Birth control pills

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.

Birth control pills are one of the hormonal methods of contraception. This method prevents pregnancy by providing the body with substances containing synthetic equivalents of female sex hormones. This, in turn, helps block ovulation and change the consistency of cervical mucus.

Some hormonal contraceptives, including pills, contain two components - estrogen and progestin, others - one-component - only progestin.

In addition to birth control pills, hormonal contraceptives include:

contraceptive patches;
contraceptive discs;
Navy;
contraceptive implants;
hormonal injections;
“after” pills.

Intrauterine device

Price for emergency contraception

Cost of the best contraceptives “after the act”

Basic services	price, rub.
Consultation with a doctor on emergency contraception	2 500
Install a spiral (without product cost)	5 000
Tablets 72 hours Zhenale (including specialist consultation)	3 500
Contraceptive Ginepriston (including doctor's appointment)	3 500
access_time Make an appointment with a gynecologist-endocrinologist

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Benefits of birth control pills

The benefits of birth control pills include:

high efficiency;
Ease of use;
influence on the regulation of the menstrual cycle;
reducing the symptoms of premenstrual syndrome and acne.

According to scientific research, birth control pills can also relieve symptoms of endometriosis and reduce the risk of certain types of cancer, such as ovarian cancer, uterine cancer and lower colon cancer.

However, taking birth control pills, like other hormone therapy measures, can have negative effects on the body. Therefore, before using hormonal contraception, an interview and medical examination should always be carried out, and contraceptive methods should be selected individually.

Birth control pills should only be sold with a prescription. Over-the-counter contraceptives are mechanical and chemical contraceptives.

Selection rules

Experts categorically do not recommend that women choose birth control pills on their own. Incorrectly selected pills can not only lead to unwanted pregnancy, but also cause serious health problems. When selecting oral contraceptives, the doctor must take into account the following factors:

General medical history of the patient;
Number of births, abortions and miscarriages;
Test results (blood, urine and gynecological smears);
Ultrasound results;
Life conditions;
The nature and regularity of the menstrual cycle;
Assessment of hormonal levels.

Obtaining all this data is possible only by visiting doctors. Before choosing birth control pills, a woman needs to consult a gynecologist or endocrinologist, and sometimes a mammologist.

Birth control pills - side effects

Are birth control pills harmful? Like any form of hormone therapy, they can negatively affect the body and cause a number of side effects. Unwanted symptoms are usually not harmful to health and most often appear at the beginning of using contraceptives, when the body becomes accustomed to hormonal changes. However, do not underestimate alarming symptoms and consult a doctor if they worsen.

Side effects that may occur when taking birth control pills include:

decreased libido;
digestive problems, including nausea and vomiting;
headaches and even migraines;
weight gain;
water retention in the body;
spotting and bleeding not associated with menstruation;
mood swings and irritability;
acne;
seborrhea;
breast tenderness and nipple pain;
shortness of breath and breathing problems;
vaginal mycosis;
vaginal discharge.

Acne
More serious side effects, such as thrombosis, jaundice, pulmonary embolism, heart attack, drug-induced amenorrhea, or an increased risk of certain types of cancer, may also occur with long-term use of birth control pills.

However, it is worth noting that each new generation of birth control pills on the market is characterized by a lower concentration of synthetic hormones, which reduces the likelihood of side effects.

What to do if the pills don't work

In rare cases, pregnancy may occur while taking birth control pills. Most often this occurs due to irregular use of contraceptives or a decrease in their effectiveness under the influence of various factors.

If you suspect pregnancy, you should immediately consult a gynecologist to confirm the presence of pregnancy. If a woman decides to terminate an unplanned pregnancy, she must act quickly to obtain a medical abortion.

This method is considered the safest for a woman’s health. However, medical abortion can only be performed until the 6th week of pregnancy, so it is important not to delay your visit to the doctor.

Birth control pills and pregnancy

Birth control pills are one of the most effective methods of contraception, as confirmed by the Pearl Index. However, like other contraceptives, the pill will only protect you from pregnancy if used correctly. Any deviation from the rule reduces the contraceptive effect of the pill.

