What are the best birth control pills to choose?
The article is devoted to the analysis of the positive and negative aspects of the use of contraceptive pills and the assessment of their potential harm to women's health:
- The first part of the article provides information on the classification, contraindications, side effects and benefits of taking hormonal oral contraceptives.
- The second part analyzes the potential risk of long-term effects from taking drugs for perfectly healthy women.
Women should be attentive to the long-term forecast of their own health. It is worth considering the following factor - every interference with the delicate and sensitive mechanism of natural processes occurring in the female body can result in both minor and tragic consequences.
Every woman should weigh her decision to take or refuse birth control pills after consulting a gynecologist. You should not recklessly refuse these drugs, but you should definitely analyze all the risks of long-term contraception with the use of oral contraceptives.
Content:
- Contraceptive pill groups
- How Do I Pick a Good Birth Control Pill?
- How to take hormonal oral contraceptives correctly?
- Contraceptive side effects
- Absolute contraindications to oral contraceptives
- Can you get pregnant while taking contraception?
- Can I take birth control when I'm pregnant?
- Can I take hormone pills after 35?
- Emergency and non-hormonal contraception
- Pros of using hormonal birth control pills
- Cons of using birth control pills
Contraceptive pill groups
Among all the other forms of the wide range of contraceptives offered to consumers by the pharmaceutical industry, hormonal pills for preventing unwanted pregnancies are the leaders in consumer demand. Unfortunately, many women "prescribe" them to themselves on their own, without thinking about side effects and contraindications to taking these drugs. Correction of the duration of the use of tablets, and, most importantly, their choice is carried out exclusively by a gynecologist based on the study of the woman's anamnesis and the results of laboratory tests.
Types of oral contraceptives:
- COCs (combined oral contraceptives),
- Mini drank.
The main active ingredient of COC is one of the progestogens (norethisterone, norgestrel, desogestrel, gestodene, etc.) and ethinylestradiol (analogue of the hormone estrogen).
Types of COCs depending on the ratio of hormones:
- Monophasic drugs
- Biphasic drugs
- Three-phase drugs
In each tablet of drugs in this group, the percentage of the progestogenic and estrogenic components is unchanged
Ethinyl estradiol and dienogest:
|
Gestodene and ethinyl estradiol:
|
||
Microginon (320 rubles) |
Minisiston (370 rubles) |
||
|
The dose of estrogen in all tablets is the same, the dose of gestagen varies depending on the period of the menstrual cycle |
Femoston Dydrogesterone + Estradiol (700-800 rubles). |
|
|
|
Doses of estrogen and gestagen change three times depending on the period of the menstrual cycle |
Tri-Regol (200 rubles) |
Three-Mersey (650 rubles) |
Triziston |
The mechanism of action of combined oral contraceptives is to block the formation of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) in the pituitary gland, which results in inhibition of ovulation. At the same time, the functioning of the ovaries and the structure of the endometrium change. Glandular regression of the mucous membrane makes it impossible for a fertilized egg to attach to the wall of the uterus. The mucus in the cervical canal becomes thicker, so the movement of sperm into the uterus is difficult.
Classification of COCs by the degree of concentration of active components:
- Microdose oral contraceptives. The content of hormones is minimal, the drugs are recommended for those who use COC for the first time, as well as for young women under 25 years of age. Monophasic drugs of this group: Zoely, Jess, Minisiston, Dimia, Novinet, Logest, Minisiston, Mersilon, Klayra three-phase drug.
- Low-dose oral contraceptives. The drugs have an antiandrogenic effect, when they are used, the growth of unwanted hair, greasiness of the face and scalp, seborrhea, and acne decreases. Recommended for young and middle-aged women who have given birth, as well as for those for whom micro-dosage drugs are not suitable, as there are spotting in the middle of the menstrual cycle. The drugs in this group are: Diana, Janine, Minisiston, Rigevidon, Yarina (Midiana), Tri-Mercy, Regulon, Belara, Femoden, Lindinet, Marvelon, Chloe, Silest, Demulen, Mikroginon.
- High-dose oral contraceptives. The content of hormones in the drugs of this group is quite high; they are prescribed for the treatment of hormonal disorders or pathologies of the female genital area (endometriosis) solely as prescribed by a doctor. Preparations: Non-ovlon, Trizeston, Trikvilar, Tri-regol, Ovidon.
