The active rhythm of the modern world affects almost all spheres of human life. Many modern women focus on self-realization and building a successful career, which, accordingly, somewhat shifts plans regarding the creation of a family. That is why the issue of contraception is very relevant for every modern woman, & nbsp; and they ask it to those specialists who are most trusted – to their gynecologists and beauticians.
In an exclusive interview for estet-portal.com, gynecologist-endocrinologist Krasovskaya Alexandra Vladimirovna spoke about the important features of the appointment and use of combined oral contraceptives, which every specialist must know about.
What is the difference between combined oral contraceptives and hormonal drugs
Combined oral contraceptives (COC) – this is a group of hormonal preparations containing 2 female sex hormones – estrogen and progestogen.
The primary task of combined oral contraceptives – prevention of unwanted pregnancy.
However, depending on the composition of this or that COC, it has an additional effect that the doctor can use as a treatment for a particular patient. In almost all COCs, the estrogen component is represented by ethinyl estradiol – it is synthetic estrogen. And the progestogen component of various COCs has many options, depending on which progestogen is in the composition - the COC has one or another additional property.
Some COCs have an antiandrogenic component and are therefore the drugs of choice for patients with hyperandrogenism (eg acne).
According to the composition, COCs are divided into:
- monophasic – active tablets containing the same amount of estrogen and progestogen;
- two-phase – active tablets containing 2 different combinations of estrogen and progestogen;
- multi-phase – active tablets containing more than 2 combinations of estrogen and progestogen.
Hormone replacement therapy (HRT) preparations also consist of two components - estrogen and progestogen. But in this group of drugs, the estrogen component is represented by natural estrogen (oral forms – estradiol valerate or 17-b estradiol).
The progestogen component, as in the case of COCs, can be represented by various representatives of this group of drugs. HRT preparations do not have a contraceptive property.
They are prescribed in case of ovarian failure (menopause, premature ovarian failure), when the ovaries stop producing female sex hormones. Thus, HRT drugs replace ovarian function, hence the name – hormone replacement therapy (HRT).
How Combined oral contraceptives (COCs) protect against pregnancy
Combined oral contraceptives have several protection mechanisms:
- inhibition of ovulation;
- thickening of the cervical mucus, thereby reducing the possibility of penetration of spermatozoa into the uterine cavity;
- changes in the endometrium that reduce the possibility of implantation;
- impact on sperm motility in the fallopian tubes.
What research is required before prescribing COCs
The protocols developed for obstetrician-gynecologists indicate that the doctor is obliged to check blood pressure before prescribing COCs. However, we must remember that contraceptives have a number of side effects, the main of which are an increased risk of thrombosis due to blood clotting, as well as an effect on the gastrointestinal tract.
So, it is necessary to carefully collect a family history, anamnesis of the patient's life, and, based on this, an individual plan for examining the patient is developed, which may include a general blood test, coagulogram, biochemical blood test, hormonal background, ultrasound of the pelvic organs, abdominal organs, thyroid gland, mammary glands, etc.
We should not forget that COCs are not prescribed to patients over 35 years of age if the patient smokes more than 15 cigarettes per day, which is associated with an even higher risk of thrombosis, as well as to patients over 40 years of age.
Can a doctor of aesthetic medicine recommend drugs to normalize hormone levels
I am sure that a gynecologist and a doctor of aesthetic medicine should be friends!
They should work in tandem to provide the woman with her basic tasks – be beautiful and not have reproductive problems. Moreover, for different women in different periods of their lives, both gynecologists and aesthetic medicine doctors solve certain problems. In youth, dermatologists struggle with the external manifestations of acne, and gynecologists determine its cause and, if necessary, prescribe treatment.
With the beginning of the patient's sexual life, gynecologists select the best contraceptive option. Then, doctors of aesthetic medicine begin to prevent the formation of the first wrinkles, and, at the same time, gynecologists can decide on pregnancy planning and management.
Closer to menopause, dermatologists will carry out therapy aimed at moisturizing and rejuvenating the skin, and gynecologists will decide on the appointment of HRT. I think that, nevertheless, it is the gynecologist who can prescribe hormone therapy. But the doctor of aesthetic medicine has a very important function of the first link, since women visit a cosmetologist or dermatologist much more often than a gynecologist, and it is a competent dermatologist or cosmetologist who should identify those patients who need a consultation with a gynecologist-endocrinologist.
In the future, the dermatologist can monitor the patient's compliance with the recommendations given by the gynecologist, again, due to the fact that the patient meets with the cosmetologist and dermatologist more often.
How do you feel about prescribing COCs to young nulliparous patients
Very topical question! Let's say again that COC – This is a drug to prevent unwanted pregnancy! This is their first and main indication for use. In developed countries, most women take COCs for their intended use. We have, since the last century, the understanding that KOC – it is, first of all, treatment, and only then contraception.
Now in Ukraine, the average age at which a woman gives birth to her first child is 27-29 years, which is much later than what it was, say, 30 years ago.
And the average age of onset of sexual activity among adolescents has decreased to 13-15 years. Now few people are surprised if a girl at the age of 15 has an abortion. Of course, it seems that I don’t really want to prescribe COCs only for contraception at the age of 13-15, and we understand that the formation of the reproductive system is taking place, & nbsp; however, I am absolutely sure that we will get significantly fewer complications from taking combined oral contraceptives at this age than from a completed abortion. Therefore, each patient should have an individual approach, and a doctor of any specialty should also be a psychologist.
Why is there no need to take breaks while taking COCs today?
A break while taking combined oral contraceptives can be understood in different ways.
So, a break between the last tablet from the previous package and the first tablet from the next package is recommended. At this time, menstruation usually passes. However, sometimes women can take monophasic COCs continuously, in which case they will only have 3-4 periods per year, this COC regimen has a number of side effects and, I think, should be agreed with the doctor.
And here are the breaks in taking COCs for 3 months (i.e. take COCs for 3 months, then take a break for 3 months to allow the ovaries to "rest", then take COCs again for 3 months, etc.), which some doctors recommended to do 20 years ago, today, are recognized as inappropriate.
Firstly, because while taking COC, a certain hormonal background is established, which changes again after the COC is discontinued. Such hormonal changes and changes for the body are stressful. Secondly, the risk of venous thromboembolism while taking COCs decreases with increasing duration of use (the maximum risk is observed during the first 6-12 months of use).
Thus, interruptions in COC use carry a potential increase in the risk of venous thromboembolism. Thirdly, the risk of an unwanted pregnancy increases in the absence of COCs.
How long before the planned pregnancy do you recommend that the patient stop taking COCs
In the first cycle after the withdrawal of combined oral contraceptives , a woman can become pregnant. Moreover, in the first cycle after the abolition of COCs, the chance of pregnancy is significantly higher than in subsequent cycles.
TOP 5 must-have recommendations for women taking COCs
- You need to take COC tablets daily, after meals and in the morning, and the condition – this is a regular intake without missed pills.
- Remember that COCs will protect against pregnancy, but will not protect against sexually transmitted diseases (STDs), therefore, in certain situations, the use of a condom is necessary.
- Restrict drinking and smoking. The simultaneous use of antibiotics and COCs is also undesirable.
- Control of the level of Prolactin in the blood (2 times a year).
- Highlights – remember that while taking COC, a woman's life should only get better! If, while taking COC, she developed any uncomfortable conditions – the patient must inform the doctor about this!
Read also: Menopausal therapy for rejuvenation from Dr. Nina Shavrina
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