There may also be situations where a woman becomes pregnant and unknowingly continues to take birth control pills. If in doubt, you should take a pregnancy test as soon as possible, and if the result is positive, stop taking the pills. To be 100% sure, it is better to consult a gynecologist.

If pregnancy is confirmed, the doctor will advise you to stop taking the pills. The tablets are not believed to have any harmful effects on the child's health in the early stages.

A woman who has been taking COCs for a long time then cannot get pregnant - is this a myth or true?

The so-called “ovarian sleep”, or hyperinhibition syndrome, is reversible [6]. There is no reliable data yet that would prove that a woman taking oral contraceptives has a reduced supply of eggs. Moreover, hormonal therapy is used to treat infertility, because after discontinuation of the drug and recovery, the ovaries work more actively. Taking birth control pills in the past does not affect the course of pregnancy and fetal development. In most cases, the risks and side effects of taking hormonal contraceptives are significantly lower than those of terminating an unwanted pregnancy.

Sources

World Health Organization, Medical eligibility criteria for contraception. 2015 // https://www.who.int/publications/i/item/9789241549158
JJ Speidel, CC Harper, WC Shields, The potential of long-acting reversible contraception to decrease unintended pregnancy // Contraception. 2008 Sep;78(3):197-200 // https://pubmed.ncbi.nlm.nih.gov/18692608/
Z. Pastor, K. Holla, R. Chmel, The influence of combined oral contraceptives on female sexual desire: A systematic review.// The European Journal of Contaception &Health Care. 2013; 18 // https://www.tandfonline.com/doi/abs/10.3109/13625187.2012.728643?journalCode=iejc20&
N. Wentzensen, A. Berrington de Gonzalez, The Pill's gestation: from birth control to cancer prevention. // Lancet Oncology. 2015 Sep; 16(9):1004-6 // https://www.sciencedirect.com/science/article/abs/pii/S1470204515002119?via%3Dihub
R. Burkman, J. Schlesselman, M. Zieman, Safety concerns and health benefits associated with oral contraception. // Am J Obstet Gynecol. 2004 Apr; 190(4 Suppl):5-22 // https://pubmed.ncbi.nlm.nih.gov/15105794/
T. Girum, A. Wasie, Return of fertility after discontinuation of contraception: a systematic review and meta-analysis. // Contracept Reproad Med. 2021 Jul;3:9 // https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6055351/

How do birth control pills work?

How do birth control pills work? Regardless of the type of birth control pill, their main effect is based on the release of an appropriate dose of synthetic sex hormones into the blood, which help prevent pregnancy.

In the case of single-component birth control pills, the so-called mini-pills, which contain only progestins, the mechanism of action is to suppress ovulation and induce changes in the uterine lining that prevent implantation of the embryo in the uterus.

How birth control pills work

Two-part birth control pills, in addition to the synthetic form of progesterone, also contain estrogen, which prolongs the effect of the pill. This type of birth control pill stops the maturation of Graaffian follicles and suppresses ovulation, changes the properties of the endometrium, thus preventing implantation, and affects the density of cervical mucus, making it difficult for sperm to move.

How to take birth control pills?

Using birth control pills is easy and shouldn't cause many problems. However, it is important to follow strictly defined recommendations. How you take birth control pills depends on the type of pill.

In the case of single-component tablets, the package contains 28 tablets, which must be taken at the same time every day. The difference in the time of taking the tablet can be up to 3 hours. Having finished one package of mini-tablets, we immediately proceed to the next one, i.e. There is no break between packs.

Combined monophasic birth control pills should be taken from the first day of the menstrual cycle and continued for the next 21 days. The tablets are taken at the same time every day.

The tablets are taken at the same time every day

After 21 days, there is a seven-day break and bleeding occurs. It is similar to your menstrual period, but is usually shorter and less heavy. After the above-mentioned break, you need to start new packaging.

