visit to a gynecologist. He will collect information about previous and current diseases, evaluate family history, perform an examination and prescribe mandatory tests. In particular, the following are important for a doctor:

• patient's age;
• height to weight ratio;
• blood pressure level;
• the presence of external signs of hyperandrogenism;
• the nature and regularity of monthly bleeding;
• relationship with smoking.

A gynecological examination with palpation of the breast, ultrasound, tests for hormones, sugar, blood clotting, liver enzymes are required; if indicated, consultations with specialized specialists (ophthalmologist, phlebologist, endocrinologist).

Based on all this data, the gynecologist determines which birth control pills to choose. If we focus only on a woman’s hormonal status, the most commonly prescribed drugs are:

Phenotype	Signs	Recommended drugs, approximate price
Balanced hormonal levels	normal body type, oily hair and skin; stable menstrual cycle of average duration	Marvelon (990 rub.) Femoden (680 rub.) Regulon (430 rub.) Mercilon (860 rub.) Lindinet (520 rub.) Rigevidon (313 rub.) Novinet (from 490 RUR)
Predominant estrogens	Feminine shapes, tendency to dry skin and hair, long, heavy menstruation	Rigevidon (313 rub.) Logest (775 rub.) Microgynon (360 rub.) Triquilar (600 rub.)
Predominance of progesterone, hyperandrogenism	Severe PMS, increased oiliness of hair and skin, short cycle, scanty periods	Yarina (1100 rub.) Jess (1100 rub.) Janine (1000 rub.) Diana-35 (1100 rub.)

Nursing mothers, women over 35 years of age with a tendency to thrombosis, as well as smokers of COCs are contraindicated and mini-pills are prescribed.

Contraindications

Oral contraceptives interfere with the functioning of the hormonal system, which means they affect the entire body. A number of restrictions make birth control pills inaccessible to many women. For COC it is:

• suspicion of pregnancy;
• lactation;
• postpartum period;
• diabetes;
• cardiovascular diseases;
• hypertonic disease;
• cerebrovascular accidents;
• renal and liver pathologies;
• migraine;
• female bleeding of unknown origin;
• oncological diseases of the reproductive system, endocrine and mammary glands;
• obesity;
• tendency to thrombosis;
• smoking after 35 years;
• upcoming surgery.

The mini-pill has a less impressive list of contraindications. In particular, this type of contraceptive is allowed for women who have recently given birth, breastfeeding, and smokers. They should not be taken if there is a history of ectopic pregnancy, malignant tumors, uterine bleeding, cardiovascular pathologies, or acute liver diseases.

It is undesirable to use OCs for autoimmune pathologies:

1. hyperthyroidism;
2. bronchial asthma;
3. congenital hyperbilirubinemia;
4. rheumatoid arthropathy;
5. sarcoidosis;
6. multiple sclerosis and others.

In any case, the gynecologist must have complete information about the patient’s existing health problems, even if she herself does not consider them dangerous. If necessary, it is advisable to involve specialized doctors in the selection of OK.

How to take hormonal contraceptives correctly

Contraceptive medications require daily use during the monthly cycle. The standard number of pills in a COC blister is 21: for 3 weeks of continuous use with a seven-day break. If the package contains a different number of tablets (24, 28), the instructions for use should be specified in the instructions.

How to take birth control pills:

1. The newly prescribed drug should be taken from the first day of menstruation.
2. Dosage regimen: 1 tablet every day, preferably at the same time.
3. After the last pill, take a break for a week.
4. At this time, “menstruation” is expected - withdrawal bleeding.
5. Exactly 7 days after the last tablet, a new blister is started.
6. Monophasic drugs are not sensitive to the sequence of administration; two- and three-phase drugs are taken strictly according to the regimen indicated on the package.

Mini-pills are designed for continuous use without pauses - there are 28 tablets in a package. Microdoses of active substances in these tablets require special punctuality in administration: hormones must be delivered daily at approximately the same hour so that their concentration does not drop to a critical level.

The contraceptive effect is reduced even after missing a pill once, during vomiting, and also when taking certain medications in parallel. In the first two cases, you need to take another pill and use condoms during sexual intercourse. To avoid drug incompatibility, it is important to always inform doctors about the use of OCs.

As for emergency contraception, postcoital medications protect against pregnancy if taken no later than 3 days (72 hours) after sexual intercourse, and the sooner the better. 12 hours after the first tablet, you need to take the second one. Instead of Postinor or Mifepristone, which are sold exclusively by prescription, you can use conventional COCs with a dosage of more than 50 mcg of ethinyl estradiol and 0.25 mg of progestin. As soon as possible after “problematic” intimacy, you need to swallow 2 tablets and 2 more after an interval of 12 hours.

Possible side effects

Bloody discharge of varying intensity while taking COCs is considered normal in the first 2 to 3 months. They occur due to the restructuring of the reproductive system to an artificial hormonal level. After stopping taking contraceptives, the body returns to its normal state. Menstruation after stopping birth control pills returns in a couple of months or faster, but it is quite possible for their character to change.

Other side effects of COCs include:

• headache;
• dizziness;
• discomfort in the mammary glands;
• weight gain;
• increased appetite;
• flatulence;
• depression;
• nausea;
• hyperpigmentation;
• acne;
• hair growth on the body and face;
• swelling;
• decreased libido.

These manifestations are usually temporary and should go away with adaptation to the tablets. If there is no improvement, it is necessary to either change the drug or switch to other types of contraception.

Hormonal OCs can also cause more serious disorders:

• loss of lateral vision;
• migraine-like pain;
• leg cramps;
• speech disorders;
• jaundice;
• pressure surges;
• thrombosis and thromboembolism;
• heart attack, stroke.

As you can see, these are life-threatening conditions, which can be caused by ignoring contraindications and illiterate choice of drugs. If symptoms such as a sharp increase or decrease in blood pressure, chest pain, pain and swelling of the calf muscle, slurred tongue, or loss of consciousness coincide with the start of taking COCs, hormones should be stopped immediately and consult a doctor.

Even if the best contraceptive pills are selected for a woman, periodic monitoring and tests are required to exclude negative effects on health:

1. blood pressure measurement every 6 months;
2. annual examination by a gynecologist;
3. urine and liver function tests - at least once a year;
4. regular self-examination of the mammary glands - every month.

