The problem of preventing unwanted pregnancy has long been a concern for mankind. And today, family planning remains one of the most relevant topics. Contraception is protection against unwanted pregnancy, and therefore from the negative consequences that may result from its termination. Any method of preventing pregnancy is safer for a woman’s health than terminating it! According to the Russian Medical Academy, only 25% of married women use contraception; in recent years, the use of the most effective methods of contraception, such as hormonal and intrauterine devices, has decreased by 1.5-2 times!
Hormonal contraception over a long century of existence has managed to acquire myths and legends, which make women beware of using it. Let’s try to figure it out, shall we?
The idea of its creation arose at the beginning of the 20th century thanks to the experiments of the Austrian doctor Haberland. The first artificially synthesized female sex hormones – estrogen and progesterone – were obtained in 1929 and 1934, and in 1960, the American scientist Pincus created the Enovid pill, which marked the beginning of the entire genus of hormonal contraception.
They consist of estrogenic and progestogen components, artificially created twin brothers of estrogen and progesterone (natural female sex hormones). Such drugs are called combined. Sometimes preparations containing only gestagens are used.
Hormonal contraception is divided into oral (OK) – the drug enters the body of a woman through the mouth in the form of tablets and parenteral – the intake of hormones occurs in other ways, bypassing the intestines. Another type of parenteral hormonal contraception isspecial ring, placed in the vagina by the woman herself once a month. Also exists a special type of intrauterine device, which has a contraceptive effect due to the release of hormones.
COCs are combined oral contraceptives (analogues of estrogen and progesterone in tablets).
Distinguish monophasic COCs (in each tablet of the drug, the content and ratio of estrogen and progesterone is the same), two-phase (the content of estrogen is the same in all tablets, but the dose of progesterone in the second phase of administration is higher), three-phase (different ratio of hormones in the three phases of administration).
Besides, COCs, depending on the dose of estrogen, are divided into high-dose, low-dose and micro-dose. Since the early days of the invention of these drugs to improve COC, scientists have been on the path of reducing hormone dosages: it is believed that the lower the dosage in a COC tablet, the fewer side effects.
Triphasic COCs do not necessarily mimic the hormonal fluctuations of a normal menstrual cycle and are not more physiological than monophasic COCs. The advantage of the former is a lower percentage of side effects than the others. But only a few women tolerate the triphasic COCs themselves well.
The hormones that make up the COC affect the process of formation and release of the egg from the follicle in the ovary in such a way that ovulation simply does not occur. That is, the egg is not “born”, therefore, its meeting with the sperm is obviously impossible. It is also impossible because COCs create a kind of trap for male germ cells. These drugs make the mucus of the cervical canal more viscous, which is a barrier to the way of spermatozoa into the uterus.
In addition, even if the fertilization of the egg did happen, for further development it is necessary that it enter the uterine cavity at a certain moment – not earlier and not later than the due date. Under the influence of COCs, the work of the fallopian tubes slows down, “moving” the fertilized egg towards the uterus, thereby preventing the progression of pregnancy.
Suppose a fertilized egg still managed to get into the uterus at the right time. But for the further development of the embryo, a special state and structure of the inner lining of the uterus (endometrium) is necessary, which provides nutrition and other conditions necessary for pregnancy. When taking COCs, such changes occur in the structure of the endometrium that prevent the further development of a fertilized egg.
The drug is started to be taken on one of the first days of menstruation or within three days after the abortion. The earlier the better. If the use of COCs did not start on the first day of the cycle, it is better to use additional methods of contraception during the first two weeks. Reception is continued for 21 days, after which they take a break of no more than 7 days. Usually a woman is advised to take COCs at the same time of day, and so that she does not forget about it, it is better if she associates the drug with a daily ritual, for example, put the pills next to her toothbrush.
If a woman still forgot to take the next pill (the most common mistake in taking COCs), it is recommended to take it as soon as possible and continue taking the next ones as usual. But in this case, additional contraception for 2 weeks is desirable.
There is no single opinion on this matter. Some gynecologists believe that with the right choice of the drug, the duration of its administration does not increase the risk of complications. Therefore, you can use this method of contraception for as long as necessary, up to the onset of menopause. Taking breaks in taking drugs is not only unnecessary, but also risky, since during this period the likelihood of an unwanted pregnancy increases.