In addition to packs containing 21 combination tablets, packs of 28 tablets are available. They are taken according to the 24 plus 4 regimen, of which 24 tablets containing active hormones should be taken at the same time every day, and during the remaining four days you need to take one inactive tablet from the four available in the package.

The placebo is supposed to make it easier to adhere to, but you need to be careful not to mix pills and take them on certain days of your cycle.

There are 21 biphasic birth control pills in a package - 11 of them are one color, and 10 are another. They differ not only in color, but also in the content of individual hormones. These tablets should be taken in the correct order as recommended on the package or leaflet.

The most difficult thing is to take combined three-phase contraceptive pills. The package contains 21 tablets in three different colors. The most common configuration is 6 light brown, 5 white and 10 yellow, or 7 tablets for each “phase”. As with biphasic tablets, the order in which they are taken is important.

Non-hormonal contraceptives

Their second name is spermicides. When she does not have regular sex life, non-hormonal contraceptives will provide her with an excellent service. Their action is of a local nature and their effectiveness is not inferior to hormonal pills, so it is better to choose them from all the available options. Ten minutes before sexual intercourse, 1 tablet should be inserted as deep as possible into the vagina.

There are some disadvantages:

It is undesirable to use constantly so as not to disturb the sexual microflora. It is worth comparing your condition before and after using the pill;
It is not allowed to take a bath or shower immediately after sexual intercourse and a couple of hours before it.

But these tablets also have many advantages:

non-hormonal medications do not cause hormone imbalance;
they are convenient to use;
they have almost no contraindications, except for individual sensitivity to certain components that cause allergic pathologies;
the price of the pills is affordable for most women. New birth control pills can be purchased without a prescription.

The effectiveness of birth control pills

Are birth control pills effective? They show a very high degree of effectiveness and are the best protection against unplanned pregnancy among hormonal contraceptive measures.

The effectiveness of birth control pills, like other methods of contraception, is determined using the Pearl index. The lower the value of the indicator, the higher the effectiveness of a particular method. Effective contraceptive methods are those with a Pearl index of 2. This means that out of one hundred couples who regularly have sexual intercourse, there were two unplanned pregnancies within a year.

Birth control pills rank high on the list of contraceptives considered for effectiveness. The Pearl Index for combination tablets ranges from 0.1 in laboratory conditions to 5 under normal use. Similarly, for mini-tablets these values are 0.5-5.

Typical use means taking into account errors made when taking pills that reduce their effectiveness.

Hormonal contraception without misconceptions

Everything has its time. Pregnancy, no matter how desired, is no exception. Contraception, in particular hormonal, will help avoid unplanned pregnancy.

Having collected frequently asked questions on this topic, we attended an appointment with the obstetrician-gynecologist at the Expert Kursk Clinic, Tatyana Ivanovna Eremeeva.

- Tatyana Ivanovna, what is more from oral contraceptives - harm or benefit?

I assume that the question of possible harm is related to the fact that previously we used drugs with a relatively high content of hormones. Their use was accompanied by weight gain and some other side effects.

ORAL CONTRACEPTIVES ARE USED NOT ONLY FOR CONTRACEPTION, BUT ALSO FOR TREATING A NUMBER OF DISEASES

Today we work with contraceptives that contain an incomparably smaller amount of hormones, and, accordingly, do not have many of the past negative aspects - provided that they are correctly selected by a doctor. In this case, there is no need to talk about any negative effects, you can only expect some possible (i.e., optional) side effects - as with any other drug.

“Often cysts are asymptomatic and are an incidental finding during examination.” Quote from the material “What is an ovarian cyst and how to treat it?”

Oral contraceptives are used not only for the purpose of contraception, but also for the treatment of a number of diseases (ovarian dysfunction, inflammatory processes of the pelvic organs, dysmenorrhea and a number of others).

— At what age can a woman start taking hormonal pills to prevent pregnancy?

For the purpose of contraception - from menarche (first menstruation) to 40 years, if patients have no restrictions on their use.

