The effect of contraceptives on the body. How birth control pills affect the body. Why there are no periods when taking oral contraceptives

common to all hormonal pills- oral contraceptives is the presence of two main hormonal components - "estrogen" and "gestagen", although in different doses and combinations. Prada, in order to reduce the side effects of estrogen, also produces a purely progestogen drug "mini-pill", which appeared on the pharmaceutical market not so long ago.

To date hormonal pills quite meticulously studied by physicians and are very reliable drugs to prevent unwanted pregnancy.

Their advantage lies in the high efficiency and reversibility of the process.

The frequency of occurrence with prescribed use is about two hundred times lower than even with withdrawal.

All oral contraceptives are divided into:

• monophasic, among them"Regulon", "Ovidon", "Novinet" and others;
• two-phase ("Anteovin"),
• three-phase, which include "Trikvilar", "Tri-regol" and "Trisiston".

There are twenty-one tablets in a box with a monophasic remedy, they are absolutely identical in composition, and in two-phase and three-phase preparations, the amount of hormones varies depending on the day of the menstrual cycle, thus allowing much more accurate simulation throughout the cycle.

The mechanism of action of hormonal pills

The mechanism of action of these pills is to block ovulation (the appearance of an egg). And even if fertilization has occurred, the means destroy the mechanism of attachment of a fertilized egg. In addition, drugs increase the viscosity of cervical mucus, preventing the movement of sperm. They also disrupt the process of transporting an egg or a developing embryo.

Use oral contraceptives can all young women who have a permanent sexual partner and are sexually active.

Spouses who temporarily postpone the birth of children to future periods, or women after childbirth, can also successfully use these funds, provided that they do not breastfeed.

Similar drugs are also needed for women who are in a state after an abortion, suffering from functional ovarian cysts, or whose relatives have had ovarian cancer.

Contraindications to the use of hormonal tablets

There are also some women who do not take hormone pills. These are pregnant women, since these remedies, while preventing pregnancy, still do not disrupt it. These drugs are not recommended for women over thirty-five who smoke, with severe liver dysfunction, suffering from breast cancer, with problems in the blood coagulation system and in the presence of frequent bleeding of unknown origin.

For women who do not have a permanent sexual partner, nothing better than a condom has yet been invented.

You can start taking oral contraceptives from the first day after the onset of menstruation, from the fifth day, or from the beginning of the week following the end of menstruation.

What is the effect of birth control pills on a woman's body? Having made the decision to protect themselves from unwanted pregnancies, many girls choose hormonal contraception. However, before deciding to start taking hormonal pills, they are interested in what changes will occur in their body, and what is the effect of contraceptives on the body ... Let's talk about it.

The principle of action of contraceptives on a woman

Contraceptive pills contain small doses of female sex hormones - estrogen and progesterone (gestagen), which cause a number of changes in a woman's body. What is the effect of the pills?

Not all girls know this, but GCs (hormonal contraceptives) have three phases of protection against pregnancy. The first, most important stage - they prevent the release of eggs from the ovaries for fertilization. Sometimes at this stage, a failure may occur, that is, a mature egg in rare cases can still move into the fallopian tube, where it usually occurs by fertilization by sperm. For this, a condition is necessary - male germ cells must freely penetrate the fallopian tube of a woman.

Here the second line of defense works - under the influence of hormones, the girl's cervical mucus becomes viscous, through such a barrier, sperm simply cannot get to the fallopian tubes, where they will meet with the egg. However, this scenario can also fail. If the most active and tenacious sperm can penetrate the thick mucus to the egg and fertilize it, the last of the conceived, the third defense option, will work.

When taking birth control pills, the mucous membrane of the uterine cavity changes, it becomes loose, which makes it an unfavorable soil for the introduction of the embryo. That is, a fertilized egg, having descended into the uterine cavity, will not be able to gain a foothold in the endometrial layer, which means that at this stage the pregnancy will stop. Everything seems to be fine, but here it is worth thinking about what effect these pills have on a woman’s body in terms of her health?

Positive effect on a woman of hormonal contraceptives

Thanks to the intake of GC, a girl can lead a normal sex life without fear of becoming pregnant. Many modern drugs significantly improve the quality of the menstrual cycle, making it regular, and the menses themselves painless. With all this, menstrual flow becomes scarce and short, so it almost does not cause women any inconvenience. At their request, girls can either delay the approach of menstruation, or bring its onset closer.

