Catad_pgroup Combined oral contraceptives

contraception plus

Jess Plus * and Yarina Plus are time-tested contraceptives with an important female vitamin for caring for an unborn child.

* as well as with therapeutic possibilities
INFORMATION IS PROVIDED STRICTLY
FOR HEALTHCARE PROFESSIONALS

Jeanine - official * instructions for use

*registered by the Ministry of Health of the Russian Federation (according to grls.rosminzdrav.ru)

JEANINE ®

Registration number:

P N013757/01

Tradename

Dosage form

Compound

Each dragee contains:

Active ingredients: ethinylestradiol 0.03 mg and dienogest 2.0 mg.

Excipients: lactose monohydrate, potato starch, gelatin, talc, magnesium stearate, sucrose, dextrose (glucose syrup), macrogol 35000, calcium carbonate, povidone K25, titanium dioxide (E 171), carnauba wax.

Description

White smooth dragees.

Pharmacotherapeutic group

Combined contraceptive (estrogen + gestagen)

ATX code G03AA

Pharmacological properties

Pharmacodynamics

Jeanine is a low-dose monophasic oral combined estrogen-progestogen contraceptive drug.

The contraceptive effect of Jeanine is mediated through complementary mechanisms, the most important of which are the suppression of ovulation and the change in the viscosity of the cervical mucus, making it impermeable to spermatozoa.

When used correctly, the Pearl Index (an indicator that reflects the number of pregnancies in 100 women taking a contraceptive during the year) is less than 1. If pills are missed or used incorrectly, the Pearl index may increase.

The gestagenic component of Zhanin - dienogest - has antiandrogenic activity, which is confirmed by the results of a number of clinical studies. In addition, dienogest improves the lipid profile of the blood (increases the amount of high density lipoproteins).

In women taking combined oral contraceptives, the menstrual cycle becomes more regular, painful periods are less common, the intensity and duration of bleeding decreases, resulting in a reduced risk of iron deficiency anemia. In addition, there is evidence of a reduced risk of endometrial cancer and ovarian cancer.

Pharmacokinetics

· Dienogest

Absorption. When taken orally, dienogest is rapidly and completely absorbed, its maximum serum concentration of 51 ng / ml is reached after about 2.5 hours. Bioavailability is approximately 96%.

Distribution. Dienogest binds to serum albumin and does not bind to sex steroid-binding globulin (SHBG) and corticoid-binding globulin (CBG). In the free form is about 10% of the total concentration in the blood serum; about 90% are not specifically associated with serum albumin. The induction of SHBG synthesis by ethinylestradiol does not affect the binding of dienogest to whey protein.

Metabolism. Dienogest is almost completely metabolized. Serum clearance after a single dose is approximately 3.6 l/h.

Withdrawal. The half-life is about 8.5-10.8 hours. A small amount in unchanged form is excreted by the kidneys in the form of metabolites (half-life - 14.4 hours), which are excreted by the kidneys and through the gastrointestinal tract in a ratio of approximately 3: 1.

Equilibrium concentration. The pharmacokinetics of dienogest is not affected by the level of SHBG in the blood serum. As a result of daily administration of the drug, the level of the substance in the serum increases by about 1.5 times.

· Ethinylestradiol

Absorption. After oral administration, ethinylestradiol is rapidly and completely absorbed. The maximum concentration in blood serum, equal to approximately 67 pg / ml, is reached in 1.5-4 hours. During absorption and first passage through the liver, ethinylestradiol is metabolized, resulting in its oral bioavailability averaging about 44%.

Distribution. Ethinyl estradiol is almost completely (approximately 98%), although non-specific, bound to albumin. Ethinylestradiol induces the synthesis of SHBG. The apparent volume of distribution of ethinylestradiol is 2.8 - 8.6 l / kg.