— On the forums they write that nulliparous women should not take hormonal contraceptives. Is this fact or fiction?

If there are no contraindications, you can take them, and in some situations it is necessary. Unfortunately, the problem of unwanted pregnancy remains a pressing issue, despite the wide arsenal of contraceptives. Emergency contraception and medical abortions are widespread - something that is far from harmless to a woman’s body.

In addition, hormonal contraceptives reduce the risk of developing certain diseases that also occur in nulliparous women. Therefore, the assumption that such women should not take them is unfounded.

— Is it true that contraceptives can be used not only to protect against unwanted pregnancy, but also for treatment?

Yes. Recently, such a trend has been observed, i.e. they are more widely used for medicinal purposes.

— What diseases of the female genital area are indications for the prescription of hormonal contraceptives for therapy?

These are the following cases:

- cysts and polycystic ovary syndrome;

- some benign ovarian tumors;

- ovarian apoplexy;

- use after operations on the ovary and for ectopic pregnancy;

- increased content of male sex hormones;

- a number of skin problems;

- excessive male pattern hair growth;

- in premenopausal women - in the treatment of osteoporosis, menopausal disorders.

“The likelihood of an ectopic pregnancy is approximately 2% of all pregnancies.” Quote from the material “When the body is confused. Why does ectopic pregnancy occur?

— They say that oral contraceptives can provoke the development of cancer. This is true?

There is a lot of discussion on this issue that relates to breast cancer. But first I will say specifically about individual types of tumors.

If we talk about endometrial, colorectal, and ovarian cancer, it has been proven that contraceptives reduce the risk of its development. In particular, this is indicated for the duration of their intake for a year or more.

No connection was found between cervical cancer and the drugs we are discussing.

CONTRACEPTIVES REDUCE THE RISK OF ENDOMETRIAL, COLON, RECTAL, AND OVARIAN CANCER

For the mammary gland. The use of contraceptives does not increase the risk of developing cancer of this location, regardless of the time of initiation and duration of their use.

Women who already have breast cancer should not take them.

For women with a history of it, their use is undesirable. If for some reason they are prescribed, careful and long-term monitoring of these patients is required.

“Pain is not a characteristic symptom of breast cancer.” Quote from the material “Breast cancer is not a death sentence!”

From my experience. In addition to seeing patients as an obstetrician-gynecologist, I also perform breast ultrasounds on patients. My personal statistics: among the women with suspicious tumor formations, there were no women who had taken oral contraceptives in the past. On the other hand, I also had patients who took these medications for a long time (more than 10 years). I did not detect any signs of breast cancer in any of them. In general, these data correlate well with the literature: the use of oral contraceptives does not increase the risk of developing breast cancer.

— Tatyana Ivanovna, is it true that those who take hormonal pills to prevent pregnancy will definitely gain excess weight?

No. This, by the way, is the biggest fear of patients. Previously, when the hormone content in the drug was high, this happened often. Today the situation is different.

When selecting a contraceptive, a woman’s physique, age, and a number of other indicators are taken into account. When the drug is chosen correctly, she will not gain weight, and sometimes she can even lose weight.

AFTER 35 YEARS OLD ORAL CONTRACEPTIVES ARE CONTRAINDICATED FOR SMOKERS

If weight gain nevertheless occurs, it is necessary to study the woman’s hormonal status in more depth.

— If a woman smokes, then taking hormonal contraceptives is contraindicated for her. Is this really true?

With reservations. Taking contraceptives is acceptable for women who smoke under 35 years of age, and no more than 20 cigarettes per day. It is necessary to take into account that their risk of developing cardiovascular diseases also increases, and headaches may bother them.

After 35 years, oral contraceptives are contraindicated for smokers.

— Even taking oral contraceptives, a woman can still become pregnant. This is true?

Yes, but in violation of the regime and rules of admission. If a woman takes a hormonal contraceptive at the same time, as prescribed by the doctor, its effectiveness is so high that the likelihood of pregnancy is almost zero. Shifting the pill intake by several hours, missing it on a certain day from the start of menstruation, or the wrong starting day are examples of situations that can lead to pregnancy.

