There is no need to remind the modern woman of the importance of contraception. We already know that contraceptives can not only protect against unwanted pregnancy, but also prevent genital infections, and in some cases solve additional tasks (getting rid of acne, reducing the manifestations of hirsutism, and much more). But do we all know about the drugs that we are ready to entrust our health to?
The World Health Association (WHO) has a clear understanding of what activities should be carried out in family planning. WHO pays special attention to unplanned pregnancies, adherence to monitoring the birth of a child in the life of a married couple, and reducing the number of revolutions 1 .
The top three most popular contraceptives for women are hormonal contraceptives (contraceptive pills), condoms and an IUD (intrauterine device).
Women are more or less familiar with the principle of operation of condoms. The spiral is placed exclusively in the gynecologist's office after preliminary consultation and analysis. Contraceptive pills, women often "prescribe" themselves, without the participation of a doctor. This is facilitated not only by the availability of contraceptives in pharmacies, but also by the seeming safety. Indeed, in recent years, the method of hormonal contraception has been significantly improved: the doses of hormones have decreased, the reliability has increased, new varieties have appeared (mini-drank).
A hormonal contraceptive drug must be prescribed by a doctor . But a woman should still understand what kind of drugs they are, what negative and positive effects they have, what they can do and what not.
What are the requirements for contraceptive pills for women? The main task is the direct appointment and minimization of the risk of pregnancy, up to 99%. Naturally, the drug must be safe for the entire female body, including the reproductive system. Affordability is also an important factor. Most modern hormonal preparations fulfill similar requirements.
In Europe, hormonal contraception is used by about half of all women of reproductive age. In Russia, the indicators are much lower and amount to 10-15% of women, in large cities about 35% 2 .
However, pregnancies do occur with contraceptive pills. The main reasons are associated with improper use of drugs or neglect of instructions for use:
gaps in admission or expired drug expiration date; combination with drugs that reduce the contraceptive effect; the inability to assimilate the drug, for example, in case of poisoning and vomiting; irrational choice of oral contraceptives (contraceptive pills may have a different scheme and method of action). If an unwanted pregnancy has occurred, then taking oral contraceptives (OC) should be discontinued. Not all, but some drugs can have a negative effect on the fetus from the first days of life.
Combined oral contraceptives ( COCs )
They are called combined due to the fact that they contain 2 types of hormones at once - progestin (progesterone) and estrogen (both belong to female sex hormones, but perform different functions) 3 .
Not everyone knows, but when taken correctly, COCs are considered more reliable contraception than a condom. True, unlike the latter, oral contraceptives do not protect against genital infections.
The main task of the progestin is to suppress the functions of the pituitary gland (the piece of the brain responsible for the production of hormones), which leads to the stopping of ovulation. As a result, the follicles (in which the eggs develop) do not grow, and the body does not produce enough estrogen, which is necessary for the female body. That is why estrogen is present in the composition of the preparations, which is an auxiliary agent, normalizes the menstrual cycle and other important processes in the body 4 .
changes in the structure of the endometrium (the lining of the uterus) to prevent the oocyte from fixing; thickening of cervical mucus, which creates a barrier in the path of sperm and reduces their activity; control of the menstrual cycle, thanks to COCs, you can regulate the arrival of menstruation; treatment and prevention of many diseases associated with menstrual irregularities. It is worth explaining that oral contraceptives are contraceptives. The main task is always to prevent unwanted pregnancy, and not to treat various hormonal diseases. There are many specialized drugs for this.
The doctor may prescribe COCs as a medicine, but only for a supportive or prophylactic role. It is strictly not recommended to purchase COCs for the treatment of certain diseases on your own, without the consent of your doctor.
They are considered analogous to COCs, but contain only mini-doses of progestin, without estrogen, for which they got their original name. There is another entertaining name for such drugs - purely progestin-only oral contraceptives, or abbreviated as CHPOK.
Mini-pills are considered less effective than combined contraceptives, but because of the minimal progestin content, they are safer.
The use of mini-pili has its own logic and sometimes they intentionally replace KOC:
the absence of estrogens allows women with certain specific diseases to take them;
mini-pills can be used during breastfeeding.
The use of birth control pills can have many nuances, and we have listed just a few of them above. Before prescribing a particular drug, a woman's history is collected (survey) and a possible tendency to diseases from the risk group is determined. Contraindications must also be taken into account.
Among the general criteria, doctors may look for the following signs:
whether there is excessive hair growth on the body; are there signs of androgen excess; what is the condition of the skin; what is the condition of the mammary glands; are there any diseases of the pelvic organs. Oral contraceptives contain different dosages of hormones. Therefore, the most important criterion when choosing a drug will be the woman's tendency to a predominance of estrogens or androgens.
Oral contraceptives have a number of undeniable benefits: the effectiveness of protection against unwanted pregnancy is almost 100%; can be taken at any reproductive age; the ability to bear children is not lost and is fully restored some time after the drug is discontinued;
has some cosmetic effect: the manifestations of acne and seborrhea are reduced, the severity of hirsutism (excess body hair growth) decreases.
Modern types of COCs are effective prevention of diseases associated with menstrual irregularities and reduce the risks of developing the following diseases 2 :
ovarian cancer; Iron-deficiency anemia; uterine fibroids ; benign breast diseases; Endometriosis and many others.
It must be remembered that taking hormonal drugs is still an interference with the natural processes of hormone production. Women's health is a very delicate mechanism that requires delicate handling. The constant supply of hormones from the outside can change the function of the ovaries. Suppression of ovulation , dysfunction of the uterus, egg production are the real consequences of taking them. Such changes can lead to bleeding, dark discharge in the middle of the cycle, and increase the risk of cancer during menopause .
While taking COCs, headaches and migraines often occur. Do not start taking hormonal drugs for women who smoke, or 4 weeks before surgery. A history of acute mononucleosis and sickle cell anemia are also relative contraindications, as is the presence of breast cancer in the past (even if it is in remission) 1 .
With regard to diseases, it is worth explaining. There are a number of diseases in which the use of OK can lead to disastrous consequences. The list of such diseases, with absolute contraindications for taking OK, includes:
thrombosis and angina pectoris; strokes and ischemic diseases, even those that have passed; migraine; diabetes with complications; pancreatitis; various liver diseases; high degree of obesity. A complete list of contraindications can be found in the instructions for a single drug.