Currently, more than 70 million women around the world choose hormonal contraceptives. Such popularity is justified, first of all, by the degree of reliability of this method - 99%. In addition, today the strategy for the development of hormonal contraception is aimed at reducing the dose of active ingredients in preparations, at finding new ways to administer them and optimizing the mode of their use.
Modern trends in the development of hormonal contraception include not only a reduction in the dose of components in preparations for their better tolerance, but also the synthesis of new progestins with high selectivity for progesterone receptors, new routes of administration of drugs and a change in the mode of their use.
All COCs to a greater or lesser extent have an antiandrogenic effect, which depends on the composition of the progestogen in them. They have a beneficial effect on oily skin and eliminate excess hair. Moreover, for the purpose of contraception after childbirth, only gestagenic preparations can be used, which were created in connection with the need to exclude the estrogen component that suppresses lactation.
Hormonal oral contraceptive regimens have now changed: the standard 21 + 7 regimen is being replaced by a new 24 + 4 regimen. In addition, drugs with a new estrogen component have appeared. Their composition includes estrogens, identical in structure to natural ones: estradiol valerate + dienogest; 17-beta-estradiol + nomegestrol acetate, with a new optimized application regimen "24 + 4".
Clinical case
Patient K., 25 years old. Worried about acne, scanty and irregular menstruation with a tendency to delay.
History of taking a three-phase oral contraceptive drug containing a combination of estrogen (ethinyl estradiol) and a progestogen (levonorgestrel) for contraception, against which she noted an increase in acne, scanty menstruation and an increase in body weight by 4 kg.
On examination: tall (174 cm), athletic body type, oily skin and hair, severe acne, breast hypoplasia.
Laboratory data: testosterone 1.02 ng/ml (norm - 0.04-0.66 ng/ml), 17-hydroxyprogesterone in the 1st phase of the cycle - 1.34 (normal - 0.73–1.09 ng / ml), lutropin in the 2nd phase of the cycle - 18.3 mIU / ml (norm - up to 14.7 mIU / ml), estradiol in the 1st phase of the cycle - 95.4 pmol / l (norm - 75.7-314.4 pmol / l), follitropin - 8.7 mIU / ml (norm - 3-14 mIU / ml), progesterone in the 2nd phase of the cycle - 4.37 ng / ml (normal - 0.95-21 ng / ml), i.e. elevated levels of testosterone and 17-hydroxyprogesterone, the predominance of secretion of lutropin over follitropin.
Diagnosis and treatment. Based on clinical and laboratory examination data, a hyperandrogenic type of hormonal sensitivity was identified. With hyperandrogenism, the appointment of hormonal contraceptives containing levonorgestrel is undesirable, because this progestogen has an androgenic and anabolic effect. Taking into account the age (25 years), the patient was prescribed a three-phase desogestrel-containing hormonal contraceptive with antiandrogenic effect, and at the 1st month of admission she noted a decrease in skin oiliness, at the 2nd month - a decrease in oily hair and acne, normalization of the volume of menstrual blood loss. Body weight for 6 months drug intake has not changed. The menstrual cycle became regular while taking the contraceptive and was not disturbed after its withdrawal.
Discussion. The proposed method provides a differentiated approach to prescribing modern 3rd generation hormonal contraceptives to women of childbearing age, which improves drug tolerance, reduces the incidence of complications and side effects of hormonal contraception, and achieves hormonal correction and therapeutic effect in patients with initial disorders. It is a convenient and simple method for clinical use.
Thus, hormonal contraception in the modern world is an effective method of preserving a woman's reproductive health and protection against unwanted pregnancy.
According to www.rmj.ru
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