- Mini drank. The drugs in this group contain only progestogen, they act on limited areas of the female genital organs. The active ingredient of mini-pili changes the composition and amount of mucus in the cervical canal, which prevents the movement of sperm into the uterus. As a result of taking the drugs, the morphology and biochemistry of the endometrium changes, thereby creating the impossibility of implantation of the egg. Half of the women who use mini-pills for contraception? ovulation does not occur. Preparations of this group with linestrenol as an active ingredient (Orgametril, Eksluton, Microlut), with desogestrel (Charosetta, Laktinet).
|
|
|
|
| Charosetta (800 rubles) desogestrel | Lactinet (530 rubles) desogestrel | Organometrile (1100 rubles) linestrenol | Exluton (1250 rubles) linestrenol |
How Do I Pick a Good Birth Control Pill?
The choice of oral contraceptives should not be trusted by friends or a pharmacy pharmacist, you should not prescribe them yourself. To choose pills for contraception, you need to visit a gynecologist. The doctor will analyze the patient's anamnesis, genetic predisposition to the main diseases of the risk group, assess possible contraindications.
As a result of a medical examination, the following indicators are assessed:
- Weight, blood pressure;
- The condition of the skin, the presence of excessive hair growth on the body;
- Signs of an excess of androgens;
- The condition of the mammary glands (by palpation);
- Analysis of blood biochemistry, blood sugar, liver enzymes, hormonal levels;
- Ultrasound of the pelvic organs and mammary glands (mammography);
- Analysis of smears from the vagina and cervical canal;
- Condition of the pelvic organs (examination in the mirrors);
- Assessment of the state of the organs of vision (examination by an ophthalmologist).
The choice of the contraceptive pill is based on the woman's constitution.
Parameters of the constitutional-biological type:
- Growth, features of appearance;
- Breast volume;
- Type of pubic hair;
- Skin and hair condition;
- Features of menstruation and premenstrual symptoms;
- Amenorrhea or menstrual irregularities;
- Existing somatic pathologies.
Female phenotypes and the most suitable oral contraceptives:
The predominance of estrogen
The phenotype is feminine, with dry skin and hair, short to medium height, long periods with a lot of blood loss, menstrual cycle over 4 weeks. For women with a predominance of estrogen, contraceptives with a high and medium dose of hormones are recommended: Rigevidon, Triziston, Milvane, etc.
|
|
|
|
Ethinyl estradiol and levonorgestrel:
|
|
Equal amount of estrogen and androgen
The phenotype is feminine, with developed mammary glands of medium size, medium height, oily skin and hair are normal, PMS is absent, the menstrual cycle lasts 4 weeks, menstruation is 5 days. New generation drugs are recommended: Mikroginon, Silest, Femoden, Marvelon, Lindinet-30 and others.
|
|
|
|
|
Silest |
|
|
The predominance of androgens (gestagens)
The phenotype is high growth, underdeveloped mammary glands, oily skin and hair above normal, PMS in the form of depression and pain in the lower abdomen and lower back, scanty menstruation with a short cycle of less than 28 days. Recommended drugs: Jess, Janine, Yarina, Diane-35.
|
|
|
|
|
Ethinyl estradiol and drospirenone: Yarina (price 800 rubles) |
Ethinyl estradiol and drospirenone: Jess (820 rub) |
Ethinyl estradiol and drospirenone: Dimia (550 rubles) |
Nomegestrol and Estradiol: Zoely (1000 rubles) |
|
|
|
|
|
Ethinyl estradiol and dienogest:
|
Ethinyl estradiol and cyproterone:
|
||
How to take hormonal oral contraceptives correctly?
A standard one cycle contraceptive pill blister contains 21 pcs. Exceptions: Jess (a new generation drug for young women) - 24 tablets, Klayra (a modern drug for women over 35) - 28 tablets.
Rules for taking oral contraceptives:
- Reception begins on the first day of menstruation, it is continued daily at the same hour selected for this.
- The rule for the forgetful is to put a blister with pills where it will constantly catch your eye (attach it with a magnet to the refrigerator door, put it in a cosmetic bag, to a glass with a toothbrush).
