Hormonal contraception: all about the features of the appointment of oral contraceptives

Acne vulgaris – a common skin disease affecting approximately 650 million people worldwide.

In 95% of cases, acne occurs in patients in adolescence, while 20-35% of patients experience textural changes in the superficial and deep layers of the dermis, followed by the formation of post-acne scars.

DoctorAdrian Beike

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 correctly
• Side effects and contraindications 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.

Contraceptive jewelry: now you won't forget to take your medicine

• 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 properly 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).

Side effects and contraindications 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.

New era of contraception: transdermal patches

 

p (Adrian Baker) in this article estet-portal.com introduces its own acne scar treatment protocol called CellRenew Microneedling.

To eliminate the cosmetic defect, a combination of mild enzyme peeling, microneedling using a conditioned stem cell medium and LED red light therapy is used.

• Initial consultation of a patient with post-acne scars
• Acne Scar Treatment Plan: CellRenew Microneedling Protocol
• Results, photos before and after post-acne therapy according to the proposed protocoly

Initial consultation of a patient with post-acne scars

A 24-year-old patient came to the author's clinic complaining of acne, which had been bothering her since adolescence.

The patient went to the doctor to draw up a

post-acne treatment plan, however, during the examination, in addition to scars, moderate acne on the cheeks and forehead in the form of open and closed comedones were revealed , papules and pustules. 

In this regard, Dr. Baker first prescribed treatment for

active acne and only after that recommended proceeding directly with the problem of post-acne scars. 

Therapy with

isotretinoin was reported by the patient as an unacceptable method of home treatment due to side effects. 

Microneedling procedure for serious aesthetic problems without laser and surgery

Acne Scar Treatment Plan: CellRenew Microneedling Protocol 

At the initial stage, in order to neutralize pathogenic factors by reducing sebum production, inflammation, corneocyte adhesion and microbial activity, as well as reducing the risk of post-inflammatory hyperpigmentation, the patient was prescribed

topical therapy for 6 weeks. 

During therapy, drugs were used: 

1% retinol;
2% salicylic acid;
mild cleansing gel;
mineral sunscreen. 

After 6 weeks, the patient's skin condition improved markedly, and the number of acne elements decreased. The author recommended that this regimen be followed for another 6 weeks. 

After this period, the skin, according to the author, was ready for the procedure according to

protocol CellRenew Microneedling. 

Atrophic scar treatment and skin rehabilitation: a case report

Fig. 1: before and 12 weeks after topical acne therapy 

Acne Scar Treatment Protocol CellRenew Microneedling 

Skin cleansing.
Application of
2. Peel Re-Texturizing Peel (AlumierMD). Exposure time – 5 minutes.

Purpose of peeling – prepare the skin for stem cell conditioned medium obtained from cord sheath (Calecim Professional) to be used during and after microneedling.

Fruit enzymes effectively break down the strong epidermal junctions of keratinocytes and make the skin barrier permeable, which

increases the absorption of topical agents.  

Apply topical
3. anesthetic cream LMX4 for 20 minutes.
Cream removal and cleansing of one side of the face
4. with Clinisept+. 

It is important to understand that dekeratinization of the skin also increases the absorption of the topical anesthetic, and therefore the toxicity of lidocaine and the patient's allergic history must be taken into account. 

Carrying out
5. microneedling (exposure depth – 0.5 mm in the "bone" and 1 mm – in the "soft" zones) on the cleaned side of the face.
Apply
6. Serum Calecim Professional Serum onto the skin in smooth motions.
 

2: Photos after the first and second CellRenew Microneedling sessions performed 6 weeks apart Puncture pattern: work small areas in a forward and backward sliding motion with a slight overlap, then in the opposite direction, followed by cross hatching in a sliding motion. The second pass of microneedling was carried out to a depth of 1.5-2 mm directly above the scars.   

Removal of anesthetic from the other side of the face followed by treatment with

preparation Clinisept

+
7. . Carrying out the above manipulations on the other side of the face. Gently apply 2 ml of Serum Calecim
Serum
8. on the skin of the face.
9. Facial treatment with sterile gel after the serum has dried. The author uses the non-cytotoxic hydrogel that comes with the microneedling cartridge SkinPen Precision. His goal – maintaining a moist wound-healing environment and moisturizing the skin.
10. Performing LED-therapy SlimFit using red, blue and near infrared light with a frequency of 415 nm, 630 nm and 830 nm. Duration of exposure – 20 minutes. 
11. LED therapy provides antibacterial (blue light), fibroblast stimulating (red light) and wound healing (near infrared light) effects.  After carrying out the above procedures, the author gave the patient recommendations for home care for the skin: 

apply

serum Calecim

Serum regularly on the skin of the face for 24 hours;

apply

water gel to skin
• ; Apply a light colloidal oatmeal cream for three days to support non-inflammatory skin remodeling and restore skin barrier. 
After that, the patient returned to her previous care regimen, which included
• acne control. 
Two more procedures according to the described protocol were performed with an interval of 6 weeks
• b.

Post-acne treatment with fillers

Results, photos before and after post-acne therapy according to the proposed protocol After the described course of treatment, the patient's skin was almost completely restored after post-acne scars. 

Results of LED-therapy in acne treatment: case report 

6 weeks after the third

treatment with CellRenew

Microneedling

protocol, the patient was delighted with the results.                             Fig. 3:

six weeks after the third procedure according to CellRenew Microneedling

During the course of treatment, no complications were recorded, in addition to transient erythema (which persisted for a couple of days), dryness and flaking of the skin (were observed for a week). 

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Telegram!  In order to maintain the effect obtained in the future, the author recommended that the patient follow the skin care regimen and once a year repeat the procedure according to the proposed protocol using:  light enzymatic peeling;

microneedling with conditioned stem cell medium;

LED therapy. 

According to Aesthetics.

 

 
 
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