In the absence of negative consequences, modern COCs can be used for a long time and do not require breaks in use. When planning a pregnancy, you must stop taking the pills; fertility should recover within 3 to 6 months. In some women, conception occurs in the first cycle after stopping the drugs.

The most frequently asked questions regarding use

Hormonal pills have become widespread since the end of the 20th century, but still raise many doubts. In particular, do COCs guarantee 100% protection, and is it necessary to pause taking them every few months? We will consider these and other questions separately.

Is it possible to get pregnant while taking birth control pills?

The effectiveness of modern drugs reaches 99%, but only if used correctly. Missing doses, gastrointestinal disorders, and too long intervals between pills taken reduce the contraceptive effect of OCs. Some medications weaken the work of synthetic hormones: antibiotics, paracetamol, antidepressants, antifungal medications, sorbents, chromium preparations, dietary supplements for weight loss that stimulate intestinal motility.

There is also a risk of pregnancy in the first month of taking the pills. Hormones require at least 2 weeks to begin contraceptive activity, and they exhibit maximum effect no earlier than a month of regular use. Until a reliable mechanism for suppressing ovulation has been formed, it is necessary to protect yourself by other methods, just as carefully as without COCs.

What to do if you forgot to take your birth control pill?

Even missing a pill once increases the risk of unplanned conception. But this is not so critical if you take the forgotten pill as soon as possible and return to your usual regimen. In any case, it is recommended to use barrier contraception for 2 to 3 days.

2 - 3 omissions nullify the contraceptive effect for a whole week. After taking one tablet, you must practice exclusively protected sex for the next 7 days. And if sexual intercourse took place 1 to 5 days before the accidental break, emergency contraception is required.

How to take birth control after an abortion?

After an artificial termination of pregnancy, as after a miscarriage, taking COCs should be started on the first day. If the deadline has already passed, it is not advisable to take the pills; you must wait until your period.

Can I take birth control pills after my period?

It is always recommended to start taking oral contraceptives on the first day of the cycle. But the instructions allow a slight delay in administration - up to 5 days with parallel use of barrier agents. You should not wait until your next menstruation to start taking birth control pills. This can be done at any time from the 1st to the 5th day of the cycle - it does not matter whether the bleeding is still ongoing or has already ended. All subsequent blisters should be taken regardless of menstruation, strictly according to the scheme of 21 tablets after a 7-day break.

What birth control pills can you take while breastfeeding?

In breastfeeding mothers, ovulation is naturally suppressed, and menstruation may be absent for several months. However, lactational amenorrhea cannot be considered a reliable method of contraception. Pregnancy may occur even before menstruation returns, and the woman should be provided with an effective and safe method of contraception.

Which birth control pills are best to take after 30?

30 years is the peak of female sexuality, but by this age many people already have health problems. Before choosing contraception, you should undergo a full examination to exclude possible contraindications.

The preferred drugs after 30 years are microdosed ones - Microdenone, Femoden. In addition to the contraceptive effect, they have a preventive effect against uterine fibroids and endometriosis. For women suffering from heavy menstruation, mini-pills are more suitable.

Beginning at age 35, the ovaries synthesize less and less reproductive steroids. To maintain normal hormonal levels, tablets must contain at least 20 mcg of estradiol - Silest, Lindinet 30, Marvelon, Triziston.

Women who smoke after 35 years need to decide: either cigarettes or oral contraception. The combination of synthetic hormones and nicotine critically increases the risk of blood clots, and, accordingly, stroke and heart attack. Instead of COCs, you can choose mini-pills, but again in the absence of cardiovascular problems, hypertension, endocrine pathologies, excess weight and varicose veins.

Which birth control pills are best to take after 40?

The best choice for a 40-year-old woman is progestin tablets: Continuin, Charozetta, Exluton. The functions of the ovaries fade away; at this age, early menopause already occurs, but conception is still possible. The therapeutic and preventive properties of contraceptives come to the fore: protection against endometriosis, uterine polyps, osteoporosis, and irregular cycles. In any case, a woman 40–45 years old should entrust the choice of drug to an experienced gynecologist, since the risks are too high.

Many women are afraid to take birth control pills for fear of side effects. Innovative technologies make it possible to produce contraceptive drugs that contain a minimal amount of hormones and only affect the process of conception.

pharmachologic effect

New generation birth control pills contain a complex of progestogens and estrogens. These sex hormones inhibit the synthesis of gonadotropins (follicle-stimulating and luteinizing hormone) in the pituitary gland of the brain. As a result, the process of egg maturation and follicle rupture is blocked, so pregnancy cannot occur.

Oral contraceptives help thicken the cervical mucus, which makes it difficult for sperm to move and penetrate into the uterus. After taking birth control pills, a secretory transformation of the endometrial layer occurs; even if spontaneous ovulation occurs, fertilization of the egg occurs, the embryo cannot be implanted into the uterine wall.

Third-generation progestogens have a high affinity for the hormonal receptors of progesterone, so they can bind to them and have a contraceptive effect, blocking ovulation and the release of FSH and LH. At the same time, progestogens have a low affinity for androgen receptors, which reduces the risk of side effects such as male-pattern hair growth, acne, excess weight, hair loss, irritability, etc.

The contraceptive effect of the pills is mainly provided by progestogens; estrogens support the proliferation of the inner layer of the uterus, control the course of the menstrual cycle, and replace the lack of estradiol, the synthesis of which is blocked along with ovulation. Thanks to synthetic estrogens, intermenstrual bleeding does not occur while taking modern birth control pills.

Depending on the composition of the active ingredients, COCs are distinguished - combined oral contraceptives containing progestogens + estrogens, and purely progestogen contraceptive pills (mini-pills).

Taking into account the daily dosage of synthetic estrogens, COCs are classified:

• High-dose ones contain up to 50 mcg/day. ethinyl estradiol.
• Low-dose contraceptives include no more than 35 mcg/day. estrogenic component.
• Microdosed tablets are characterized by the smallest amount, not exceeding 20 mcg/day.

High-dose hormonal contraceptives are used only for medicinal purposes and for emergency protection after unprotected sexual intercourse. Currently, preference is given to low and micro-dose contraceptives for the prevention of unwanted pregnancy.

Depending on the combination of progestogens and estrogens, COCs are divided into:

• Monophasic tablets are characterized by a constant daily dose of both sex hormones.
• Multiphasic contraceptives are characterized by variable dosages of estrogen. This creates an imitation of fluctuations in hormonal balance in a woman’s body during different phases of the menstrual cycle.