Having started taking birth control pills, many girls notice a weakening of the premenstrual syndrome - their mammary glands do not engorge, and their mood is kept at the same level. Preparations such as Yarina help relieve swelling, as well as moderate sebum production. Thanks to this, acne disappears and the condition of hair and nails improves. The positive effect of GCs also lies in the fact that their intake helps to reduce blood loss during menstruation, the hemoglobin level normalizes.

It is known that even after a short use of contraceptive pills (within 3-6 months) and their subsequent cancellation, it is much easier for girls to get pregnant. Thanks to these pills, the function of the ovaries is controlled, and when they are stopped, the ovaries work more briskly and steadily. It is not for nothing that couples who cannot get pregnant for a long time are recommended this method. A woman takes hormonal contraceptives, then stops drinking them, and over the next 2-3 months, a long-awaited pregnancy almost always occurs.

The negative impact of birth control pills on a woman and her health

There are also negative sides to the GK. For example, if an incompetent doctor prescribed them to a girl, without taking into account the peculiarities of her health, without taking into account the anamnesis and her habits, the pills can lead to serious health problems. The thing is that GCs, which are taken orally, affect the cardiovascular system.

If a girl has problems with veins, for example, thrombophlebitis, then birth control pills are contraindicated for her. When they are taken, the blood becomes thicker, clots can form in it, and this leads to thrombosis and other health problems. GCs are also not recommended for women who smoke, since the simultaneous use of nicotine and pills significantly increases the load on the heart.

There is information that girls who take birth control pills for a long time are more at risk of developing breast and cervical cancer. In a special risk group are those who are diagnosed with cervical erosion. All these features must be taken into account by the doctor prescribing the pills.

Contraceptive pills undoubtedly benefit healthy women by helping to cope with premenstrual syndrome, mood swings, and make critical days more comfortable. However, in the case of certain diseases, it is better to refrain from them, since the harm from taking them will exceed the benefits. You should never prescribe these pills on your own, because you do not know if they will suit you and what consequences they can lead to.

So, you have become the “proud” owner of a prescription for a hormonal drug that your doctor prescribed for treatment or contraception. Since any hormonal drugs have a rather serious effect on a woman's body, you need to remember a few rules that will help you avoid not-so-good consequences:

• Immediately set a reminder on your mobile phone to take a pill (best in the evening, when the main things are done).
• At the time of taking hormonal drugs, forget about alcohol. The only exception is those days when you have a break in taking pills, and then it is undesirable to use too much. It is known that alcohol and drugs can increase or decrease the effect of each other. And there may be completely unpredictable consequences that will arise much later, and you are unlikely to associate this with that fun evening that you spent with a glass in your hands.
• Avoid stale foods, weird combinations, and hard-to-digest foods. For diarrhea (diarrhea) or vomiting can reduce the desired concentration of the drug and lead to the fact that instead of a “sleeping” cycle, you will get a completely “working” cycle that will nullify all treatment or contraception.
• Remember that almost any hormonal agent "thickens" the blood. Therefore, monitor the state of your blood, take tests on time.

• The most exciting moment is weight gain. Unfortunately, this is a common fact, no matter how doctors try to convince us. Of course, now hormonal drugs are improved, with a minimum dosage. But still, the danger of weight gain remains. Here you need to know that in the first months of taking such pills, the body will send signals that it seems to be hungry, although you ate just an hour ago. Learn to catch this moment and don’t “get fooled by the provocations” of your own body.
• There are also cases of decreased libido. This is also quite natural and understandable.

Be that as it may, hormonal drugs, like any medicine, have their advantages and disadvantages. But still, it is better to use them only for treatment, and for contraception it is better to consider other options, as more and more new studies have recently been opened on the negative effect of such drugs on the woman's body as a whole. In any case, the choice is yours.

The main essence of contraceptive pills is that they are a means of preventing unwanted pregnancy, which saved humanity from numerous abortions and spoiled destinies.

Despite the fact that modern contraceptive pills have the most positive and numerous reviews, disputes about their use continue both among consumers and among specialists. Such disputes are due to a number of side effects that can occur when taking drugs. Often the question arises as to whether it is possible to get pregnant while taking birth control pills. All the problems that have arisen, most often, are explained simply: the questions of how to take birth control pills and which birth control pills should be taken are incorrectly resolved.

