Safe hormonal pills. What are the best birth control pills to take

A long time ago, more than one or even two children were born in Russian families. A family in which there are “seven on benches” and a mother in the process of demolition is a typical example of the way of pre-revolutionary life. A hundred years ago, a woman was in two states for almost the entire reproductive period - pregnancy and breastfeeding, and the latter smoothly flowed into the next interesting position.

Whether it's good or bad, but in modern families there are much fewer heirs. One or two children are considered normal. And in order not to exceed the upper limit, a healthy woman needs to take contraception seriously.

In the contraceptive arsenal today, there are about a dozen methods of preventing unwanted pregnancies. Almost the most popular way is the use of birth control pills.

How effective and safe is contraception using pills? Who shouldn't rely on this method? And in general, what should be understood by the term "contraceptive pills"? Every woman should own these concepts no worse than a local gynecologist - after all, health sometimes depends on this knowledge. Well, let's figure it out together.

Contraceptive pills: both orally and vaginally

The concept of "contraceptive pills" includes two completely different categories of drugs:

• hormonal contraceptives, which are based on synthetic hormones;
• local spermicides in tablets. The action of these contraceptives is based on the spermicidal effect, which is achieved with topical, vaginal application.

Of course, hormonal agents are of greatest interest from the point of view of the pharmacological effect. With them, we will begin our acquaintance with contraceptives.

Hormonal contraception: origins

Already at the end of the 19th century, it became known that the development of follicles and ovulation is completely suppressed during pregnancy, and the reason for this is the high concentration of corpus luteum hormones. In the 1920s, Ludwig Haberlandt proposed the use of such substances as contraceptives. In the next ten years, three estrogens were synthesized: estrone, estriol and estradiol, and at the end of 1929, scientists also identified progesterone.

Probably, the first hormonal contraceptive pills would have appeared ten years earlier, if not for the problem with the synthesis of progesterone. It was mastered only in 1941, after which it was the turn of other progesterone drugs - norethisterone and norethindrone. It was then that these substances received the common name progestogens (or progestins), which emphasized progesterone-like properties.

In the early 50s, scientists began experimenting with hormonal drugs. The first pancake came out lumpy: the use of hormonal pills for the treatment of infertility did not give results. But it was found that in women taking these drugs, ovulation was suppressed. It took researchers another 5 years to select the right formula, and in 1957 the first hormonal contraceptive drug was released. As early as 1960, 0.5 million American women were taking these pills. The era of hormonal contraceptives has begun.

Pharmacological effect of hormonal pills

The action of contraceptive hormonal drugs does not depend on the composition and dosage. The contraceptive effect is achieved by influencing a complex reproductive chain, which includes the pituitary gland, hypothalamus, ovaries, uterus, and even fallopian tubes.

First of all, hormonal contraceptives suppress the production of releasing hormones by the hypothalamus, resulting in a decrease in the gonadotropic function of the pituitary gland. Due to this, ovulation is inhibited, and temporary sterility occurs.

Secondly, hormonal pills suppress ovarian function: estrogen synthesis is almost halved, and the ovaries even decrease in size.

Thirdly, under the influence of hormonal drugs, the properties of cervical mucus change, which becomes very difficult for spermatozoa to pass.

Fourth, the peristalsis of the fallopian tubes slows down significantly. A miraculously mature egg is unlikely to be able to get out of the long, inactive fallopian tubes and, most likely, will be doomed to death.

And fifthly, the endometrium changes, which quickly regresses and does not reach the thickness necessary for the implantation of a fertilized egg. This mechanism serves as additional protection - even if conception has occurred, the embryo simply cannot attach to the uterine wall.

The effectiveness of contraceptive drugs is evaluated using a single indicator - the Pearl index. It is equal to the number of pregnancies in one year in 100 women who used a particular method of contraception. The Pearl Index of hormonal contraceptives rarely exceeds 3-4% and fluctuates around 1%.

Hormone Dosage: Then and Now

The first hormonal contraceptives contained simply lethal doses of hormones: 150 micrograms of estrogen and 9.35 mg of progestogen. In 1964, it was possible to reduce the concentration of active substances to 100 micrograms and 2 mg, respectively. However, these dosages were far from perfect.

The next step was the release of hormonal contraceptives containing 50 micrograms of estrogen. Scientists came to the conclusion that lowering the dose of hormones does not affect the effectiveness of the drug, but it greatly reduces side effects.

In the 1970s, the upward trend in the use of hormonal contraceptives stopped. This resulted in pronounced adverse events in the form of thromboembolism (blockage of blood vessels by blood clots), especially in women who smoke. Pharmacists had no choice but to develop new low-dose drugs. And it succeeded.

Birth control pills of the new, latest generation contain less than 35 mcg of estrogen - the component that causes most of the side effects. In addition, highly active progestogens have been synthesized, including drospirenone, desogestrel, gestodene, and others. Due to these advances, low-dose hormonal drugs have a very high safety profile and a low chance of side effects. Nevertheless, when choosing a contraceptive drug, you need to be vigilant, given the many nuances. However, more on that later.

Classification of hormonal contraceptives

All hormonal drugs can be divided into three large groups:

1. combined oral contraceptives (COCs).
   Such tablets contain both components: both estrogen and progestogen;
2. progestin preparations - mini-pills.
   Monocomponent means, which include only gestagen.
3. emergency contraceptive drugs.
   These contraceptives contain extremely high doses of hormones and are intended for urgent, that is, urgent contraception.

Each of the groups of hormonal pills has its own advantages and disadvantages, on the basis of which the conclusion is based on the appointment of a particular remedy.

KOC: positive aspects

Undoubtedly, the most common hormonal pills are combined contraceptives. They have a lot of positive aspects, including:

• high contraceptive effect;
• excellent tolerance;
• ease of use;
• reversibility of action;
• security;
• therapeutic action;
• preventive action.

To understand all the advantages of contraceptive hormonal drugs, we will consider each criterion in detail.

Efficacy and tolerability of combined contraceptives

The Pearl Index KOC ranges from 0.1-5%. The average statistics state that the probability of pregnancy with the constant use of hormonal pills during the year does not exceed 1%. Thus, the effectiveness of combined contraceptive pills reaches 99%. An indispensable condition for achieving such results, of course, is compliance with the dosing regimen.

Oral combined contraceptives are generally well tolerated. Side effects develop, as a rule, in the first months of taking, and notice that they decrease on their own and completely disappear.

Types of combined hormonal pills

Depending on the qualitative composition, COCs are divided into three groups:

1. monophasic drugs.
   These drugs contain estrogen and progestogen in the same dosage. Regardless of the phase of the menstrual cycle, the same amount of hormones enters the body. Tablets of monophasic COCs are painted in one color. These monophasic contraceptive drugs include most of the modern low-dose COCs: Logest, Silest, Jeanine, Microgynon, Lindinet-20 and Lindinet-30, Regulon, Diana, Yarina, Jess and others;
2. biphasic drugs.
   Biphasic COC tablets are divided into two groups: the first contains more estrogen, and the second - progestogen. For ease of administration, the tablets are colored in two colors. Biphasic COCs are rarely used;
3. triphasic drugs.
   A package of a three-phase COC contains three groups of tablets, the level of hormones in which changes approximately in the same way as in a physiological menstrual cycle. Each group of tablets is coated with its own color. Three-phase preparations are considered the most adapted to the natural cycle of a woman. Among the modern representatives of this group, we note Tri-merci, Tri-regol, Triziston.

Rules for taking birth control pills

The first and main rule, on which both the effectiveness and side effects of COCs depend, is the regularity of intake. Forgetfulness is the main enemy of any contraceptives, and hormonal ones in particular.

We list the main postulates that every woman who takes hormonal contraceptives should remember:

1. It is better to start taking contraceptive drugs on the first day of a new cycle, although it is also allowed in the first 5-7 days from the onset of menstruation. Some experts recommend starting treatment on some convenient day for counting, for example, on Sunday. If a woman needs immediate therapy, you can drink the first tablet immediately after the complete exclusion of pregnancy;

2. It is better to take medicine at the same time. Ideally, you should associate the reception with some kind of ritually repetitive action, for example, evening dress or dinner. Although there are no specific recommendations on the best time of day to take the pill, many doctors advise taking COCs at night. This is due to the fact that at the beginning of treatment there is a possibility of mild nausea, which practically does not annoy during sleep;

3. In the first cycle of taking COCs, additional contraceptive measures should be used: according to some reports, the effectiveness of hormonal contraceptive pills reaches a maximum only after 2–4 weeks of continuous use;

4. After a 21-day intake, a 7-day break follows, during which menstrual-like bleeding occurs. On the eighth day of withdrawal, you should start taking the first tablet of a new treatment cycle. If within a week after the abolition of COC menstruation has not occurred, the next package is still not canceled. However, in such a situation, it is better to seek advice from your doctor: you need to exclude pregnancy and gynecological pathologies;

5. If there was vomiting within four hours after taking the pill, the contraceptive effect is reduced. In such cases, it is better to use an additional method of contraception until the end of the cycle. Usually, the barrier method is considered the best "safety" method, which involves the use of a banal, but true condom;

6. If bleeding occurs while taking COCs, treatment should be continued. Some experts recommend that patients who bleed more than 4 days start taking an additional COC tablet (eg, morning). As a rule, 2-3 additional tablets are enough to restore the normal picture. After stopping the bleeding, you should take another 2-4 days for half the additional dose, and then switch to the standard course of treatment. If, despite the measures taken, the bleeding continues, you will have to see a gynecologist;

7. Patients who take COCs for a long time need to undergo periodic examinations by a gynecologist with monitoring of the condition of the mammary glands.

