Cock with antiandrogenic effect reviews. Features of the influence of antiandrogenic drugs on a woman’s body. Prevention of cancer using hormonal drugs

The main argument in favor of using contraceptives to treat acne is the powerful antiandrogenic effect. Thanks to this effect, the functioning of the sebaceous glands is stabilized and the condition of the epidermis as a whole is improved.

But, I want to point out that birth control pills will be useless in cases where the appearance of acne is caused not by hormones, but by bacteria, for example, or improper skin care.

Do they help? oral contraceptives remove acne? Judge for yourself, but first read Malysheva’s recommendations regarding the use of such drugs to treat problem skin.

Mechanism of action of antiandrogenic combined oral contraceptives

Today there are several combined oral contraceptives. Their composition is characterized by two components - estrogens and gestagens.

All drugs contain ethinyl estradiol, which is the main estrogen. Its dosage is various drugs varies from 15 to 50 mcg.

Modern COCs contain gestogens: gestodene, desogestrel or norgestimate, which are third-generation gestagens, which makes it possible to create low-dose oral contraceptives.

Types of medications for acne treatment

There are three main groups of contraceptives, the division of which is based on the characteristics of the composition:

Any medications must be prescribed by a doctor strictly according to indications.

You can’t just buy a drug at a pharmacy and start taking it. After all, every remedy has contraindications and side effects. And not all of them cope equally well with rashes on the face and body.

It is simply impossible to guess which pills help and which are completely ineffective on your own.

If a rash suddenly appears that does not go away for a long time, you need to consult a dermatologist and undergo examination by specialized specialists.

It is important to exclude diseases of internal organs, infections, allergies and other pathologies, causing symptoms acne.

Antibiotics

Prescribed to eliminate bacterial skin lesions.

Acne is often caused by excessive activity of pathogenic microflora - staphylococci, streptococci, propionic organisms.

Modern antibiotics have a wide spectrum of action. Some of them prevent the proliferation of microbes, others simply destroy them.

In any case, they are dispensed according to a doctor’s prescription, and the dosage and course of administration are determined individually.

Photo: antibiotics are prescribed if available bacterial infection

Depending on the degree of the disease, therapy lasts on average from 7 days to several months. Erythromycin is suitable for treating mild forms, but in advanced cases more powerful agents will be required.

Levomycetin

It is used when other antibiotics are powerless.

Birth control pills are hormonal medications that are aimed at preventing unwanted pregnancy, as they can inhibit ovulation, without which conception does not occur. Such drugs are divided into three types.

Who is suitable for treatment?

It has been established that androgens (male sex hormones) increase the activity of the sebaceous glands and secretion sebum. Read more about this in the topic The role of sex hormones and zinc in the development of acne.

Antiandrogen treatment can reduce sebum production by 13-65%. But this type treatment is possible only in female patients. Antiandrogen therapy is NOT used in boys or men.

There are antiandrogenic drugs of different effects, the most common of which are combined oral contraceptives and antiandrogens.

Oral contraceptives in the treatment of acne

Due to their contraceptive activity, antiandrogenic effects, and low incidence of side effects, oral contraceptives have been used for acne since the 2000s. Treatment is possible only for women after a consultation with a gynecologist or gynecologist-endocrinologist.

For acne, oral contraceptives are prescribed if there are additional indications (need for contraception, gynecological diseases).

Combined oral contraceptives (COCs) contain 2 components:

The main estrogen is ethinyl estradiol. which is contained in all oral contraceptives in a dosage of 15-50 mcg.

Gestagens come in three generations:

• first generation (norethinodrel, norethinodrone acetate, ethynodiol diacetate),
• second generation (norgestrel, norethisterone, levonorgestrel),
• third generation (gestodene, desogestrel, norgestimate).

The mechanism of suppression of testosterone (the main male sex hormone) when using oral contraceptives has a couple of components:

• Estrogens increase the synthesis of globulin in the liver, which binds sex hormones. due to which the content of free (not bound to proteins) testosterone in the blood decreases,

Antiandrogen drugs relieve acne due to their effect on the presence of free testosterone in the blood serum by reducing sebum production.

As a rule, such drugs belong to combined oral contraceptives (COCs). You need to know that antiandrogens are not prescribed exclusively for acne; they are indicated only if there are additional indications, which include:

Contraceptives for acne can be taken in the following cases:

1. Over the age of eighteen.
2. With an established menstrual cycle.
3. With active sexual life.
4. With a concomitant desire to prevent conception.

Separately, it should be emphasized that taking birth control pills for acne is only suitable for the fair sex. This method is strictly contraindicated for men and can lead to severe hormonal imbalance and cause serious health problems.

The use of oral contraceptives is contraindicated in the following cases:

1. During puberty.
2. During pregnancy.
3. For hepatitis.
4. In the presence of diseases of the biliary tract.
5. For problems with liver function.
6. In case of individual intolerance certain drugs or their components.
7. Taking combined contraceptives is not recommended for nursing mothers.

The selection of contraceptive medications for acne should be done individually, taking into account the woman’s health status, the presence or absence of chronic diseases and a number of other factors.

Therefore, before starting a course of treatment, you must seek medical help. Moreover, it is advisable to get advice not only from a gynecologist, but also from such specialists as a dermatologist and endocrinologist.

In this case, the woman will be prescribed several tests, based on the results of which doctors will select the most effective and safe drug for her.

Treatment of acne with tablets is carried out according to the doctor’s recommendations and the instructions for the medicine.

Taking medications containing antibiotics is carried out only under the supervision of a doctor.

Photo: antibacterial drugs for internal use should be prescribed by a doctor

They are prescribed only when external remedies do not help, and the disease has already acquired a serious form.

Such medications are aimed at destroying bacteria that cause acne.

Retinoids

Retinoids are used only after a doctor's prescription.

Photo: retinoids are very effective in treatment acne

This is very strong drugs. They are made on the basis of vitamin A derivatives.

When excessive sebum secretion occurs, causing neglected form acne, these medications are very effective (“Retinol Palmitate”, “Roaccutane”, “Isotretinoin”).

Retinoids and zinc are used in combination.

Roaccutane

Hormonal agents

If the appearance of acne on the back or face is caused by an increase in the level of male hormones in the body, then hormonal agents are prescribed for treatment.

Photo: in case of hormonal imbalance, the doctor may prescribe contraceptives

These drugs are also used as contraceptives (“Jess”, “Diane-35”, “Yarina”, “Regulon”).

Treatment of acne with hormonal agents is acceptable in adults with a stable menstrual cycle. A prerequisite is the presence of an active sex life and the desire to prevent the possibility of conception during the period of treatment.

It is worth emphasizing that it is impossible to use this method to combat acne for men. The use of such drugs will lead to significant hormonal imbalances and severe consequences from the genital area.

The use of oral contraceptives is prohibited:

• during the period of bearing a child;
• up to 18 years of age, while puberty occurs;
• in the presence of liver disease (hepatitis);
• with individual hypersensitivity to active substances drugs;
• the group of combined drugs is not used during lactation.

We test drugs

Other names are glucocorticoids. corticosteroids.

They are not prescribed externally. They can be prescribed orally and parenterally (intravenously, intramuscularly) only for very rare serious forms of acne:

• abscess acne,
• phlegmonous acne,
• quick acne.

This use is due to the fact that glucocorticoids suppress the immune system and, therefore, contribute to the spread of infection. They should only be used temporarily to limit excessive inflammation.

Birth control pills regulate hormonal background, reducing the production of androgens. This is the basis of the action of drugs used to treat acne and acne of hormonal origin.

There are two types of oral contraceptives - combined and non-combined.

Combination drugs have more strong effect and usually consist of two types of hormones - derivatives of estrogen and progestin. They are contained in tablets in microdoses, so they do not cause severe negative consequences.

As a result of using combined birth control pills against acne, you can get:

Combined products with a pronounced cosmetic effect include Yarina, Janine, Jess, Diane 35 and others.

You should not expect an immediate effect from using contraceptives for acne. The result will be noticeable in about a month.

Non-combined contraceptive drugs (also called mini-pills) contain only one hormone - progestin. Their therapeutic effect is significantly lower, but they serve as an alternative to combination drugs for estrogen intolerance.

But their undeniable advantages include:

Monocomponent birth control pills include Exluton, Microlut and others.

Your doctor should decide which contraceptive medications will help and are right for you. Hormonal contraceptives are not harmless pills. Taking them incorrectly can lead to very unpleasant consequences:

• unwanted weight gain;
• deterioration of skin condition;
• the appearance of heart and vascular diseases;
• decreased libido levels.

In order to understand whether acne is of hormonal origin, it is advisable to do a hormone test.