The principle of action of hormonal drugs

In general, several conditions are necessary for conception: the maturation and release of the egg (ovulation), its meeting with the sperm in the fallopian tube, the penetration and fixation of the fertilized egg in the uterine cavity. The whole process is controlled by the pituitary gland of the brain, which regulates the production of sex hormones by the ovaries - estrogen and progesterone. It is these hormones, or rather their balance, that provide the necessary conditions for the process of conception.

Hormonal-type contraceptive pills or oral contraceptives prevent the maturation of the egg, interfere with the penetration of sperm into the fallopian tubes and affect the structure of the endometrium of the uterine cavity, preventing the egg from gaining a foothold on it. Thus, these drugs create the maximum obstacle to conception.

The contraceptive effect is achieved by the presence of estrogen and progesterone in the composition of the tablets. This results in the following impact:

1. Estrogens prevent the maturation of the egg in the follicle, inhibiting pituitary functions, disrupt the structure of the endometrium, increase the peristalsis of the fallopian tubes, inhibit the formation of the corpus luteum, and inhibit the production of their own hormone by the ovaries.
2. Progesterone increases the density of mucus in the cervical canal, inhibiting the movement of spermatozoa, disrupts the release of statins, blocking the production of GnRH, which inhibits the process of ovulation.

How non-hormonal drugs help

The second direction of contraceptives is non-hormonal contraceptive pills. Such funds, although they are available in the form of tablets, are not taken orally. They belong to the group of vaginal agents and are inserted into the vagina. The composition of the preparations introduces an active substance that can suppress the activity of spermatozoa, thereby preventing the fertilization of the egg. In addition, the active component of the tablets increases the density of cervical mucus, blocking the passage of sperm through it.

Thus, the principle of action of non-hormonal drugs is based on a decrease in sperm motility and blocking their movement, without changing the hormonal balance. Benzalkonium chloride and nonoxynol are actively used as active substances. Other ingredients may also be used.

Non-hormonal drugs have less effect on the hormonal female mechanism, which reduces the risk of side effects. Moreover, under their influence, a protective film is formed in the cervical canal, preventing the penetration of fungal and other infections. However, it should be noted the lower contraceptive ability of such drugs compared with hormonal contraceptives (82-86% versus 98-99%). To increase efficiency, women sometimes additionally use vaginal diaphragms, cervical caps.

Why do we need funds after the act

Another way to prevent unwanted pregnancy is birth control pills after intercourse or postcoital pills. Such funds belong to the so-called emergency protection group. They are used after unprotected sex or after a condom breaks. Postcoital tablets contain 2 types of active substance: levonorgestrel or mifepristone. The principle of operation of the first group is based on blocking the ovulation process, increasing the density of cervical mucus and, most importantly, preventing the fixation of the egg on the uterine endometrium. By changing the structure of the endometrium, the active substance provides an abortive effect. When using such a remedy, it should be remembered that the drug is considered hormonal and can significantly affect the hormonal balance.

The second type of drug has pronounced antiprogestogenic properties, which prevents the uterine endometrium from preparing to receive the egg, and also increases the contractility of the uterus, which helps to remove the egg from the cavity.

What hormonal drugs are popular

Hormonal contraceptive pills are available in 2 main types:

• combined preparations that include both main hormones;
• mini-pill containing only progesterone.

The group of mini-pill drugs belong to a monophasic composition. Combined funds can be two-phase and three-phase. Mestranol and Ethinylestadiol are commonly used as estrogen substitutes. Progesterone is administered using the following substances: Norethindrone, Norgestrel, Levonorgestrel, Norgestimate, Desogestrel, Drospirenone. When contraceptive pills are chosen, the following names are preferred: Jess, Yarina, Tri-Merci, Mercilon, Logest, Jeanine, Regulon, Lindinet, Novinet, Marvelon, Charozetta, Diana 35.

Among the combined drugs, you can distribute the tablets according to the required dosage:

• microscopic dosing: provide efficiency, no side effects - these are contraceptive pills Jess, Miniziston, Yarina, Lindinet-20, Novinet, Tri-Merci, Logest, Mercilon;
• low dosage: Lindinet-30, Silest, Marvelon, Microgynon, Femoden, Regulon, Regividon, Jeanine, Belara,
• average dosage: Chloe, Diane-35, Demulen, Triquilar, Triziston, Tri-regon, Milvane;
• drugs that require a high dosage and are used with low efficiency of the previous groups: Ovidon, Non-Ovlon.

Common mini-pills include tablets such as Ecluton, Charozetta, Norkolut, Microlut, Micronor.