Tablets with low hormone content provide reliable protection against unplanned pregnancy (99%), are well tolerated, and allow you to control the menstrual cycle. After stopping taking COCs, reproductive function is restored within 1–12 months.

In addition to the contraceptive effect, oral contraceptives are prescribed for the treatment of dysmenorrhea, reducing the volume of blood loss during menstruation, ovulatory pain, and reducing the frequency of relapses of inflammatory diseases of the genitourinary system. COCs reduce the risk of developing endometrial cancer of the uterus, ovaries, rectum, anemia, and ectopic pregnancy.

Pros and cons of taking COCs

The main benefits of taking combined birth control pills include:

• high level of reliability – 99%;
• additional therapeutic effect;
• prevention of chronic diseases, cancer;
• rapid contraceptive effect of pills;
• protection against ectopic pregnancy;
• accidental use of COCs in early pregnancy is not dangerous;
• prevent the occurrence of intermenstrual, dysfunctional uterine bleeding;
• contraceptives are suitable for long-term contraception;
• the ability to stop taking the pill if you want to get pregnant;
• the condition of the skin improves.

After short-term use of combined oral contraceptives (3 months), the sensitivity of hormonal receptors in the ovaries increases, therefore, after discontinuation of COCs, increased stimulation of ovulation and the release of gonadotropins occurs - a rebound effect. This method of therapy helps women suffering from anovulation to become pregnant.

The disadvantages of taking birth control pills include high cost and possible side effects. Undesirable manifestations are rare (10–30%), mainly in the first few months. Later, the women's condition returns to normal. The simultaneous use of COCs and anticonvulsants, antituberculosis drugs, tetracyclines, antidepressants reduces the therapeutic effect of contraceptives.

Common side effects include:

• irritability, aggressiveness, tendency to depression;
• migraine;
• swelling of the mammary glands;
• impaired glucose tolerance;
• weight gain;
• chloasma - the appearance of age spots on the skin;
• acne, seborrhea;
• breakthrough bleeding;
• intermenstrual bleeding;
• thrombophlebitis;
• decreased libido;
• amenorrhea due to endometrial atrophy;
• increased blood pressure.

If side effects do not go away after 3 months of taking contraceptives, the pills are discontinued or replaced with other drugs. A complication such as thromboembolism is extremely rare.

Indications and contraindications for taking COCs

Combined oral contraceptives are suitable for women who have regular sex life, suffer from painful, heavy menstruation, endometriosis, and benign tumors of the mammary glands. It is possible to prescribe birth control pills in the postpartum period if the mother does not breastfeed.

Contraindications:

• thrombophlebitis;
• diseases of the cardiovascular system;
• diabetes;
• pregnancy or suspicion of possible conception;
• pancreatitis;
• inflammatory diseases, liver tumors;
• renal failure;
• lactation;
• uterine bleeding of unknown etiology;
• migraine;
• individual intolerance to the active ingredients.

If pregnancy occurs, birth control pills should be stopped immediately. But if a woman takes the medicine after conception, there is no significant risk to the intrauterine development of the child.

COC dosage regimens

Contraceptives are selected individually for each woman. This takes into account the presence of gynecological diseases, concomitant systemic ailments, and possible contraindications.

The doctor advises the patient about the rules for taking COCs and monitors them for 3–4 months. During this period, the tolerability of the pills is assessed, and a decision may be made to cancel or replace the contraceptive. Dispensary records are maintained throughout the entire period of contraceptive use.

First-line drugs include monophasic COCs containing estrogen no more than 35 mcg/day. and gestagens with weak androgenic effects. Three-phase tablets are prescribed for primary or secondary estrogen deficiency, decreased libido, dry vaginal mucous membranes, and menstrual irregularities.

After starting to take birth control pills, side effects may occur in the form of spotting, intermenstrual bleeding, breakthrough uterine bleeding caused by changes in hormonal levels. After 3 months, all symptoms should go away. If the discomfort persists, the drug is replaced taking into account the problems that have arisen.

Birth control pills are taken every day at the same time. For convenience, serial numbers are indicated on the blister. COCs are started on the first day of the menstrual cycle and continued for 21 days. Then they take a break for 1 week, during this period withdrawal bleeding is observed, which ends after the start of a new package.

If you miss taking another contraceptive pill, you should take it no later than 12 hours later. If more time has passed, the contraceptive effect of the drug will be lower. Therefore, over the next 7 days it is necessary to use additional barrier agents against unwanted pregnancy (condom, suppositories). Do not stop taking COCs.

Dosage regimens

Schemes for prolonged use of combined oral contraceptives for menstrual irregularities:

• Short dosing of birth control pills allows you to increase the interval between periods by 1-4 weeks. Such regimens are used to delay spontaneous menstruation, prevent bleeding, and cancel after a course of oral contraceptives.
• Long-term dosing is prescribed to delay menstruation from 7 weeks to several months. Treatment with birth control pills is prescribed for anemia, endometriosis, premenstrual syndrome, hyperpolymenorrhea.

Some women prefer cyclic use of COCs with a seven-day break due to fear of pregnancy and infertility. Some patients believe that menstruation is a physiological process.

Popular combined oral contraceptives

Low Hormone Microdose Pills:

• Median is a monophasic estrogen-progestogen COC. The drug contains drospirenone, which has an antimineralkorticoid effect, prevents excess body weight gain, the appearance of edema, acne, oily skin, and seborrhea.
• contains ethinyl estradiol 20 mcg, dospirinone 3 mg. The contraceptive drug is prescribed for contraception purposes, for the treatment of severe acne, painful menstruation.
• Lindinet 20 tablets include ethinyl estradiol 20 mcg, gestodene - 75 mcg. Indicated for use in painful menstruation, irregular cycles, and for contraception.
• Zoely. Active ingredients: estradiol hemihydrate – 1.55 mg, nomegestrol acetate – 2.5 mg. Nomegestrol acetate is a highly selective progestogen with a similar structure to progesterone. The active component has mild androgenic activity and does not have mineralocorticoid, estrogenic or glucocorticoid effects.