- Take 1 tablet daily until the end of them in the blister, then take a break for 7 days, during which there will be bleeding like menstruation.
- After seven days, you need to start a new blister with contraceptives, regardless of whether the bleeding has ended or not.
- If vomiting occurs, take the pill out of turn.
- If the next pill was missed, you must resume it immediately.
- In case of vomiting and skipping taking the drug, it is advisable to use other methods of protection for 1-2 days.
- A similar tactic of additional contraception is used in the first 2 weeks of taking oral contraceptives, if this happened for the first time in life.
- Bloody discharge in the middle of the cycle is not a reason to stop taking COCs. Most likely, they are associated with a restructuring of the hormonal background of the body, and will last no longer than 2-3 months.
After the artificial termination of pregnancy, taking contraceptive pills begins either on the day of the abortion, or a month after it, on the day of the onset of the first menstruation.
There are drugs, with the simultaneous use of which the contraceptive effect of the pills decreases. An example is Rifampicin, which stimulates the production of liver enzymes. In the case of systematic treatment of somatic diseases, you should carefully study the instructions for the drugs, inform the doctor about the regular use of oral contraceptives. If such medications have to be taken, it is necessary to provide for methods of barrier contraception during treatment (condom).
As for mini-drinks, there is no break for menstruation during their intake. The tablets are taken within 28 days at the same time. For taking mini-pills, lactation is not a contraindication, breastfeeding can be continued. If a woman is not breastfeeding her baby, low-dose contraceptives are indicated. They are allowed to be used from 3-4 weeks after childbirth.
It is important to remember that in the first 2 weeks of taking oral contraceptives, the contraceptive effect is not strong enough. It reaches a 100% guarantee only in the second month of taking the pills, although the ovarian blockage occurs almost immediately.
Contraceptive side effects
Side effects are manifested with the use of oral contraceptive pills.
|
Minor side effects:
|
Serious side effects:
|
The emergence of serious side effects or the regular occurrence of minor side effects is the reason for the abolition of oral contraceptives.
Women taking oral contraceptives should periodically assess their current state of health in order to notice side effects in time.
Necessary measures:
- Blood pressure monitoring - every six months;
- Physical examination (condition of the mammary glands, liver, gynecological examination of the pelvic organs), urine analysis - annually;
- Self-examination of the mammary glands - monthly.
There is a world practice in the distribution of oral contraceptives. These are programs for countries with a low level of medical development. For this reason, access to regular check-ups for these women is almost impossible. They have an increased risk of side effects.
Absolute contraindications to oral contraceptives
There are diseases for which birth control pills are not prescribed. These are congenital hyperebilirubinemia (Gilbert's syndrome), multiple sclerosis, myasthenia gravis, thalassemia, bronchial asthma, thyrotoxicosis, sarcoidosis, the need for renal dialysis, rheumatoid arthritis, lymphogranulomatosis, retinitis pigmentosa.
|
Absolute contraindications to combined OK:
|
|
The danger from the use of oral contraceptives should not be underestimated even for seemingly completely healthy women. It is quite possible that neither the patient nor the attending physician is aware of hidden diseases from the list of contraindications. Consequently, the risk of developing oncological diseases, pulmonary thromboembolism cannot be completely excluded.
There is a belief, widespread in the professional environment and among consumers of contraceptive pills, not without the help of advertising of the manufacturers of these drugs, about the safety of a low dose of hormones in modern contraception. Meanwhile, long-term intake of hormonal drugs in any quantity negatively affects the female body. Often women are convinced of this too late, when nothing can be changed. The danger of oral contraceptives is not really visible, no one can reasonably prove that the woman's current health problems (oncology, stroke, thromboembolism), infertility are the consequences of long-term use of contraceptive pills.
Can you get pregnant while taking contraception?
There is such an opportunity, but its likelihood against the background of the use of contraceptive pills is minimal.
Conditions for the occurrence of an unwanted pregnancy while taking OC:
- Violation of the rules for taking the drug - the use of expired tablets with an expired expiration date, omissions or irregular intake at different times of the day.
- Vomiting in case of poisoning immediately after taking OK or taking pills together with other drugs that reduce the contraceptive effect.