Metabolism. Ethinylestradiol undergoes presystemic conjugation both in the small intestine mucosa and in the liver. The main metabolic pathway is aromatic hydroxylation. The rate of clearance from blood plasma is 2.3 - 7 ml / min / kg. Withdrawal. The decrease in the concentration of ethinylestradiol in the blood serum is biphasic; the first phase is characterized by a half-life of about 1 hour, the second - 10-20 hours. It is not excreted from the body unchanged. Metabolites of ethinyl estradiol are excreted in the urine and bile in a ratio of 4: 6 with a half-life of about 24 hours.
equilibrium concentration. The equilibrium concentration is reached during the second half of the treatment cycle.

Indications for use

Contraception.

Contraindications

Jeanine should not be used in the presence of any of the conditions/diseases listed below. If any of these conditions develop for the first time while taking it, the drug should be immediately discontinued.

Thrombosis (venous and arterial) and thromboembolism at present or in history (including deep vein thrombosis, pulmonary embolism, myocardial infarction, stroke), cerebrovascular disorders.
Conditions preceding thrombosis (including transient ischemic attacks, angina pectoris) at present or in history.
· Migraine with focal neurological symptoms at present or in history.
· Diabetes mellitus with vascular complications.
· Multiple or pronounced risk factors for venous or arterial thrombosis, including complicated lesions of the valvular apparatus of the heart, atrial fibrillation, cerebrovascular disease or coronary artery disease; uncontrolled arterial hypertension, major surgery with prolonged immobilization, smoking over the age of 35 years.
Pancreatitis with severe hypertriglyceridemia at present or in history.
Liver failure and severe liver disease (before normalization of liver tests).
Liver tumors (benign or malignant) at present or in history.
Identified hormone-dependent malignant diseases (including the genital organs or mammary glands) or suspicion of them.
Bleeding from the vagina of unknown origin.
Pregnancy or suspected pregnancy.
The period of breastfeeding.
· Hypersensitivity to any of the components of the drug Jeanine.

With caution

The potential risk and expected benefit of using combined oral contraceptives should be carefully weighed in each individual case in the presence of the following diseases / conditions and risk factors:

· Risk factors for the development of thrombosis and thromboembolism: smoking; obesity; dyslipoproteinemia, arterial hypertension; migraine; valvular heart disease; prolonged immobilization, major surgical interventions, extensive trauma; hereditary predisposition to thrombosis (thrombosis, myocardial infarction or cerebrovascular accident at a young age in one of the next of kin)
Other diseases in which peripheral circulation disorders may occur: diabetes mellitus; systemic lupus erythematosus; hemolytic uremic syndrome; Crohn's disease and ulcerative colitis; sickle cell anemia; phlebitis of superficial veins
Hereditary angioedema
Hypertriglyceridemia
Liver diseases
Diseases that first arose or worsened during pregnancy or due to previous use of sex hormones (for example, jaundice, cholestasis, gallbladder disease, otosclerosis with hearing loss, porphyria, herpes pregnant, Sydenham's chorea)
Postpartum period

Pregnancy and lactation
Janine should not be used during pregnancy and while breastfeeding. If pregnancy is detected while taking the drug Jeanine, it should be immediately discontinued and consult a doctor. However, extensive epidemiological studies have not found an increased risk of developmental defects in children born to women who received sex hormones before pregnancy or who inadvertently took sex hormones in early pregnancy.
Taking combined oral contraceptives can reduce the amount of breast milk and change its composition, so their use is not recommended until breastfeeding is stopped.