Vomiting and loose stools can also lead to a decrease in contraceptive effectiveness; the use of certain other medications.

— How long can you take hormonal contraceptives without interruption?

There is no time limit. During the use of contraceptives, the patient should be monitored and laboratory and instrumental studies should be periodically prescribed.

— Does the female body need to take a “rest” from taking oral contraceptives?

It depends on what you mean by this. For example, there is a practice of “six months on, three months off.” This should not be done, since such breaks increase the likelihood of pregnancy and the appearance or intensification of side effects. In addition, in the first three months of use, the risk of blood clots is greatest. Therefore, such appointments and cancellations increase the time a woman remains in the “risk zone.”

THERE IS A PRACTICE OF “HALF A MONTHS RECEPTION – THREE MONTHS BREAK.” DO NOT DO THIS

If she wants to “take a break” from taking it, then the break should be more than 6 months. Such interruptions can be made no more often than once every two years of taking the drug.

— When is hormonal contraception contraindicated?

The question of how hormonal drugs can be dangerous for women is actually relevant. As well as indications, there are also quite a lot of contraindications for taking these medications. Among the absolute ones:

- pregnancy;

- breastfeeding (up to 6 weeks after birth);

- women who smoke after 35 years of age, as well as before 35, but smoke more than 20 cigarettes per day;

- women with a high risk of cardiovascular pathologies (such patients need to consult a therapist or cardiologist);

- deep vein thrombosis, pulmonary embolism, history of heart attacks and strokes;

- severe neurological pathology;

- other conditions, the course of which may be complicated when taking contraceptives (for example, breast cancer, benign and malignant liver diseases, active viral hepatitis).

“Endometriosis ranks third in the structure of gynecological diseases.” Quote from the material: “Endometriosis: symptoms, diagnosis and treatment”

Additionally, contraception is not recommended while breastfeeding (6 weeks to 6 months postpartum); gynecological bleeding with an unspecified cause; taking medications that increase the activity of liver enzymes; the use of anticonvulsants, some antibiotics, carbamazepine, barbiturates.

— How to choose the right hormonal pills to prevent pregnancy? Tell us what examinations a woman needs to undergo before prescribing medications

Consultation with a gynecologist is required. The woman’s phenotype (hyper-, hypoestrogenism, hyperandrogenism, etc.), the time of the first menstruation, characteristics of the menstrual cycle, the presence of premenstrual syndrome, the condition of the skin, hair, the condition of the mammary glands, weight, height, and concomitant diseases are determined.

Laboratory examination methods include:

— general blood and urine analysis;

— advanced biochemical blood test with determination of lipids;

- hormonal status;

— analysis of the blood coagulation system;

- smears from the genital organs for cancer.

“24 hours before taking a general blood test, ultrasound, X-ray examinations, and MRI are excluded.” Quote from the material “How to correctly take a general blood test?”

From instrumental - ultrasound of the pelvic organs (twice - before and after menstruation).

You also need to consult a mammologist with an ultrasound scan of the mammary glands on days 5-9 of the cycle; consultation with a therapist based on the results obtained. According to indications, an ECG is prescribed.

Taking into account the data obtained, a contraceptive drug is selected. Some of the listed studies are repeated regularly, once every six months, even if the woman tolerates the drug perfectly.

Disadvantages of birth control pills

The main disadvantages of using birth control pills include a number of the above-mentioned side effects, which are mainly associated with the effect of hormonal contraceptives on the body and health of a woman.

They are not prescribed to women with:

obesity;
diabetes mellitus;
hypertension;
cardiovascular diseases;
epilepsy;
depression;
varicose veins;
high blood pressure.

Some women cannot afford to take combined birth control pills, but mini-pills can be substituted. This group includes, but is not limited to, women who cannot take estrogen, women over 35, women who smoke, teenagers, and breastfeeding mothers.