What if memory fails?

Every woman, no doubt, knows about the regularity of taking hormonal contraceptive pills. But the girl's memory is fragile: there are gaps and gaps in it. What to do with forgetful patients? Moaning: “All is lost!”? Or ... Of course, act! Depending on how many birth control pills the patient missed:

• if no more than 12 hours have passed since the last pill was taken, you need to take the next one immediately after memory recovery and calm down. The contraceptive effect will not change;
• if the interval between doses was more than 12 hours, it is necessary to take the next pill, regardless of the time of day, and then continue according to the schedule. The scheme does not change, even if you have to drink two tablets a day;
• if two doses were missed, that is, the interval between doses was more than 24 hours, you need to take two tablets at once and drink two more doses the next day. It should be borne in mind that in such cases, bleeding may occur;
• if the memory was lost for a long time, and this led to the omission of three or more pills, the likelihood of spotting is very high. Of course, you can forget about the contraceptive effect, and it’s even better to remember where the condoms are. However, what to do with COC? Doctors recommend taking two tablets for the first three days, and then switch to the standard regimen. There is a second way out of the situation: to abandon the old packaging altogether and start from scratch, that is, with a new KOC packaging, for example, next Sunday.

If everything is taken and canceled: the reversibility of COC action

Contraception involves deliberate family planning. And someday there comes a time when a woman would gladly start taking germ pills, if such existed. The purchase of new packs of hormonal contraceptives is postponed indefinitely. The only question that worries a woman is when can you get down to business?

The action of combined hormonal contraceptives is reversible, and this, of course, can be attributed to the important advantages of such drugs. In most cases, in the first 1-3 months after the abolition of COCs in healthy women, a full-fledged ovulatory menstrual cycle is completely restored. The maximum recovery period is 12 months.

There is information about the so-called withdrawal syndrome or rebound effect that occurs after stopping the use of hormonal contraceptives. The ovaries, which have been “resting” for quite a long time, begin to work actively and fruitfully immediately after recovery from “hibernation”. The result of such work is the maturation of the follicles and the release of an egg ready for battle, hungry for action. According to the theory based on the COC withdrawal syndrome, the probability of pregnancy in the first 1-2 months after stopping treatment with hormonal pills is much higher than in the standard cycle.

However, some experts believe that normalization of hormonal levels is still needed for a healthy pregnancy. Many gynecologists insist that conception should occur several months after hormone withdrawal.

Therapeutic effects of COCs: birth control pill therapy

In addition to the contraceptive effect, hormonal preparations also have a proven therapeutic effect, and in this capacity, COCs containing both estrogen and progestogen are mainly used. Consider the main indications for the appointment of combined contraceptives.

Dysfunctional uterine bleeding

Intermenstrual uterine bleeding, not associated with pregnancy and organic pathology, is considered to be dysfunctional. Their main cause lies in a hormonal imbalance caused by a malfunction in the complex circuit of the hypothalamus-pituitary gland-ovaries. It has been proven that long-term use of COCs contributes to the normalization of hormonal levels and the cessation of dysfunctional bleeding.

endocrine infertility

As we have already said, in some cases COCs are used for the sake of the rebound effect. Some endocrinologists believe that if endocrine infertility is suspected, it is first necessary to start treatment with combined contraceptives. If pregnancy does not occur after the abolition of COCs, then proceed to ovulation stimulants.

Premenstrual syndrome

For the treatment of PMS, modern low-dose contraceptives are prescribed, including Novinet, Median, Silhouette, Lindinet, Mercilon, Jeanine, Dimia and other drugs. Symptoms characteristic of premenstrual syndrome - irritability, weakness, swelling, pain in the back, chest, headaches - disappear after 1-2 months of treatment.

endometriosis

Endometriosis is a fairly common disease that can be one of the causes of infertility. With this pathology, a tissue similar to the endometrium (the tissue of the inner lining of the uterus) grows in the pelvis. COCs are recognized as one of the treatment options for endometriosis. As a rule, these drugs are prescribed in long courses for a period of at least 12 months.

Among the contraceptives that are most often used for the treatment of endometriosis are Marvelon, Femoden, Regulon, Microgynon, Logest and others.

Hyperandrogenism

A condition that is accompanied by an increased content of testosterone in the blood - hyperandrogenism - is manifested by a number of striking symptoms. These include excessive hair on the face and body in women, acne (acne) and seborrhea.

The drugs of choice for the treatment of mild and moderate forms of hyperandrogenism include COCs with an antiandrogenic effect. This action is inherent in the gestagen, which is part of some combined contraceptives, namely Diana, Zhanin, Yarina and some others.

Separate words deserve a drug with a powerful antiandrogenic and antimineralocorticoid effect - Yarina. As a progestogen, these tablets use drospirenone, which not only helps to reduce testosterone levels, but also reduces swelling. Therefore, the likelihood of weight gain when taking Yarina is minimal.

With acne and seborrhea in adolescents, a three-phase COC Tri-merci is prescribed, which is able to reduce testosterone levels three times.

And the last. The antiandrogenic effect is achieved after three months of constant use of COCs, so contraceptives in order to get rid of acne will have to be taken for a long time.

COC: not only treatment, but also prevention

Combined contraceptives are also an additional prevention of gynecological diseases.

Inflammatory diseases

It has been proven that regular use of COCs reduces the likelihood of developing an inflammatory process in the small pelvis. This effect is achieved through:

1. increase the viscosity of cervical mucus.
   More viscous mucus turns out to be a barrier not only for spermatozoa, but also for some bacteria;
2. decrease in the intensity of menstruation.
   Menstrual blood is an ideal environment for the growth of pathogenic microorganisms. Therefore, a decrease in monthly blood loss also reduces the likelihood of infection;
3. decrease in the strength of uterine contractions during menstruation.
   With uterine contractions, the infection easily penetrates from the uterus into the fallopian tubes, contributing to the development of dangerous diseases - salpingitis (inflammation of the fallopian tubes) and salpingo-oophoritis (simultaneous inflammation of both the ovaries and tubes). It is these processes that occupy an honorable first place among diseases that lead to the formation of adhesions in the pelvis, and as a result, infertility.

According to the recommendations of the WHO - the World Health Organization - combined contraceptive pills are used in a complex treatment regimen for already developed inflammatory processes. In such cases, COCs allow the ovaries to “rest” and recover, and the cervical mucus plug additionally protects the body from reinfection, that is, re-infection.

Functional ovarian cyst

These pathologies include follicular cyst and cyst of the corpus luteum. Monophasic COCs reduce the likelihood of formation of functional cysts by 3-4 times, and also contribute to the resorption of existing formations.

It is worth noting that triphasic birth control pills may, on the contrary, stimulate the development of cysts. This is because "floating" doses of hormones in such preparations are not able to completely suppress ovarian function.

uterine fibroids, endometriosis

Both uterine fibroids and endometriosis are estrogen-dependent diseases. A decrease in estrogen levels significantly reduces the likelihood of developing these pathologies.

Official figures sound more convincing than words: with the constant use of birth control pills for five years, the risk of fibroids decreases by 17%, seven years - by 20%, and 10 years - by 30%.

Birth control pills: simple cancer prevention

The most reliable studies in the medical world have confirmed that the regular use of COCs reduces the risk of gynecological cancer. Continuous use of birth control pills reduces the risk of developing ovarian cancer by as much as 40%, and such prevention lasts for 15 years after the elimination of COCs. In addition, the use of combined contraceptives reduces the likelihood of developing uterine cancer by exactly half, and the protective effect is also enough for 15 years.

The only condition that should not be overlooked: to obtain a serious preventive effect, birth control pills must be taken for at least two years.

Combined contraceptives: side effects

Of course, the other side of the coin cannot be ignored. COCs have both side effects and contraindications.

Let's start with the first one. The most common side effects of hormonal birth control pills include:

• headache;
• nausea, vomiting;
• discomfort in the stomach and intestines;
• irritability and mood changes;
• increased sensitivity of the mammary glands;
• change in libido;
• dryness of the vagina;
• intermenstrual bleeding: both spotting and breakthrough (many women perceive this effect as menstruation when taking contraceptives).