Dosage and administration

When and how to take dragees
The calendar package contains 21 dragees. In the package, each dragee is marked with the day of the week on which it should be taken. Take the tablets by mouth at the same time each day with a small amount of water. Follow the direction of the arrow until all 21 pills have been taken. You do not take the drug for the next 7 days. Menstruation (withdrawal bleeding) must begin within these 7 days. It usually starts 2-3 days after taking the last Janine dragee. After a 7-day break, start taking the pills from the next package, even if the bleeding has not yet stopped. This means that you will always start a new pack on the same day of the week, and that withdrawal bleeding will occur around the same day of the week each month.
Reception of the first package of Jeanine
When no hormonal contraceptive has been used in the previous month
Start taking Janine on the first day of your cycle, which is the first day of your menstrual bleeding. Take the dragee that is labeled with the corresponding day of the week. Then take the pills in order. You can also start taking on days 2-5 of the menstrual cycle, but in this case, you must use an additional barrier method of contraception (condom) during the first 7 days of taking the pills from the first package.
When switching from other combined oral contraceptives, vaginal ring or contraceptive patch
You can start taking Janine the day after you take the last pill of your current pack of combined oral contraceptives (i.e., without interruption). If the current package contains 28 tablets, you can start taking Janine the day after taking the last active tablet. If you are not sure which tablet it is, ask your doctor. You can also start taking later, but in no case later than the next day after the usual break in taking (for preparations containing 21 tablets) or after taking the last inactive tablet (for preparations containing 28 tablets per pack).
Janine should be started on the day the vaginal ring or patch is removed, but no later than the day a new ring or patch is to be inserted.
When switching from oral contraceptives containing only progestogen (mini-pill)
You can stop taking the mini-pill any day and start taking Janine the next day, at the same time. During the first 7 days of taking the pills, you must also use an additional barrier method of contraception.
When switching from an injectable contraceptive, an implant, or a progestogen-releasing intrauterine contraceptive (Mirena)
Start Janine on the day your next injection is due or on the day your implant or intrauterine contraceptive is removed. During the first 7 days of taking the pills, you must also use an additional barrier method of contraception.
· After childbirth
If you have just had a baby, your doctor may recommend that you wait until your first normal menstrual period has ended before you start taking Jeanine. Sometimes, on the recommendation of a doctor, it is possible to start taking the drug earlier.
After a spontaneous miscarriage or abortion in the first trimester of pregnancy
Check with your doctor. It is usually recommended to start taking immediately.
Taking missed pills
· If the delay in taking the next pill is less than 12 hours, the contraceptive effect of Zhanin is preserved. Take the dragee as soon as you remember it. Take the next pill at the usual time.
· If the delay in taking the pill was more than 12 hours, contraceptive protection may be reduced. The more pills missed in a row, and the closer this pass is to the beginning of the intake or to the end of the intake, the higher the risk of pregnancy.
In this case, you can follow the following rules:
· Forgotten more than one tablet from the packageConsult your doctor.
One tablet was missed in the first week of taking the drug
Take the missed pill as soon as you remember (even if it means taking two pills at the same time). Take the next pill at the usual time. Additionally, use a barrier method of contraception for the next 7 days. If sexual intercourse took place within a week before skipping the dragee, the likelihood of pregnancy should be considered. Consult your physician immediately.
One tablet was missed in the second week of taking the drug
Take the missed pill as soon as you remember (even if it means taking two pills at the same time). Take the next pill at the usual time. If you have taken the pills correctly in the 7 days preceding the first missed pill, the contraceptive effect of Jeanine is maintained and you do not need to use additional contraceptive measures. Otherwise, as well as skipping two or more pills, you must additionally use barrier methods of contraception for 7 days.
One tablet was missed in the third week of taking the drug
If during the 7 days preceding the first missed pill, all the pills were taken correctly, there is no need to use additional contraceptive methods. You can stick to either of the following two options
1. Take the missed pill as soon as you remember (even if it means taking two pills at the same time). Take the next pill at the usual time. Start the next pack immediately after finishing taking the pills from the current pack, so there will be no break between packs. Withdrawal bleeding is unlikely until the pills in the second pack are finished, but there may be spotting or breakthrough bleeding on the days of taking the drug.
2. Stop taking the pills from the current package, take a break of 7 days or less (including the day you missed the pills) and then start taking the pills from the new package.

