Hormonal contraceptives: should they be feared

The question of protection against unwanted pregnancy is often heard at a gynecologist's appointment, since fears of unplanned pregnancy greatly reduce the quality of a woman's sexual life, and no woman wants to expose herself to the risk of a probable abortion, because she knows what risk for her health bears a similar operation. The task of the doctor in this case is to conduct the necessary examinations and prescribe the patient a convenient method of contraception, including suggesting the use of combined oral contraceptives.

Pregnancy and termination of pregnancy are the most significant health risks women face during their reproductive years. According to the World Health Organization, more than 46 million pregnancies end in induced abortions every year, about 20 million of them are unsafe. The complications of unsafe abortion contribute to serious reproductive health problems for women, including the risk of infertility.

Reasons to use contraceptives

Reproductive health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and its functions and processes. Choosing a method of contraception plays a huge role, which allows you to regulate the birth rate, mainly by preventing unwanted pregnancy, which makes it possible to reduce maternal mortality from induced abortions by 25-50%.

With the rational use of contraceptive methods, a married couple has the opportunity to postpone the appearance of the desired child, to regulate the intervals between births until a certain material and social well-being is achieved. Currently, at least 200 million women prevent unwanted pregnancies using combined oral contraceptives (COCs).

The first COCs were used in the early 60s of the last century, but their side effects were quickly identified. COC contains two components: ethinyl estradiol and a synthetic progestogen involved in the suppression of ovulation, which is the main mechanism of contraceptive action.

It is known that a number of contraceptives protect against sexually transmitted diseases, reduce menstrual blood loss and reduce pain during menstruation. In addition, taking COCs has a positive effect on the skin condition, reduces the risk of anemia, ectopic pregnancy, has a therapeutic effect on the reproductive system, and also prevents the development of benign and malignant ovarian tumors, endometrial cancer. It is well known that in women of reproductive age there are diseases such as anemia, arthritis, bronchial asthma, dysmenorrhea, endometriosis, uterine fibroids, premenstrual syndrome (PMS), etc. These disorders associated with menstruation and menstrual irregularities are one of the leading causes gynecological morbidity in the world.<

Why are women afraid of oral contraceptives

Despite the effectiveness, availability, and convenience of using oral contraceptives, many women do not adhere to their medication regimens or refuse to use them completely. Factors that lead to refusal to take oral contraceptives or their misuse include fear of side effects, insufficient control of the menstrual cycle, weight gain, and fears caused by false information about hormonal drugs. Side effects of hormonal contraceptives are a common reason for stopping or changing a contraceptive method. According to various studies, out of 3,000 women, 66% indicate the side effects of drugs as the reason for changing hormonal contraceptives.

Ease of use, safety, efficacy and absence of side effects are among the main requirements that women place on a contraceptive method.

Currently, COCs are very popular due to their high contraceptive reliability, good tolerability, availability, lack of connection with sexual intercourse, adequate control of the menstrual cycle, complete restoration of fertility within 1–12 months. after discontinuation, safety for most somatically healthy women. When using COCs in a woman's body, metabolic changes develop, similar to those occurring during pregnancy, due to the influence of both estrogenic and progestogenic components. Depending on the type and dose of estrogen and progestogen, COCs have predominantly estrogenic, progestogenic, androgenic or anabolic effects.

Until now, there is an opinion about the danger of long-term, without interruption for 2-4 months, the use of hormonal contraception, but it is unfounded and harmful. During breaks, an unwanted pregnancy occurs in every fourth young woman. On the contrary, the point of view of modern specialists about the possibility and necessity of taking COCs without interruptions for as long as there is a need for contraception is quite legitimate. According to some researchers, the beneficial effect of COCs on the reproductive system increased with increasing duration of their use, and the protective effect of the drugs was much stronger in sexually active women who started taking COCs at a young age. The frequency of subsequent infertility in women using COCs was hundreds of times less than in their peers,

Benefits of combined oral contraceptives

Daily intake of COCs provides a concentration of hormones in the blood that is sufficient to suppress the secretion of gonadotropin-releasing hormone (GnRH) by the hypothalamus. Suppression of GnRH secretion in turn prevents the pituitary gland from secreting follicle-stimulating hormone (FSH) and, consequently, maturation of the follicle. High levels of progestogen prevent the mid-cycle peak secretion of luteinizing hormone (LH), which is necessary for the development of a mature follicle and subsequent ovulation. Suppression of FSH and LH secretion is sufficient to prevent pregnancy.

In addition to suppressing ovulation, the action of the progestogen component of COCs increases the viscosity of the cervical mucus, which makes it difficult for sperm to pass through the cervical canal and reduces the susceptibility of the endometrium to implantation of a fertilized egg during the secretory phase of the menstrual cycle. It should be noted that the properties of COCs are reversible, thanks to which a woman can plan the time of the birth of the desired child.

Depending on the composition, combined estrogen-progestin (COC) and purely progestin contraceptives are distinguished. Synthetic estrogen, ethinyl estradiol, is used as the estrogen component of COCs, and synthetic progestogens are used as the progestogenic component. According to the daily dose of the estrogen component, high-dose, low-dose and micro-dose COCs are distinguished:

High-dose contains 50 mcg/day. ethinylestradiol;

• low-dose - no more than 30-35 mcg / day. ethinylestradiol;
• microdosed - contain microdoses of ethinyl-estradiol up to 20 mcg/day.
Currently, low-dose and micro-dose preparations are commonly used for contraception. High-dose COCs can be used for planned contraception only for a short time (if it is necessary to increase the dose of estrogen). In addition, they are used for medicinal purposes and for emergency contraception.

The main clinical differences of modern COCs - individual tolerability, frequency of adverse reactions, peculiarities of influence on metabolism, therapeutic effects - are due to the properties of their progestogens. Chemically synthesized progestogens are steroids.

In addition to the gestagenic effect, progestogens differ in partial androgenic, antimineralocorticoid and glucocorticoid activity. Progestogens III, or the last generation - desogestrel, drospirenone, gestodene, norgestimate, dienogest - have minimal androgenic activity, do not disrupt metabolism, and do not have a significant effect on body weight. Low-dose and microdose COCs containing III generation progestogens are metabolically inactive, do not affect the levels of glucose, insulin, cholesterol and lipoproteins, do not change hemostasis parameters. Endogenous progesterone acts as an aldosterone receptor antagonist. In the natural menstrual cycle, the secretion of progesterone into the luteal phase neutralizes the mineralocorticoid effect of endogenous estrogens.

Thus, properly selected hormonal contraceptives will not only protect the patient from unwanted pregnancy, but also have a positive effect in the complex therapy of certain diseases, and improve the quality of life of a woman.

According to www.rmj.ru