The intensity of COC side effects is greatest in the first 1-3 months of treatment. After this period, as a rule, taking birth control pills is not accompanied by any adverse events.

You should be aware that with prolonged use or cancellation of oral contraceptives, hormonal disorders may occur. The duration and frequency of menstruation is reduced or increased, and the discharge may become too scarce or plentiful, accompanied by pain in the lower abdomen. A complex of biologically active substances has a beneficial effect on the functions of the female reproductive system -
"Time Factor". It contains extracts of medicinal plants, vitamins B9, C, E and PP, minerals Fe, Mg and Zn - reduce muscle spasms, pain during menstruation and are involved in restoring hormonal balance, including during or after the use of contraceptives.

Important: When are COCs banned?

Combined contraceptives are absolutely contraindicated in:

• pregnancy or the slightest suspicion of it;
• breastfeeding;
• vein diseases;
• IHD - coronary heart disease;
• severe diseases of the heart and blood vessels;
• oncological diseases;
• uncontrolled diabetes mellitus;
• severe pathologies of the liver or kidneys;
• uterine bleeding, the cause of which is not established;
• over 40 years of age;
• smoking a large number of cigarettes, especially women over 35 years of age.

In the presence of one of the above contraindications, COCs should be completely forgotten. There is an additional list of diseases in which it is necessary to weigh the risks and benefits by prescribing contraceptive pills.

Such pathologies include diabetes mellitus, fibroids, age over 35, smoking, and others.

Women suffering from migraine should be especially careful when using COCs. Migraine is a relative contraindication to treatment with hormonal pills. Experts recommend prescribing low-dose contraceptive drugs containing less than 35 micrograms of ethinylestradiol, in particular, Janine, Logest, Minisiston, Mercilon, Regividon, Yarina. If severe headaches appear during COC treatment, the tablets should be discontinued, and as soon as possible.

Monocomponent birth control pills: mini pills

The second large group of hormonal contraceptive pills contains only one hormone - progestogen. Due to the low dose of the active substance, these drugs have received the sonorous name of mini-pills. Some of the most popular mini-pill birth control pills include:

• Exkluton containing 500 micrograms of linestrenol;
• Microlut, which includes 3 mg of levonorgestrel;
• Charozetta and Lactinet, which contain 75 micrograms of desogestrel.

It should be noted that Charozetta and Lactinet occupy a special place among mini-pills. The composition of these funds includes a modern gestagen, which has unique properties. In addition to contraception, desogestrel has an antiandrogenic and antimineralocorticoid effect.

The pharmacological action of the mini-pill is similar to that of COCs. By blocking the production of gonadotropic hormones of the pituitary gland, gestagens contribute to an increase in the viscosity of cervical mucus, forming a barrier to spermatozoa. In addition, mini-pills reduce the contractile activity of the fallopian tubes and cause endometrial hypotrophy, which makes implantation of a fertilized egg difficult.

Rules for taking mini-pills

Unlike combined birth control pills, mini-pills are used daily without taking a break.

The elimination half-life of the mini-pill is quite short: it is 12 hours less than that of the combined drugs and is only 22-24 hours. In this regard, monocomponent contraceptives must be taken at the same time in order to prevent a critical drop in the dose of hormones.

Charozetta and Lactinet can be attributed to a pleasant exception to the rule: their half-life occurs 36 hours after administration.

Monocomponent birth control pills: benefits

What distinguishes mini-pills from COCs? What are the advantages of monocomponent contraceptives over traditional combination drugs? The positive aspects of the mini-pill include:

• no side effects associated with the intake of estrogen.
  Estrogen is responsible for most of the adverse events associated with COC use. Due to the lack of this hormone in mini-pills, they are better tolerated than combination pills;
• the possibility of prescribing during lactation.
  Monocomponent contraceptives are considered a means for nursing mothers. It has been proven that the gestagens used in mini-pili do not affect the qualitative composition of breast milk and do not reduce its amount. On the contrary, there is information stating that taking a mini-pill helps to improve lactation and lengthen the duration of breastfeeding. WHO recommends the use of monocomponent contraceptive pills 6 weeks after birth;
• the possibility of using mini-pills in women who are contraindicated in combination pills.
  Monocomponent contraceptives are safe in patients with severe diabetes mellitus, migraine, heart and vascular diseases, varicose veins, as well as in smokers. In addition, mini-pills are birth control pills that are indicated for women of older reproductive age, including those after 40 years;
• no side effects after abrupt withdrawal of tablets.
  Unlike COCs, you can stop taking monophasic contraceptives at any time during treatment.

Disadvantages of minipill

Along with a significant list of advantages, monocomponent tablets are not without some disadvantages, including:

• high probability of menstrual irregularities while taking drugs: intermenstrual bleeding, shortening of the cycle, etc.;
• relative low efficiency compared to COCs. The Pearl mini-peel index ranges from 0.5 to 3%. The higher probability of conception is due to the fact that low doses of progestogens in mini-pills cannot completely suppress ovulation. The only monocomponent tablets that guarantee this effect by 96% are Charozetta (Lactinet).
• increased risk of ectopic pregnancy If ovulation and conception still occur while taking the mini-pill, the fertilized egg will not be able to implant in the uterus. Therefore, the embryo is attached to the fallopian tubes or ovaries, as a result of which an ectopic pregnancy develops.

In addition, mini-pills also have side effects, including:

• increased appetite;
• decreased libido;
• nausea, rarely - vomiting;
• headaches;
• increased sensitivity of the breast.

And the last. After the abolition of the mini-pill, a full menstrual cycle is restored within 1-3 months. At the same time, the rebound effect that combined contraceptives are famous for should not be expected.

Emergency contraception: contraceptives in haste

Along with planned contraception, every woman should remember that there is a second, emergency option of contraceptive pills. They are intended primarily for patients who rarely live sexually, as well as in unforeseen cases when, for some reason, planned contraceptive measures were not carried out.

Preparations for emergency contraception are called postcoital, used already post factum, that is, after. If sexual intercourse occurred before ovulation, high doses of birth control pill hormones ensure that it does not occur. If conception does occur, emergency contraceptives provide endometrial hypotrophy, as a result of which the embryo cannot attach to the walls of the uterus. In addition, a low concentration of progesterone guarantees the impossibility of pregnancy.

To quickly achieve the desired effect, it is necessary to administer the highest possible doses of hormones. Therefore, postcoital contraception preparations are high-dose hormonal agents that are recommended to be used as rarely as possible. The effectiveness of urgent drugs reaches 97–99%.

Medicines for emergency contraception

There are several means of postcoital contraception:

1. combined tablets.
   Conventional combined COCs at a certain concentration can provide emergency contraception. This method of contraception is called the Yuzpe method. Among the contraceptives used according to the Yuzpe method are Microgynon, Minisiston, Femoden, Regividon, Regulon and others;
2. gestagens.
   This group is represented by the contraceptive Postinor and its analogues - Microlut, Escapel and Eskinor-F;
3. antigonadotropic drugs.
   These include Danazol, which is a treatment for endometriosis;
4. antiprogesterone agents.
   A modern drug that suppresses the synthesis of progesterone - Mifepristone - is used as both an emergency contraceptive and in medical abortion.

Rules for taking postcoital contraceptive pills

There are strict rules for the use of hormonal emergency contraception, and deviation from them can lead to the most disappointing consequences.

Almost all emergency birth control pills must be taken within 72 hours of intercourse. Dosages of drugs depend on the pharmacological group.

Combined hormonal pills

At the same time take 4 tablets of both colors twice a day with an interval of 12 hours.

Gestagens

Postinor and its generics are prescribed one tablet twice a day after 12 hours.

Antigonadotropic and antiprogesterone drugs

Danazol for the purpose of emergency contraception is used at 400-600 mg twice or three times after 12 hours. An alternative regimen involves the appointment of 200 mg per day for five days in a row.

Mifepristone is used once at a dosage of 600 mg. Perhaps the appointment of 200 mg of mifepristone once a day from the 23rd to the 27th day of the cycle.

Note that according to some data, Mifepristone contributes to abortion up to a period of 5 obstetric weeks.

Emergency contraception side effects

The possible consequences of taking high-dose birth control pills cannot be overlooked.

In the vast majority of cases, taking hormonal pills for emergency contraception is accompanied by menstrual irregularities. Therefore, some experts recommend starting taking COCs to restore hormonal levels next to the “emergency” cycle.

In addition, taking high doses of estrogen is associated with nausea and even vomiting. To reduce these side effects, it is best to take the medication with or after meals. If vomiting could not be avoided, it is necessary to drink another, extraordinary dose.

Local contraceptive pills: alternative contraception

The contraceptive effect of local, that is, vaginal, contraceptives is based on the spermicidal action of the components of the drug. Most spermicides come in the form of suppositories, but pharmaceutical companies have mastered the technology for the production of both contraceptive cream and foam and, of course, vaginal tablets.