Using this scheme, you can always start taking the pills from the next pack on the day of the week when you usually do it.
If you don't have your expected period after you stop taking the pills, you may be pregnant. Consult your doctor before you start taking pills from a new package.
In situations where you are advised to stop taking the combined oral contraceptive, or where the reliability of COCs may be reduced, you should abstain from sexual intercourse or use non-hormonal contraceptive methods (for example, a condom or other barrier methods). Do not use rhythmic or temperature methods. These methods can be unreliable because taking COCs leads to changes in temperature and cervical mucus.
Recommendations in case of vomiting and diarrhea
If you have had vomiting or diarrhea (indigestion) up to 4 hours after taking Jeanine tablets, the active substances may not have been completely absorbed. This situation is similar to skipping a drug. Therefore, follow the instructions for missed pills.
Delaying the onset of menstruation
You can delay the start of your period if you start taking the next pack of Jeanine immediately after the end of the current pack. You can continue taking the pills in this package for as long as you wish or until the package runs out. If you want your period to start, stop taking the dragee. While taking Janine from the second package, spotting or bleeding may occur on the days of taking the dragee. Start the next pack after the usual 7-day break.
Changing the day of your period
If you take the pills as recommended, you will have your period on about the same day every 4 weeks. If you want to change it, shorten (but do not lengthen) the period of time free from taking pills. For example, if your menstrual cycle usually starts on Friday and in the future you want it to start on Tuesday (3 days earlier), the next pack should start 3 days earlier than usual. If the pill-free break is very short (for example, 3 days or less), menstruation may not occur during the break. In this case, bleeding or spotting may occur while taking the pills from the next package.

Additional information for special categories of patients
Children and teenagers
The drug Jeanine is indicated only after the onset of menarche.
Elderly patients
Not applicable. Jeanine is not indicated after menopause.
Patients with liver disorders
Jeanine is contraindicated in women with severe liver disease until liver function tests return to normal. See also section "Contraindications".
Patients with kidney disorders
Jeanine has not been specifically studied in patients with renal impairment. Available data do not suggest a change in treatment in these patients.