Special allocation funds

Numerous reviews of women highlight the following as the best birth control pills:

1. Jess was developed by Bayer Schering Pharma. It contains a small amount of estrogen and a progesterone substitute, drospirenone. In addition to contraceptive abilities, it can help with acne, seborrhea, hirsutism. Designed for women of all ages.
2. Yarina contraceptive pills are widely used. The drug is effective for normalizing the menstrual cycle and eliminating painful symptoms during menstruation. The main effect is aimed at blocking ovulation and changing the structure of the uterine endometrium. Serious side effects are practically not observed.
3. Tablets Novinet inhibits ovulation as a result of blocking the production of luteinizing hormone, increases the viscosity of cervical mucus.
4. Janine is a low-dose drug. It affects all 3 main areas of exclusion of conception. The active substances are ethinylestradiol and dienogest.
5. The drug Regulon contains ethinylestradiol and desogestrel. The main action is the inhibition of the ovulation process. A positive effect is noted for menstrual irregularities, treatment of uterine bleeding.

High-quality hormonal contraceptives provide very high efficiency with regular use, and strictly according to the recommendations of the instructions and the doctor. Can you get pregnant while taking birth control pills? This probability is estimated below 1%, and even it is associated with violations of the rules of admission and its regularity.

The choice of non-hormonal agents

Contraceptives of a non-hormonal type have lower protective properties, but they are recommended in a number of cases when hormonal drugs are contraindicated: neglected fibroids, breastfeeding a child, endocrine pathologies, allergic reactions to hormonal drugs. The main advantage of non-hormonal tablets is the absence of contraindications and side effects.

The following non-hormonal agents are noted in the form of vaginal tablets:

• Pharmatex (action up to 3 hours);
• Gynekotex, Erotex, Benatex (action 3-4 hours);
• Countertex (4 hours);
• Nonoxenol, Patentex, Traceptin.

An important property of these tablets is the simultaneous antifungal and antibacterial protection. They are especially effective against trichomonas, chlamydia, staphylococci, gonococci, proteus and other microorganisms. The disadvantages include a fairly short time of action, which requires an accurate calculation of the time of sexual contact.

An important property of these tablets is the simultaneous antifungal and antibacterial protection. They are especially effective against trichomonas, chlamydia, staphylococci, gonococci, proteus and other microorganisms. The disadvantages include a fairly short time of action, which requires an accurate calculation of the time of sexual contact.

Use of drugs after the act

Emergency protection in the implementation of unplanned sex is carried out by hormonal birth control pills after intercourse. Different types of funds allow you to use them at different times after contact. Such a gap can be, when high-quality contraceptives are used, 72 hours. However, most drugs are designed to be administered within 20-50 hours.

The following contraceptive pills of this type are distinguished:

• funds based on levonorgestrel: Postinor, Escapel, Eskinor F;
• tablets containing estrogen and progesterone: Rigevidon, Non-ovlon, Silest, Ovidon;
• preparations based on mifepristone: Ginepristone, Mifolian, Genale, Agesta.

When using such contraceptive pills, it should be remembered that the maximum period is 72 hours after sexual contact, but the greatest degree of protection is achieved when the drug is administered during the day. In this case, the probability of conception after taking the pills does not exceed 5%. In addition, it should be borne in mind that drugs of this type are considered emergency aid, which is not recommended to get carried away. In view of the high content of hormones in them, the risk of serious complications and the occurrence of hormonal imbalance is quite high.

When not to take drugs

There are a number of contraindications for taking birth control pills. They should not be used in the following cases:

• after a heart attack, stroke, angina pectoris, pulmonary embolism, venous thrombosis; in the presence of malignant tumors;
• with hepatic pathologies of a chronic nature;
• with vaginal bleeding of unknown etiology;
• with diseases of the endocrine nature;
• before the planned surgical intervention for any reason;
• after an abortion or miscarriage;
• when breastfeeding a child.

With great care and only after consulting a doctor, tablets can be used in such conditions.

From previous publications, we know about the abortive effect of hormonal contraceptives (GC, OK). Recently, in the media, you can find reviews of affected women from the side effects of OK, we will give a couple of them at the end of the article. To highlight this issue, we turned to the doctor, who prepared this information for the ABC of Health, and also translated for us fragments of articles with foreign studies on the side effects of HA.

Side effects of hormonal contraceptives.