In Russia, only one spermicidal vaginal tablet is registered - Pharmatex. The active substance of the drug is an antiseptic and spermicide benzalkonium chloride. Pharmatex has a complex effect:

• spermicidal.
  The Pearl Pharmatex Index, when used correctly, is about 1%. Benzalkonium chloride contributes to the destruction of the flagella and the head of the spermatozoon;
• bactericidal.
  Pharmatex also provides protection against sexually transmitted diseases, including chlamydia, gonorrhea, trichomoniasis, HIV infection, herpes simplex virus type 2.

Rules for the use of Pharmatex

To achieve a contraceptive effect, it is necessary to strictly follow the rules for the use of Pharmatex:

• the tablet must be inserted into the vagina 10-15 minutes before sexual intercourse.
  It is this period of time that is needed for a solid tablet to break up and start working. The duration of action is about three hours. Before each subsequent sexual intercourse, it is necessary to use an additional tablet, even if the previous one has not yet expired;
• it is strictly forbidden to use soap and other alkaline detergents for the toilet of the external genitalia two hours before and after the use of birth control pills. This is due to the fact that soap contributes to the rapid and complete destruction of benzalkonium chloride.

As contraindications to the use of Pharmatex, only individual intolerance to the active substance and ulceration of the vaginal mucosa appear. In other cases, benzalkonium chloride preparations are completely safe.

Among all the contraceptive pills on the market, Pharmatex occupies a special place. If you need to consult a doctor to buy a hormonal drug, then Pharmatex tablets can be purchased at any pharmacy in the world without a prescription.

In conclusion, it is worth recognizing that the choice of birth control pills for a modern woman is great. It's a matter of small things: responsibility.

Means for the prevention of pregnancy can rightly be attributed to the oldest. After all, they were used in ancient times. For example, women of the indigenous population of America for this purpose used douching with a remedy made from lemon and a decoction of mahogany bark. In ancient Egypt, tampons soaked in honey and decoction of acacia were used. Even condoms are not a modern method of protection against unexpected pregnancy.

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

What is hormonal contraception?

The mechanism of action of contraceptive pills is based on the ability of substances that are synthetic analogues of sex hormones produced by the female body to influence the hormonal background. In this case, the brain receives a signal that there are enough hormones in the blood and the command to the ovaries to produce their own does not pass.

The hormones that enter the body, depending on the type, trigger several mechanisms at once. All of them lead to the fact that pregnancy, even with the occurrence of ovulation and fertilization of the egg, does not occur.

Estrogens help:

• The next egg does not mature in the ovaries and ovulation does not happen.
• In the uterus, there is a violation of secretory processes, due to which the development of edema of the mucous membrane - the endometrium occurs, which, in turn, makes it impossible to implant a fertilized egg.
• A process called luteolysis is launched - that is, the reverse development of the corpus luteum, which normally forms after ovulation and serves to synthesize the hormone progesterone, which prepares the body for a possible pregnancy.

• Stimulate the compaction of cervical mucus, which clogs the cervix and makes it impermeable to sperm.
• They inhibit the activity of enzymes that help the sperm enter the egg.
• They reduce the contractile activity of the fallopian tubes and the uterus itself and prevent the egg from moving along them.
• They thin the endometrium, making it unsuitable for egg implantation.
• Block the release of hormones that are responsible for ovulation in the middle of the cycle.

Regardless of the type of components and composition, all hormonal contraceptives have almost the same mechanism of action.

Application features

Any hormonal pills should be taken strictly according to the scheme, preferably at the same time of the day. You can't miss another appointment. Depending on the composition and type of the drug, in case of omission, the contraceptive effect will last on average only up to 12 hours. After this time, the effectiveness of the drug decreases.

The start of taking most COCs coincides with the first day of the cycle. At the same time, you can choose the most convenient time for you. Most women prefer to take birth control pills in the evening, before bed. In this case, negative effects such as nausea, headache or mood changes are not so pronounced.

All hormonal birth control pills are prescription drugs and are used only on prescription. Before you start drinking the drug, carefully read the instructions and rules for taking.

Advantages

Of course, the main advantage of COC contraception using both monophasic and multiphasic drugs is the simplicity of the method itself. Agree, taking a pill is much easier than, for example, using a vaginal ring. And with such means as injectable contraception or intrauterine devices, which can not be used without a doctor, there is no comparison at all.

However, this is far from the only plus, the undoubted advantages of hormonal contraception are:

• High efficiency, even for three-phase preparations, the reliability index does not exceed 0.6%. In other words, out of one thousand women using this method of protection for one year, pregnancy occurred in only one case.
• Security. Despite the fact that all birth control pills interfere with the hormonal background, their effect is much more harmless than the consequences that abortion is dangerous for.
• Normalization of the menstrual cycle, which becomes regular while taking the pills, and the menstruation itself is not so painful, long and plentiful.
• Due to the improvement of the barrier properties of cervical mucus, the incidence of inflammatory diseases or exacerbation of chronic pathologies is almost halved.
• The use of hormonal contraceptives during the year reduces the risk of endometrial cancer by 50%, ovarian cancer by 30%, and the risk of developing mastopathy is reduced by 70%.

disadvantages

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

• They do not protect against sexually transmitted infections, including dangerous ones such as HIV or cytomegalovirus.
• They affect the blood coagulation system and can increase the risk of blood clots and the development of thromboembolism.
• They can aggravate the course of chronic diseases of the liver and gallbladder or provoke the occurrence of cardiovascular pathologies, disorders in the circulatory system, as well as severe headaches and migraines.

Types of COCs

The whole variety of birth control pills can be divided into two main groups. The first includes drugs containing only gestagens, their other name is mini-pills. The second group is combined contraceptives, which contain several hormones.

Usually these are synthetic analogues of estrogens and progesterone. It is this group that is most popular and is prescribed by doctors most often. Combined drugs are also divided into three types.

Monophasic

They are the first generation of drugs intended for hormonal contraception. They contain two hormones: estrogen and progesterone, which are contained in each tablet in the same amount. The most famous of this group are Janine, Yarina or Diane-35.

Despite the fact that this generation of drugs is not new and has been around for a long time, in terms of their effectiveness they are practically in no way inferior to multi-phase drugs.

The advantage of monophasic contraceptives can be considered ease of use and the possibility of doubling the dose in case you forget to take another pill. But with multi-phase agents, this is not always possible, and their use requires more caution and attention.

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

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

Two-phase

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

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

Three-phase

This group of drugs differs in that the tablets intended for different days of the cycle contain their own, specific dose of hormones. Such a change in the concentration of estrogens and gestagens is as close as possible to those hormonal fluctuations that occur in a woman's body. Due to this, three-phase contraceptives are considered the most physiological.

Typically, this group of drugs is prescribed to women over 35 or under 18, as well as smokers or obese. Such drugs include, for example, Tri-regol, Triziston or Tri-merci.

The main positive quality of this group of drugs is to reduce the risk of side effects from progestins. The main disadvantage is higher, compared with monophasic drugs, the incidence of bleeding between periods. A more complex regimen and not always possible to double the dose in case of missing the next pill.

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

The Pearl index for monophasic preparations is 0.15–0.18, while for three-phase preparations, depending on the characteristics of the composition, the values ​​can range from 0.19 to 0.68.

Criterias of choice

If before this experience of taking hormonal contraceptives a woman did not have, then usually the doctor prefers monophasic preparations containing minimal doses of hormones. But only after receiving the results of all necessary tests. Such as: smear for cytology, hormone analysis, general and biochemical blood tests, ultrasound of the pelvic organs. In some cases, an additional consultation with a mammologist may be necessary. In addition, the doctor must take into account the peculiarities of the menstrual cycle and the phenotype of the woman.

It is simply impossible to choose the right drug without consulting specialists and a series of tests. You should not buy hormonal contraceptives on your own, this can harm your health.

To date, combined oral contraceptives are considered one of the most reliable methods of protection against pregnancy. However, from a woman they require a careful attitude to their condition and strict adherence to the regimen.

Reading time: 12 min.

Today, any pharmacy can boast the widest range of contraceptives, including combined oral contraceptives. Properly selected pills will help not only to avoid unwanted pregnancy, but also to prevent or cure many gynecological diseases. We offer for consideration the best contraceptive pills in the TOP-15 rating.

Oral contraceptive "Belara" reduces the secretion of follicle-stimulating hormone, inhibits ovulation, transforms the secretory ball and reduces the risk of sperm entering the uterus. In addition to the contraceptive effect, "Belara" also helps to normalize the menstrual cycle and reduce the risk of gynecological diseases, has a positive cosmetic and health-improving effect on the female body. The drug has established itself as a high-quality and reliable contraceptive, but it has a fairly extensive list of contraindications.