Side effect

When taking combined oral contraceptives, irregular bleeding (spotting or breakthrough bleeding) may occur, especially during the first months of use.
While taking the drug Jeanine, other undesirable effects may be observed, although their appearance is not necessary in all patients.
Serious unwanted effects:
See sections "With caution" and "Special instructions". Please read these sections carefully and if you experience any adverse effects, including serious reactions associated with the use of the drug, consult your doctor.
Other undesirable effects identified during the study of the drug Janine:
Common side effects (more than 1/100 and less than 1/10):
- headache;
- pain in the mammary glands, including discomfort in the mammary glands and engorgement of the mammary glands.
Uncommon side effects (more than 1/1000 and less than 1/100):
- vaginitis / vulvovaginitis (inflammation of the female genital organs);
- vaginal candidiasis (thrush) or other fungal vulvovaginal infections;
- increase in appetite;
- decrease in mood;
- dizziness;
- migraine;
- high or low blood pressure;
- abdominal pain (including pain in the upper and lower abdomen, discomfort / bloating);
- nausea, vomiting or diarrhea;
- acne;
- alopecia (hair loss);
- rash (including patchy rash);
- itching (sometimes itching of the whole body);
- abnormal menstruation, including menorrhagia (heavy menstruation), hypomenorrhea (scanty menstruation), oligomenorrhea (irregular menstruation), and amenorrhea (absence of menstruation);
- intermenstrual bleeding, including vaginal bleeding and metrorrhagia (irregular bleeding between periods);
- an increase in the size of the mammary glands, including swelling and bursting of the mammary glands;
- swelling of the mammary glands;
- dysmenorrhea (painful menstruation);
- vaginal discharge;
- ovarian cysts;
- pain in the pelvic area;
- fatigue, including asthenia (weakness) and malaise (fatigue, including weakness and general malaise);
- weight change (increase or decrease).
Rare side effects (more than 1/10000 and less than 1/1000):
- adnexitis (inflammation of the fallopian (uterine) tubes and ovaries);
- urinary tract infections;
- cystitis (inflammation of the bladder);
- mastitis (inflammation of the mammary gland);
- cervicitis (inflammation of the cervix);
- candidiasis or other fungal infections;
- herpetic lesions of the oral cavity;
- flu;
- bronchitis;
- sinusitis;
- infections of the upper respiratory tract;
- viral infection;
- uterine fibroids (benign neoplasms in the uterus);
- breast lipoma (benign neoplasms of adipose tissue);
- anemia;
- hypersensitivity (allergic reactions);
- virilism (development of male secondary sexual characteristics);
- anorexia (severe loss of appetite);
- depression;
- mental disorders;
- insomnia;
- sleep disorders;
- aggression;
- ischemic stroke (reduced or suddenly stopped blood supply to part of the brain);
- cerebrovascular disorders (disorders of the blood flow system to the brain);
- dystonia (muscle tension (contractures) caused by an uncomfortable posture);
- dryness or irritation of the mucous membrane of the eyes;
- oscillopsia (impaired visual clarity, the illusion of motionless objects fluctuating) or other visual disturbances;
- sudden hearing loss;
- noise in ears;
- dizziness;
- hearing impairment;
- cardiovascular disorders (impaired blood supply to the heart);
- tachycardia (rapid heartbeat);
- thrombosis (formation of a blood clot in the blood vessels);
- pulmonary embolism (acute blockage of the branches of the pulmonary artery by blood clots);
- thrombophlebitis (inflammation of the venous wall with the formation of a blood clot in the lumen of the vein);
- an increase in diastolic pressure (the minimum indicator of blood pressure, corresponds to the pressure in the arterial vessels between heartbeats);
- orthostatic circular dystonia (feeling of dizziness, weakness or fainting when changing body position from sitting or lying to vertical);
- tides;
- phlebeurysm;
- pathology of veins, pain in the area of ​​veins;
- bronchial asthma;
- hyperventilation;
- gastritis;
- enteritis;
- dyspepsia (indigestion);
- skin reactions;
- skin pathology, including allergic dermatitis, neurodermatitis / atopic dermatitis, eczema, psoriasis;
- hyperhidrosis (excessive sweating);
- Chloasma (golden-brown pigmented spots, the so-called "spots of pregnant women", mainly on the face);
- violation of pigmentation / hyperpigmentation;
- seborrhea (oily skin);
- dandruff;
- hirsutism (male pattern hair growth);
- Orange peel;
- spider veins (expansion of subcutaneous vessels in the form of a mesh with a central red spot);
- back pain;
- discomfort in the muscles and bones of the skeleton;
- myalgia (muscle pain);
- pain in the arms and legs;
- cervical dysplasia (abnormal changes in the epithelium of the cervix);
- pain in the area of ​​the uterine appendages or cysts of the uterine appendages (ovaries and fallopian (uterine) tubes);
- breast cysts;
- fibrocystic mastopathy (benign neoplasms in the mammary glands);
- dyspareunia (pain during intercourse);
- galactorrhea (milk secretion);
- violations of the menstrual cycle;
- chest pain;
- peripheral edema;
- flu-like conditions;
- inflammation.
Undesirable effects identified during the study of the drug, the frequency of which is unknown: mood changes, increased or decreased libido, contact lens intolerance, urticaria, skin disorders (such as erythema nodosum or multiforme), discharge from the mammary glands, fluid retention.
If you have hereditary angioedema, medicines that contain certain female sex hormones (estrogens) may cause symptoms to worsen (see Precautions section).
If any of the side effects gets serious or if you notice any side effects not listed in the instructions, please tell your doctor or pharmacist.
Overdose
Serious violations with a single dose of a large number of Zhanin dragees were not reported.
Symptoms that may occur in overdose include nausea, vomiting, spotting or vaginal bleeding.
In case of overdose, you should consult a doctor.