Other scientists adhere to a different point of view, insisting on small but mandatory breaks of 3-6 months. So, some recommend, as it were, imitating a natural pregnancy, that is, taking COCs for 9 months, and then canceling the drug for 3 months, using other methods of contraception. The body is given a kind of rest from the “imposed rhythm and doses of hormones”. There is evidence that with the continuous use of COCs for a number of years, the ovaries seem to be depleted, in other words, they “forget” how to work independently.
This method of contraception is highly reliable in terms of preventing unwanted pregnancy. According to statistics, in twelve months of their use, 1000 women experience 60-80 pregnancies, but only one is the result of an insufficient contraceptive effect of the drug, and the rest are due to errors in the use of COCs. For comparison: with interrupted intercourse during the year, there are 190 cases of unplanned pregnancies per 1000 women, of which 40 are due to the unreliability of the method itself.
With the correct use of COCs, the ability to conceive is restored immediately after the withdrawal of COCs. After 3-6 months, it reaches 85%: as in women who did not use hormonal contraception.
There is no single answer, everyone is individual. But most women note an increase in sexual desire, since there is no fear of an unwanted pregnancy when taking OK. If there is a decrease in sexual desire when using COCs, then this problem can sometimes be solved by changing the contraceptive used to others – with a lower content of progesterone.
The fear of gaining weight from hormonal pills has existed since ancient times. Weight gain (usually plus 2-3 kg) occurs in the first three months of taking the drug, mainly due to fluid retention in the body. OCs can increase appetite, which also contributes to weight gain. However, in other women, taking OK on the contrary causes the loss of extra pounds or does not affect weight at all.
Even teenage girls, in some cases, gynecologists prescribe OK, since these drugs, in addition to preventing unwanted pregnancy, have a number of medicinal properties.
With various menstrual disorders, with some uterine bleeding, with polycystic ovaries, as well as for the treatment of severe forms of premenstrual syndrome, endometriosis, etc. There is also evidence that COCs have a positive effect on the course of gastric ulcers and rheumatoid arthritis.
In some forms of endocrine infertility, “intermittent use” of OCs is used. For example, taking some of these drugs for 3 months followed by a break of 2 months in certain cases restores ovulation.
In the absence of contraindications to taking hormones, COCs are recommended for women of any age who want to protect themselves from unwanted pregnancy:
• after an abortion
• after childbirth (after 3 weeks if the woman is not breastfeeding)
• in the presence of an ectopic pregnancy in the past
• after inflammatory diseases of the pelvic organs
• with some types of menstrual irregularities
• women with anemia
• with some gynecological and other diseases.
OK reduce the amount of blood that a woman loses during menstruation, which is especially important in patients with anemia. Also, when taking these drugs, menstrual and ovulatory pains decrease.
In fact, birth control pills are sometimes used by women to “plan” their periods. This is often used by athletes on the eve of competitions or ladies before a trip, vacation, etc. The gynecologist will tell you how to do it correctly so as not to harm the body. However, this is often not recommended.
Taking OK reduces the risk of developing ovarian and uterine cancer by more than half! OK can also be called a kind of prevention of the development of diseases such as uterine fibroids, ovarian cysts, benign diseases of the mammary glands. Such positive effects are noted already after 3-6 months of COC use and last at least 15 years after their withdrawal.
Although these hormonal drugs prevent the development of ovarian and uterine cancer, they can accelerate the growth of the tumor that was present before they were used. Here, in particular, is why it is dangerous to use COCs without a doctor’s prescription.
As already noted, COCs increase the viscosity of mucus in the cervical canal, which reduces the risk of pelvic inflammatory disease by almost half.
At this age, the problem of osteoporosis (brittle bones and easily occurring fractures) is of particular importance for women due to the fact that the body is being rebuilt to a different mode of operation, and the amount of sex hormones is sharply reduced. OK prevent the occurrence of this condition, as they contribute to the normal process of renewal of bone tissue cells and inhibit their destruction. However, the intake of any hormones must be agreed with the attending physician!
The end follows.
Elena VYSOTSKA,
gynecologist
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