Can I take birth control when I'm pregnant?
Of course not. Taking OK during pregnancy will greatly affect the fetus. The medication should be stopped immediately.
Can I take hormone pills after 35?
In countries with a high level of development of medicine, approximately 50% of married couples prefer sterilization as a method of contraception. Women after 35 years of age are not recommended to take hormones with a combination of diseases of the cardiovascular system with smoking, or a high risk of cancer.
After 40-45 years, it is advisable to take drugs from the mini-drank group. They have proven to be excellent for endometrial hyperplasia, uterine myoma, endometriosis.
Emergency and non-hormonal contraception
Emergency contraception
To prevent unwanted pregnancy with unprotected intercourse, a woman can use emergency contraception. The most famous drugs from this group are Postinor and Escapel. Postinor is used no later than 72 hours after sexual intercourse without contraception.
First, a woman should take 1 tablet, after 12 hours a second. Conventional oral contraceptives (COCs) can also be used as emergency contraception. It is important that the tablet contains at least 0.25 mcg of levonorgestrel and at least 50 mcg of ethinyl estradiol. Immediately after intercourse, you should take 2 tablets of oral contraceptive, after 12 hours, repeat the intake in the same dose.
Prescribing emergency contraceptives is an exceptional indication (rape, damaged barrier contraception). According to the recommendation of the World Health Organization, such drugs should not be used more than 4 times a year. In Russia, they are used by women on an ongoing basis, which is fundamentally wrong. Emergency contraceptive drugs have an abortive function and harm a woman's reproductive capacity.
Non-hormonal contraception
Non-hormonal birth control pills are spermicides that are used topically for contraception.
The main active ingredient of these contraceptives serves as a kind of barrier to the penetration of sperm into the uterine cavity. An additional effect of non-hormonal contraceptives is an anti-inflammatory and antimicrobial effect.
Method of application - the introduction of the drug intravaginally 10-15 minutes before the intended sexual intercourse. Drugs in this group: Pharmatex, Patent Oval, Benatex and others.
Pros of using hormonal birth control pills
If we compare barrier contraceptives and modern contraceptive pills of the new generation, then all the advantages will be on the side of the latter.
Pros of using oral contraceptives, taken on the recommendation of a gynecologist:
- Almost 100% effective method of contraception;
- Available for use by women of any age;
- Against their background, the menstrual cycle becomes regular, menorrhagias disappear;
- There is a cosmetic effect - hirsutism, acne, seborrhea of the hairline decreases;
- The woman gains psychological comfort, as the fear of unwanted pregnancy disappears;
- It becomes possible to regulate the time of the onset of menstruation;
- Presumably, there is a therapeutic effect with mastopathy, ovarian cysts, endometriosis, uterine myoma (this question remains open, since most of the research is funded by the manufacturers of the app);
- Fertility does not suffer, fertility is restored after 2-6 cycles, maximum after a year.
To get an objective picture, the arguments against taking oral contraceptives should be analyzed. In any case, a woman should make a decision armed with knowledge about the benefits and dangers of long-term use of drugs.
Cons of using birth control pills
Modern drug production is the same business as construction, trade and any other sectors of the economy. The more often the drugs have to be taken, the more benefit their manufacture brings to the manufacturers. It can be assumed how beneficial it is to manufacture the contraceptive pill, which should be taken daily by millions of women around the world. Independent experts from the United States have conducted several studies over the past decade, the results of which can be shocking.
Consequences of taking oral contraceptives in nulliparous women (according to research):
- Breast cancer risk;
- Increased risk of liver cancer, cervical cancer;
- Increased blood sugar levels;
- Alopecia (hair loss);
- Migraine attacks;
- Development of osteoporosis;
- Depression attacks;
- The appearance of pigmentation on the skin of the face and body.
The centers of hormonal regulation - the pituitary gland and the hypothalamus, connected with the peripheral glands that produce hormones (ovaries, adrenal glands, thyroid gland), perform the functions intended by nature in the human body. The ovaries use this system to interact with all organs of the woman. Each cycle the uterus prepares to receive a fertilized egg, and this delicate balance can disrupt any outside interference.