Mini-pill

Popular contraceptive pills with minimal hormone content - mini-pills - are an alternative means of contraception for women who are contraindicated in taking COCs. The drugs contain microdoses of progestin, an analogue of progesterone. One capsule contains 300–500 mcg/day. The action of mini-pills is inferior to COCs, but they have a milder effect; they are recommended for women who experience side effects after taking combined contraceptive pills.

Representatives of the fairer sex can take low-dose progestin preparations during lactation; the active substance does not affect the taste of breast milk and does not reduce its volume. Unlike COCs, mini-pills do not cause blood thickening, do not contribute to thrombus formation, or increase blood pressure, therefore they are approved for use in cardiovascular pathologies and thrombophlebitis.

Progestin-only birth control pills do not affect ovulation; they thicken cervical mucus, preventing sperm from entering the uterine cavity and ovaries. In addition, the peristalsis of the fallopian tubes slows down, proliferative changes in the endometrium occur, which does not allow the embryo to implant in the event of fertilization of the egg. When taking gestagen drugs, the menstrual cycle and regular bleeding are maintained.

The contraceptive effect is achieved 3–4 hours after taking the tablet and lasts for 24 hours. Mini-pills provide 95% protection against unplanned pregnancy.

Rules for using the mini-pill

Before starting to use contraceptives, women must be examined by a gynecologist to rule out pregnancy and chronic diseases of the reproductive system. To get the desired result, you must strictly follow the rules for using the mini-pill:

• Taking pills starts from the first day and continues until the 28th day of the menstrual cycle, drinking them continuously at the same time. Missing the next dose of contraceptives for more than 3 hours completely eliminates the contraceptive effect.
• Nausea may occur during the first few weeks, but this symptom usually goes away gradually. To reduce discomfort, it is recommended to take the tablet with food.
• If you vomit after taking the mini-pill, you should take the pill again as soon as you feel normal. This recommendation also applies to diarrhea. In the next 7 days, you must use additional contraception (condom) to protect against unwanted pregnancy.
• When switching from COCs, you should take mini-pills immediately after finishing the package of combined contraceptives.
• Pregnancy can occur in the first month after stopping progestogen pills. Ovulation occurs 7–30 days (average 17) after the end of the 56-day course.
• Women who are prone to the appearance of age spots (chloasma) after exposure to the sun should avoid prolonged exposure to ultraviolet radiation.
• When taking mini-pills and barbiturates, activated carbon, laxatives, anticonvulsants, and Rifampicin at the same time, the effectiveness of contraceptives becomes less.
• In the postpartum period, progestin contraceptives are prescribed on the first day of menstruation, but not earlier than 6 months after the birth of the child.
• After an abortion, you start taking pills immediately after the operation; no additional contraception is required.
• The contraceptive effect of the mini-pill is weakened if the gap between taking the next contraceptive pill is more than 27 hours. If a woman forgets to take the medicine, it is necessary to do so as soon as possible and then strictly follow the treatment regimen. Over the next week, it is necessary to use additional means of protection against pregnancy.

Contraindications

It is contraindicated to take oral contraceptives with a low dose of hormones during pregnancy, with uterine bleeding of unknown etiology, liver disease, taking steroids, exacerbation of herpes, liver failure. You should not take the pills if you have previously had an ectopic pregnancy, or if you have detected or suspected malignant tumors of the mammary glands. Contraindications include lactose intolerance and glucose-galactose malabsorption.

A decrease in the effectiveness of contraceptives can be observed if the rules of administration are violated, the use of laxatives, barbiturates, anticonvulsants, after vomiting, diarrhea. Irregular menstruation may occur against the background of gestagen pills. In such cases, it is necessary to stop taking the mini-pill, rule out possible pregnancy (including ectopic) and only then resume the course.

Side effects of birth control pills

Mini-pills have fewer side effects than COCs. The negative consequences of taking birth control pills include:

• vaginal candidiasis (thrush);
• nausea, vomiting;
• intermenstrual bleeding;
• intolerance to contact lenses;
• swelling of the mammary glands, discharge from the nipples;

• contraceptives cause weight gain;
• the appearance of chloasma;
• urticaria, erythema nodosum;
• headache;
• acne;
• breakthrough bleeding while taking drugs that affect liver function;
• decreased libido;
• follicular ovarian cyst;
• amenorrhea, dysmenorrhea.

Minipills may increase insulin requirements in patients with diabetes. Therefore, before taking birth control pills, it is necessary to consult with an endocrinologist and, if necessary, adjust the dosage of hypoglycemic agents. Women should constantly monitor their blood sugar levels during the first month of taking the mini-pill.

In rare cases, the use of progestin agents can provoke the development of thromboembolism. It should be taken into account that in women over 40 years of age, the risk of developing breast cancer increases during treatment with hormonal drugs. If serious side effects occur, the mini-pill should be discontinued.

If, after pregnancy, there is an accidental use of contraceptives, there is no risk to the fetus, but the further course of pills should be discontinued. At high dosages of progestogens, masculinization of the female embryo can be observed. During lactation, some of the active substances of the drug penetrate into breast milk, but its taste does not change.

Popular mini-pills

• Femulen (ethinodiol).
• Exluton (linestrenol 0.5 mg).
• Charosetta. The active substance is desogestrel in a dosage of 75 mcg. The tablets do not cause significant disturbances in carbohydrate, lipid metabolism, or hemostasis.
• Microlut (levonorgestrel 0.03 mg).
• Continuin (ethinodiol acetate 0.5 mg).

The disadvantages of using progestin contraceptive pills include the possible formation of follicular ovarian cysts, menstrual irregularities, edema, weight gain, and irritability. The contraceptive effect of the mini-pill is lower than that of COCs, it is 90-97%.

Modern contraceptive drugs contain small doses of hormones, provoke the development of side effects to a lesser extent, and provide reliable protection against unplanned pregnancy. The attending physician prescribes tablets, taking into account the individual indications of the woman. The patient must be registered at the dispensary for the entire period of use of the COC or mini-pill. Particularly careful monitoring is carried out during the first 3–4 months from the start of using oral contraceptives.

Means for the prevention of pregnancy can rightly be attributed to 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 decoction of acacia were used. Even condoms are not a modern method of 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 levels. 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.
• In the uterus, a disruption of secretory processes occurs, which causes the development of swelling of the mucous membrane - the endometrium, which, in turn, makes implantation of a fertilized egg impossible.
• A process called luteolysis is launched - that is, the reverse development of 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, 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 is almost halved.
• 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 side effects, which sometimes make taking the drug 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.
• They can aggravate the course of chronic diseases of the liver and gallbladder or provoke the occurrence of cardiovascular pathologies, disorders in the 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 ability to double the dose if you forget to take another pill. But with multiphase agents this is not always possible, and their use requires greater 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 the 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.

