List of hormonal contraceptives. Mechanical local contraceptives. Side effects associated with suppression of your own estrogens

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 promote thickening cervical mucus, this 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 hair growth. male type, 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, when taking modern birth control pills, there are no problems between menstrual bleeding.

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 different least amount, not exceeding 20 mcg/day.

High-dose hormonal contraceptives are used only in medicinal purposes and for emergency protection after unprotected intercourse. Currently, low and microdose contraceptives are preferred 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 when different phases menstrual cycle.

Low hormone tablets provide reliable protection from unplanned pregnancy(99%), are well tolerated and allow you to control the menstrual cycle. After stopping taking COCs reproductive function recovers 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 inflammatory diseases organs of the genitourinary system. COCs reduce the risk of developing endometrial cancer of the uterus, ovaries, rectum, anemia, 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 chronic diseases, cancerous tumors;
• rapid contraceptive effect of pills;
• protection against ectopic pregnancy;
• accidental use of COCs early stages pregnancy is not dangerous;
• prevent the appearance 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 combined oral contraceptives (3 months) increases the sensitivity of hormonal receptors in the ovaries, therefore, after discontinuation of COCs, there is increased stimulation of ovulation and the release of gonadotropins - 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 - appearance age spots on the skin;
• acne, seborrhea;
• breakthrough bleeding;
• intermenstrual bleeding;
• thrombophlebitis;
• decreased libido;
• amenorrhea due to endometrial atrophy;
• promotion 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 and suffer from painful, heavy menstruation, endometriosis, 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 a significant risk for intrauterine development there is no child.

COC dosage regimens

Contraceptives are selected individually for each woman. This takes into account the presence of diseases gynecological field, concomitant systemic ailments, 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 at the same time every day. 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). You cannot 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 and prevents the accumulation of overweight body, the appearance of edema, acne, oily skin, 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. Active ingredient has mild androgenic activity, does not have mineralocorticoid, estrogenic and glucocorticoid effects.

Mini-pill

Popular birth control pills with minimal hormone content - mini-pills are alternative means contraception for women who are contraindicated to take 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, peristalsis slows down fallopian tubes, 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 need to 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 developing age spots (chloasma) after exposure to the sun should avoid long stay under ultraviolet radiation.
• At simultaneous administration mini-pills and barbiturates, activated carbon, laxatives, anticonvulsants, Rifampicin, 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, additional funds no contraception 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. During 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 ectopic pregnancies; malignant tumors mammary glands or suspicion of them. 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. Against the background of gestagen tablets, irregular menstruation. In such cases, it is necessary to stop taking the mini-pill, eliminate possible pregnancy(including ectopic) and only after that 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 diabetes mellitus. 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 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 part active substances The drug passes 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. Pills don't cause significant violations carbohydrate, lipid metabolism, hemostasis indicators.
• Microlut (levonorgestrel 0.03 mg).
• Continuin (ethinodiol acetate 0.5 mg).

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

Modern contraceptives contain small doses of hormones, provoke the development of side effects to a lesser extent, and provide reliable protection against unplanned pregnancy. The pills are prescribed by the attending physician, taking into account the woman’s individual indications. 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.

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

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

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

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

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

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

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

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

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

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

What is treated with hormonal medications?

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

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

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

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

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

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

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

What is hormone replacement therapy?

At chronic conditions associated with dysfunction of the glands or their partial removal, medications with synthetic and natural hormones provide high quality and the patient's life expectancy.

There are several types of hormone replacement therapy:

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

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

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

Substitution therapy uses drugs such as:

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

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

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

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

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

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

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

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

Oral contraception

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

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

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

Modern contraceptives are classified into three categories:

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

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

Combined hormonal contraceptives

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

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

Combined contraceptives:

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

Hormonal products for men

Male hormonal drugs are classified into recruiting agents muscle mass, directly medications to suppress the pathological process and hormones for replacement therapy.

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

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

Male hormone replacement therapy can be used both when the gland that produces them is completely removed, or when its functionality is reduced. After 40-45 years, the level of testosterone in a man’s blood begins to decline, which leads to problems in the sexual sphere. To restore potency, the following drugs are used:

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

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

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

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

Rules for taking hormonal drugs (GP):

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

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

Most people, due to a lack of knowledge in the field of medicine, consider hormonal drugs to be something terrible that bring great amount(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 and, which is known to every woman;
• – used in the treatment of insufficient or excessive synthesis of hormonally active substances;
• pancreatic agents (based on);
• 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 (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. It was first synthesized in the USA in 1942, 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 weight loss. side effects.