Doses of hormones given daily with birth control pills alter the function of the uterus and ovaries. Oral contraceptives suppress ovulation and ovarian activity, and egg production is impaired. These violations are reflected in the work of the higher regulatory centers of the hormonal system. Over the years and even decades of taking contraceptive drugs, there is a change in the uterine endometrium. Its uneven rejection is manifested by bleeding and dark discharge in the middle of the cycle. Transformation of the upper layer of the endometrium is dangerous with the appearance of oncological diseases during menopause.
The lack of demand for hormones produced by the ovaries leads to a decrease in their amount, malnutrition and the size of the ovaries. Hormonal "jolt" at the beginning of taking contraceptives and during the period of their cancellation - stress for the reproductive system of a woman. That is why fertility takes so long to recover (up to a year), and in some cases it does not recover at all.
The negative effects of taking birth control pills:
- In the presence of serious contraindications, women are prohibited from taking oral contraceptives in order to avoid vein thrombosis with a fatal outcome, the development of an oncological process;
- Excretion of vitamins b 2, b 6 is accelerated, which leads to skin diseases, damage to the nervous system (irritability, insomnia, weakness, fatigue);
- The body's receipt of folic acid, which is necessary for conception and pregnancy, is disrupted, the marketing course of pharmaceutical companies about its inclusion in hormonal preparations is most often not confirmed in practice;
- Long-term use of birth control pills doubles the risk of developing glaucoma, according to research from the University of California, among 3500 women who took OC, glaucoma is more common than among those who do not take such drugs;
- Increased risk of developing osteoporosis, increasing after 40 years;
- The risk of developing Crohn's disease in women who have been taking oral contraceptives for 5 years or more increases 3 times (according to a study conducted with 230 thousand women);
The oncological tension of recent decades, the imperfection of cancer diagnostics at the initial stage without the manifestation of obvious symptoms, can lead to the fact that a woman at an early stage of this disease will take contraceptives and cause a sharp tumor growth.
- Increased risk of developing brain tumors by 1.5-3 times with prolonged use of OC (according to scientists from Denmark);
- Increased thrombus formation in the vessels of the brain, cardiac and pulmonary arteries, which increases the risk of stroke and premature death from thromboembolism, which often affects women who smoke, patients with hypertension and a genetic predisposition;
- The appearance of venous insufficiency - vascular "asterisks", edema of the legs, a feeling of heaviness, pain and cramps, varicose veins, the appearance of trophic ulcers;
- Increased risk of inflammatory diseases of the cervical canal, breast tumors;
- Disorders of fertility, problems with conception and bearing;
- Failure to protect against sexually transmitted diseases;
- The appearance of pigmentation on the skin of the face and body;
- Increased risk of multiple sclerosis by 35% (according to a study by scientists from the United States);
- Hair loss;
- Development of transient hypothyroidism (decreased thyroid function);
- The development of depression;
- Decreased sex drive;
- The possibility of skipping reception time, errors in use, the need for self-control;
- The need to visit a gynecologist;
- The high cost of birth control pills.
According to the statistics provided by the WHO, about 100 million women worldwide use oral contraceptives. This huge market brings in colossal profits, so the truth about the dangers of OK is detrimental to the interests of manufacturers.
Public organizations create their own lobby, the purpose of which is to draw the attention of women to the dangers of oral contraceptives, as well as to ban especially dangerous drugs. The result of this is the recommendations of American and European gynecologists to use condoms to protect against unwanted pregnancies and genital infections. A hormonal patch and an ectopic spiral can play the same role.
The propaganda of the danger of contraceptive pills, a number of deaths and lawsuits in the countries of the United States and Europe led to the prohibition of the drug Diane-35. According to surveys, 67% of Europeans aged 16 to 64 use condoms for contraception, 16% use a hormonal patch, 7% use a spiral. Only about 10% of those surveyed use oral contraceptives.
In Russia, gynecologists still recommend the use of OC for women, starting from adolescence. Most doctors do not provide women with full information about the true picture of the health risks of contraceptives.
The author of the article: Kuzmina Vera Valerievna | Endocrinologist, nutritionist
Education: Diploma of the Russian State Medical University named after NI Pirogov with a degree in General Medicine (2004). Residency at Moscow State University of Medicine and Dentistry, diploma in Endocrinology (2006).