The combined drug Silest has a contraceptive effect on the female body, inhibiting ovulation in the ovaries and immobilizing spermatozoa in the cervix. In addition to contraceptive properties, Silest has the ability to normalize the menstrual cycle, reduce pain and reduce blood loss during menstruation. The drug is very reliable, but, unfortunately, not suitable for everyone. With the correct appointment and observance of the regimen, Silest does not cause side effects.

The contraceptive drug "Femoden" suppresses ovulation and increases the density of cervical mucus. Doctors usually prescribe this drug to women with an unstable menstrual cycle or heavy menstrual blood loss. During the period of taking the medication, the regularity of menstruation is observed, their pain decreases, the discharge is reduced, which significantly reduces the risk of iron deficiency anemia.

The popular contraceptive drug "Mikroginon" is equally effective for mature and nulliparous women aged 15 to 45 years. The contraceptive effect of the drug is based on the suppression of ovulation and the thickening of cervical mucus, which makes it difficult for sperm to enter the uterine cavity. "Microgynon" helps to improve skin condition, stabilize the menstrual cycle, reduce blood loss during menstruation, and eliminate pain. With prolonged use of the drug, the risk of ectopic pregnancy, oncological pathologies of the ovaries and endometrium, inflammation of the pelvic organs, and benign neoplasms of the mammary gland is reduced.

The contraceptive effect of "Jess" is achieved by inhibiting ovulation and immobilizing spermatozoa in the cervix. The drug also helps to normalize the menstrual cycle, minimize pain and blood loss during menstruation, and alleviate the symptoms of PMS. According to statistics, "Jess" reduces the risk of oncological pathologies of the female reproductive organs. In taking the drug, the skin becomes healthier, the hair becomes less greasy, the number of acne rashes is significantly reduced. Due to the minimum content of hormones, side effects from the use of the drug appear only in exceptional cases. "Jess" is easily tolerated, does not harm the gastrointestinal tract, does not block the removal of fluid from the body.

At the heart of the contraceptive effect of the drug "Trikvilar" is the work of complementary mechanisms, consisting of the suppression of ovulation and the increase in the density of cervical mucus. The drug has a positive effect on the stabilization of the menstrual cycle, reduces the intensity of bleeding and reduces pain, prevents the symptoms of iron deficiency anemia, reduces the risk of developing oncological pathologies of the ovaries and endometrium. "Trikvilar" is ideal for women who are used to planning their lives, does not fail, but requires strict adherence to the admission schedule.

The effective contraceptive drug "Regulon" acts by inhibiting the work of the pituitary gland, hindering ovulation and increasing the density of cervical mucus. Since the influence of Regulon is softer than that of most other similar drugs, doctors often recommend it to young girls as their first oral contraceptive. It is reliable and does not lead to weight gain with prolonged use. The drug is prescribed for contraception or the treatment of menstrual disorders: dysmenorrhea, PMS, dysfunctional uterine bleeding. In women taking Regulon, the appearance of the skin, hair and nails improves.

The result of the action of the drug "Novinet" is the blocking of ovulation, changes in the endometrium and thickening of the cervical mucus, preventing fertilization. The drug has other medicinal properties, among which it should be noted: stabilization of the menstrual cycle, reduction of blood loss during menstruation, prevention of inflammatory processes in the pelvic organs, reduction of the risk of ectopic pregnancy, counteraction to the occurrence of neoplasms in the ovaries, endometrium and mammary glands. Long-term use of the drug "Novinet" has a positive effect on the general condition of the skin of a woman.

"Klaira" is a multi-phase contraceptive drug, whose effectiveness is achieved through the inhibition of ovulation, the increase in the density of cervical mucus and the creation of obstacles to the implantation of a fertilized egg. Refers to natural oral contraceptives. In addition to the contraceptive effect, the drug has the properties to reduce the intensity and duration of menstrual flow, to alleviate the manifestations of PMS and pain during menstruation. Taking "Klayra" reduces the risk of developing certain gynecological diseases, reduces excessive vegetation in hypertrichosis, and helps to endure the manifestations of menopause.

The contraceptive drug "Yarina" prevents unwanted pregnancy by putting pressure on the process of ovulation, inhibiting the maturation of follicles and making it difficult for sperm to enter the uterus. Thanks to the regular use of contraceptives, women develop a clear and regular menstrual cycle, pain is reduced and the amount of menstrual flow is noticeably reduced. Since the contraceptive has a significant cosmetic effect, it is often prescribed to women with acne or seborrhea. Taking "Yarina" does not affect the weight of a woman, but it improves mood and increases libido.

An effective contraceptive "Marvelon", due to the low content of hormones, is suitable for women of any reproductive age. The high level of guarantee of protection (99%) makes the drug indispensable for the fair sex, who live an active sexual life. "Marvelon" eliminates menstrual problems, helps to cope with PMS, has a positive effect on the skin of the face, reduces vegetation in unwanted places and normalizes the level of hormones in the body. Long-term use of the drug contributes to the prevention of gynecological diseases.

The effective action of the contraceptive is based on three important mechanisms: the suppression of ovulation at the level of the pituitary gland, an increase in the viscosity of mucus in the cervical canal, and a change in the endometrium that prevents the implantation of a fertilized egg. In women taking "Janine", there is an adjustment of the menstrual cycle, less painful menstruation, a decrease in the intensity of bleeding, and a decrease in the risk of iron deficiency anemia. With prolonged use of "Janine", the condition of the skin and hair improves markedly. The active substances of the drug help to reduce the number and volume of the sebaceous glands, which allows the use of "Janine" for the treatment of acne.

The contraceptive effect of the drug "Logest" is achieved by changing the cervical mucus and suppressing ovulation. The amount of hormones in the preparation is minimized, which allows you to achieve a good result without tangible harm to the body. With prolonged use, the drug is able to: normalize the menstrual cycle, reduce pain, reduce spotting, prevent iron deficiency anemia, minimize the likelihood of developing ovarian cancer and benign breast diseases, prevent inflammation of the organs of the reproductive system, prevent ectopic pregnancy and the formation of ovarian cysts.

A very effective contraceptive drug with good tolerance. The drug is one of the few suitable for use by adolescents. "Three-regol" not only prevents unwanted pregnancy, but also has a beneficial effect on the health and appearance of a woman. Long-term use of "Three-Regol" will help bring a woman's health in order if she has problems in the form of: an irregular menstrual cycle, greasy, acne-prone skin and spotting caused by menopause. The drug will help the formation of the cycle, cleanse the skin, reduce the risk of inflammatory processes and diseases in the pelvic organs, help prevent the formation and development of oncological formations in the uterus and ovaries. The drug is often prescribed for certain gynecological problems and diseases. They can be: dysmenorrhea, oligomenorrhea, non-systematic menstruation, profuse blood loss during menstruation, hormonal dysfunction.

Microdosed hormonal contraceptive with an almost 100% guarantee of effectiveness. Mercilion prevents unwanted pregnancy by inhibiting ovulation and increasing the viscosity of the cervical mucosa. In addition to preventing fertilization, the drug also helps to improve the condition and appearance of the skin, removes acne and acne, stabilizes the menstrual cycle, reduces the risk of anemia, prevents certain types of gynecological diseases, and prevents the development of malignant and benign formations of the female reproductive organs.

Today, every couple can plan for the birth of children and control their sex life thanks to the merits of the pharmaceutical industry. A huge selection of contraceptives allows you to choose the appropriate method of protection against pregnancy and / or sexually transmitted infections.

Overview of some contraceptives

The list of means and methods of protection is estimated at a dozen positions or more. This is the calendar method, and the use of spermicides (the so-called non-hormonal pills and suppositories), and common condoms, and hormonal patches, rings, and the intrauterine device, and injections, and patches, and oral contraceptives. More about each method, and especially birth control pills, - below.

Coitus interruptus

The most unreliable options for contraception are coitus interruptus and the calendar method. PPA is generally difficult to call a method of contraception. The essence of the method is to remove the penis before ejaculation.

In 60% of couples who are protected by PPA, pregnancy occurs in the first year of using the method. Yes, and according to statistics, 80% of women who became pregnant "accidentally" were protected precisely by interrupted intercourse. The problem is that not all men feel the onset of ejaculation. One "wrong" move, and the likelihood of getting pregnant increases significantly.

calendar method

The method is slightly more efficient than the previous one - 65%. There are 10-15 pregnancies per 100 women who take the risk of contraception in this way. This method becomes more relevant after 30 than for young girls. Only girls and women with a regular menstrual cycle can afford to be protected in this way.

The essence of the method is to calculate the so-called dangerous days on the calendar and not have sex during this period. In general, from the 16th day until the expected start of the next menstruation, the probability of conception is greatest. The most dangerous days fall in the middle of the cycle - from the 12th to the 18th day of the cycle (with a 28-day cycle).

