Almost every woman has felt the need to use contraceptives at least once in her life. And during such a period, many questions arise, namely, which contraceptives to choose, how to take them, whether there are side effects, and much more. Let's look at all the features of birth control and figure out which pills are best to take at a certain age.
Groups of contraceptives for women
The pharmacological market currently offers a wide range of drugs to prevent pregnancy. All of them are divided into the following groups:
- Combined oral contraceptives are based on hormones similar to the action of estrogens, these are progestogen and ethinyl estradiol. There are two-, three- and monophasic drugs.
- Mini-drink. Contains exclusively progestogen. The principle of action is a local effect on the peripheral zones of the reproductive organs. As a result of taking such drugs, there is a change in the biochemical and morphological parameters of the endometrium, so the development of the fertilized egg does not occur. In most women, the ovulation process is suppressed. Effective representatives: Microlut, Laktinet, Exluton, Charozetta.
COCs are divided into 3 groups based on the active substance content in the tablets:
- Monophasic - contain a low level of hormones. Therefore, they are recommended for use by young girls who have not given birth before. And for people who are encountering contraceptives for the first time, such medications will be the most suitable.
- Biphasic - prescribed to young and middle-aged women, especially relevant in the postpartum period. These pills should be taken by those who experience discharge while taking microdosed contraceptives. These drugs have an antiandrogenic effect, therefore they have a positive effect on the skin and prevent unwanted hair growth. These include: Regulon, Marvelon, Siluet.
- Triphasic - characterized by a high content of female hormones. They are prescribed for some gynecological diseases and to restore hormonal levels. Representatives: Trikvilar, Ovidon, Trizeston.
There is no need to be afraid - you need to know! Educational program about COC
Dobrokhotova Alina Danilovna
Obstetrician-gynecologist
March 27, 2020
Let’s skip the fundamental concepts about this group of contraceptives (they were described in the previous article) and move on to the essentials. What worries women most and most often when deciding on long-term use of oral contraceptives? Weight gain. But gynecologists are worried about thrombotic complications when using this method. We'll sort it out in order, reassuring you and us. Let's start with the fact that the balance of risk and benefit has been confirmed by a large number of studies, but still the word “hormones” still manages to instill fear in a woman.
Firstly, “terrible” estrogens reduce the concentration of cholesterol and reduce the content of atherogenic lipoproteins. Secondly, this is the 21st century, and now there are no high-dose combined oral contraceptives. Currently used drugs contain a small amount of those same estrogens and are metabolically neutral, i.e. your figure is safe.
Thirdly, if we are talking about thrombotic complications, then the risks (with proper selection of the drug) are no higher than with smoking, long flights, major operations and in the postpartum period. There is also a nocebo effect (occurs when a drug without pharmacological action causes a negative reaction in the patient).
There are several large groups of drugs, and depending on your complaints/established diagnosis/desired result, the gynecologist can choose the ideal option.
What is needed to prescribe COCs?
No tests for hormones. Yes! We do not need to know the baseline to prescribe oral contraceptives. And you need:
- Interview you. Carefully, meticulously, in detail and with passion! There are questionnaires for a more convenient conversation, but you can simply collect an anamnesis of your life and illnesses. Please, when you come to the doctor, trust him, tell him about the diseases you have suffered, the diagnoses you have received, the medications you are taking and your bad habits. We can only help if we see the full picture. You also need to measure your blood pressure (we are concerned not only about hypertensive conditions, but also about hypotension, i.e., a decrease in pressure).
- Inspect. This includes a gynecological examination in a chair and examination of the mammary glands (with ultrasound of the mammary glands for women under 35 years old or mammography if you are older).
- Prescribe a coagulogram (to assess blood clotting) and a biochemical blood test (the level of glucose, lipoproteins, cholesterol, bilirubin and liver enzymes is important).
Take a smear for oncocytology from the cervix and for examination for STIs.
Now to the main questions.
When and how should you start taking oral contraceptives?
Ideally, the onset should coincide with the first day of the menstrual cycle. You can also start taking it later (no later than the fifth day of the cycle!), but then over the next seven days you need to use an additional method of contraception (preferably a condom).
After an abortion? Reception immediately. Have you used a vaginal ring but changed your mind? They pulled it out and started taking combined oral contraceptives or also after a seven-day break. Did you use the injection method? On the day of the planned injection.