The main positive quality of this group of drugs is the reduction in 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.

Studies have shown that triphasic contraceptive drugs are inferior to monophasic ones in terms of reliability of protection against unplanned pregnancy.

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 test, general and biochemical blood test, 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.

Most people, due to a lack of knowledge in the field of medicine, consider hormonal drugs to be something terrible, bringing a huge number of side effects (from weight gain to significant hair growth). Such fears are unfounded. An example is hormonal pills for women. These drugs are widespread and effective in their use. What hormones are, why they are taken, and which of them are the best is discussed in the article.

Hormonal medications include synthetic hormones or hormonoids (substances that have similar properties). Hormones are produced by glands of the endocrine system. Entering the blood, they spread throughout the body and reach target cells, on which they have a direct effect. Specific reactions occur there that control the vital functions of the body.

All hormonal medications can be divided into the following types:

• pituitary gland preparations - representatives are human chorionic gonadotropin and oxytocin, which is known to every woman;
• thyroid hormones – used in the treatment of insufficient or excessive synthesis of hormonally active substances;
• pancreatic agents (insulin-based);
• parathyroid preparations;
• hormones of the adrenal cortex - glucocorticosteroids, which are used in most areas of medicine to relieve insufficiency, inflammatory and allergic processes;
• preparations of sex hormones (estrogens, progestins, androgens);
• anabolic steroids

What are hormonal drugs used for?

Hormonal drugs are used to treat and prevent a number of pathological conditions, namely:

• as contraception;
• for replacement treatment during menopause and menopause, this also includes men with androgen deficiency;
• treatment of inflammatory and allergic diseases;
• replacement therapy for deficiency of certain hormones;
• as part of the complex treatment of tumor processes.

Female hormonal drugs are used for the following purposes:

• menstrual irregularities;
• prevention and treatment of anemia;
• period after ectopic pregnancy;
• postpartum contraception (3 weeks after the end of lactation);
• therapy of gynecological pathologies;
• condition after abortion.

Features of oral contraception

The history of contraception goes back to ancient times. Everything was not used until the structure of steroidal hormonally active substances was studied and the suppressive effect of high doses of sex hormones on ovulation was discovered. This included interrupted sexual intercourse, various cases soaked in infusions and decoctions of herbs, fish bladders, and prolonged breastfeeding.

The use of hormones began in 1921, when the Austrian professor Haberlandt confirmed the possibility of inhibiting the ovulation process by introducing an extract from the ovaries themselves. In 1942, progesterone was first synthesized in the USA, and used in 1954. The negative point was that the hormones in the tablets contained at that time a significant dose of the active substance (tens of times higher than what a woman now takes), and therefore caused a lot of side effects.

Modern agents that are well tolerated were synthesized in the 90s of the 20th century. How effective a drug is is assessed by the Pearl Index. This indicator clarifies the possibility of pregnancy within 12 months of regular use of the drug. The index of modern hormonal drugs ranges from 0.3% to 3%.

Hormone-based contraceptives:

• combined;
• mini-pills (non-combined);
• drugs for urgent contraception.

Combined hormonal agents

COCs are a group of the most popular modern contraceptives. They contain estrogen (ethinyl estradiol) and gestagen (norgestrel, levonorgestrel, desogestrel) - hormonoids similar in their action to female sex hormones.

Depending on the dosage, as well as the ratio of gestagens and estrogens, several groups of hormonal tablets are distinguished:

1. Monophasic - have the same dosage of active substances in each tablet of the package.
2. Biphasic - the amount of estrogen is constant, and the dose of gestagen varies depending on the phase of the cycle.
3. Three-phase - variable content of hormones in the composition.

The last group is considered the most physiological. It contains three types of tablets. The amount of hormones in each type depends on the phase of the menstrual cycle. The first 5 tablets correspond to the follicular phase, the next 6 tablets imitate the periovulatory phase, the remaining 10 - the luteal phase. The amount of estrogen in each of the tablets is maximum, and the level of progestogen gradually increases, reaching its highest levels by the third phase of the cycle.

Mechanism of action

All hormone-based contraceptives are aimed at preventing the production and release of active substances, the action of which is associated with ovulation and implantation of the fertilized egg into the uterine cavity. The gonads decrease in size, as if “falling asleep.”

The drugs have the property of making cervical mucus thicker, which prevents a significant number of sperm from penetrating into the uterus. In addition, there is a change in the functional state of the endometrium, it becomes thinner, and its ability to attach the fertilized egg to itself decreases, if conception does occur.

Reviews from women who use products from this group confirm the effectiveness of use under the age of 35. The package contains 21 tablets of the same color. There may be a strict usage pattern, but it is of little value since all tablets have the same composition. The following is a list of the most popular and effective remedies.

The drug contains ethinyl estradiol in an amount of 30 mcg and 2 mg of dienogest. Regular intake has the following features:

• Pearl index does not exceed 1%;
• has androgenic activity - taken by women with elevated levels of male hormones;
• normalizes blood cholesterol levels.

A good product made in Germany. Gestagen is represented by gestodene (75 mcg). Available in the form of dragees. It is not advisable to use with other medications, as the risk of uterine bleeding increases.

The product is the most popular representative of the group. Drospirenone acts as a gestagen. Properties are similar to the drug Janine. In addition to lowering cholesterol and anti-adrogenic effects, Yarina has a positive effect on the condition of the skin. This explains why dermatologists prescribe tablets in the treatment of acne and acne.

It is an analogue of Logest. Significant differences are the country of manufacture, the color of the tablet shell and the slightly higher estrogen content in the composition.

The name of this representative is also constantly heard. Contains ethinyl estradiol and cyproterone acetate. The product is the drug of choice for those women who have an increased level of hair growth, since the gestagen included in the composition has a powerful antiandrogenic effect.

One of the well-tolerated drugs, eliminating the formation of edema, weight gain, and increased appetite. Drospirenone, which is part of the composition, has the following features:

• softens the effect of estrogen;
• relieves manifestations of premenstrual syndrome;
• reduces blood cholesterol levels.