Cons: errors, an irregular cycle, in which it is almost impossible to accurately calculate the day of ovulation, hormonal disruptions. There are other nuances - if sexual intercourse occurred a few days before the expected ovulation, spermatozoa can live in the genital tract for several days and fertilize the egg even after such a seemingly long time. To increase the reliability of this method of contraception, you need to learn how to correctly calculate dangerous days. In addition to the calendar method, you can use ovulation test strips or follow the charts of basal temperature.

Spermicides and non-hormonal pills

Another not very effective method (70% reliability) is spermicides. These are special substances that are introduced into the vagina and have a negative effect on spermatozoa, after which they can no longer fertilize the female egg. Drugs with a similar mechanism of action are sold in pharmacies in the form of suppositories, creams, capsules or tablets, which are injected directly inside before sex.

Such non-hormonal (which is better to choose, reviews of different types - below) are used by many women who, for one reason or another, are afraid to take conventional OK (oral contraceptives). Such non-hormonal tablets are recommended for use in premenopausal women, patients with endocrine system dysfunction, individual sensitivity and an adverse reaction to conventional OK. Importantly, these can be used for HB (breastfeeding).

How to choose non-hormonal contraceptives? The rating of the best is presented by such tablets:

1. Pharmatex. Available in the form of tablets, cream and suppositories. The average price of a pack of 12 tablets is 250 rubles.
2. "Gynekoteks". The same form of release, the price is 100 rubles for the same 12 tablets.
3. Benatex. The cost of 10 tablets is 250-300 rubles.
4. "Erotex". Price 5 pcs. - 110 rubles.
5. "Contratex".

How to choose tablets? It is advisable to consult a doctor, otherwise it is worth focusing on personal feelings when using. Some pills, for example, cause itching in some women, which disappears when switching to another brand of drugs.

Barrier contraception

Barrier methods protect not only from conception and unwanted pregnancy, but also from sexually transmitted infections. But the reliability of such means is not 100% (moreover, not a single contraceptive is 100% reliable, except for complete abstinence from any kind of sexual contact), but is only about 85%. Barrier methods include the use of condoms, but they can also break, and then all efforts will go in vain, and lubricate the sensations of sexual intercourse.

Hormonal patches and ring

Other non-invasive methods include patches and a hormone ring. The effectiveness of such funds reaches 92%. The patch adheres to the skin, but is noticeable, requires regular replacement, and is not suitable for use by women over 90 kg. The ring is inserted into the vagina, but also has disadvantages: in some cases, it can cause a change in the nature of menstrual bleeding and disrupt the regularity of menstruation. These methods do not have contraceptive side effects such as treating acne, relieving PMS symptoms, or preventing seborrhea.

Implants and injections

Hormonal implants and injections are essentially the same oral contraceptives, that is, birth control pills, only with a different mechanism of action. If substances from tablets are absorbed through the digestive tract, then injectable contraceptives are administered intramuscularly. The frequency of injections is once a month or every three months. Implants are inserted into the shoulder and require replacement only once every five years. The effectiveness of the methods is 90-99%.

Such contraception, however, can cause migraines, changes in the menstrual cycle, hormonal disruptions, decreased sex drive or weight gain. Injections and implants are generally not used by young women who have not yet given birth, this method of contraception is more suitable for women in their thirties and forties who do not plan to have a child in the near future.

Intrauterine device

The second most effective method of contraception after birth control pills is the intrauterine device. The method also refers to the barrier, only the spiral is installed in the uterine cavity, preventing the embryo from fixing. But the installation of a spiral can cause a change in the nature of menstruation, sometimes causes pain, increases the risk of developing various inflammations and the onset of an ectopic pregnancy.

Oral contraceptives

Oral contraceptives protect against unwanted pregnancy, but not against sexually transmitted diseases. The latest birth control pills have an additional effect: many drugs contain the active form of folic acid, so they alleviate the symptoms of PMS, have an antidepressant effect, help fight acne, improve skin and hair. The reliability of OK is 99.7%, but this method of contraception requires prior consultation with a gynecologist, the care and organization of a woman when taking it. It is about this method of planned contraception that will be discussed further.

Classification of OK according to the content of hormones

All are divided into 2 large groups: combined oral contraceptives (COCs) and mini-pills. COCs contain an estrogen analogue and a progestogen. The mechanism of action of such pills is that they block the onset of ovulation (the maturation of the egg and its readiness for conception), make the implantation of the egg into the uterine cavity impossible due to "glandular regression" and thicken the mucus, which disrupts the advancement of spermatozoa to the female reproductive cell.

COCs are divided into groups according to the variation of hormones and their content. So, there are monophasic, two- and three-phase tablets (more on them later), as well as microdosed, low-dosed and high-dosed COCs. Microdosed OK are suitable for young girls, since the content of active substances in tablets is minimal. The rating of contraceptive pills of this type is presented as follows:

1. "Jess".
2. Marvelon.
3. "Klayra" (the only three-phase tablets in the list of microdosed).
4. "Dimia".
5. "Zoeli".
6. "Logest".
7. Mercilon.
8. "Lindinette".
9. "News".

Low-dose OCs are suitable for both young and older women, and can be used by those patients who experience intermenstrual bleeding when using microdose tablets. Such birth control pills are suitable for women who have given birth. In addition, low-dose OCs prevent hair growth in unwanted places, eliminate increased oily skin and acne, and reduce the manifestations of seborrhea.

1. "Yarina.
2. Tablets "Janine".
3. "Silhouette".
4. "Diana".
5. Tablets "Femoden".
6. "Three-merci".
7. "Lindinette".
8. Tablets "Silest".
9. "Minisiston" and others.

High-dose OK can be taken only on the recommendation of a gynecologist. Such drugs are used, as a rule, for therapeutic purposes (for the treatment of endometriosis, hormonal disorders and other diseases). In the ranking of contraceptive pills with a high concentration of hormones, such OK:

1. "Non-Ovlon".
2. "Trikivlar".
3. "Ovidon".
4. "Trieseston".
5. "Three-Regol".

Another type of contraceptive - mini-pill - contains only progestogen. Mini-pills affect the reproductive system only at the local level:

• increase the viscosity and amount of cervical mucus, which interferes with the free movement of spermatozoa;
• change the biochemical and morphological structure of the uterine endometrium, which makes it impossible to fix the embryo even in the case of fertilization.

Mini-pills completely block ovulation in only half of women, but this does not affect the reliability of pills as a method of protection.

1. "Charozetta" (800 rubles per pack).
2. "Laktinet" (530 rubles).
3. "Orgametril" (1100 rubles).
4. "Exluton" (1250 rubles).

There is also emergency contraception, which is used if unprotected sex has occurred, which can lead to pregnancy. These birth control pills are taken within 72 hours after sex. A common example of this type of OK is Postinor. You need to take birth control pills within 72 hours after having sex, otherwise there will be no effect from emergency contraception. You can not use such drugs constantly.

Monophasic, two- and three-phase preparations

COCs also differ in the variation in the content of hormones, dividing into monophasic, two- and three-phase. In monophasic tablets, the percentage of substances does not change in each tablet, in two-phase tablets, the ratio of active components changes in the first and second halves of the cycle, in three-phase tablets, the percentage of substances changes three times per package.

Monophasic birth control pills:

• "Regulon";
• "Rigevidon";
• "Janine";
• "Silhouette";
• "Lindinet";
• "Logest";
• "Femoden";
• "Microgynon" and others.

Biphasic OK:

• "Femoston";
• "Binovum";
• "Bifazil";
• "Adepal";
• "Anteovin" and others.

Three-phase drugs are represented by Tri-Merci, Triziston, Tri-Regol and others.

How to choose the right birth control pills

You cannot choose birth control pills on your own or even with the help of a pharmacist in a pharmacy. To find the right contraceptive, you need to go to the doctor. The gynecologist will interview the patient, find out if there are any diseases (whether they were in the past) and which ones, and will conduct an examination. During the examination, the gynecologist will measure the patient's weight, blood pressure, assess the condition of the skin, palpate the breasts and prescribe tests. You may also need to visit an ophthalmologist, as long-term use of OCs increases the risk of various eye diseases.

The pills that are best for the patient, the doctor chooses depending on the phenotype. The phenotype takes into account the growth and appearance of a woman, the mammary glands, the degree of hair growth, the condition of the skin, hair, existing chronic diseases, the nature and frequency of menstruation, the presence and severity of PMS, and so on.

There are three main phenotypes:

1. Women of short or medium stature, whose skin and hair are prone to dryness. Menstruation is profuse and long, the cycle is more than 28 days. Such patients are suitable for medium and high-dose COCs, for example, "Milvane", "Trisiston", "Femoden" and others.
2. Women of average height, with normal oily hair and skin, with medium-sized breasts. There are no symptoms of PMS in this type of women or they do not cause negative, painful sensations. The menstrual cycle is standard - 5 days, every 28 days. Suitable tablets are Marvelon, Regulon, Tri-Merci, Silest, Logest, Tri-Regol and others (most COCs on the market).
3. Women who are tall, underdeveloped mammary glands, oily hair and skin. Menstruation is frequent and painful, but scanty, PMS symptoms are often severe. The tablets "Yarina", "Jess", "Zoeli", "Dimia" are suitable.