Mini tablets

In addition to the side effects that may or may not occur while taking the pill, women may complain that they are uncomfortable taking the pill regularly or their effectiveness will be reduced. In addition, alcohol, medical conditions, or the concomitant use of certain medications may interfere with the proper functioning of birth control pills.

Why oral contraceptives are not suitable for everyone

First, you need to understand what is going on in the female body, namely the hormonal background. Each woman has her own and depends on many factors. The concentration of hormones is influenced by: age, weight, number of pregnancies, abortions and births, the presence of chronic diseases associated with the thyroid and pancreas, pituitary gland and adrenal glands, regularity of intimate relationships and other factors.

Therefore, each patient needs its own composition. which is almost impossible to implement in practice. Of course, there are average standards - they are used as the basis for different drugs. Combined contraceptives may contain different hormone components, their weight and concentration vary.

For example, the mini-pill contains only progestin. The first generations of combined tablets contain large dosages of both types of hormones. If you prescribe such a “bouquet” to a young, nulliparous, fragile girl, then the side effects of oral contraceptives are guaranteed. And for a 30-year-old woman, this composition can be of great benefit, protecting her from pregnancy and disorders and tumors caused by hormonal imbalances.

To choose the right hormonal contraceptives, it is not enough to know the composition of the contraceptives. The instructions only tell you about contraindications and warn about side effects, without giving recommendations for use. A gynecologist can choose the right contraceptive drug, and only after receiving the results of tests for sex hormones.

Types of birth control pills

Among the types of birth control pills are:

single-component birth control pills, so-called mini-pills;
combined contraceptive pills.

Single-part birth control pills, also called mini-pills, contain small doses of one hormone, progestogen. Their job is to thicken cervical mucus, which prevents sperm from reaching the egg. The mini-pill sometimes suppresses ovulation.

Single-component birth control pills are recommended for women:

very young, due to low hormone levels;
with breastfeeding;
with problems with thrombosis;
who cannot take estrogen pills;
those who do not want to use a spiral;
with approaching menopause;
smoking cigarettes;
at risk of stroke;
after 35 years.

Combined birth control pills consist of two types of female sex hormones: estrogen and progestogen. The hormones contained in the pills suppress the growth of eggs in the ovary and prevent ovulation. They also thicken the mucus in the cervix so that sperm cannot pass through.

Two-component hormonal tablets are divided into:

single-phase tablets - all tablets have the same composition,
biphasic tablets - the package contains two types of tablets with different doses of hormones,
triphasic tablets - the package contains three types of tablets with different doses of hormones.

Due to their estrogen content, combined birth control pills are not recommended for all women of any age. In many cases, the gynecologist will recommend single-part pills without estrogen or two-part single-phase pills with low estrogen content. Therefore, you should always consult your doctor before taking hormonal birth control pills.

MAKE AN APPOINTMENT

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Abortion and contraception clinic in St. Petersburg - department of the medical gynecological association "Diana"

Make an appointment, tests or ultrasound via the contact form or by calling +8 (812) 62-962-77. We work seven days a week from 09:00 to 21:00.

We are located in the Krasnogvardeisky district, next to the Novocherkasskaya, Ploshchad Alexander Nevsky and Ladozhskaya metro stations.

The cost of a medical abortion in our clinic is 3,300 rubles. The price includes all pills, an examination by a gynecologist and an ultrasound to determine the timing of pregnancy.

Hormonal contraceptives: how do they work?

OCs contain synthetic hormones - estrogen and progesterone. They inhibit ovulation - that is, they do not allow the egg to mature and exit into the fallopian tube. In addition, these same hormones prevent the sperm from meeting the egg and securing the fertilized egg in the uterus: the mucus becomes thick, the endometrium changes structure. This is the reason for such high efficiency - it reaches 98%. Thus, out of 100 women, pregnancy is possible in only two.

Some gynecologists are confident that taking OCs should be constant if a woman is not planning a pregnancy. But won't this cause harm to health?