Monophasic drugs do not end with this list. There are also a significant number of representatives:

• minisiston;
• Mercilon;
• Silest;
• Regividon;
• Dimia;
• Midiana.

Two-phase and three-phase agents

Experts prefer monophasic drugs to representatives of these groups due to fewer side effects. Biphasic ones are rarely used, which is why among them there are tablets whose names are not familiar even to pharmacists: Femoston, Anteovin, Binovum, Neo-Eunomin, Nuvelle.

Three-phase drugs, due to their physiological composition, are more popular, however, side effects and complications when taking them are no less pronounced. The representative of the group will be called as follows: the name begins with the prefix “three”. For example, Tri-regol, Tri-mercy, Trister, Triziston.

The tablets are colored differently depending on the phase of administration. Such drugs must be taken strictly according to the regimen that comes with the package.

Advantages and disadvantages

Modern contraceptives have a lot of positive qualities, which makes them widely used:

• fast effect and high reliability;
• the ability of the woman herself to control the state of her fertility;
• knowledge of the means;
• low incidence of side effects;
• ease of use;
• lack of influence on the partner;
• reducing the possibility of developing an ectopic pregnancy;
• positive effect in the presence of benign tumor processes of the mammary gland;
• prevention of tumor processes of the female reproductive system;
• relief of manifestations of dysmenorrhea;
• positive effect on the condition of the skin, gastrointestinal tract, and musculoskeletal system.

The negative aspects of COCs include the need for regular use according to a specific regimen, as well as the possibility of delaying subsequent ovulation cycles after discontinuation of the drug.

Contraindications

Absolute contraindications for prescribing COCs include pregnancy, malignant tumors of the reproductive system and mammary glands, pathology of the liver, heart and blood vessels, acute thrombosis or thrombophlebitis, as well as uterine bleeding of unknown etiology.

Pathological conditions that create problems during the period of drug use include:

• arterial hypertension;
• epileptic condition;
• migraine;
• depression, psychosis;
• diabetes mellitus of any type;
• chronic liver pathologies;
• bronchial asthma;
• tuberculosis;
• porphyrin disease is a pathology of pigment metabolism, accompanied by a high level of porphyrins in the blood and their massive excretion in urine and feces;
• benign tumors of the uterus;
• upcoming immobilization or surgery.

There are a number of factors that reduce the effectiveness of the products used. These include dyspeptic symptoms in the form of vomiting and diarrhea, taking laxatives, antibiotics, and anticonvulsants. If vomiting and diarrhea occur within 3 hours of taking the last tablet, you need to take an additional one.

What are progestin oral contraceptives?

These are alternative drugs (mini-pills) that contain exclusively gestagens. Hormones from this group are needed in the following cases:

• older women;
• during lactation;
• those who smoke;
• those for whom COCs are contraindicated;
• patients with hypertension.

Progestin contraceptives have a higher Pearl index. It can reach 4%, which is a negative point for the contraceptive process. Representatives: Levonorgestrel, Charozetta, Ovret, Micronor.

Reception scheme

The tablets must be taken once a day at the same time. If a woman misses a dose, then she should take hormones as soon as she remembers, even if she has to take two tablets at the same time.

If a woman remembers the pill no later than 12 hours from the time she needed to take it, the contraceptive effect remains, but after 12 hours, additional methods of protection should be used.

Urgent remedies

Emergency contraception is represented by drugs used in times of emergency. These drugs contain significant doses of hormones that prevent the ovulation process or change the functional state of the endometrium of the uterus. The most famous are Postinor, Escapelle, Ginepriston. Cases when there is a need to take such drugs should be as rare as possible, since they cause a huge hormonal surge in the body.

How to choose an oral contraceptive

The specialist assesses the hormonal balance of the patient’s body and determines what minimum dose of the drug will be able to show the desired effect. The dose of estrogen should not be higher than 35 mg, and the dose of gestagen (in terms of levonorgestrel) - 150 mcg. The doctor also pays attention to the woman’s constitutional type. There are three main types:

• with a predominance of estrogen;
• balance;
• with a predominance of gestagens.

Representatives of the first type are suitable for those products that have an increased dose of gestagens, the third - with an increased level of the estrogen component. If a woman has signs of an increased amount of male sex hormones, the ideal option would be to use drugs with an enhanced antiandrogenic effect.

The gynecologist also evaluates the condition of the patient’s reproductive organs. Heavy menstruation over a long period, increased size of the uterus are factors in increased estrogen levels in the body. Scanty menstruation in combination with uterine hypoplasia indicates high levels of gestagen.

Currently, the most used are combined mono- and triphasic oral contraceptives, which have a low dose of hormonally active substances included in the composition. These products have the same effectiveness and safety if you follow the rules for their use. The choice between specific representatives is made on the basis of each individual clinical case. Confirmation that the contraceptive has been chosen correctly is the absence of uterine bleeding or bloody discharge between menstruation.

Bibliography

1. Obstetrics: course of lectures. UMO stamp for medical education. Strizhakov A.N., Davydov A.I., Budanov P.V., Baev O.R. 2009 Publisher: Geotar-Media.
2. Obstetrics. National leadership. UMO stamp for medical education. Ailamazyan E.K., Radzinsky V.E., Kulakov V.I., Savelyeva G.M. 2009 Publisher: Geotar-Media.
3. Gestosis: theory and practice. Ailamazyan E.K., Mozgovaya E.V. 2008 Publisher: MEDpress-inform.
4. Intrauterine infection: Management of pregnancy, childbirth and the postpartum period. UMO stamp for medical education. Sidorova I.S., Makarov I.O., Matvienko N.A. 2008 Publisher: MEDpress.
5. Clinical guidelines. Obstetrics and gynecology. Savelyeva G.M., Serov V.N., Sukhikh G.T. 2009 Publisher: Geotar-Media.

Hormonal contraception is a highly effective method of preventing pregnancy if used correctly. If we judge the pros and cons of a particular method of contraception, then the advantages of hormonal contraceptives are much greater than the disadvantages. But in addition to following the rules of administration, you should choose the right hormonal pills or their analogues to avoid side effects.

Types of hormonal contraception

There are different types of hormonal contraceptives. There are several types of hormonal contraceptives:

• combined oral contraceptives or COCs;
• progestin drugs:
  • pure progestins or mini-pills;
  • injectable progestins (have a prolonged effect);
  • progestins that are implanted;
  • contraceptive patch;
• drugs for emergency or fire contraception;
• hormonal intrauterine system;
• vaginal rings with hormones.

