In the life of a modern woman, with her workload, the need to combine family and work, there is no place for unexpected surprises. Therefore, an unplanned pregnancy often ends with its termination. Due to the extremely dangerous impact of medical abortion on a woman's reproductive health, it is necessary to prevent every such pregnancy. That is why it is extremely important to provide advice to women of reproductive age in different life periods about contraception.
The choice of contraceptive method is largely determined by how effective it is in preventing unwanted pregnancy, which for a number of methods depends not only on the degree of protection, but also on how systematically and correctly they are used. Both regularity and correctness of contraceptive use can vary significantly depending on factors such as age, income, desire to prevent or delay pregnancy, and cultural background.
Currently, hormonal contraception based on the use of synthetic analogues of female sex hormones is recognized as the most effective method of preventing unwanted pregnancy.
The first oral contraceptive appeared only in the twentieth century, it was patented in 1960. It contained a high percentage of hormones and was hard tolerated by the female body, but despite this, the drug was popular.
Over the past 30 years, significant advances have been made in the technology of developing new contraceptives, including the transition from high-dose COCs to low-dose drugs (the dose of estrogens has decreased by more than 5 times).
To ensure the maximum therapeutic effect of hormonal contraception by using a new, convenient for clinical use algorithm for prescribing hormonal contraceptives based on individual prediction of their action, a method is proposed, the essence of which is the appointment of contraceptives taking into account age (up to 25 years, 25–35 years, older 35 years old) and types of hormonal sensitivity of women (hyperandrogenism, hyperestrogenism and normal, while hypoestrogenism, combinations of hypoestrogenism with hyperandrogenism and hyperestrogenism with hyperandrogenism are additionally isolated).
The selection of the drug is carried out taking into account the type of contraceptive (monophasic, triphasic), the dose of the estrogen component, the type and dose of the progestogen component. The algorithm takes into account the features of 3rd generation contraceptives containing gestodene, desogestrel, norgestimate as a progestogen component.
Clinical case
Patient M., 21 years old. Complaints of weakness, fatigue, brittle nails, dryness and itching in the vagina, decreased libido, painful menstruation.
History: taking a microdosed gestagen-containing drug, against which all the above symptoms persisted.
Objectively: infantile body type, sparse hair growth in the axillary region, dry skin and hair.
On gynecological examination: poor vaginal secretion, hyperemic mucosa, conical cervix, reduced uterus in hyperanteflexion.
Laboratory data: estradiol in the 1st phase of the cycle - 64.9 pmol / l (norm - 75.7-314.4 pmol / l), follitropin - 14.5 mIU / ml (norm - 3-14 mIU / ml), progesterone in the 2nd phase of the cycle - 23.3 ng / ml (normal - 0.95-21 ng / ml), testosterone - 0.55 ng / ml (normal - 0.04-0.66 ng / ml), 17-hydroxyprogesterone in the 1st phase of the cycle - 0.82 (norm - 0.73-1.09 ng / ml), lutropin in the 2nd phase of the cycle - 10.7 mIU / ml (norm - to 14.7 mIU / ml), i.e. a decrease in the level of estradiol and an increase in the levels of follitropin and progesterone were found.
Based on the data of laboratory and clinical examination, the hypoestrogenic type of hormonal sensitivity was determined.
In case of hypoestrogenism, it is undesirable to prescribe microdose contraceptives, as well as gestagen-containing drugs, since they have a pronounced progestogenic effect and a moderate antiestrogenic effect.
Treatment. Taking into account the age (up to 25 years), the patient was prescribed a low-dose desogestrel-containing contraceptive, against the background of which her skin and hair condition returned to normal, brittle nails decreased, libido increased, dryness and itching in the vagina disappeared, and painless menstruation.
Thus, hormonal contraception in the modern world is one of the important components of a healthy lifestyle.
According to www.rmj.ru
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