Actually, this is what the doctor will do first, especially if the acne is severe. And, based on the results, he will prescribe you a drug.

Combining hormonal therapy and cosmetic care problem skin will have a positive effect on the condition of the skin and reduce treatment time.

Do all birth control pills help with acne? This is a purely individual question. The same remedy can give excellent results in one woman and cause the opposite reaction in another.

This is why you should not use birth control pills on the advice of a friend or recommendations on the Internet.

As we have already said, the best birth control pills for skin problems are combination drugs. Let's try to evaluate them based on objective parameters.

Advantages of the drug:

• high quality;
• efficiency;
• relative safety (less side effects than other contraceptives).

• high price;
• long-term treatment.

Treatment of acne with hormonal drugs involves the use of two groups of drugs:

glucocorticoids;

· antiandrogens.

Glucocorticosteroid drugs can only be prescribed in special cases severe cases acne, as they negatively affect the functioning of the human immune system. This leads to an even greater spread of infection. However, if we're talking about O:

· fulminant acne,

acne with the formation of abscesses,

phlegmonous acne,

then there is no choice left. These medications are taken orally, intramuscularly or intravenously in strict accordance with the doctor's prescriptions.

The second type of acne hormones (antiandrogens) is used only to treat women. It is strictly contraindicated for men.

Antiandrogens suppress the production of sebum by the sebaceous glands located inside the hair follicles, in some cases even by 60–65%, thus destroying the cause of acne.

Antiandrogens are used both independently and as part of oral contraceptives.

Anti-acne tablets are effective due to their powerful antiandrogenic effect, which normalizes the functioning of the sebaceous glands. How does this happen? In most cases, acne and pimples form on the facial skin due to an imbalance of sex hormones: androgens and estrogens.

If a woman appears in her blood increased content male hormone testosterone, then a certain imbalance occurs, which provokes increased work of the sebaceous glands, leading to their blockage and the development of subcutaneous inflammatory processes.

Hormonal contraceptives come to the rescue by stabilizing the balance of androgens and estrogens in female body.

In most cases, they should be taken for one or two months. The presented method not only solves existing problem skin rashes, but also has a preventive effect, preventing their reappearance.

However, only a doctor has the right to prescribe such treatment, taking into account a number of individual indicators and characteristics of the patient.

To completely get rid of acne, women can use hormonal contraceptives for a long period (from a year or more). However, prolonged uncontrolled use of birth control pills can cause serious problems for a woman's health. In particular, the risk of diseases such as:

Oral contraceptives, which are modern times prescribed for teenagers, they give noticeable results within a month after starting treatment. There are a huge variety of such drugs.

I categorically do not recommend choosing contraceptives for yourself. This should be done by a doctor (gynecologist and endocrinologist) for each patient individually. Before choosing hormonal contraceptives, you will have to donate blood for hormones.

The choice of drug for the treatment of acne depends on the causes that caused it.

They may be as follows:

• increase in androgen levels during puberty;
• hormonal imbalance associated with illness or pregnancy (abortion);
• gynecological pathologies;
• ailments of the endocrine system;
• hyperkeratosis;
• poor nutrition and lack of vitamins in the body;
• disruption of lipid metabolism;
• special skin microflora;
• gastrointestinal diseases;
• stressful state;
• immune disorders;
• too hot and humid climate;
• cosmetical tools;
• inaccurate cleaning of the skin;
• taking certain medications (corticosteroids);
• frequent washing and poor hand hygiene.

Acne can be cured using products for external and internal use.

Tablets are usually used in as a last resort when lotions or lotions do not help.

Photo: depending on the cause of acne, medications are prescribed

Depending on the pathology causing acne, the doctor may prescribe the following medications:

The first place, according to reviews of women who treated acne with the help of contraceptives, is occupied by the drug Yarina, a monophasic combination drug. Yarina is considered one of the most expensive remedies and has a large number of contraindications.

Second place is the monophasic drug Jess, which has a weaker effect, but a smaller list of side effects and contraindications.

The third place is occupied by the well-known drug Diane-35. Belongs to the middle price category, has less pronounced effect compared to previous representatives.

Fourth place belongs to Janin. The drug is effective against acne and blackheads, however, the result of use may disappear immediately after stopping therapy.

Fifth place is taken by Chloe, which is similar to Diane-35 in composition and quantity of active substances.

The rating is not a final indicator of the need to use hormonal drugs. It must be remembered that each girl’s body is individual, which means it can react differently to the drugs presented.

Hormonal drugs are highly effective in protecting against unplanned pregnancy, combating acne and acne. At the same time, long-term use can cause the development of the following pathologies:

• malignant neoplasms of the genital organs;
• breast cancer during menopause;
• reducing the possibility of fertilization and conceiving a child during normal menstrual cycles;
• thrombosis if taking medications is combined with smoking;
• development of obesity;
• decreased libido, anorgasmia;
• bleeding.

It turns out that hormonal drugs not only protect against unwanted pregnancy, but also cure acne.

After long-term use, the oiliness of the skin and hair decreases, the menstrual cycle normalizes, and the intensity of bleeding decreases.

But they are indicated only when the rash is caused by hormonal imbalances in the body.

Photo: vitamins are prescribed as part of complex treatment

Vitamins and mineral supplements are prescribed as part of complex treatment.

• Zinc sulfate is necessary to normalize metabolic processes in tissues, accelerate wound healing, and eliminate inflammation. Tradename Zincteral supplements.
• Omega-3 fatty acids are important for the body, improving the overall condition of the skin and reducing sebum production.

It is difficult to meet the daily requirement with food, so it is better to purchase capsules from the Evalar, Medicolight, and Doppelgerz brands.

The tablets contain one form of the progestin hormone - the hormone levonorgestrel, which has a depressing effect on ovulation, disrupts the process of fertilization and the movement of the egg to the uterus with its subsequent attachment.

Advantages

• The tablets do not need to be taken regularly;
• From the moment of unprotected sexual intercourse, a maximum of 48 or 72 hours may pass before taking the drug;

Flaws

• Temperature increase;
• Discomfort in the lower abdomen;
• Nausea, vomiting, headaches, dizziness, fatigue, pain in mammary glands Oh;
• High price;

Contraindications

• Pregnancy;
• Puberty;
• Diseases of the biliary tract or liver, hepatitis.

So, how can birth control pills, which are designed to prevent unwanted pregnancy, be a remedy for acne?

Antibiotics to fight acne and acne

“Side effects” from the use of antibiotics can be:

Treatment of acne with antibiotics is contraindicated in people under 12 years of age. Before purchasing any medication, you must consult your doctor!

He will study the condition of your skin and your body, offer solutions, diet and medication regimen.

All antibiotics are tablets for acne and pimples, which can be divided into 3 groups:

List of antibiotic tablets for acne

Erythromycin. An antibiotic with a gentle effect that can be taken even by pregnant women. Daily dose drug for adults – 1,000 mg (the doctor will tell you more specifically after consultation, studying the condition of the skin, the characteristics of acne).

Taking the product should not be too long: bacteria quickly get used to the composition and become immune to it. To protect the gastrointestinal tract from the effects of the antibiotic, it is recommended to take it about 1 hour before meals (3 times a day).

Josamycin (vilprafen). It is prescribed only to persons over 14 years of age, it has a strong effect and a large number of side effects: nausea, diarrhea, headache, weakness, malaise, feeling tired.

When taking josamycin (vilprafen), the effectiveness of oral contraceptives is noticeably reduced, so be careful when using other methods of contraception.

For the first 25-30 days, josamycin (vilprafen) should be taken at a dose of 1,000 mg per day: 500 mg 2 times a day. After this, the dose is reduced to 1 tablet.

Antibiotics to eliminate acne:

Birth control pills for treating acne:

• Janine;
• Silest;
• Yarina;
• Jess;
• Marvelon;
• Tri-regol;
• Anteovin.

Hormonal tablets for acne (retinoids) - Roaccutane (Isotretinoin).

Cleansing preparations for the gastrointestinal tract and other body systems:

There are also yeast tablets, which are available in capsule form and have antibacterial, restorative, protective, cleansing and other types of effects.

1. You can buy and take them only after consultation with specialists. In some cases, a visit to an endocrinologist, dermatologist, or gynecologist may be required.
2. Antibiotics are “powerful artillery” in the fight against acne, pimples and acne. You cannot take this product if you are under 14 years of age.
3. All pills have side effects (irritability, pain, constipation, nervous breakdowns, headache, decreased activity and concentration).
4. The course of treatment can range from 1 week to several months and is discussed with each patient individually.

You can buy skin treatment medications in an online store or order them at a regular pharmacy. Look carefully at the catalogs, because the cost is different organizations may vary significantly. Approximate prices they are indicated in the table below:

Find out which acne treatments are also effective.