The actions of hormonal contraceptives, like those of other drugs, are determined by the properties of their constituent substances. Most contraceptive pills prescribed for planned contraception contain 2 types of hormones: one gestagen and one estrogen.

Gestagens

Gestagens = progestogens = progestins- hormones that are produced by the corpus luteum of the ovaries (a formation on the surface of the ovaries that appears after ovulation - the release of the egg), in a small amount - by the adrenal cortex, and during pregnancy - by the placenta. The main progestogen is progesterone.

The name of the hormones reflects their main function - "pro gestation" = "to [preserve] pregnancy" by restructuring the uterine endothelium into a state necessary for the development of a fertilized egg. The physiological effects of gestagens are combined into three main groups.

1. vegetative effect. It is expressed in the suppression of the proliferation of the endometrium, caused by the action of estrogens, and its secretory transformation, which is very important for a normal menstrual cycle. When pregnancy occurs, gestagens suppress ovulation, lower the tone of the uterus, reducing its excitability and contractility ("protector" of pregnancy). Progestins are responsible for the "maturation" of the mammary glands.
2. generative action. In small doses, progestins increase the secretion of follicle-stimulating hormone (FSH), which is responsible for the maturation of ovarian follicles and ovulation. In large doses, gestagens block both FSH and LH (luteinizing hormone, which is involved in the synthesis of androgens, and together with FSH provides ovulation and progesterone synthesis). Gestagens affect the center of thermoregulation, which is manifested by an increase in temperature.
3. General action. Under the influence of gestagens, amine nitrogen in the blood plasma decreases, the excretion of amino acids increases, the separation of gastric juice increases, and the separation of bile slows down.

The composition of oral contraceptives includes various gestagens. For a while it was believed that there was no difference between progestins, but now it is known for sure that the difference in molecular structure provides a variety of effects. In other words, progestogens differ in spectrum and in the severity of additional properties, but the 3 groups of physiological effects described above are inherent in all of them. The characteristics of modern progestins are shown in the table.

Pronounced or very pronounced gestagenic effect common to all progestogens. The gestagenic effect refers to those main groups of properties that were mentioned earlier.

Androgenic activity is not characteristic of many drugs, its result is a decrease in the amount of "good" cholesterol (HDL cholesterol) and an increase in the concentration of "bad" cholesterol (LDL cholesterol). As a result, the risk of atherosclerosis increases. In addition, there are symptoms of virilization (male secondary sexual characteristics).

Explicit antiandrogenic effect available for only three drugs. This effect has a positive meaning - an improvement in the condition of the skin (cosmetic side of the issue).

Antimineralocorticoid activity associated with an increase in diuresis, sodium excretion, and a decrease in blood pressure.

Glucocorticoid effect affects metabolism: there is a decrease in the body's sensitivity to insulin (risk of diabetes), increased synthesis of fatty acids and triglycerides (risk of obesity).

Estrogens

The other ingredient in birth control pills is estrogen.

Estrogens- female sex hormones, which are produced by the ovarian follicles and the adrenal cortex (and in men also by the testicles). There are three main estrogens: estradiol, estriol, and estrone.

Physiological effects of estrogens:

- proliferation (growth) of the endometrium and myometrium according to the type of their hyperplasia and hypertrophy;

- development of genital organs and secondary sexual characteristics (feminization);

- suppression of lactation;

- inhibition of resorption (destruction, resorption) of bone tissue;

- procoagulant action (increased blood clotting);

- an increase in the content of HDL ("good" cholesterol) and triglycerides, a decrease in the amount of LDL ("bad" cholesterol);

- retention of sodium and water in the body (and, as a result, an increase in blood pressure);

- ensuring the acidic environment of the vagina (normally pH 3.8-4.5) and the growth of lactobacilli;

- increased production of antibodies and activity of phagocytes, increased resistance of the body to infections.

Estrogens in oral contraceptives are needed to control the menstrual cycle, they do not take part in protection against unwanted pregnancy. Most often, the composition of the tablets includes ethinylestradiol (EE).

Mechanisms of action of oral contraceptives

So, given the basic properties of gestagens and estrogens, the following mechanisms of action of oral contraceptives can be distinguished:

1) inhibition of the secretion of gonadotropic hormones (due to gestagens);

2) a change in the pH of the vagina to a more acidic side (the effect of estrogens);

3) increased viscosity of cervical mucus (gestagens);

4) the phrase “ovum implantation” used in instructions and manuals, which hides the abortive effect of HA from women.