Interaction with other drugs

Some medicines may reduce the effectiveness of Jeanine. These include drugs used to treat epilepsy (eg, primidone, phenytoin, barbiturates, carbamazepine, oxcarbazepine, topiramate, felbamate), tuberculosis (eg, rifampicin, rifabutin), and HIV infection (eg, ritonavir, nevirapine); antibiotics for certain other infectious diseases (eg, penicillin, tetracyclines, griseofulvin); and St. John's wort medicines (used mainly in the treatment of low mood).
Oral combined contraceptives may interfere with the metabolism of other drugs (eg, cyclosporine and lamotrigine).
Some medicines may interfere with the metabolism of the active ingredients in Jeanine. These include antifungal drugs (eg, ketoconazole), H2 blockers to treat gastric and duodenal ulcers (eg, cimetidine), some drugs to treat hypertension (eg, verapamil, diltiazem), antibiotics to treat bacterial infections (macrolides, erythromycin), antidepressants, grapefruit juice.
Always tell your doctor who prescribes Janine what medicines you are already taking. Also tell any doctor or dentist who prescribes other drugs, or any pharmacist who sells you drugs at a pharmacy, that you are taking Janine.
In some cases, your doctor may recommend that you additionally use a barrier method of contraception (condom).

special instructions

The following warnings regarding the use of other combined oral contraceptives should also be taken into account when using Janine.
Thrombosis
Thrombosis is the formation of a blood clot (thrombus) that can block a blood vessel. When a thrombus breaks off, thromboembolism develops. Sometimes thrombosis develops in the deep veins of the legs (deep vein thrombosis), the vessels of the heart (myocardial infarction), the brain (stroke), and very rarely in the vessels of other organs.
The risk of deep vein thrombosis in women taking combined oral contraceptives is higher than in those who do not use them, but not as high as during pregnancy.
The risk of thrombosis increases with age and also increases with the number of cigarettes smoked. When using Jeanine, you should stop smoking, especially if you are over 35 years old.
The risk of deep vein thrombosis is temporarily increased during surgery or prolonged immobilization (immobilization), for example, when applying a cast to the leg, prolonged bed rest. In the event of a planned operation or hospitalization, tell your doctor in advance that you are taking combined oral contraceptives. Your doctor may recommend that you stop using the drug (if you are going to have surgery, at least four weeks before it) and not resume taking it until two weeks after immobilization ends.
If high blood pressure is detected, your doctor may recommend that you stop taking combined oral contraceptives.
Tumors
The relationship between taking combined oral contraceptives and breast cancer has not been proven, although in women taking combined oral contraceptives, it is slightly more common than in women of the same age who do not use them. Perhaps this difference is due to the fact that when taking the drug, women are examined more often and therefore breast cancer is detected at an early stage.
In rare cases, against the background of the use of sex steroids, the development of benign, and in extremely rare cases, malignant liver tumors, which can lead to life-threatening intra-abdominal bleeding, was observed. The relationship with the use of drugs has not been proven. If you suddenly develop severe abdominal pain, consult your doctor immediately.
The most significant risk factor for developing cervical cancer is persistent papillomavirus infection. Cervical cancer was detected slightly more often in women using combined oral contraceptives for a long period of time. The relationship with the use of combined oral contraceptives has not been proven. This may be due to more frequent gynecological examinations for cervical disease or to sexual behavior (more rare use of barrier methods of contraception).
Reduced efficiency
The effectiveness of combined oral contraceptives may be reduced in the following cases: when you skip pills, with vomiting and diarrhea, or as a result of drug interactions.
Women with a tendency to chloasma while taking combined oral contraceptives should avoid prolonged exposure to the sun and exposure to ultraviolet radiation.
In women with hereditary forms of angioedema exogenous estrogens may cause or worsen symptoms of angioedema

Intermenstrual bleeding
As with other combined oral contraceptives, irregular vaginal bleeding (spotting or breakthrough bleeding) between menstrual periods may occur during the first few months while taking Janine. Use hygiene products and continue taking the tablets as usual. Intermenstrual vaginal bleeding usually stops as your body adapts to Jeanine (usually after 3 cycles of pills). If they continue, become severe, or recur after stopping, see your doctor.
Absence of another menstruation
If you took all the pills correctly, and you did not vomit while taking the pills or taking other medications at the same time, then the chance of pregnancy is small. Continue taking Janine as usual.
If you miss two periods in a row, see your doctor immediately. Do not start taking the pills from the next package until the doctor has ruled out pregnancy.