Consequences of increasing the amount of androgens in the body

Despite its effectiveness, taking contraceptives (especially for a long time) can provoke the development of a number of complications. The most common side effects include factors such as:

1. Hypertension.
2. Headache.
3. Decreased libido.
4. Increase in body weight.
5. Development of thrombosis.
6. Pain in the lower abdomen.
7. Swelling of the arms and legs.
8. Fever.
9. Pain and hypersensitivity of the mammary glands.
10. Chronic fatigue.
11. Painful sensations in lower limbs.
12. Vomit.
13. Cough.
14. Hearing impairment.
15. Decreased vision.
16. Painful sensations during breathing, which are periodic in nature.
17. Risk of bleeding.

If you experience at least a few of the above symptoms, you should stop taking contraceptives and immediately seek advice from a specialist. You may need to adjust the dosage of the drug or stop taking it altogether.

From the editors With this article we open the series of articles “Pro et contra” (“For and against”, lat.). Our life is full of contradictions. The corresponding law of dialectics states that “the basis of all development is contradiction - the struggle (interaction) of opposite, mutually exclusive sides and tendencies, which at the same time are in internal unity and interpenetration.”

In the human body, androgens and antiandrogens, estrogens and antiestrogens, gonadotropins and antigonadotropins, prostaglandins and antiprostaglandins “exist peacefully” and interact... Many of these substances are currently successfully used in the form of medications.

Pro et contra.

M. V. Mayorov, obstetrician-gynecologist highest category, member of the National Union of Journalists of Ukraine ( Women's consultation city ​​clinic No. 5, Kharkov)

Sapiens nil affirmat, quod non probet (“A wise man does not affirm anything without evidence,” lat.)

Back in 1849, Bertholg proved that the effects of castration in a rooster disappear when the removed testicles are reimplanted. Thus, he founded the scientific endocrinology. Sensational experiments “on oneself”, carried out in 1889 by Brown - Sequard, consisted of the rejuvenating effect of introducing an extract of bull testes. But only in 1935 David, Laqueu, Ruzicka managed to establish the structure of testosterone and carry out its synthesis.

As is known, sex hormones with a steroid structure androgens play an important role in the life of the body. They provide male sexual differentiation (formation of the appropriate morphotype, voice timbre, etc.), determine the specific function of the testicles, prostate, and testes in men.

However, recent work has proven that androgen receptors are present in many organs not only in men, but also in women, therefore, they are dependent on the activity of these hormones. Thus, their participation in the maturation of bone tissue, regulation of the secretion of gonadotropins and the synthesis of lipids of various densities, the production of β-endorphins, growth factors, and insulin has been shown. Along with the anabolic effect, androgens regulate libido and sexual potency, stimulate the function of the sebaceous glands and hair follicles. In physiological concentrations, androgens participate in the mechanism of follicle regression in the ovaries and determine the growth of hair in the pubis and armpits. With an increase in androgen production or a change in their balance towards active fractions, signs of defeminization (reverse development of female genital organs) and even masculinization (development of male sexual characteristics) are observed.

Often erased forms of hyperandrogenism (HA) play an important role in the genesis of infertility, anovulation, and miscarriage in women. To provide the right approaches To diagnose and treat conditions associated with increased production or activity of androgens, the practitioner needs to understand the main pathways of androgen metabolism in normal and pathological conditions (Rogovskaya S.I., 2000).

Table:: Classification of androgens by physiological action

The concept of “androgen metabolism” means not only the routes of their transformation, but also the nature of binding to transport proteins in the blood, as well as the implementation of the peripheral effect of various fractions of androgens in target organs. The lack of correlation between clinical manifestations and the degree of androgen secretion can be explained by a change in the balance between fractions, as well as different sensitivity of receptors in target organs and different numbers of these receptors.

From the academic course of biochemistry it is known that the production of androgens from cholesterol in women is carried out by the ovaries, adrenal glands and through corresponding transformations in other organs (in particular in the liver, skin, adipose and muscle tissues). Unlike the male body, in the female body the processes of converting individual fractions of androgens into each other are very difficult to monitor, since they can be intermediate links in the synthesis of other sex steroids - progesterone and estrogens. For example, testosterone (T), dihydrotestosterone (DHT), androstenediol, androstenedione, dihydroepiandrosterone (DHEA) and dihydroepiandrosterone sulfate (DHEAS) can be identified as intermediates in various organs.

One of the most active androgens, testosterone, is produced in other ways. It is believed that healthy women 50–70% of testosterone is formed by peripheral conversion from androstenedione; the rest is produced by the ovaries and adrenal glands.

The testosterone content in the blood may not reflect the actual degree of androgenization, since the bulk of androgens are in the blood plasma in a bound state, which makes them inactive. Approximately 20% of them are bound by albumins, 78% by globulins. The most stable connection is ensured with the help of sex steroids - binding globulins (PSG), the synthesis of which occurs in the liver. Only a small portion of testosterone (1.6%) remains free and active. It is believed that the level of free testosterone is a more informative indicator of androgenicity than the level of bound testosterone, but its determination requires special technologies and is rarely used in widespread practice.

Determination of total testosterone is a fairly adequate test, available in almost any clinic. The concentration of PSSH in women is 2 times higher than in men, since their synthesis is stimulated by estrogens. It has been established that in women with HA the concentration of PSSH is often lower than in healthy women.

In pathological conditions leading to androgenization, not only quantitative shifts in the synthesis of hormones are detected, but also the qualitative nature changes with the predominance of metabolites with different properties. In addition, physiological responses to excess androgens vary among individuals and depend on many factors. In recent decades, the existence of specific receptors in target organs has been established. Cytosolic PAs, which are proteins of a certain structure, exist in a number of organs (muscle and bone, skin, sebaceous glands, pituitary gland, hypothalamus, etc.) and are exposed to many circulating androgen metabolites that enter the cytoplasm by passive diffusion. The function of the receptor is that it must recognize its hormone, combine with it into a single complex, enter the nucleus and provide a specific response. This process is extremely complex and multi-component. It is believed that RA in the female body is stimulated by estrogens.

Clinical manifestations of androgenization

Various disorders of androgen metabolism cause a wide range of clinical symptoms, which are determined by the cause of pathological changes and the age of the patient. These manifestations include virilization and anabolization and, when pronounced, are usually not particularly difficult to diagnose. However, in gynecological practice, the doctor has to deal with symptoms of hidden androgenization, such as anovulation, amenorrhea, hypoplasia of the uterus and mammary glands, alopecia, acne, oily seborrhea, hirsutism, etc. Hirsutism can vary from mild (above the lip and chin) to complete hair growth male type (belly, hips, back).

Pathogenetically, hirsutism is a consequence of increased production of androgens, increased activity of the skin enzyme 5-β-reductase, which promotes the conversion of T into DHT, as well as increased sensitivity of target organ receptors to androgens. With an increase in the sensitivity of skin receptors to androgens, idiopathic hirsutism develops, which, as a rule, is not accompanied by HA. There is an opinion that 30% of the female population have some degree of hirsutism, 10% require diagnosis and treatment.

Clinical manifestations of androgenization and subsequent treatment are determined by its causes, the main of which are: genetic (for example, racial, family); physiological (for example, in athletes); post-traumatic; iatrogenic (for example, in newborns - after the mother takes drugs with androgenic effects during pregnancy); adrenal; ovarian; hypothalamic-pituitary; genetic chromosomal abnormalities; hypothyroidism

Differential diagnosis consists of the consistent exclusion of certain causes and should be carried out at the initial stage by an endocrinologist. Adrenal and ovarian forms of HA are most often encountered in the practice of obstetrician-gynecologist.

Adrenal forms of hyperandrogenism are conventionally divided into primary and secondary. Primary ones include adrenal hyperplasia and adrenal tumors.

Pathology of the adrenal glands most often manifests itself in the form of adrenogenital syndrome (AGS), when there is an inferiority of enzyme systems, leading to a decrease in the production of cortisol. Depending on the specific biochemical defect that caused the lack of cortisol, 5 groups of hyperplasia are distinguished when there are defects in 20-22-desmolase, 3-ol-dehydrogenase, 21-hydroxylase (21 HO), 11-hydroxylase, 17-hydroxylase. It has now been proven that the main cause of AGS is a congenital genetically determined disease associated with an autosomal recessive gene ( short shoulder chromosomes 6). In 80–90% of patients, the inferiority of enzyme systems manifests itself in the form of a deficiency of 21-hydroxylation with a subsequent decrease in normal products of steroidogenesis (mainly cortisol), which leads to an increase in ACTH, which stimulates the synthesis of androgen-active precursors of cortisol to the level of 17 - hydroxyprogesterone, the excess of which promotes the development of cortical hyperplasia and a further increase in androgen production.