Gynecologist's commentary on the abortive mechanism of action of hormonal contraceptives

When implanted in the wall of the uterus, the embryo is a multicellular organism (blastocyst). An egg (even a fertilized one) is never implanted. Implantation occurs 5-7 days after fertilization. Therefore, what is called an egg in the instructions is actually not an egg at all, but an embryo.

Unwanted estrogen...

In the course of a thorough study of hormonal contraceptives and their effect on the body, it was concluded that undesirable effects are associated to a greater extent with the influence of estrogens. Therefore, the smaller the amount of estrogens in a tablet, the fewer side effects, but it is not possible to completely eliminate them. It was these conclusions that prompted scientists to invent new, more advanced drugs, and oral contraceptives, in which the amount of the estrogen component was measured in milligrams, were replaced by tablets containing estrogen in micrograms ( 1 milligram [ mg] = 1000 micrograms [ mcg]). There are currently 3 generations of birth control pills. The division into generations is due to both a change in the amount of estrogen in the preparations and the introduction of newer progesterone analogues into the composition of the tablets.

The first generation of contraceptives include "Enovid", "Infekundin", "Bisekurin". These drugs have been widely used since their discovery, but later their androgenic effect was noticed, manifested in the coarsening of the voice, the growth of facial hair (virilization).

Second-generation drugs include Microgenon, Rigevidon, Triregol, Triziston and others.

The most commonly used and widespread are third-generation drugs: Logest, Merisilon, Regulon, Novinet, Diane-35, Zhanin, Yarina and others. A significant advantage of these drugs is their antiandrogenic activity, which is most pronounced in Diane-35.

The study of the properties of estrogens and the conclusion that they are the main source of side effects from the use of hormonal contraceptives led scientists to the idea of ​​​​creating drugs with an optimal reduction in the dose of estrogen in them. It is impossible to completely remove estrogens from the composition, since they play an important role in maintaining a normal menstrual cycle.

In this regard, the division of hormonal contraceptives into high-, low- and microdosed preparations has appeared.

High-dose (EE = 40-50 mcg per tablet).

• "Non-ovlon"
• Ovidon and others
• Not used for contraception.

Low-dose (EE = 30-35 mcg per tablet).

• "Marvelon"
• "Janine"
• "Yarina"
• "Femoden"
• "Diana-35" and others

Microdosed (EE = 20 mcg per tablet)

• "Logest"
• Mercilon
• "Novinet"
• "Minisiston 20 Fem" "Jess" and others

Side effects of hormonal contraceptives

Side effects from the use of oral contraceptives are always described in detail in the instructions for use.

Since the side effects from the use of various contraceptive pills are approximately the same, it makes sense to consider them, highlighting the main (severe) and less severe ones.

Some manufacturers list conditions that should stop taking immediately. These states include the following:

1. Arterial hypertension.
2. Hemolytic-uremic syndrome, manifested by a triad of signs: acute renal failure, hemolytic anemia and thrombocytopenia (decrease in the number of platelets).
3. Porphyria is a disease in which the synthesis of hemoglobin is impaired.
4. Hearing loss due to otosclerosis (fixation of the auditory ossicles, which should normally be mobile).

Almost all manufacturers designate thromboembolism as rare or very rare side effects. But this grave condition deserves special attention.

Thromboembolism is the blockage of a blood vessel by a thrombus. This is an acute condition that requires qualified help. Thromboembolism cannot occur out of the blue, it needs special “conditions” - risk factors or existing vascular diseases.

Risk factors for thrombosis (formation of blood clots inside the vessels - thrombi - interfering with the free, laminar blood flow):

- age over 35 years;

- smoking (!);

- high levels of estrogen in the blood (which occurs when taking oral contraceptives);

- increased blood clotting, which is observed with a deficiency of antithrombin III, proteins C and S, dysfibrinogenemia, Marchiafava-Michelli disease;

- trauma and extensive operations in the past;

- venous congestion with a sedentary lifestyle;

- obesity;

- varicose veins of the legs;

- damage to the valvular apparatus of the heart;

- atrial fibrillation, angina pectoris;

- diseases of the cerebral vessels (including transient ischemic attack) or coronary vessels;

- arterial hypertension of moderate or severe degree;

- connective tissue diseases (collagenoses), and primarily systemic lupus erythematosus;

- hereditary predisposition to thrombosis (thrombosis, myocardial infarction, cerebrovascular accident in the closest blood relatives).