Rating of oral contraceptives

Oral contraceptives are too diverse to form an overall rating. But still, the recommendations of gynecologists and patient reviews allow us to highlight some of the best COCs of the new generation. The rating of contraceptive pills is represented by such drugs:

1. "Jess". They not only perform a direct function, that is, they protect against unwanted pregnancy, but also treat a number of gynecological diseases, hormone dependence, improve the condition of the skin and hair, reduce the manifestations of PMS and relieve painful periods. How to drink birth control pills "Jess"? According to the instructions, you need to start taking the first day of menstruation, pink pills should be taken every day, and on the 28th day - take white (placebo). After the end of the cycle, start the next pack.
2. Jess Plus. The same "Jess", only the composition also includes an active form of folic acid, which normalizes the psycho-emotional state and avoids unpleasant consequences if pregnancy does occur: the body will be ready to bear a child, despite taking pills. If the patient decides to stop taking OCs in order to become pregnant, planning can begin as early as the next cycle after stopping. In addition, Jess Plus is a birth control pill that does not make you fat. The latter is confirmed by the responses of patients.
3. Tablets "Janine". According to the girls and women who took Janine, this drug somewhat reduces sexual desire, but is reliable. In addition, "Janine" is a contraceptive pill that does not make you fat, which has been proven by many reviews.
4. Marvelon. OK are recommended for use by women after 25-35 years of age who are of childbearing age, but have already given birth. The content of hormones is minimal, but the tablets are suitable for patients who are sexually active. Like other OK, "Marvelon" improves the appearance, condition of the skin and hair, normalizes hormonal balance and reduces hair growth in unwanted places.
5. "Regulon", instructions for use, price, reviews of which are of interest to many women, costs about 1150 rubles (63 tab.). Tablets should be taken daily, from the first to the twenty-first day of the cycle. This is followed by a seven-day break. After a break, you need to start taking it again, even if your period has not stopped yet, the drug "Regulon". Instructions for use, price, reviews should be studied before buying. The opinions of the patients are contradictory: some women became irritable and gained weight, noted a significant deterioration in well-being and a menstrual cycle failure, others were completely satisfied with the drug, while others did not suit them.
6. Depo Provera. Tablets are recommended for women after forty years of age, can be used in the treatment of various kinds of gynecological diseases. There are injections - doctors say that Depo-Provera is much more effective than in the form of tablets.
7. Pharmatex. This is a non-hormonal contraceptive that is inserted directly into the vagina in the form of suppositories. It is recommended to apply "Pharmateks" to women from 45 years old, leading an active sex life.
8. "Yarina". The drug is low-dose and has an anti-adrogenic effect. Some patients claim that they managed to get pregnant while taking Yarina strictly according to the instructions. How to take contraceptive pills "Yarina"? You need to drink OK every day, starting from the 1st day of the cycle, in the order indicated on the blister.
9. "Lactinet" is not a combined remedy, but a mini-pills, which have a number of contraindications, so a doctor's consultation is a must before you start taking it. The tablets are suitable for women over 45 years of age, patients with diabetes, varicose veins, smokers, breastfeeding.
10. Contraceptive pills "Silhouette". Many patients note a visible improvement in the appearance of the skin and hair, stabilization of the menstrual cycle, reduction of pain during menstruation and symptoms of PMS. But birth control pills "Silhouette" can cause weight gain - about half of women complain of such a side effect.

Side effects of taking a contraceptive

Reliable, safe (if you consult a gynecologist before taking) and a convenient method of contraception - birth control pills. Side effects, however, also exist. Among them:

• nausea;
• lack of menstruation;
• lack of appetite;
• weight gain;
• uncharacteristic discharge between periods;
• dizziness, headaches;
• decreased libido;
• swelling of the legs;
• pain in the chest.

In case of side effects, birth control pills are canceled.

Contraindications for admission

Contraindications to taking OK can include:

• hypertension;
• kidney pathology;
• pregnancy;
• serious diseases of the cardiovascular system;
• migraines of unknown origin;
• preparation for surgery;
• overweight (more than 30%);
• smoking after 35 years (for some tablets, this fact is not a contraindication - a mandatory consultation with a doctor is needed);
• diabetes mellitus (you can use some OK) and so on.

Whether to take birth control pills is a personal choice for every woman. This is a reliable method of contraception, which is convenient to use for those who have an active sex life. At the same time, there are a number of side effects that occur if you choose the wrong remedy. So, the main thing to be guided by when choosing and taking birth control pills is the recommendations of a gynecologist.

Pregnancy after thirty-five years is often undesirable, and according to statistics, in half of the cases it is artificially interrupted. Abortion is dangerous for women's health, so it is important to choose a reliable way to prevent conception. The most effective method is considered to be oral contraception. The choice of contraceptive pills after 35 years should be approached especially carefully. Not all drugs are suitable for protection at this age, a number of drugs have contraindications. How to choose the right pills? What other methods can be used? Every woman who cares about her health should know about this.

The specialist will help with the choice of the drug on an individual basis.

Pharmacies offer a huge number of varieties of pills that protect against conception. It is easy to get confused in such a variety. The first thing to remember is that drugs are divided into two large groups:

• combined (COC);
• mini-drank.

What is the difference between these types of pills? They differ in content and principle of operation. Each type is suitable for a certain age group, has its own contraindications. Naturally, comprehensive information on drugs can only be obtained from a specialist: prepare questions of interest to your gynecologist.

COC: types and principle of operation

COCs contain synthetic analogues of progestogen and estrogen. Preparations are divided into phase groups according to the variation of hormone-containing components:

• Monophasic. The content of the two hormones per package does not change.
• Two-phase. The amount of estrogen in each pill is the same, but the amount of progestogen varies in cycles.
• Three-phase. The package contains tablets with different content of hormones. The dose per cycle is changed three times.

There is another classification of COCs: according to the quantitative indicator of active substances. There are three types of oral hormonal contraceptives:

How do COCs “work”? The mechanism is simple: they block ovulation by inhibiting luteinizing and follicle-stimulating hormones. There is also a blockage of the main function of the ovaries, the uterine mucosa changes, the mucus of the cervical canal thickens. Combined contraceptives "work" on all fronts. Thanks to the pills, the path of spermatozoa becomes more difficult, and implantation becomes impossible. This principle of action is the key to the 100% effectiveness of the tablets (of course, if the regimen is not violated).

What are mini pills

The main difference between mini-pill and COCs is the content of only one hormone. The active ingredient in monocomponent tablets is progestogen. Mini-pills do not affect the entire reproductive system, but certain areas of it. Under the influence of tablets, the structure of the endometrium changes. It becomes loose, which reduces the possibility of implantation to zero. Changes also apply to the cervical fluid. By the middle of the cycle, there is a noticeable decrease in the volume of mucus, its viscosity remains the same in all phases. The high viscosity of the cervical fluid is necessary to create unsuitable conditions for the movement of spermatozoa. Mini-pills can also block ovulation, but blocking occurs only half the time. At the same time, pills are considered effective, because even in the presence of ovulation, implantation is impossible due to various changes in the body.

Mini-pills are popular among women who have recently given birth to babies. The advantages of drugs include their compatibility with lactation. Mini-pills give a woman who has recently become a mother the confidence that a new pregnancy will not occur until the body recovers. Not only lactating women can take mini-pills: the gynecologist attributes such contraceptives if there are contraindications for taking COCs.

Tablets for the age group "35+"

From the age of 35, the reproductive system of women begins to gradually fade away. The production of two important hormones, estrogen and progesterone, by the ovaries decreases. After this milestone, chronic diseases worsen, the risk of thrombosis increases, and the likelihood of heart problems increases. In order not to harm your own health, you need to responsibly approach the choice of contraceptives. It is important that pills aimed at preventing conception are:

Preference should be given to the latest generation of drugs. Their advanced formula minimizes the likelihood of side effects. Such pills provide maximum protection against unplanned pregnancy, which is especially important after 35.

As for the dosage of hormones in preparations, women of this age group are recommended to drink low-dose COCs. The fewer hormones the tablets contain, the higher their tolerability, which is important if the processes of extinction of the reproductive system are running. The minimum dose of hormones after 35 - 20 mcg. So much is contained in microdosed COCs, but they are rarely prescribed, because they are suitable for the protection of young girls. Usually, microdosed tablets are turned to if a woman after 35 is unable for some reason to choose a drug from the group of low-dose COCs.

Preparations with a high content of hormones can be taken only as prescribed by a doctor. Women of the age category "35+" are often prescribed them. At this age, diseases of the reproductive system make themselves felt, hormones are "loose". Birth control helps to cope with such problems.