When to consult a doctor
Regular checkups
If you are taking Jeanine, your doctor will tell you to have regular checkups, at least once a year.
Consult your doctor as soon as possible:

• for any health condition, especially any of the conditions listed in this package insert (see also "Contraindications" and "Use with caution");
• with local compaction in the mammary gland; if you are going to use other medicines (see also "Interaction with other medicines");
• if prolonged immobility is expected (for example, a cast is applied to the leg), hospitalization or surgery is planned (consult your doctor at least 4 to 6 weeks before);
• if you experience unusual heavy vaginal bleeding;
• if you forgot to take a pill in the first week of taking the package and had sexual intercourse seven days before;
• you have missed your period twice in a row or suspect you are pregnant (do not start the next pack until you have consulted with your doctor).

Stop taking the dragee and consult your doctor immediately if you notice possible signs of thrombosis: first-time: unusual cough; unusually severe pain behind the sternum, radiating to the left arm; unexpected shortness of breath; unusual, severe or prolonged headache or migraine attack; partial or complete loss of vision or double vision; inarticulate speech; sudden changes in hearing, smell, or taste; dizziness or fainting; weakness or loss of sensation in any part of the body; severe pain in the abdomen; severe pain in the leg or sudden swelling of any of the legs.

One of the most reliable methods of contraception for women are hormonal pills. Here are described in detail and collected all the facts and knowledge about the drug Jeanine, instructions for use in various health conditions.

The drug is sold in the form of dragees, 21 pcs. in a plate, which is covered on one side with foil. The name and dosage of the drug must be written on the foil. It is difficult to find an analogue of Jeanine in the domestic pharmacology market, since the drug is distinguished by the quality of the active ingredients, which the manufacturer carefully took care of.

general description

The active substance is dienogest and ethinylestradiol - these are chemicals that belong to the contraceptive pharmacological group of drugs. It is considered one of the best in the subgroup "female sex hormones: estrogens, gestagens."

The hormonal drug Janine is a combined drug that has a low dosage of estrogen and progestogen in the right ratio. It is taken exclusively inside, that is, orally, washed down with plenty of water. It is necessary to strictly observe the same intervals of time between taking the tablets.

The action of Janine is due to the suppression of the ovulation process, as well as the thickening of the mucus of the cervical canal of the uterus. A change in the density of this mucus affects the penetration of spermatozoa into the uterus, which not only complicates the process of conception of the fetus, but also reduces the possibility of infection and bacteria entering the uterine cavity.

According to the results of the study, long-term and regular use (according to the instructions) of Jeanine contraceptive pills leads to the stabilization of the menstrual cycle, helps to reduce bleeding during menstruation and reduces pain associated with blood filling of organs during menstruation.

In studies, it was noted that out of 1000 women who take the drug without interruption during the year according to the instructions, the percentage of unwanted pregnancies is 0.001%.

Women who do not take combined oral contraceptives lose about 200 ml of blood during menstruation. With this monthly blood loss, girls often develop iron deficiency anemia. This disease is associated with iron deficiency in the body and is accompanied by a decrease in hemoglobin in the blood, as well as general manifestations of asthenovegetative syndrome. Taking Jeanine reduces blood loss during menstruation, and also reduces the duration of bleeding.

The action of the drug

The contraceptive effect of the drug is associated with the suppression of the ovulatory phase of the menstrual cycle. Jeanine maintains the desired concentration of estrogen in the blood of a woman, which eliminates the possibility of pregnancy.

One of the contraceptive properties of Jeanine is also the thickening of the mucus of the cervical canal of the cervix. Normally, the egg is most often fertilized either in the fallopian tube or in the uterine cavity. After fertilization, the egg is implanted in the wall of the uterus on the 7-8th day from conception.

Changing the physical characteristics of cervical mucus prevents sperm from entering the uterine cavity, which reduces the risk of pregnancy. Thickening of the cervical mucus reduces the possibility of inflammatory diseases of the uterus due to the ingress of bacteria, viruses and protozoa.