If these risk factors are present, a woman taking hormonal contraceptive pills has a significantly increased risk of developing thromboembolism. The risk of thromboembolism increases with thrombosis of any localization, both present and past; with myocardial infarction and stroke.

Thromboembolism, whatever its localization, is a severe complication.

	… coronary vessels →	myocardial infarction
	… brain vessels →	stroke
	… deep leg veins →	trophic ulcers and gangrene
	... pulmonary artery (PE) or its branches →	from pulmonary infarction to shock
Thromboembolism…	... hepatic vessels →	liver dysfunction, Budd-Chiari syndrome
	… mesenteric vessels →	ischemic bowel disease, intestinal gangrene
	... renal vessels
	... retinal vessels (retinal vessels)

In addition to thromboembolism, there are other, less severe, but still uncomfortable side effects. For example, candidiasis (thrush). Hormonal contraceptives increase the acidity of the vagina, and in an acidic environment, fungi multiply well, in particular Candidaalbicans, which is an opportunistic pathogen.

A significant side effect is the retention of sodium, and with it water, in the body. This may lead to edema and weight gain. Decreased tolerance to carbohydrates, as a side effect of the use of hormonal pills, increases the risk of diabetes mellitus.

Other side effects, such as: decreased mood, mood swings, increased appetite, nausea, stool disorders, satiety, swelling and soreness of the mammary glands, and some others - although they are not severe, however, affect the quality of life of a woman.

In the instructions for the use of hormonal contraceptives, in addition to side effects, contraindications are listed.

Contraceptives without estrogen

Exist gestagen-containing contraceptives ("mini-drank"). In their composition, judging by the name, only gestagen. But this group of drugs has its indications:

- contraception for lactating women (they should not be prescribed estrogen-progestin drugs, because estrogen suppresses lactation);

- prescribed for women who have given birth (because the main mechanism of action of "mini-drank" is the suppression of ovulation, which is undesirable for nulliparous women);

- in late reproductive age;

- in the presence of contraindications to the use of estrogen.

In addition, these drugs also have side effects and contraindications.

Particular attention should be paid to emergency contraception". The composition of such drugs includes either a progestogen (levonorgestrel) or an antiprogestin (mifepristone) in a large dose. The main mechanisms of action of these drugs are inhibition of ovulation, thickening of cervical mucus, acceleration of desquamation (desquamation) of the functional layer of the endometrium in order to prevent the attachment of a fertilized egg. And Mifepristone has an additional effect - an increase in the tone of the uterus. Therefore, a single use of a large dose of these drugs has a very strong simultaneous effect on the ovaries, after taking emergency contraceptive pills, there can be serious and prolonged menstrual irregularities. Women who regularly use these drugs are at great risk to their health.

Foreign studies of side effects of GC

Interesting studies on the side effects of hormonal contraceptives have been carried out in foreign countries. Below are excerpts from several reviews (translation by the author of the article of fragments of foreign articles)

Oral contraceptives and the risk of venous thrombosis

May, 2001

CONCLUSIONS

Hormonal contraception is used by more than 100 million women worldwide. The number of deaths from cardiovascular diseases (venous and arterial) among young, low-risk patients - non-smoking women from 20 to 24 years old - is observed worldwide in the range from 2 to 6 per year per million, depending on the region of residence, the estimated cardiovascular - vascular risk and the volume of screening studies that were carried out before the appointment of contraceptives. While the risk of venous thrombosis is more important in younger patients, the risk of arterial thrombosis is more relevant in older patients. Among older women who smoke and use oral contraceptives, the number of deaths is from 100 to just over 200 per million every year.

Reducing the dose of estrogen reduced the risk of venous thrombosis. Third-generation progestins in combined oral contraceptives have increased the incidence of adverse hemolytic changes and the risk of thrombosis, so they should not be given as first choice in hormonal contraceptive beginners.

Reasonable use of hormonal contraceptives, including avoidance of their use by women who have risk factors, is absent in most cases. In New Zealand, a series of deaths from PE were investigated, and often the cause was an unaccounted for risk by doctors.

Reasonable prescription can prevent arterial thrombosis. Almost all women who had a myocardial infarction while using oral contraceptives were either of an older age group, or smoked, or had other risk factors for arterial disease - in particular, arterial hypertension. Avoiding the use of oral contraceptives in such women may lead to a reduction in the incidence of arterial thrombosis, as reported by recent studies in industrialized countries. The beneficial effect that third-generation oral contraceptives have on the lipid profile and their role in reducing the number of heart attacks and strokes has not yet been confirmed by control studies.