Virile AGS forms are most common and are conventionally divided into congenital and “soft” (late). Congenital forms are accompanied by signs of pseudohermaphroditism; the diagnosis is usually made at birth. It is much more difficult to identify late and, especially, latent forms of AGS. In the pubertal form of late AGS, clinical symptoms appear during puberty, and in the postpubertal form - later, in different periods woman's life. It is important to note that the so-called “mild” forms of AGS, when the deficiency of 21-hydroxylase is insignificant, is often combined with secondary polycystic ovaries (PCOS).

Diagnostic criteria for hyperfunction of the adrenal cortex are not always unambiguous, and differential diagnosis is often extremely complex, however, summarizing the literature data, we can cite some signs that are most often encountered in practice.

Main diagnostic criteria for adrenal HA(Rogovskaya S.I., 2000): characteristic anamnesis (heredity, later menarche, disorder menstrual function with menarche, infertility, miscarriage); a specific morphotype with significant hirsutism, hypoplasia of the genital organs and mammary glands, poor development of the subcutaneous fat layer; examination results (anovulation, amenorrhea, inferiority of the luteal phase of the cycle, etc.); laboratory data and test results (high 17-CS, DHEAS, DHEA, T, 17?-hydroprogesterone, positive test with dexamethasone and ACTH); early closure of growth zones according to X-ray examination.

Adrenal tumors (glucosteroma, glucoandrosteroma) can also cause clinical manifestations virilization. The presence of a tumor is often characterized by a sudden onset and rapid progression of the process. The diagnosis is established on the basis of ultrasound, computed tomography and hormonal tests (high levels of DHA, T and 17-CS do not decrease after a test with dexamethasone).

Secondary hyperandrogenism adrenal origin is detected in other types of neuroendocrine pathology: hypothalamic-pituitary syndrome of puberty, Itsenko-Cushing disease, acromegaly, etc.

Hypothalamic-pituitary syndrome of puberty(GSPPS) is a symptom complex of polyglandular dysfunction with disruption of metabolic and trophic processes, damage to the cardiovascular and nervous systems, menstrual dysfunction. GSPPS is most often characterized by a certain morphotype, tall, obesity in the form of an apron and in the area shoulder girdle, the presence of stretch marks, hyperpigmentation and marbling of the skin, hyperproduction of glucocorticoids and androgens. In Itsenko-Cushing disease, the hypothalamic-pituitary structures are primarily affected, which leads to secondary hyperfunction of the adrenal cortex. The most common symptoms: obesity, flatulence, delayed growth and sexual development with premature puberty, acne, metabolic disorders, asymmetry tendon reflexes. With Itsenko-Cushing syndrome, clinical manifestations depend on the cause that caused the syndrome; it is often accompanied by persistent hypertension, damage to the cardiovascular system, obesity, and osteoporosis.

Ovarian forms of GA

Increased production of androgens by the ovaries is observed in PCOS, hyperthecosis, and some types of tumors. The etiology and pathogenesis of PCOS have long been and remain quite controversial. Currently, this disease is considered as a polyglandular, polyetiological, polysymptomatic pathology. Most authors find it convenient to distinguish between primary and secondary forms.

Primary PCOS are believed to be caused by increased formation of androgens in the ovaries due to disruption of the aromatization processes of steroids, in particular, deficiency of 17-β-hydroxysteroid dehydrogenase. Secondary PCOS may accompany a number of other pathological processes, such as inferiority of hypothalamic structures, hyperprolactinemia, AGS, GSPPS, changes in the reception of hormones in the periphery, etc.

Hypersecretion of androgens in PCOS is a luteinizing hormone (LH)-dependent process. In addition to increasing LH levels, the LH/FSH index also changes upward. Chronic hyperstimulation of LH is manifested by hyperplasia of the theca - ovarian tissue. The synthesis of excess amounts of androgens occurs in small maturing follicles that have not reached 6 mm, since granulosa cells in them are not mature and aromatase activity has not appeared in them. With a large amount of testosterone, the peripheral production of estrogen increases, which is considered as one of the reasons for the increase in LH levels in PCOS. A metabolic vicious circle is created, leading to anovulation, infertility and PCOS.

Work in recent years has established the active role of growth factors and insulin hyperproduction in the genesis of ovarian GA. Growth hormone has been shown to increase the formation of insulin-like growth factor (IGF) in granulosa cells, which in turn increases the binding of LH by theca cells and the production of androgens. Insulin reduces the production of PSSH and increases the level of free testosterone, which is resistant to insulin. This is why hyperproduction of androgens can be combined with the development of diabetes mellitus, which is important to consider when examining and treating patients with symptoms of androgenization. The diagnostic criteria for ovarian HA, like adrenal HA, are also very ambiguous, but the following are most often mentioned.

Main diagnostic criteria for HA ovarian origin: the appearance of amenorrhea or oligomenorrhea after a period of normal regular menstruation with the onset of sexual activity or after stressful situations, burdened heredity can also be traced; female morphotype with moderate hirsutism and female-type obesity; enlargement of the ovaries and PCOS according to ultrasound and laparoscopy, anovulation against the background of relative and absolute hyperestrogenia; laboratory data and results of hormonal tests (high levels of testosterone, LH, increased LH/FSH index, sometimes hyperprolactinemia, positive hCG test, etc.).

Morphologically, PCO is differentiated from the rare disease of hyperthecosis, when many islands of hyperplastic luteinized cells of the superficial ovarian stroma are found in the ovaries. Clinical diagnosis difficult (most often there are such manifestations as acne, hirsutism, clitoral hyperplasia; among hormonal studies, it is most likely to identify high level testosterone at low concentrations of gonadotropins).

Therapy

Treatment of diseases accompanied by symptoms of androgenization in women is determined by the type of pathology, localization of the process, severity, age, etc. and should be comprehensive. Etiopathogenetic therapy includes removal of tumors, cessation of iatrogenic influence, suppression increased synthesis androgens, treatment of Cushing's syndrome and disease, hypothyroidism, resection or cauterization of the ovaries, prescription of drugs with antiandrogenic effects, etc. Symptomatic therapy involves a combination of drug treatment with antiandrogens in order to neutralize the effect of androgens on target organs with cosmetic procedures and psychological support. Most a clear example Pathogenetic therapy can be considered by prescribing glucocorticoids (dexamethasone, prednisolone) for AGS, aimed at replenishing cortisol deficiency and reducing the synthesis of androgens by the adrenal glands. However, an integral part of therapy for erased and severe symptoms of androgenization of almost any etiology is the use of antiandrogens to reduce these symptoms.

Antiandrogens

To eliminate the symptoms of androgenization, drugs called antiandrogens are used due to their ability to limit the synthesis of active androgens and the effect in target organs. They are used for signs of androgenization in women and for certain diseases in men.

Based on ideas about the biodynamics of androgens in the body, the following ways of blocking androgenic influences are theoretically proposed: inhibition of androgen biosynthesis and hormone secretion in the glands; decrease in gonadotropic stimulation (LH, FSH, ACTH); reducing the effects of androgen stimulation on target organs due to blockade of RA in responding cells; decrease in the concentration of active fractions of androgens; increase in PSSG production; acceleration of metabolic inactivation of androgens and their removal from the body.

Real results can be obtained under the condition of a complex effect on different parts of the androgenization process, i.e. by ensuring a significant reduction in the level of active androgens circulating in the blood, preventing the formation of the androgen-receptor complex, etc.

The main purpose of using OCs in GA- reduction in the synthesis of gonadotropins, inhibition of the proliferative effect of estrogens on the endometrium and normalization of the menstrual cycle. Depending on the gestagenic component, when using OCs, both intensification and regression of androgenization signs may occur. Thus, it is known that the latest generation of gestagens - gestodene, desogestrel, norgestimate - have a minimal androgenic effect. Therefore, low-dose OCs containing these gestagens are more appropriate to use for mild manifestations of androgenization. OCs are most effective for GA of ovarian origin. The mechanism of their action is the suppression of ovulation, inhibition of the secretion of gonadotropins and endogenous ovarian hormones, in particular androgens. Since with long-term therapy with OCs, the ovaries may shrink over time due to suppression of gonadotropin production, they should not be prescribed for a long period time in hypothalamic and adrenal forms of GA.