Modern agents that are well tolerated were synthesized in the 90s of the 20th century. How much effective drug, evaluates the Pearl index. This indicator clarifies the possibility of pregnancy within 12 months regular use facilities. 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

COC is a group of the most popular modern means contraception. 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 30 mcg and 2 mg of dienogest. Regular intake has 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. Not recommended for use with others medicines, since 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 antiadrogenic effects, Yarina has positive influence 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;
• stops manifestations premenstrual syndrome;
• reduces blood cholesterol levels.

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

• Miniziston;
• 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 different colors depending on the phase of reception. Such drugs must be taken strictly according to the regimen that comes with the package.

Advantages and disadvantages

U modern contraceptives There are a lot of positive qualities that make 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 moment of need to take it, the contraceptive effect remains; after 12 hours, it should be used additional methods protection.

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 occur as rarely as possible, since they cause a huge hormonal surge in organism.

How to choose an oral contraceptive

The specialist evaluates hormonal balance 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 constitutional type women. 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 increased amount 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 with a long period, increased size of the uterus are factors higher level estrogen in the body. Scanty menstruation in combination with uterine hypoplasia indicates high rates 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 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. Preeclampsia: 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 recommendations. Obstetrics and gynecology. Savelyeva G.M., Serov V.N., Sukhikh G.T. 2009 Publisher: Geotar-Media.

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

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

What is hormonal contraception?

The mechanism of action of birth control pills is based on the ability of substances that are synthetic analogues of sex hormones produced by the female body to influence hormonal 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 such negative effects, 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, there is a decrease in the incidence of inflammatory diseases or exacerbations chronic pathologies almost twice.
• The use of hormonal contraceptives for a year reduces the risk of endometrial cancer by 50%, ovarian cancer by 30%, and the risk of developing mastopathy becomes less by 70%.

Flaws

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

• They do not protect against sexually transmitted infections, including such dangerous ones as HIV or cytomegalovirus.
• They affect the blood coagulation system and can increase the risk of blood clots and thromboembolism.
• May aggravate the course of chronic diseases of the liver and gallbladder or provoke the occurrence of cardiovascular pathologies, 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 possibility of doubling the dose in case you forget to take another pill. But with multiphase agents this is not always possible, and their use requires more caution and attention.

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

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

Two-phase

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

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

Three-phase

This group of drugs differs in that the tablets intended for different days of the cycle contain their own specific dose of hormones. This change in the concentration of estrogens and gestagens is as close as possible to 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 everyone 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.

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 also choose the right hormonal pills or their analogues in order to avoid side effects.

Types of hormonal contraception

• 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 mucus in cervical canal, which makes it impossible for sperm to penetrate the uterine cavity and changes the uterine mucosa (to some extent atrophying it), which prevents egg implantation.

How to choose the best COCs

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 expressed in moderate degree: mammary gland average size, the body structure is proportional, the skin is of normal oil content and moisture, the hair is thick and dense, and has 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 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
The composition of this combined oral contraceptive includes: 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 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. Renders 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 ( increased fat content, acne) has a beneficial effect on hair condition 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

From negative aspects When 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);
• possible spotting bloody issues 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 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 premenopausal.

Charosetta
The drug contains desogestrel in 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 drug contains 75 mcg 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 tablets contain 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 the mini-pill 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);
• relieves premenstrual syndrome well;
• indispensable for the occurrence of regular ovulatory pain and cycle disorders;
• Possibility of use by women who smoke;
• simplicity and ease of use.

Cons of the mini-pill

Among the disadvantages 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 violations cycle in the form acyclic bleeding;
• shortening of the cycle (25 days or less).

Injectable progestins

The mechanism of action of these contraceptives is the same as that of the mini-pill. The most common drugs are Depo-Provera (150 mg) and norethisterate. Positive points Such contraceptives are: long-lasting (one injection once a quarter), easy to use, high reliability. Disadvantages include: long recovery 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 therapeutic 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 effectiveness 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 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 exercise, in a sauna or bathhouse, during a tanning procedure;
• normalization of the menstrual cycle, elimination of intermenstrual bleeding;
• absence negative influence on the liver (hormonal components bypass the digestive tract);
• reduction of symptoms of premenstrual syndrome.

Cons of the hormonal patch

Among the disadvantages 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

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 case of absence 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.