To avoid venous thrombosis, the doctor asks if the patient has ever had a venous thrombosis in the past, to determine if there are contraindications to prescribing oral contraceptives, and what is the risk of thrombosis while taking hormonal drugs.

Nixodosed progestogen oral contraceptives (first or second generation) caused a lower risk of venous thrombosis than combination drugs; however, the risk in women with a history of thrombosis is not known.

Obesity is considered a risk factor for venous thrombosis, but it is not known whether this risk is increased with the use of oral contraceptives; thrombosis is uncommon among obese people. Obesity, however, is not considered a contraindication to oral contraceptive use. Superficial varicose veins are not a consequence of pre-existing venous thrombosis or a risk factor for deep venous thrombosis.

Heredity may play a role in the development of venous thrombosis, but its tangibility as a high risk factor remains unclear. Superficial thrombophlebitis in history can also be considered as a risk factor for thrombosis, especially if it is combined with aggravated heredity.

Venous thromboembolism and hormonal contraception

Royal College of Obstetricians and Gynecologists, UK

July, 2010

Do combined hormonal contraceptive methods (pills, patch, vaginal ring) increase the risk of venous thromboembolism?

The relative risk of venous thromboembolism increases with the use of any combined hormonal contraceptive (pills, patch and vaginal ring). However, the rarity of venous thromboembolism in women of reproductive age means that the absolute risk remains low.

The relative risk of venous thromboembolism increases in the first few months after starting combined hormonal contraception. As the duration of taking hormonal contraceptives increases, the risk decreases, but as a background it remains until the cessation of the use of hormonal drugs.

In this table, the researchers compared the incidence of venous thromboembolism per year in different groups of women (in terms of 100,000 women). From the table it is clear that in non-pregnant and non-using hormonal contraceptives women (non-pregnantnon-users) an average of 44 (with a range of 24 to 73) cases of thromboembolism per 100,000 women are registered per year.

Drospirenone-containingCOCusers - users of drospirenone-containing COCs.

Levonorgestrel-containingCOCusers - using levonorgestrel-containing COCs.

Other COCs not specified - other COCs.

Pregnantnon-users are pregnant women.

Strokes and heart attacks while using hormonal contraception

"New England Journal of Medicine"

Medical Society of Massachusetts, USA

June, 2012

CONCLUSIONS

Although the absolute risks of stroke and heart attack associated with hormonal contraceptives are low, the risk was increased from 0.9 to 1.7 with drugs containing ethinylestradiol at a dose of 20 mcg and from 1.2 to 2.3 with the use of drugs containing ethinyl estradiol at a dose of 30-40 mcg, with a relatively small risk difference depending on the type of gestagen included.

Risk of thrombosis of oral contraception

WoltersKluwerHealth is a leading provider of qualified health information.

HenneloreRott - German doctor

August, 2012

CONCLUSIONS

Different combined oral contraceptives (COCs) are characterized by a different risk of venous thromboembolism, but the same unsafe use.

COCs with levonorgestrel or norethisterone (the so-called second generation) should be the drugs of choice, as recommended by national contraceptive guidelines in the Netherlands, Belgium, Denmark, Norway and the UK. Other European countries do not have such guidelines, but they are essential.

In women with a history of venous thromboembolism and/or known coagulation defects, the use of COCs and other contraceptives containing ethinyl estradiol is contraindicated. On the other hand, the risk of venous thromboembolism during pregnancy and the postpartum period is much higher. For this reason, such women should be offered adequate contraception.

There is no reason to abstain from hormonal contraception in young patients with thrombophilia. Progesterone-only preparations are safe in relation to the risk of venous thromboembolism.

Risk of venous thromboembolism among users of drospirenone-containing oral contraceptives

American College of Obstetricians and Gynecologists

November 2012

CONCLUSIONS
The risk of venous thromboembolism is increased among users of oral contraceptives (3-9/10,000 women per year) compared with non-pregnant and non-users of these drugs (1-5/10,000 women per year). There is evidence that drospirenone-containing oral contraceptives have a higher risk (10.22/10,000) than drugs containing other progestins. However, the risk is still low and much lower than during pregnancy (approximately 5–20/10,000 women per year) and postpartum (40–65/10,000 women per year) (see table).

Tab. risk of thromboembolism.