How long can you take the pills, and do you need a break?
Considering how far medicine has come, and the low (15 and 20 mg) dosages of ethinyl estradiol, you can start taking oral contraceptives simultaneously with the onset of sexual activity, and end with the onset of menopause. There is no need to take any contraceptive holidays! Breaks are needed for the onset and gestation of pregnancy, after which you can safely start taking it again. As for breaks “to rest the ovaries,” this is a misconception. The process of folliculogenesis does not stop due to blocking ovulation (the main effect of COCs). Moreover, please note: the greatest number of side effects of oral contraceptives occur in the first year of taking the drug! Especially when it comes to thrombosis. That is, by taking breaks, you reset your term and return to the risk group.
How to “quit” an appointment?
There are no smooth patterns. Have you decided it's time to have a baby? You finish the pack and don’t start again. You can get pregnant already in the next menstrual cycle - don’t waste time. The ovaries do not need time to recover, and the hormonal levels do not need to return to some kind of normal.
Do COCs protect ovarian reserve? Saving eggs?
No and no. We create an artificial menstrual cycle, during which follicles and eggs are also formed. I will say more, they also die in the same way as in ordinary life, if pregnancy does not occur.
Is irregular menstrual cycle treated with COCs?
Combined oral contraceptives do not cure anything, but they help manage symptoms.
Used for:
- severe forms of PMS (premenstrual syndrome),
- acne,
- prevention of functional ovarian cysts,
- PCOS (polycystic ovary syndrome),
- endometriosis,
- abnormal uterine bleeding,
- painful menstruation.
But this does not mean that COCs will cope with foci of endometriosis on organs or cure a polyp that leads to bleeding.
Do COCs cause cancer and other women's diseases?
No! Moreover, there is a proven oncological protective effect on the endometrium, ovaries and colon, and as a bonus there is a visible positive effect on appearance and quality of life.
Side effects of oral contraceptives
Now another side of the coin: side effects. It seems to me that in the annotation it is the COC that lists the largest number of possible “side effects”, including death, and there is a reason for this. What are the most popular unpleasant surprises that can await you?
- Weight gain. The most common question and fear of a woman. Weight fluctuations are usually minor (about 2-3 kg). If you have gained more, it is most likely due to an increase in appetite. Numerous studies have not found strong evidence that hormones are to blame (again, I repeat, dosages are now minimal and do not cause huge weight gains).
- Breast tenderness, nausea, headaches. These effects are temporary and are the body’s “adaptation” to what is happening. Most often, the above concerns you in the first three months of use. If troubles persist longer, consult your doctor; this can all be corrected by doses of hormones in the drug. By the way, you can get rid of nausea on your own by changing the time you take it and doing it strictly after eating.
- Changing your mood and attitude towards life. It also depends on the correct choice of contraceptive. Each woman tolerates taking the drug in her own way, which is why you should not self-medicate and use the advice “I take these COCs, so do you.”
- Decreased libido. Quite a common complaint. “I wanted to protect myself from an unwanted pregnancy, and not from sexual activity at all”... COCs reduce the level of testosterone in the blood, and it is this that is responsible for sexual desire. If the problem persists for more than three months of use, then you can reduce the level of ethinyl estradiol, replace the progestin component, or completely stop taking oral contraceptives in favor of a patch, IUD, or vaginal ring.
- Amenorrhea is the absence of a menstrual-like reaction after drinking a pack. This is the result of changes in the endometrium, which is the expected norm. It most often occurs when taking pills continuously, that is, you took them for 21 days and didn’t take a break (this scheme is also possible). First of all, pregnancy or a violation of taking pills is always excluded. If everything is fine, but neither you nor your doctor is happy with it, switching to higher dosages of estrogen may be recommended.
As you can see, “the devil is not as scary as he is painted.” With a competent approach, you can avoid the “harm” of oral contraceptives, get not only reliable contraception, but also improve your quality of life.
Trust the specialist you are contacting and describe your complaints and state of mind in detail!
How to choose the right birth control pills
In no case is it recommended to choose and start a course of taking contraceptives on your own. This should only be done by a doctor.
Before prescribing a contraceptive method, the specialist collects the patient’s medical history, takes into account the presence of any diseases in the present or future and pays attention to the individual characteristics of the body.