Combined oral contraceptives (COCs)

These types of hormonal pills include those that contain both estrogens and gestagens. Depending on the content of hormonal components, COCs are divided into:

• monophasic (each tablet contains the same dose of estrogen and progestogen components) - rigevidon, logest, silest;
• two-phase – anteovin, divina;
• triphasic – tri-regol, triziston.

The effect of this type of hormonal contraception is to suppress the production of the ovaries' own hormones, as a result of which ovulation does not occur. In addition, such tablets thicken the mucus in the cervical canal, which makes it impossible for sperm to penetrate into the uterine cavity and change the uterine mucosa (to some extent atrophying it), which prevents egg implantation.

How to choose the best COCs

It should be noted that among any hormonal contraceptives, both pills and other drugs, not a single doctor will say which is better. The female body is a complex system that easily responds to the slightest changes in hormonal levels, and what is ideal for one woman does not necessarily suit another, it all depends on individual characteristics. It is not recommended to choose COCs on your own, as well as any other hormonal contraceptives; your doctor will help you suggest the appropriate option. After passing certain tests, conducting an external examination and a gynecological examination, the doctor will get an idea of ​​the type of female phenotype and, based on this, will recommend the most suitable drug.

Types of female phenotypes:

• Estrogen (feminine) type
  It is characterized by a long menstrual cycle, fairly heavy menstruation, significant vaginal leucorrhoea, and the woman is very feminine in appearance: developed mammary glands, rounded shape with a tendency to be overweight, normal skin (closer to dry) and hair. For women with a predominance of estrogen, COCs are suitable, the dose of the progestogen component in which is higher than the estrogen content (Norinil, Minulet).
• Balanced type
  Characterized by a balance between estrogens and gestagens. All external and clinical signs are expressed to a moderate degree: the mammary glands are of medium size, the body structure is proportional, the skin is of normal oiliness and moisture, the hair is thick and dense, there are no problems with conceiving and carrying a pregnancy. For such women, three-phase (tri-Mercy) or single-phase COCs with a low content of hormones (Lindinet-20, Mercilon, Marvelon) are optimal.
• Progesterone phenotype
  Another name is the bone or ectomorphic phenotype. Characterized by a predominance of progesterone (released in phase 2 of the cycle). Women have the following features: uniform development of shoulders and hips, like a “sports figure”, uniform distribution of subcutaneous fat, closer to the android (male) type, underdeveloped mammary glands, tall stature, oily skin and hair, acne and seborrhea . Hypertrichosis and hirsutism are also characteristic (depending on nationality). Menstruation is scanty and short, the menstrual cycle is short. For women with a progesterone phenotype, COCs with an antiandrogenic component (Zhanine, Yarina, Diane, Jess) are suitable.

New generation hormonal COCs

The list of new generation hormonal contraceptives includes:

Jess
Ideal for young women. The dose of hormones in these tablets is very low, so they are classified as low-dose hormonal contraceptives. Due to the low hormone content, the risk of developing vascular complications (thrombophlebitis, thromboembolism) is reduced. Jess is well tolerated and does not affect the digestive tract (nausea, vomiting). Recommended to eliminate signs of premenstrual syndrome and eliminate acne. Taking Jess does not affect a woman’s weight and has a positive effect on hair and nails.

Novinet
This combined oral contraceptive contains: ethinyl estradiol in an amount of 20 mcg and desogestrel in a dose of 150 mcg.

The drug normalizes the menstrual cycle, reduces the amount of menstrual flow, does not affect a woman’s weight and has a minimum of side effects. After childbirth (in the absence of lactation), taking Novinet is allowed for 21 days.

Janine
Included in the group of monophasic low-dose COCs. Has an antiandrogenic effect: successful fight against acne, seborrhea and oily skin, hirsutism. Has an excellent contraceptive effect.

Lindinet-20
The drug contains ethinyl estradiol in an amount of 20 mcg and gestodene in a dosage of 75 mcg. Refers to COCs with low hormone content. Taking Lindinet-20 does not increase weight, the risk of side effects (nausea, vomiting) is minimal.

Yarina
Yarina belongs to the new generation of COCs and has an antiandrogenic effect. The drug contains ethinyl estradiol 30 mcg and drospirenone at a dose of 3 mg. Successfully eliminates skin problems (excessive oiliness, acne), has a beneficial effect on the condition of the hair and reduces the manifestations of premenstrual syndrome. The development of side effects is minimal.

Pros of taking COCs

The benefits of taking COCs include:

• simplicity and ease of use;
• relief of symptoms of premenstrual tension;
• reduction of menstrual blood loss;
• normalization of the menstrual cycle;
• prevention of mastopathy and the development of benign tumors of the internal genital organs;
• high contraceptive effect.

Disadvantages of taking COCs

Of the negative aspects of taking COCs, the following should be noted:

• not recommended for women 35 years of age or older;
• require discipline (daily intake at the same time);
• spotting is possible when taking hormonal contraceptives (in the middle of the cycle, especially during the first 3 months of use);
• prescribed with extreme caution to women who smoke;
• do not protect against sexually transmitted infections.

Mini-pill

These tablets (Exluton, Microlut) contain only progestogens, and in very small doses. The mechanism of action of this type of hormonal contraceptives consists of several points. First of all, this is a cervical factor - the volume of cervical mucus decreases, but it becomes thick and viscous, which makes it difficult for sperm to penetrate the uterus. Secondly, this is a uterine factor - progestogens cause premature secretory transformation of the uterine mucosa (normally this occurs in phase 2 of the cycle), which makes implantation impossible. Moreover, with long-term use of the mini-pill, endometrial atrophy occurs. There is also a tubal factor, caused by weakened peristalsis of the tubes, which slows down the movement of the egg through the tube and reduces its chances of fertilization. And in 25–30% of women, such pills suppress ovulation.

• breastfeeding;
• are overweight;
• cannot tolerate estrogens;
• are in premenopausal age.

Charosetta
The drug contains desogestrel at a dosage of 75 mcg. Excellent for use by nursing mothers and women who have contraindications to the use of estrogens. Does not affect the amount of milk, quickly restores the menstrual cycle after childbirth.