Simple (“pure”) antiandrogens. “Pure” antiandrogens include drugs whose main mechanism of action is to reduce the utilization of androgens in the periphery and, to a lesser extent, their synthesis. They are divided into compounds of steroidal and non-steroidal origin. In recent years, reports have appeared on the use of finasteride, which is a 5-β-reductase antagonist, does not replace RA and does not have the properties steroid hormones, which does not affect the gonadotropic function of the pituitary gland and does not reduce the level of gonadotropins. It is mainly used for the treatment of prostate hyperplasia, but in recent years information has appeared about its successful use in women in the treatment of diseases accompanied by hirsutism and alopecia. It is shown that after 3 months. daily intake of finasteride at a dose of 5 mg/day. There is a significant decrease in the level of T and DHT in the blood, and the severity of hirsutism decreases.

Other drugs in this group include flutamide, data on the use of which in women have appeared since the 90s. The mechanism of action of this non-steroidal antiandrogen is explained by its ability to replace RA in target organs. The average therapeutic dose is 500 mg/day; in higher doses, flutamide can have a toxic effect on the liver. After 3–6 months. As a rule, there is a significant decrease in hirsutism, but data on the content of androgens in the blood are contradictory; a significant decrease in androgens in the blood usually does not occur. However, some reports indicate that flutamide at a dose of 375 mg/day. can reduce testosterone and DHT levels in the blood. Thus, “pure” antiandrogens can be used in the treatment of diseases accompanied by androgenization. However, the experience of use in women is still insufficient, especially with regard to side effects, in particular toxic effects on the liver, which does not allow them to be widely recommended for practical use.

Antiandrogens are progestogens. Drugs in this group have all the necessary properties of antiandrogens and are considered the most effective, safe and accessible in clinical practice. One of the most active representatives of this group are cyproterone and cyproterone acetate (CPA), a synthetic hydroxyprogesterone with antiandrogenic and antigonadotropic activity.

Cyproterone has less antiandrogenic activity than CPA, so the latter deserves more attention and is used quite widely. The mechanism of action of CPA is explained by its ability to replace RA and, due to its progestogen properties, suppress the release of gonadotropins. Thus, by suppressing ovulation, CPA reduces the synthesis of sex hormones in the ovary. In addition, it increases the level of endorphins, counteracting the negative effect of androgens on endorphins, which has a beneficial effect on sexual function, pain reflexes, and the emotional state of patients. CPA was also effective in treating premature puberty in girls. So, at a dose of 50–75 mg/day. it contributed to stabilization of growth and regression of prematurely developed secondary sexual characteristics. Prescribe CPA 10–50 mg from the 5th to the 14th days of the cycle as monotherapy or in combination with estrogens.

The most famous drug in gynecological practice is Diane-35, a hormonal contraceptive used for mild degrees of hirsutism. Each tablet of the drug contains 35 mcg ethinyl estradiol and 250 mg CPA. As a rule, with pronounced androgenization or insufficient effect from monotherapy with Diane-35 for 6–9 months. It is recommended to include additional CPA (Androkur-10, 50) in the first phase of the cycle, 1 or more pills according to a 15-day scheme from the 1st to the 15th days of the cycle. This combination therapy is more effective and has a faster effect. The recommended duration of taking Diane-35 to reduce the severity of symptoms of hirsutism is 12 months; for acne and alopecia, the effect occurs faster - on average after 6 months. Diane-35 is especially effective in complex therapy diseases accompanied by PCOS, since the cycle is regulated, chronic estrogen stimulation is eliminated, LH levels are reduced, signs of androgenization are reduced, PSSG content is increased, DHEA-S is reduced, the ovaries are reduced in size, which increases the effect of subsequent stimulation of ovulation in infertility. CPA satisfies the main goals of antiandrogen therapy, is generally well tolerated by patients, and is known by clinicians.

Spironolactone (veroshpiron)- an aldosterone antagonist was used for 15 years as an antihormone with a diuretic effect, after which its pronounced antiandrogenic properties were revealed. SL in large doses is able to suppress the production of androgens in the ovary, although it does not have the central mechanism of action inherent in CPA. Spironolactone is known to prevent the conversion of testosterone to DHT. Best results obtained in his treatment of acne and seborrhea. It is prescribed at 150–200 mg/day. course of 20–30 days for SHPPS, since secondary aldosteronism is detected in this syndrome. Spironolactone is the second drug of choice after CPA for androgenization symptoms and may be recommended if a woman has contraindications or tolerance to CPA. To obtain the effect, it should be used for at least six months. It was noted that at a dose of 100 mg/day. spironolactone reduces hirsutism, but does not always reduce the level of androgens in the blood.

Before treatment with antiandrogens, it is necessary to establish the source of hyperandrogenism, excluding, first of all, tumors, pregnancy, and carefully justify the purpose of etiopathogenetic therapy. You should also take into account contraindications to the product used and possible adverse reactions. After obtaining a therapeutic effect, it is advisable to reduce the dose and continue treatment in a maintenance regimen.

Advance information to patients plays an important role. It should be explained that treatment can be lengthy, does not always achieve the desired effect, and after cessation of therapy, some signs of virilization may recur.

(Literature)

(1) Boroyan R. G. Clinical pharmacology for obstetricians and gynecologists. - M.: MIA, 1999. - 224 p.

(3) Mayorov M.V. Polycystic ovary syndrome: a modern view // Pharmacist. - 2002. - No. 16. - P. 39–41.

(4) Gynecological disorders, trans. from English / Ed. K. J. Powerstein. - M., 1985. - 592 p.

(5) Pishchulin A. A., Karpova F. F. Ovarian hyperandrogenism and metabolic syndrome. - M.: Endocrinological science Center RAMS. - 15 p.

(6) Podolsky V.V. Correction of hyperandrogenism in women with polycystic ovary syndrome // Reproductive health women.- 2002.- No. 3.- P. 7–9.

(7) Reznikov A. G., Varga S. V. Antiandrogens. - M., 1988.

(8) Starkova N. T. Clinical endocrinology. Guide for doctors. - 1991. - 399 p.

Full list of references - on the website

Nowadays, there is a huge selection of contraceptive methods that prevent the onset of unplanned pregnancy. Despite this, the percentage of abortions in Russia is only growing. The negative attitude of women towards hormonal contraceptives is based on existing myths about the dangers of their use. However, the new generation of contraceptives differs from previous ones minimum content hormones, as well as a minimum number of side effects. However, hormonal contraceptives can also be used by young nulliparous women who have multiple sexual partners.

Birth control pills have the highest effectiveness in preventing pregnancy among available contraceptives (98% of cases). This is due to the content of artificially synthesized sex hormones in hormonal contraceptives. It should be noted that after stopping treatment hormonal pills all the changes that have occurred in the female body are quickly restored, resulting in the desired pregnancy. It is also worth saying that taking hormonal contraceptives significantly improves the condition of the skin, hair and nails, as well as the general well-being of a woman.

Birth control may be prescribed by a doctor for treatment hormonal disorders. Do not forget that only a gynecologist can prescribe you certain contraceptives. It is not recommended to do this on your own, since when selecting a remedy, the doctor takes into account the individual characteristics of the individual patient’s body. In addition, before prescribing one or another hormonal contraceptive, the doctor must direct the patient to undergo hormone tests. Only after receiving the test results can he choose one or another drug for you.

Mechanism of action.
Hormonal contraceptives are divided into two groups: combined oral contraceptives (COCs) and minipills (non-combined oral contraceptives). The first group includes artificially synthesized hormones (ethinyl estradiol and progestins). Drugs in this group suppress ovulation, change the structure of the internal mucous membrane of the endometrium (uterine cavity), excluding implantation of the embryo even in the case of fertilization of the egg. In addition, COCs contribute to the thickening of mucus in the cervical canal, as a result of which the penetration of sperm into the uterine cavity is significantly more difficult. Thus, combined oral contraceptives provide a multi-level level of protection against the occurrence of unplanned pregnancy. Therefore, the pill is by far the most reliable and preferred method of contraception.

The mini-pill contains only progestogens. Tablets of this group are recommended for women during breastfeeding, since they do not affect the woman’s body in any way. The mechanism of action of such drugs is simple: they promote thickening cervical mucus and change the structure of the internal mucous membrane of the uterine cavity, which prevents implantation of the embryo.

The benefits of new generation birth control pills:

• They have a highly effective contraceptive effect.
  Normalizes the menstrual cycle in women with irregular cycles.
• Helps reduce blood loss, and also eliminates symptoms of PMS and pain during menstruation.
• Prevents the development of diseases such as iron deficiency anemia.
• Reduces the likelihood of developing ovarian and endometrial cancer.
• Significantly reduces the risk of developing inflammatory genital diseases.
• Some drugs have a pronounced therapeutic effect (in the case of fibroids, the condition significantly improves or, in some cases, a complete cure occurs).
• Some drugs have antiandrogenic effects.
• Reduces the risk of developing osteoporosis several times.
• Possess positive impact on skin, hair and nails, as well as a therapeutic effect for skin diseases against the background of hormonal imbalances.
• Are excellent prophylactic against uterine fibroids and endometriosis.
• Prevention of ectopic pregnancy.