The next stage is a complete examination of the woman, the doctor evaluates the constitution, body weight, skin condition and blood pressure level. Additionally, he prescribes instrumental and laboratory tests, it is especially important to conduct ultrasound and mammography.
Also, when choosing contraceptives, be sure to take into account:
- Breasts, their shape and structure.
- Type of hair growth on the genitals.
- Growth.
- Health status of skin and hair.
- Peculiarities of the flow of menstruation.
- Presence of chronic diseases.
Is it worth taking a break from hormones?
At the dawn of the use of hormonal contraceptives, they contained large amounts of hormones (50 mcg or more). Long-term use of such drugs suppressed the work of the ovaries, and in order for the ovaries not to “forget” how to work, a break was taken from taking the pills for 6–9 months. Now this need has disappeared: most manufacturers have managed to significantly reduce the dosage of hormones. While taking COCs, the physiological processes of follicle maturation continue in the ovaries, preserving the most genetically complete eggs until the drug is discontinued. So it is possible to take birth control pills without interruption for as long as there is a need for contraception [2].
“Pauses” in taking oral contraceptives without the consent of a doctor are fraught with disruption of the hemostatic system, lipid and carbohydrate metabolism. In addition, an unplanned pregnancy may occur.
How to take birth control
The nature and rules for taking COCs are specified in the instructions for the drug. This information can also be obtained from your doctor.
As a rule, the package includes a blister of 21 tablets, but there are exceptions. Taking the drug should begin at the start of menstruation and continue daily until the tablets run out. Afterwards, it is important to take a break for 7 days and resume taking it again.
If a dose is missed for some reason, you should immediately take the pill.
For more reliable protection against pregnancy, you need to use condoms.
Where to choose oral contraceptives in St. Petersburg, prices
In St. Petersburg there is a specialized gynecologist-urological clinic Diana. Here you can get tested for sex hormones and any type of infection, undergo all types of ultrasound (the latest machine with Doppler), choose birth control pills or safely terminate a pregnancy.
Here you can also select and install an IUD, remove any tumors using the most modern radio methods without pain or complications, or undergo other procedures.
The cost of visiting a gynecologist is 1000 rubles. Comprehensive pelvic ultrasound - 1000 rubles. Appointment based on the results of tests taken at the clinic - 500 rubles.
Side effects
Taking medications to prevent pregnancy may cause the following side effects:
- Headache, dizziness.
- Weight gain.
- Cessation of menstruation.
- Swelling of the limbs.
- Breast pain.
- Flatulence.
- Disorders of the skin.
- Nausea.
- Decreased appetite.
- Profuse bleeding.
- Pressure changes.
- Disturbance of consciousness.
- Allergic reactions.
- Heavy breathing.
If such symptoms occur, the use of tablets should be stopped.
Do hormonal drugs have a therapeutic effect?
Birth control pills can indeed be prescribed not only for the contraceptive effect [5]. Due to the mechanisms of their action, hormones reduce the symptoms of premenstrual syndrome and premenstrual dysphoric disorder. COCs have worked well for problems such as hirsutism (increased male pattern hair growth), acne and in some cases alopecia. If a woman has endometriosis or cysts on the ovaries, the gynecologist may also suggest taking hormonal medications to alleviate the patient’s condition.
Contraindications for contraception
Contraindications to the use of any group of contraceptives are:
- Breastfeeding.
- Diseases of the cardiovascular system.
- Pregnancy.
- Kidney diseases.
- Oncological processes in the body.
- Overweight.
- Severe form of hypertension.
- Liver pathologies.
- Diabetes mellitus.
- Preparation for surgery.
- Uterine bleeding of unknown origin.
How effective is hormonal contraception compared to condoms and IUDs?
In theory, oral contraceptives provide an effectiveness of over 99%, but in practice, with “typical use” the effectiveness can decrease to 91% [1]. The risk of pregnancy increases if a woman does not take the pill at the same time, misses a day or two, or experiences a “side effect” in the form of vomiting. Some antibiotics can also reduce the effectiveness of hormones.
The IUD is also said to be more than 99% effective and can remain in the body for up to 10 years, depending on the type. One of the disadvantages is that the IUD may be rejected due to individual intolerance.
Condoms are the only means of contraception that, in addition to controlling pregnancy, provides protection against many sexually transmitted diseases. Male condoms are considered 98% effective, female condoms (inserted into the vagina) - 95%.
