Hormonal Contraception

An important step in the development of contraception was the successful creation of contraceptive pills. They contain synthetic hormones, similar to those that are produced by the female body and are necessary for it.

The most widely used tablets containing a mixture of two hormones - estrogen and progestogen. They are also called combined oral contraceptives( OK).Estrogen prevents ovulation( the exit of the female egg from the ovary), and the synthetic hormone progestin affects the cervical mucus, promoting its thickening and obstruction for sperm. It also affects the inner layers of the uterine wall, making it impossible to attach a fertilized egg.

Currently used third-generation OK.They significantly reduced the share of estrogen, which had previously been associated with some complications - thrombophlebitis, cardiovascular diseases, and also included progestogen hormones of a new generation( desogestrel, norgestimate, gestodene).This led to a significant reduction in side effects and made the OC even more safe and attractive for long-term use. Their effectiveness is 97-99%.

The reliability index is closely related to the correctness of the use of tablets: OK are usually produced in packs of 21 tablets. They need to be taken every day at about the same time. After three weeks of taking pills, a woman should take a one-week break, during which there is a monthly bleeding. At the end of this period, a new OK package is opened. Sometimes packages are produced containing 28 tablets, designed for their constant reception during the whole cycle. In this case, some of the tablets do not contain hormones, which ensures the onset of menstruation. If on some day a woman forgot to take a pill, then the next day you have to take two tablets.

Around 180 million women use the OK region, while in Russia they are used by 8% of women( data for 1998), while in Great Britain - 26% of women. OK have a whole range of advantages: ease of use and high efficiency;Menstruation becomes more regular, less prolonged, plentiful and painful. The premenstrual syndrome often decreases or disappears. Most women restore the ability to become pregnant within two months after stopping the taking of tablets. The ability to conceive even rises. Approximately 2 times reduced the likelihood of ovarian cancer and endometrium. This effect persists for 10-15 years after stopping the intake of OK.The number decreases and the risk of developing benign breast tumors( 4 times) and ovarian cysts( 14 times) decreases. Compaction of the mucus of the cervix in 2 times reduces the risk of bacterial diseases of the pelvic organs, possibly the disappearance of acne on the face.

Currently, the most common reason for refusing to take OC is the side effects of hormones - nausea, headache, weight gain( with regular intake of body weight increases on average per year by 400 g), breast tenderness, increased pressure and mood swings.

It is undesirable or dangerous to use OK smoking women over 35 years old( risk of stroke and heart attack), women suffering from hypertension, circulatory disorders, heart disease, thrombophlebitis, some forms of migraine, and overly complete.

There are tablets containing only the minimum dose of one hormone - progestogen( "mini-drank").They do not have estrogen, which removes the question of some side symptoms( a complex of "pseudobregnancy": nausea, vomiting, dizziness, swelling).They are somewhat less reliable than combination tablets. Their effect is based on the thickening of the mucous cork of the cervix, which is an insurmountable barrier to sperm. The maximum effectiveness of the contraceptive is 3-21 hours after taking the pill."Minitabletki" can be used by smokers, as well as after childbirth.

The disadvantage is the need to take tablets every day at the same time of day - only in this case they provide reliable protection. There may be bloody discharge, not associated with the monthly cycle, pain in the chest, there may be sudden changes in mood and depression. It is not recommended for women who have had an ectopic pregnancy. For women weighing more than 70 kg, the reliability of these tablets may be reduced. The effectiveness of contraception "minitablets" - 95-97%.

Comparison of the cycle when taking OK and micropipules: a comparison of the hormonal level in the normal course of the monthly cycle and when taking oral contraceptives, and how this affects ovulation, cervical secretion and uterine mucosa. As a result of taking OK for three weeks( out of four), a high level of estrogen and progesterone is maintained. This suppresses the production of pituitary hormones. As a result, ovulation does not occur, the secret of the cervix remains dense and impenetrable for spermatozoa throughout the cycle, and the mucous membrane of the uterus does not ripen to the level required for implantation of the oocyte. When taking "mini-pills" containing only progestin, an intermediate level of progesterone is maintained throughout the cycle. The estrogen is produced naturally, but its fluctuations are less. Ovulation can persist. The main mechanism of action is associated with the consolidation of the mucus of the cervix and the creation of an impenetrable barrier to spermatozoa. The uterine mucosa also changes somewhat.

Hormonal implants

Long-acting hormones have been developed to address the problem of the regularity of taking birth control pills.

One of them is Norplant - six soft capsules the size of a match made of silicone rubber, which are placed under the skin of the shoulder through a small incision and within 5 years the woman is protected from pregnancy due to the constant release of progestogen( levonorgestrel).

All this time the capsules themselves are not felt, and after this period they are removed by a surgeon under local anesthesia. Disadvantages: the implanted capsule shines through the skin after removal leaving a small scar. Possible side effects as with the use of tablets. The most common is the irregularity of the monthly cycles, prolonged bleeding. The effectiveness is somewhat reduced with a woman weighing more than 60 kg. Usually, pregnancy occurs only 6 months after removal of the capsules.

Injectable hormonal contraceptive

Another alternative to tablets is the injection drug Depo-Provera. The method consists in injecting a progestin, which prevents pregnancy for 3 months. The first injection is done in the shoulder region or buttock in one of the first seven days of the cycle. Follow-up is repeated after 12 weeks. The drug prevents ovulation and implantation of the egg into the wall of the uterus. Its effectiveness is even slightly higher than that of combined contraceptive pills, becausethe possibility of irregular reception of the drug is excluded.

It is not always possible to predict what effect the preparation will have on the cycle. Sometimes there are headaches, depression, weight gain. After cancellation of injections, the childbearing function is restored after 6 months.

In the process of improving injecting contraceptives, combined monthly injectable contraceptives( Perlutal, Mezigina, Cyclofen, etc.), devoid of the side effects of long-acting preparations containing only gestagens( Depo-Provera, Noristerat), were developed and introduced. When using these contraceptives, the frequency of bleeding that is not related to menstruation is lower, in terms of their effectiveness and safety, they are close to OK.

Vaginal ring with hormones

Another interesting development is the vaginal contraceptive ring. The ring is placed in the vagina of the week's sodium, where it releases hormones similar to combined oral contraceptives. In order to have menstruation, you need to remove it for a week.

Their advantage over OK is a more convenient form of application. A side effect may be nausea and vomiting.