Microdosed hormonal contraceptive pills are well tolerated and are recommended for young and new mothers who have regular regular sex life(once a week or more). Ideal for women who have never used hormonal contraceptives. Thanks to minimum quantity hormones in drugs of this group, the likelihood of side effects is minimized. The most popular microdosed drugs are: Mercilon, Lindinet, Miniziston, Novinet, Yarina, Jess with an antiandrogenic effect, Tri-Mercy, Logest.

Low-dose hormonal drugs in the form of tablets are prescribed to young women who have no history of childbirth and have regular sex life, in the absence of positive result from the use of microdosed drugs. In addition, drugs in this group are suitable for women of late reproductive age. Have some side effects. The most popular drugs in the group are: Lindinet-30, Silest, Miniziston 30, Marvelon (can cause menstrual irregularities), Microgynon, Femoden, Regulon, Rigevidon, Janine (with antiandrogenic effect), Belara (with antiandrogenic effect).

Medium-dose hormonal tablets are ideal for use by women who have given birth and women in the late reproductive period who have regular sex life. The drugs have a high degree of protection and help normalize the menstrual cycle: Chloe (has an antiandrogenic effect), Diane-35 with an antiandrogenic effect, Demoulen, Triquilar, Triziston, Tri-regol, Milvane.

High-dose hormonal tablets are prescribed only by a doctor as therapeutic drugs. This type of contraception is recommended for women with children, as well as women of late reproductive age who have regular sex life if there is no effect from the use of low- and medium-dose drugs. The most common representatives of this group of contraceptives are: triquilar triziston, non-ovlon, Ovidon.

Mini-drinks.
The mini-pill contains only progestogens. This contraceptive option is suitable for women who have given birth and women of late reproductive age who have regular sexual activity if there are contraindications to the use of COCs. These drugs have fewer side effects, but are inferior in effectiveness to COCs. These are drugs such as: Lactinet, Norkolut, Exluton, Micronor, Charozetta, Microlut.

Disadvantages of application.
In women using COCs as a means of preventing unplanned pregnancy, blood pressure may periodically increase (in three to five percent of cases), and in some cases, existing hypertension may worsen.

COCs do not contribute to the development of gallstone disease. However, if a woman has gallstones, there may be an increase in cases of biliary colic.

When taking hormonal contraceptive pills, you should know that in the first months of use, menstrual irregularities may occur. Usually there is spotting or menstruation does not occur at all. These phenomena are absolutely normal; after some time (usually two to three months) after starting to take the pills, the process returns to normal. If this does not happen, and this occurs in rare cases, the woman should consult a gynecologist to select another most suitable drug.

Taking COCs, contrary to popular belief, does not affect weight gain. If recruitment occurs excess weight, then its cause is not hormonal drugs, but an improper diet and low level of physical activity. Properly selected new generation contraceptives with a low content of hormones do not affect body weight in any way.

Some contraceptives may cause discomfort in the mammary glands due to their use. This may result in a feeling of tension or pain. The manifestation of symptoms is similar to the condition of pregnancy in the early stages. There is no need to worry about this either. Everything will go away on its own after several doses of the drug.

In rare cases, taking COCs can cause severe headaches. If headaches become frequent, in combination with hearing and vision impairment, it is recommended to stop taking the drug and consult a gynecologist.

Often, women over forty when taking these oral contraceptives experience bouts of nausea, which in rare cases turn into vomiting. Experts attribute this to age-related hormonal changes in the female body. Usually, taking pills immediately before bed helps to significantly reduce the symptoms of these attacks.

In some cases, women experience emotional mood swings after taking the drug. Despite the fact that doctors deny the connection of this phenomenon with taking COCs, it is still worth consulting a doctor.

Taking hormonal pills has a positive effect on a woman’s libido, significantly enhancing it. But in some cases the effect may be the opposite. There is no need to be afraid of this, because this phenomenon is temporary.

While taking oral hormonal contraceptives, age spots may occur, especially on exposed areas of the body that are most often exposed to the sun. In this case, it is recommended to stop taking this drug. Usually this phenomenon is temporary.

Properly selected contraceptives individually for each woman reduce the risk of side effects to a minimum.

Contraindications for the use of COCs:

• presence of coronary heart disease now or in the past;
• women who smoke (15 or more cigarettes per day) over 35 years of age;
• women with estrogen-dependent tumors;
• blood pressure readings above 160/100 mm Hg;
• damage to the valvular apparatus of the heart;
• severe diabetes mellitus;
• the presence of vascular changes and thrombotic complications;
• tumors and liver dysfunction.

Antiandrogens are a group of drugs and compounds that reduce the level or activity of the male androgen hormones in the body. Androgen antagonists can be broadly defined as any compound that has biological effect blocking or suppressing the action of male sex hormones, such as testosterone, in the human body.

Antiandrogen therapy in women may work through:

1. Blocking androgen receptors/reducing their sensitivity.
2. Reducing the production of androgens by the adrenal glands or ovaries.
3. Reduced production of the “lactation hormone” prolactin by the pituitary gland.
4. Inhibition (suppression) of 5-alpha reductase, thereby reducing dihydroxytestosterone, or DHT.
5. Decrease .

The list of diseases for which women are prescribed these medications includes:

• hirsutism (""),
• hair loss (alopecia),
• blackheads (acne),
• seborrhea,
• hidradenitis suppurativa,
• endocrine disorders and pathologies.

Women with excess androgens usually seek medical care for treatment primary symptoms, such as hirsutism, acne and menstrual irregularities.

It is best treated by combining mechanical and chemical methods. Mechanical methods immediately remove hair, while chemical methods prevent further transition of vellus (vellus, thin) into final hair (dark, thick).

Associated with insulin resistance, most often treated with OCs with or without the addition of an antiandrogen (spironolactone). For polycystic disease not associated with insulin resistance, COCs are prescribed with or without the addition of spironolactone.

Treatment of acne and pimples is aimed at reducing flaking and excessive keratinization of the skin using topical and systemic medications. Suppressing androgen production reduces sebum production and reduces acne.

ANTIANDROGENS FOR WOMEN: DRUGS, TABLETS FOR HAIR AND ACNE

1. Cyproterone acetate

A synthetic steroid that acts as a powerful antiandrogen. It also has progestogenic properties and can be used for complex treatment infertility in women.

Tablets with cyproterone acetate (Androcur - Androcur, Procur, Siterone) 50-200 mg can be purchased with a doctor's prescription. This potent antiandrogen is usually taken from days 1 to 10 of the menstrual cycle (i.e., the first day of your period).

1. KOK, OK

Oral contraceptives (birth control pills) containing ethinyl estradiol (estrogen) and the antiandrogen progesterone are also prescribed to reduce male hormones in the body. These include cyproterone acetate (Diane-35, Estelle 35, Ginet-84), drospirenone (Yasmin, Jess - Yaz) or dienogest (Valette). Other low-dose combined oral contraceptives have minimal antiandrogenic effect. They contain ethinyl estradiol and desorgestrel, gestodene or norgestimate.

1. Spironolactone (Veroshpiron

Spironolactone is a synthetic corticosteroid commonly used as a competitive aldosterone antagonist and acts as a potassium-sparing diuretic. It is used to treat hypokalemia, Conn's syndrome and hypertension due to low renin hormone, but also has antiandrogenic effects and weakly inhibits 5-alpha reductase.

Spironolactone is usually prescribed to women over 30 years of age at 25–200 mg daily (Aldactone, Spirotone, Spiractin).

1. Flutamide / Nilutamide / Bicalutamide

These are non-steroidal, pure antiandrogens. Bicalutamide is a relatively new drug that has fewer side effects.

Flutamide is prescribed at 250–500 mg/day and is commonly used as a hormonal anticancer agent in men with prostate cancer. This remedy can cause serious liver damage and should not be used to treat skin conditions.

1. Ketoconazole

Ketoconazole is an imidazole derivative that is used as a broad-spectrum antifungal agent. It reduces the formation of androgens in the adrenal glands in women. It is a relatively weak antiandrogen, but has a good effect in patients with Cushing's syndrome.

Preparations with ketoconazole can be used externally for hair loss and seborrhea. In this case, they have virtually no side effects.

1. Finasteride

Finasteride and Dutasteride are inhibitors of 5-alpha reductase, an enzyme that is responsible for converting testosterone into the active form of dihydrotestosterone (DHT). They are specific antiandrogens because they only counteract the effects of testosterone and not other androgens. Finasteride does not reduce sebum production and is not effective in treating acne.