Lactinet
The composition of the drug contains 75 micrograms of desogestrel. It has a good contraceptive effect, is suitable for lactating women, and does not affect weight. Side effects: spotting may appear during the first three months of use.

Exluton
The composition of the tablets includes linestrenol at a dose of 500 mcg. Does not affect weight, does not reduce libido, an excellent choice for contraception for postpartum women who are breastfeeding.

Pros of the mini-pill

The advantages of mini-pills are:

• low risk of developing cardiovascular and cerebrovascular pathology (heart attacks, strokes) due to the small amount of progestogen and the absence of estrogens;
• do not affect blood clotting;
• do not affect lipid metabolism (do not provoke weight gain);
• well stop premenstrual syndrome;
• indispensable for the occurrence of regular ovulatory pain and cycle disorders;
• the possibility of taking women who smoke;
• simplicity and ease of use.

Cons of the mini-pill

Of the shortcomings of these tablets, it should be noted:

• the contraceptive effect is less pronounced than that of COCs;
• require strict adherence to the pill regimen;
• the risk of functional ovarian cysts and ectopic pregnancy increases;
• frequent cycle disturbances in the form of acyclic bleeding;
• shortening of the cycle (25 days or less).

Injectable contraceptives - Depo-Provera

Injectable progestins

The mechanism of action of these contraceptives is the same as that of the minipill. The most common drugs are Depo-Provera (150 mg) and norethisterate. The positive aspects of such contraceptives are: long-lasting action (one injection once a quarter), easy to use, and high reliability. The disadvantages include: long restoration of fertility (about 5 - 7 months), the drug cannot be quickly removed from the body, frequent occurrence of acyclic bleeding and regular visits to the clinic for repeated injections.

Transdermal Therapy System

This method of contraception includes the hormonal contraceptive patch Evra. Presented in the form of a square piece of plaster measuring 5 by 5 cm, flesh-colored. Contraceptive efficiency reaches 99%. The patch contains ethinyl estradiol at a dose of 600 mcg and norelgestromin at a dosage of 6 mg, that is, it belongs to combined hormonal contraceptives. The package contains 3 patches, each of which is glued to a specific area of ​​the skin (in the area of ​​the buttocks or abdomen, on the outer surface of the shoulder or in the scapular area) once a week. The patch should be applied on the first day of menstruation, but it can also be applied on any other day of the week, but in this case additional contraception is required for 7 days. After a week, you need to peel off the patch and attach a new one, but on a different area of ​​the skin. After using 3 patches (21 days), you must take a week's break, during which menstrual-like bleeding will begin. After the break, on the 8th day, a new patch is applied.

Pros of the hormonal patch

The advantages of this hormonal method of contraception include:

• lower dose of hormones (compared to COCs);
• simplicity and ease of use;
• no need for daily monitoring, for example, as with daily hormonal pills;
• resistant to moisture and sun (will not come off in the shower or while sunbathing);
• maintaining the contraceptive effect when performing physical exercises, in a sauna or bathhouse, during tanning;
• normalization of the menstrual cycle, elimination of intermenstrual bleeding;
• no negative effect on the liver (hormonal components bypass the digestive tract);
• reduction of symptoms of premenstrual syndrome.

Cons of the hormonal patch

Of the shortcomings, it should be noted:

• itching (possibly, but not necessarily) at the site of attachment of the patch;
• visible on the skin as an aesthetic defect;
• the likelihood of side effects;
• peeling of the patch upon frequent contact with water;
• There is no protection against sexually transmitted infections.

Subcutaneous implants

Subcutaneous implants are also included in long-acting progestogen contraceptives (Norplant, Implanon). The essence of their contraceptive effect, the disadvantages and advantages are the same as those of injectable progestins. The only difference is that they are injected subcutaneously (capsules with levonorgestrel) into the forearm area from the inside. The duration of the contraceptive effect of Norplant is 5 years (6 capsules are implanted at the same time with a special syringe).

Emergency contraceptive pills

Hormonal drug Escapelle for emergency contraception Hormonal contraceptives for emergency (postcoital) contraception are divided into 2 groups. The first group includes tablets with a high content of levonorgestrel - progestin (postinor or escapelle), and the second group includes drugs with mifepristone - an antiestrogen (gynepristone). Hormonal contraception is called emergency or emergency, as it is used after unprotected sexual intercourse (damage to the condom, rape).

The essence of such pills is either to block ovulation or to prevent implantation. If all conditions for taking the medicine are met, the contraceptive effect is quite high. Emergency contraception should be carried out no later than 72 hours after unprotected sex, and the earlier the pill was taken, the higher the effectiveness (you should take 2 pills in total: the first immediately after intercourse, and the second no later than 12 hours after the first).

The disadvantages of this method of contraception include: frequent occurrence of heavy discharge up to massive bleeding, severe side effects, and menstrual irregularities. But it is important to remember that you should not resort to emergency contraception more than three times a year.

Hormonal intrauterine system

This group of hormonal contraceptives includes the intrauterine device (Mirena), which contains levonorgestrel, which begins to be released immediately after installation of the device. The mechanism of action is double - pregnancy prevention, both with the spiral and with levonorgestrel.

Vaginal hormonal contraceptives

A vaginal contraceptive ring that contains hormones (estrogen - ethinyl estradiol and progestogen - etonogestrel components) - NuvaRing. The contraceptive is presented in the form of an elastic ring, which is installed in the vagina for 3 weeks; during the specified time, hormones are released from it, which have a contraceptive effect similar to COCs.

Cancellation of hormonal contraceptives

The abolition of hormonal contraceptives is carried out either at the request of the woman (she is determined to become pregnant or switch to another type of contraception), or for medical reasons. In the absence of emergency indications, you must stop taking hormonal contraceptive pills according to the following rules:

• finish the entire package (stopping taking pills at the beginning or middle of the cycle threatens the development of hormonal imbalances);
• consult a doctor (select a different method of contraception or discuss the stages of pregnancy planning);
• take a biochemical blood test and blood clotting test (hormonal contraceptives affect the metabolism of proteins, fats and carbohydrates, increase blood viscosity).

After abrupt withdrawal of hormonal contraception (suspicion of pregnancy, thrombosis, liver disease, increased blood pressure, etc.), the following side effects are possible:

• depression;
• the appearance of acne;
• increased hair growth;
• weakening of sexual desire;
• the occurrence of breakthrough bleeding;
• the appearance of headaches;
• nausea, vomiting.