Birth control pills for women over 40
For women who have crossed the age limit of 40 years, it is necessary to use contraceptives with small doses of the active substance and take into account all individual characteristics.
As contraception you can use:
- Janine.
- Novinet.
- Divina.
- Microlute.
- Excluton.
- Trisiston.
- Silest.
The above medications should be used after consultation with a specialist. It is important to follow the dosage and administration regimen, excluding any omissions.
Copper intrauterine devices (IUDs)
This method is also used in emergency cases and is a drug that must be injected into the uterus within 5 days after sexual intercourse. For some reason, women call copper-containing contraceptives pills, although in fact this device does not look like a pill at all.
The action is based on a change in the composition of the mucous membrane, which leads to damage to the egg and sperm. The effectiveness of this method of emergency contraception is 99%, but only if the timing and technique of administration are observed. The only contraindication to the use of copper-containing contraceptives is pregnancy, so you must first undergo a pelvic ultrasound.
Absolute contraindications for the use of hormonal pills
The main indication for the use of birth control pills is reliable contraception. Sometimes they are used in preparation for an IVF program to prevent hormonal imbalance.
COCs are contraindicated in the following conditions:
- tendency to thrombosis or previous thrombotic diseases;
- coronary heart disease, previous heart attack or stroke;
- frequent migraines;
- arterial hypertension;
- liver cirrhosis cysts and tumors;
- diabetes mellitus with a history of disease of more than 20 years or established angiopathy;
- smoking up to 15 cigarettes a day, especially after 35 years;
- oncopathology of the mammary gland;
- pregnancy.
Do not use medications in case of individual intolerance to the components, hormone-sensitive tumors, vaginal bleeding of unknown origin.
Diane-35, according to recent studies, is not recommended as a contraceptive drug due to its effect on the androgen spectrum. It is used as a remedy.
When are oral hormonal contraceptives used?
- For menstrual irregularities.
- For certain tumor diseases of the female genital organs (for example, adenomyosis, uterine fibroids, ovarian cysts).
- With pronounced premenstrual syndrome (PMS), painful menstruation (algomenorrhea, menalgia).
- With severe iron deficiency anemia.
- To reduce the risk of developing osteoporosis in mature women.
- For the prevention of ectopic pregnancy.
- For the treatment of acne, acne due to hormonal disorders.
How to understand that the product is not suitable?
Even if all the conditions are met, a situation may arise that birth control is not suitable, and this can be understood after a period of adaptation. It takes an average of 3 months to get used to COCs. During this period, intermenstrual spotting, engorgement of the mammary glands, and early onset of menstruation may be observed.
If birth control pills are not suitable, symptoms may include:
- decreased libido;
- depressive moods;
- acne;
- tenderness of the mammary glands when menstruation approaches;
- dryness of the vaginal mucosa;
- pain in the leg muscles;
- scanty or heavy periods;
- bleeding between periods;
- amenorrhea.
Also, if the COC or mini-pill is not suitable, effects associated with the main component of the drug appear, which are also an indication for changing the medication.
Types of contraceptives
Drugs that can help prevent conception are:
- hormonal direction;
- non-hormonal.
Hormonal pills, in turn, are distributed into:
- oral;
- mini-pill.
Oral medications are taken orally daily to achieve maximum effect. These contraceptives contain different amounts of hormones. While some women can take pills with large amounts of hormonal substances without consequences, for others certain contraindications are identified. They are divided into:
- Monophasic;
- Two-phase;
- Three-phase.
Hormonal patch
A small patch that is applied to the stomach, thigh or shoulder. You can only wear it for seven days; on the eighth day, we attach a new one.
Before you decide to stick it on, you need to visit a gynecologist. Doctors do not recommend using the patch for women who have thrombosis, those over 35 years of age, or those who have a history of stroke or myocardial infarction.
Side effects: headache, dizziness, nervousness, irritability, depression, discomfort in the digestive tract, tension in the mammary glands (mastodynia), weight gain.
Pearl index: 0.4 - 0.9
Daria Rakhmaninova: “This method is a highly effective method of contraception (the probability of pregnancy with ideal use is 0.3%). It can be used by women of all ages: both those who have given birth and those who have not. Also, the patch reduces menstrual pain. Among the inconveniences: the patch must be glued to open areas of the body, which can be inconvenient, especially in the summer. You must first consult with a gynecologist.”