5-alpha reductase inhibitors also include zinc, azelaic acid and some antiandrogens plant origin. Isotretinoin reduces the amount of sebum in part by reducing the production of dihydrotestosterone in the sebaceous gland.

1. Bromocriptine, cabergoline and quinagolide

These drugs help reduce excessive blood pressure, which also reduces testosterone.

1. Metformin (Glucophage, Siofor)

Prescribed when diabetes mellitus type 2, obesity, metabolic syndrome. Helps reduce manifestations of insulin resistance. Reducing elevated insulin levels in women can also reduce signs of hyperandrogenism. Metformin is safe at dosages of 250 mg to 2 g daily, but may cause diarrhea, so it should be taken after meals and gradually increased in dose. Rosiglitazone and pioglitazone, prescribed for insulin resistance, are more harmful and can be toxic to the heart and liver.

PLANT ANTIANDROGENS FOR WOMEN

In recent decades, Western experts have begun to pay more attention to the so-called herbal antiandrogens for women, obtained from natural natural remedies. Antiandrogenic chemical substances in plants, herbs and foods are an alternative to modern synthetic pharmaceuticals and are believed to have far fewer side effects.

1. Licorice, Licorice (Glycyrrhiza glabra)

Licorice is an aromatic substance that is several tens of times sweeter than sugar. Liquorice is traditionally used not only for food, but also for medicinal purposes (for example, for coughs). Licorice may also lower testosterone levels in women. This is thought to be due to glycyrrhizic acid, which has a weak antiandrogenic effect.

results various studies vary. The decrease in testosterone appears to be short-lived and dose dependent. Small doses of licorice (100 g licorice as a food product) do not reduce androgen levels. Therapeutic effect begins to appear when taken from 500 mg, however, the same doses can cause side effects: hypertension, an increase in DHEA and cortisol. It is not recommended to use licorice and additives with it for a long time and in high doses.

1. White peony (Paeonia lactiflora)

Chinese peony - widespread ornamental plant, which is used in traditional Chinese medicine and has been shown to affect human androgen levels in vitro (test tube). A 1991 study described the effects of peloniflorin, a compound found in white peony, that inhibited testosterone production and promoted the activity of aromatase, which converts testosterone to estrogen. To date there is no evidence that white peony will also effectively reduce androgens in a woman’s body.

1. Flax seeds (lignans, flaxseeds)

According to experiments, flax reduces total and free testosterone, as well as FSH in women, but does not affect estradiol levels. The course of treatment is usually 12 weeks, 40 grams of seeds per day.

1. Peppermint (Mentha spicata)

Mint and tea with this herb are widely used by women in the Middle Eastern regions as herbal remedy against hirsutism. The antiandrogenic properties of this plant reduce the level of free testosterone in the blood, leaving total testosterone and DHEA (DHEAS) unchanged. A cup of peppermint tea taken twice a day for 5 days during the follicular phase helps reduce the symptoms of hirsutism in women. In addition to those indicated hormonal effects, mint increases LH, FSH and estradiol.

Another study found that drinking peppermint tea twice daily for 30 days significantly reduced plasma androgen levels in patients with hirsutism and polycystic ovary syndrome. At the same time, there was no objective change on the Ferriman-Gallwey scale in the subjects.

1. (Chaste Tree, Vitex agnus-castus)

Vitex is traditionally used to restore hormonal balance. Clinical researches demonstrated the effectiveness of drugs obtained from the plant extract in PMS treatment and mastodynia. The mechanism of action is believed to be dopaminergic effects (), leading to changes in prolactin production in the anterior pituitary gland. At low doses it blocks the activation of D2 receptors in the brain by binding, which causes a slight increase in prolactin release. In more high concentrations binding activity is sufficient to reduce prolactin release.

A decrease in prolactin affects FSH and estrogen levels in women, and testosterone can also normalize.

This pseudovitamin improves insulin sensitivity, and if associated with insulin resistance, myo-inositol may help reduce it. According to studies, it also lowers LH, increases SHBG and progesterone.

1. Cinnamon (Ceylon cinnamon, Cinnamomum verum)

Cinnamon also helps in the fight against testosterone, which is increased due to insulin. It is almost as effective as metformin (). Used as a supplement or as a seasoning for food (from 1 gram together with carbohydrate foods).

Products such as green tea (EGCG) have not yet proven effective in reducing testosterone and DHT in women. Research, however, shows that green tea catechins can reduce insulin secretion and improve skin quality, and palmetto is sometimes added to topical hair loss medications.

One blister contains 28 tablets. 24 of them are active and contain a hormonal component, and the last 4 tablets are pacifiers. They are necessary to maintain the rhythm of taking the drug.

The active ingredients are estrogenic and progestin components, which are presented the following substances:

• ethinyl estradiol in the form of betadex clathrate – 20 mcg;
• drospirenone – 3 mg.

The composition of Jess and Jess Plus is distinguished by the presence of an additional substance - Metafolin - in the latter. It is included in the active 24 tablets and is also the main component of 4 extra tablets.

How does androgenization occur?

Some herbs have antiandrogenic activity, but it is important to consider that plant substances should never be used in combination with synthetic hormones.

The latter neutralize the healing effect of herbs. If a doctor has prescribed COCs to normalize hormonal levels, you should not give preference to herbal stabilizers.

Among the advantages of consuming herbal antiandrogens are the following factors:

• availability;
• safety of use;
• efficiency;
• inexpensive price;
• no side effects.

Plant antiandrogens do not have a contraceptive effect. Among their healing abilities there are special provisions:

1. Similar remedies naturally normalize girl's hormonal background.
2. They help normalize the concentration of testosterone in the body.
3. Blocked androgenic activity.
4. When taken, the level of globulin in the blood naturally increases. This substance is capable bind hormones.
5. Such herbs help reduction blood glucose concentrations.

The antiandrogenic properties of herbs have not been fully studied. They can be used, like any other drugs, after prior consultation with a doctor.

Only a specialist will be able to determine the required dosage and frequency of administration, which will benefit and not harm the patient’s body.

Combined oral contraceptives (COCs) contain a combination of two main female sex hormones:

• progestogen;
• ethinyl estradiol.

Progestins are included in COCs in significant concentrations. These drugs consist of a special type of substance that has the ability to bind to andorene receptors.

It is these elements that are responsible for the production of testosterone in the body. Under the influence of contraceptives, the production of sex hormones decreases male type.

Among the list of popular combined oral contraceptives with antiandrogenic effects, the following popular drugs stand out:

• Yarina;
• Logest;
• Janine;
• Chloe;
• Diana;
• Tri-Mercy;
• Belara.

The elements ethyl estradiol and progestogen are contained in sufficient volumes in these medications. They are presented as the main component of successful therapy.

A monophasic oral contraceptive with antiandrogenic properties is a drug containing hormones called Jazz.

The drug has a number of contraindications and in some cases causes side effects. In addition, the product is not recommended for girls under 35 years of age.

In any case, the possibility of using such a component should be discussed with your gynecologist.

"Pitfalls" in the form of undesirable effects

Any drug can cause unwanted effects in some patients. Their appearance is not necessary, but if they appear, in most cases they may require discontinuation of the medication. The most common side effects of Jess are as follows:

• nausea;
• pain in the mammary glands;
• irregular uterine bleeding.

The most severe adverse reactions are thromboembolism of arteries or veins.

During clinical trials The following possible effects have been identified, which are listed in decreasing order of frequency of occurrence.

Before starting to take the drug, you should discuss any individual contraindications with your doctor. Against the background of its use, some painful conditions may intensify.

Contraindications for taking Jess

What to do if a woman misses taking a pill? It all depends on the number of the missed pill. If it is inactive and one of the last, then the pass has no consequences, you can ignore it and start using it at the required time new packaging.

A delay of less than 12 hours does not reduce the contraceptive effect. It is necessary to take the forgotten pill as soon as possible, and the next one at the usual time. If the break is more than 12 hours, the contraceptive effect may be reduced.

Missed any tablets from 1 to 7

Sometimes it is necessary to use combined oral contraceptives simultaneously with other drugs. The effectiveness of either side may vary, and COCs may have a decreased contraceptive effect or increased adverse reactions.

Metabolism of most drugs occurs in the liver. This may happen in different ways: using microsomal oxidation, by conjugation with proteins, through the cytochrome P-450 system. Some substances can enhance or inhibit these processes, which affects the metabolism of drugs.