Features of the selection of hormonal contraceptives

The selection of contraceptive pills should be done by a doctor. The appointment of drugs is preceded by a history taking and various tests. Only in this way can a gynecologist determine which pills will not only be effective, but also safe. For the appointment of contraceptives, the decisive ones are:

• blood sugar analysis;
• study of liver enzymes;
• assessment of blood fluid clotting;
• study of the hormonal background;
• oncocytology;
• examination of the mammary glands and small pelvis by ultrasound.

The determining factor is the presence of any chronic diseases. For some diseases (for example, problems with the liver, heart), hormonal pills are prohibited, while for others (endocrine diseases), on the contrary, such drugs are necessary.

If you choose contraceptives on your own, the consequences can be sad. A woman cannot objectively assess the state of her body, hence a number of side effects: from a sharp weight gain to diseases caused by hormonal imbalance.

The significance of the phenotype in the selection of tablets

Not only the results of the tests are decisive when prescribing tablets. The selection of hormonal contraceptives is always carried out taking into account the constitutional-biological type of the patient. Here the decisive ones are:

According to constitutional and biological features, three groups of women are distinguished. When prescribing contraceptives, the doctor must take into account the patient's belonging to a certain group. The following phenotypes are distinguished:

1. estrogen dominance.
   Signs: Medium/short stature. Dry skin. Hair suffers from dryness. Feminine look. Prolonged menstruation, accompanied by significant discharge. The cycle consists of more than 4 weeks. Tablets: Low and high doses.
2. Balanced.
   Features: Average height. The chest is medium, well developed. Good condition of skin and hair. Absence of premenstrual phenomena. Menstruation occurs exactly four weeks later, lasts five days. Tablets: COC second generation.
3. Androgens / gestagens prevail.
   Signs: Tall. "Male" facial features. Underdeveloped chest. Problematic skin and oily hair. Short cycle with scanty menses. In the premenstrual period, there are severe pains in the lower abdomen. Tablets: Containing an antiandrogenic component.

Some women mistakenly believe that, having determined their own phenotype, they can choose birth control pills for themselves. This approach to choosing hormonal contraceptives can lead to health problems. The gynecologist approaches the issue in a complex way: takes into account the phenotype, anamnesis, test results.

When hormonal contraceptives are prohibited

Oral contraceptives, although considered the most reliable protective method against unwanted conception, are not suitable for everyone. If by the age of 35 a woman has not quit smoking, then she is strictly forbidden to take hormonal contraceptives. Nicotine, combined with hormonal fluctuations, increases the risk of thrombosis. After thirty-five, the risks of developing heart pathologies increase, which can be facilitated by heavy smoking against the background of a course of contraceptives.

Reception of hormone-containing pills is prohibited in the presence of:

Taking hormone-containing contraceptives should be stopped a month before the proposed surgical intervention. Antibiotics reduce the effectiveness of contraceptives: due to changes in the intestinal flora that occur while taking antibiotics, hormones are absorbed worse.

Contraceptive injections

Everyone knows that hormonal contraceptives are recognized as the most effective. However, many women are confused by the need to take pills every day, following a time schedule. If you do not follow the instructions, then the guarantees are nullified. Modern women after 35 years of age are burdened with caring for the family, building a career and engaging in self-development. In such a rhythm, it is easy to forget about taking the next pill. For these reasons, many active ladies choose contraceptive injections.

The action of injections is based on the same principle as oral agents. Injections are also related to hormonal protection. After injections, ovulatory processes are suppressed, the cervix thickens, which eliminates the risk of conception. Compared to birth control pills, injections have a number of advantages:

• ease of use (an injection is given once every three months);
• high degree of protection due to the exclusion of force majeure;
• can be used for some female diseases (endometriosis, myoma);
• have virtually no side effects.

Only a doctor can prescribe injections, he also makes injections. This method of protection is often recommended for use after 35. It is suitable for women who have cardiovascular problems.

After injections, the menstrual cycle is almost always disturbed. At the end of adaptation, it returns to normal, but for a long time this method of protection should not be used, otherwise the period of menstruation will increase. Often after injections, weight gain is observed: in order not to get better, you will have to change your eating habits.

When choosing an injectable method of contraception, one should not forget to visit the gynecological office every six months. It is also important to regularly do oncocytology, pelvic ultrasound, and be examined by a mammologist.

Non-hormonal pills

After a certain age, it is necessary to more carefully select means of protection.

After the age of 35, women often experience health problems. They make taking contraceptives with synthetic hormones impossible. However, it is important for "age" ladies to provide themselves with reliable protection against conception, because pregnancy during this period is associated with numerous risks, and abortion can lead to irreversible consequences. New generation non-hormonal pills will come to the rescue. They belong to the group of spermicides. These tablets are intended for insertion into the vagina. This also includes gels, tampons, creams, but tablet preparations are considered the most effective.

The main component of the pills are chemical compounds that have a negative effect on spermatozoa. The active substances damage the membrane of spermatozoa, which leads to their death. Non-hormonal contraceptives thicken the mucus in the uterine canal, which prevents sperm from reaching the target. If especially active spermatozoa manage to break through the viscous liquid, they become so lethargic that fertilization is impossible.

New generation spermicides have additional protective properties. Vaginal contraceptive pills create a film on the mucous membrane through which the fungus, as well as some bacteria, cannot break through. Non-hormonal contraception is recommended to be used in tandem with barrier means of protection to eliminate the possibility of unplanned conception.

Who are vaginal tablets suitable for?

Although vaginal birth control pills do not contain hormones, however, their use must be agreed with your personal gynecologist. The components of the drug can cause allergies, so it is important to first make sure that this method of contraception is suitable in a particular case. If vaginal tablets are chosen incorrectly, itching, irritation, and allergic reactions may occur. The use of vaginal tablets to prevent pregnancy is indicated for:

• some gynecological diseases (myoma);
• diabetes mellitus;
• contraindications to taking hormonal drugs;
• allergic reactions to latex;
• the onset of the premenopausal period.

The choice of remedy depends on the frequency of sexual intercourse

This method of contraception can be used at any age. It is best suited for women who rarely have sex. If sexual life is regular, then for protection it is better to choose hormonal contraceptives. The use of vaginal tablets with frequent sexual intercourse can result in the development of dysbacteriosis.

In order for spermicides to "work" effectively, it is important to use them according to the instructions. Intimate life will have to be planned: the tablet must be administered immediately before contact. For a certain time (for each drug, the time is specified in the instructions) it is impossible to carry out water procedures.

Can I use emergency contraception?

There are times when protection is needed after the fact. Unprotected sex, a torn condom, missing birth control pills - all these factors make a woman look for post-coital methods of contraception.

There are emergency pills. They are taken after sexual intercourse, if the risks of untimely pregnancy are high. The action of emergency contraceptive drugs is aimed at inhibiting ovulatory processes, changing the endometrium, rejection of the fetal egg. Postcoital pills contain a huge dose of hormones, so they are strictly forbidden to be considered as a regular contraceptive method. The use of emergency drugs is permissible no more than twice a year.

If until the age of 35 a woman can occasionally turn to emergency contraception, then after this age limit she should forget about this method. A high dose of hormones in postcoital tablets is dangerous for the possibility of thrombosis, which leads to a stroke and even death. After the age of 35, the likelihood of blood clots increases significantly. These pills are especially dangerous for women who smoke. With the disappearance of the use of emergency contraception, you need to reconsider your approach to contraception. With age, it is important to choose the most reliable means, consulting about each with your gynecologist.

Intrauterine devices after 35

Among the popular methods of contraception in women who have crossed the 35-year mark is the spiral. It is inserted into the uterine cavity. The plate acts on the epithelium, prevents implantation from occurring. In the presence of a spiral in the uterine cavity, foam is formed, which prevents the movement of spermatozoa.

In terms of effectiveness, this method is equivalent to hormonal contraceptive pills, but it takes the lead in terms of convenience. The economic factor also speaks in favor of the spiral: the costs of installing the plate are much lower than with regular pills.

Why, then, not all women put spirals on themselves? It's easy to explain. Closer to the age of forty, age-related changes in the reproductive system begin to occur, in particular, the tissues of the cervix become pathological. This makes the installation of the spiral impossible. The expediency of such a method of contraception can only be determined by a gynecologist after a complete examination of the patient.

Surgical contraception

There are also irreversible methods of contraception. Sterilization is one of them. After the surgical method of contraception, the possibility of conception disappears forever. The operation is aimed at ensuring obstruction of the fallopian tubes.

Women over 35 turn to this method of contraception for medical reasons. There are a number of conditions in which pregnancy (ending in delivery or abortion) is strictly prohibited: it carries risks to life. Such circumstances require 100% guarantees. In other cases, the doctor will help you choose a reliable, but not a radical method of protection.