Hormonal contraception: features of the appointment of oral contraceptives

Combined oral contraceptives – it is an effective contraceptive method that also has other health benefits.

The correct prescription of these drugs will help the patient to reduce the severity of acne, reduce the amount of blood loss during menstruation, make menstruation less painful and get rid of premenstrual syndrome.

Oral contraceptives are effective when taken correctly.

Therefore, it is extremely important to convey to women that only taking contraceptives according to the scheme gives the desired contraceptive effect.

On estet-portal.com we will review the main types of oral contraceptives, the rules for their appointment and administration, as well as possible side effects of drugs.

• Combined oral contraceptives: main types
• How to prescribe oral contraceptives
• Contraindications and side effects of combined oral contraceptivesov

Combined oral contraceptives: main types

• Estrogens

Ethinylestradiol, a 17-beta-estradiol derivative, is the predominant estrogen in birth control pills due to its high oral bioavailability.

Until recently, estradiol has not been used due to its rapid hepatic inactivation, short half-life, and breakthrough bleeding when combined with older progestogens.

However, formulations that combine estradiol (1.5mg) in micronized form with the newer progestogen (nomegestrol), appear to provide good cycle control.

At doses prescribed in tablets, estradiol may have a beneficial effect on hemostasis and lipid and carbohydrate metabolism (and therefore reduce cardiovascular risks) compared to ethinyl estradiol.

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• Progestogens

Pills containing levonorgestrel or norethisterone have been in use since the 1960s.

The combination of these progestogens with 35 micrograms or less of ethinyl estradiol is considered the "gold standard" for their safety profile.

Newer progestogens such as gestodene and desogestrel are structurally related to progesterone but have greater progesterone receptor specificity than older progestogens.

They reduce the potential for androgenic, estrogenic and glucocorticoid effects.

Drospirenone is an analogue of spironolactone and has a mild diuretic effect.

Cyproterone has antiandrogenic effects which may be useful for women with severe AKnot.

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How to prescribe oral contraceptives

The guiding principles when considering which contraceptives to prescribe are selecting a formulation that:

• has the lowest dose of estrogen and progestogen to ensure good cycle control and effective contraception;
• well tolerated;
• has the best security profile;
• affordable;
• offers additional non-contraceptive benefits.

Combined oral contraceptives should be taken at approximately the same time each day every day.

Do not take them more than 24 hours apart as this may affect the effectiveness of contraception. 

When a patient starts taking birth control pills, she

is not protected from pregnancy during the first 7 days and an alternative method of contraception is recommended during this periodand.

If a drug is missed, the patient must take the missed tablet as soon as she remembers it, and the next tablet at the usual time (2 tablets per day).

Contraindications and side effects of combined oral contraceptives

There is a

risk of venous thromboembolism associated with combined hormonal contraception, but this risk is much less than during pregnancy and the immediate postpartum period.

Factors that influence

the risk of thromboembolism include:

age;
smoking;
body mass index,
immobilization;
personal or family history of thromboembolism.

These factors need to be assessed when considering

the safety of combined oral contraceptives.

Only

progestogen methods are safer for women with risk factors for venous thromboembolism.

During breastfeeding, combined oral contraceptives are not recommended as they may affect the volume of breast milk.

Combined oral contraceptives are associated with

increased risk of myocardial infarction and ischemic stroke.

Women with significant risk factors such as obesity, smoking, migraine with aura, diabetes with vascular complications, or uncontrolled hypertension should therefore not use any combined hormonal method of contraception.

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