Drugs that can induce microsomal liver enzymes cause an increase in the clearance (detoxification coefficient) of sex hormones. These are the following medications:

• Phenytoin;
• Carbamazepine;
• Rifampicin;
• Barbiturates;
• Primidone;
• Griseofulvin.

The herb St. John's wort has a similar effect.

The compatibility of the drug Jess and alcohol depends on the dose. With a small dose (a glass of wine) there will be no significant effect on metabolism. But when constant use alcohol also induces microsomal liver enzymes, which means that the effectiveness of Jess may be reduced.

Jess and antibiotics can be combined, but when treating with some of them, it is necessary additional methods contraception. Penicillins and tetracycline can reduce the circulation of estrogen in the liver by reducing the concentration of ethinyl estradiol, the main component of Jess.

If necessary, simultaneously take antibiotics such as Ampicillin, Amoxicillin, Tetracycline, use a condom throughout the entire period of treatment and for a week after it.

How to take Jess correctly?

The general rules are as follows:

1. On the first day of menstruation, take the first tablet, indicated by number 1 on the package.
2. Every day, at approximately the same time, take the next numbered tablet. They wash it down a small amount water.
3. You should not skip taking a pill.
4. You cannot change the numbering of the tablets; you should move strictly according to the numbers.
5. The packaging is designed for 28 days.
6. After finishing one package, start the next one the next day.

Menstruation when taking Jess begins 2 days after switching from active tablets to placebo. They do not stop immediately after switching to new packaging, but can last another 2-3 days.

There are some features of using the drug after certain conditions:

• Switching to Jess after another oral contraceptive, hormonal ring or patch: the first tablet is taken the day after stopping the previous drug. If switching from a patch or vaginal ring, then the tablet is taken on the same day when a new patch is to be applied.
• Switching from the mini-pill: can be done any day, without interruption.
• Removal intrauterine device: switch to Jess on the same day, but during the first 7 days you need to use additional barrier methods of contraception.

How to take Jess for the first time after an abortion?

This depends on the timing of the abortion. Women who had an abortion before 12 weeks take the pill on the day of the procedure.

If an abortion was performed before 21 weeks for medical reasons, as well as after childbirth, Jess is taken on days 21-28. If you start taking hormones later, you need to use barrier contraceptives for 7 days.

Those women who had sexual intercourse before taking it should make sure that they are not pregnant and wait until their first menstruation.

Contraindications and indications for taking medications

It must be remembered that hormonal contraceptives can increase the likelihood of developing thromboembolism. Therefore, if there are conditions that further increase the same risks, it is necessary careful use hormonal pills and additional examination. These are the following states:

• smoking in women over 35 years of age;
• obesity;
• arterial hypertension;
• prolonged lying position due to injuries, surgical operations.

If the operation is planned, then you must stop taking Jess and any other COCs a month in advance. After prolonged immobilization, the use of hormones can be resumed no earlier than after 2 weeks.

Brown discharge in the middle of the cycle may bother you during the first two months after starting to take Jess. Therefore, the first three cycles are called the adaptation period and are not taken into account when assessing bleeding.

If bleeding appears after normal cycles or does not stop after an adaptation period, then a thorough examination is necessary to exclude an oncological neoplasm.

Sometimes after finishing the active pills when switching to placebo pills, there are no periods. If this happens only once, then there is no cause for concern. But if there is no menstruation for two cycles, you need to consult a doctor.

The use of Jess for endometriosis can have a positive effect. The effect of the drug does not allow the endometrium to actively grow, and a normal hormonal rhythm is imposed on the body. Under the influence of these factors, foci of endometriosis may reduce their activity. But in cases of severe endometriosis, the use of COCs for treatment is ineffective.

In some cases, it is necessary to delay the onset of menstruation. This can be done using a hormonal contraceptive. To do this, after finishing taking the active pills, you need to start a new pack the next day, ignoring the placebo pills. You should drink the second package until the end. But it is not recommended to resort to this method too often. This can lead to hormonal imbalance.

Interaction with other drugs

The pharmacy chain offers a large number of combined oral contraceptives. At first glance, they are analogous to Jess in composition, but this is not always the case.

Only a doctor can determine what is best for a particular patient. Many of the drugs have additional effects or, despite the same composition, a different dosage.

You can compare some trade names with each other. So, Jess or...

The composition of the drugs is similar, but in Yarin the dosage active ingredients increased to 30 mcg ethinyl estradiol and 3 mg drosperinone. It also has a nathianrogenic effect, but more pronounced than Jess. Therefore, it is recommended for severe PMS, as well as significant signs of hyperandrogenism. The purposes for prescribing the drugs are the same.

Switching from Jess to Yarina may be necessary if the medicine with a lower dosage does not reduce the severity of PMS and swelling. A reverse switch may be required in cases where the side effects of Yarina are bothersome. It has been found that sometimes when the dosage is reduced, the severity of the undesirable effect also decreases.

The drugs are complete analogues in composition. The only difference is that Dimia is a generic version of Jess.

those. This hormonal product is produced under license from the pharmaceutical company that developed Jess, but by a different company. She did not participate in the development and did not incur material costs, so the cost of the generic is lower than original drug.

Sometimes there are differences in the preparation of raw materials and some technological aspects, so many consider generics to be less effective. Both of these COCs are recommended for use in at a young age in nulliparous adolescents, as the safest.

The differences between them are significant. Qlaira belongs to three-phase hormonal agents.

Its packaging contains five types of tablets. The first type contains only estradiol valerate.

The second type is supplemented with dienogest, a progestin component. In the third type, the combination is similar, but the dose of gestagens is increased.

The fourth type of tablet (1 piece) also contains only estrogen. The last two are placebos.

There are 28 pieces in total.

Dienogest in Qlaira also has an antiandrogenic effect. Qlaira is recommended for women with increased concentration estrogen in the blood, as well as abundant long periods. Most often these are patients over 40 years of age. The estrogen component also combats age-related changes such as vaginal dryness.

A doctor will help you make the right choice of hormonal medication, because both drugs are monophasic oral contraceptives. But in Janine’s composition, drospirenone is replaced by dienogest, another form of gestagen, which also has an antiandrogenic effect.

Some women report more pronounced side effects from taking Janine. Therefore, you can try to replace COCs if you are intolerant to one of them.

...Logest

The composition uses gestodene as a gestagenic component. But it does not have the additional effects characteristic of Jess. Therefore, it is used only for the purpose of contraception. Can be used in teenage girls after the onset of their first menstruation.

...Diana-35

It has contraceptive, estrogenic, antiandrogenic and gestagenic effects. This is ensured by the composition of the drug, which includes ethinyl estradiol in a dose increased to 35 mcg, and cyproterone acetate.

While using Diane-35, weight gain may occur. Additional effects are used for acne, androgenetic alopecia, seborrheic dermatitis, hirsutism, i.e. more pronounced manifestations of hyperandrogenism.

...Regulon

Contains ethinyl estradiol and desogestrel. The latter has weak antiandrogenic and anabolic activity. When using Regulon, side effects such as decreased libido, depressed mood, and depression are less pronounced. It is not typical for him to have spotting in the middle of the cycle. But there may be some weight gain and engorgement of the mammary glands.

The choice of hormonal drug should be made by the doctor, based on the patient’s condition, her lifestyle, and existing diseases. It is also necessary to take into account following features, in which some COCs are especially effective, while others can only increase undesirable manifestations:

• for acne you need to choose Jess, Yarina, Diana-35, Dimia;
• if there is engorgement of the mammary glands, you need to reduce the dosage of ethinyl estradiol to 20 mcg, which is possible in Jess and Dimia;
• Three-phase contraceptives, for example, Qlaira, cope with vaginal dryness;
• with decreased libido, bloody discharge in the middle of the cycle, Klaira, Lindinet, Yarina, Femoden, Regulon, Rigevidon, Janine are needed;
• Novinet, Miniziston, Mercilon will help with heavy menstruation;
• absence of menstruation – three-phase COC.

Combined oral contraceptives are a means of preventing unwanted pregnancy, but they are unable to protect against sexually transmitted infections. Therefore, when having unprotected sex with a new partner, you should use a condom.

Special packaging

Manufacturers took care of forgetful women, and specially developed such packaging so that they could easily navigate not only in the order of administration, but also correlate it with the days of the week.

The fold-out packaging contains a blister containing 24 pink tablets containing active ingredient, and 4 orange ones with placebo effect.

There is also a block of stickers of 7 strips, each of which starts with one of the days of the week, and then the rest follow in order. When a woman starts taking Jess, she must determine the current day of the week and select the strip that starts with it.

The sticker is transferred to the front of the blister above the first row of tablets, starting from the starting one. This way you can always find out by the days of the week whether the required dose was taken, how many days were missed and when to start drinking the next package.