The response of the body to the intake of Jeanine

Jeanine contains hormonal substances, therefore it is taken exclusively inside and washed down with plenty of water. This allows you to increase the rate of dissolution of the dragee and accelerate the absorption of the drug into the body.

Drinking water after swallowing tablet preparations prevents the possibility of the tablet sticking to various parts of the esophagus. After dissolving the dragee in the digestive tract, the active substance of the drug is absorbed into the bloodstream and after 2-3 hours its concentration in the blood increases to maximum numbers. After entering the blood through the blood vessels of the small intestine, the drug binds to the serum proteins that are part of the blood elements, more often with albumin, and is delivered to the organs of the reproductive system.

The drug is completely eliminated from the body within two days, and therefore, to maintain a good concentration, it is necessary to take the drug every day at the same time. A decrease in the concentration of hormones in the blood can reduce the contraceptive effect.

Rules for the use of the drug Jeanine in various diseases

During pregnancy and lactation, the use of Jeanine is absolutely contraindicated. It is worth clarifying that the studies that were conducted on the drug did not show any negative effects on the phenotypic and genetic characteristics of the child. But with a deeper study of the effect of contraceptives on a woman's body, there are some concerns about their harmlessness for small children.

When planning pregnancy, you should stop taking combined contraceptive drugs 1-3 months before conceiving a child. This will restore the basic hormonal background. In some diseases, on the contrary, it is recommended to plan the conception of a child immediately after discontinuation of the drug. You can clarify this question with your doctor.

The intake of Jeanine for any kidney disease should be treated very carefully, since it is the filtration barrier of the kidneys that removes this contraceptive from the body. Therefore, if kidney disease occurs, you should immediately consult with a gynecologist-endocrinologist about the problem. Of course, often this problem does not cause difficulties for urologists, but a specialized consultation of a specialist will never hurt.

Women with severe liver disease, especially in the stage of subcompensation and decompensation, are contraindicated in the appointment and use of any oral contraceptives. This is due to the perception of any drug by our body as a poison.

And when any drugs enter the body, the liver begins to work actively to get rid of it in the shortest possible period of time. This condition of the liver is very bad for overall health and often leads to an aggravation of the course of the disease.

Girls should always consult with a gynecologist about the possibility of taking this drug, and it is also worth noting that it is recommended to use it only after the onset of a regular menstrual cycle. Women of the menopausal period are also not recommended to take the drug Janine due to the high risk of thromboembolic complications.

Rule of application and dosage

Many women turn to gynecologists with a request to tell them how to take hormonal drugs correctly and for how long. This paragraph of this article describes in detail all the main points of the instructions for use.

The rules for taking combined hormonal drugs should be treated very scrupulously. Reception according to the instructions will not only provide an almost one hundred percent result of contraception, but also reduce possible side effects.

The drug is taken at the same time every day orally, washed down with water. For the first time, Jeanine is strongly recommended to be taken only after the onset of regular sexual activity and the onset of a constant cycle of menstruation. Usually the drug can be drunk from the first day of the onset of menstruation (the first day of the menstrual cycle). The duration of admission is 21 days according to the order indicated on the package. After taking it for three weeks, you need to take a break for one week. Within 2-4 days, menstruation begins. After 7 days of so-called rest, you need to start a new course.

You need to start taking medicinal tablet contraceptives, taking into account some circumstances:.

1. Exclude diseases of the kidneys, liver, thyroid gland.
2. Consult with a gynecologist about the need to take Janine.
3. Exclude hormonal disorders and gynecological diseases.
4. It is necessary to consult a doctor when switching from one type of contraception to another, as in this case there are many features. But the main one is to avoid interruptions between taking contraceptives.
5. When deciding to take combined drugs for contraception, you need to make sure that you are not pregnant.

If, nevertheless, you decide to take it, they will provide you with complete protection against unwanted pregnancy. But there are situations when the pill was missed, and then the risk of a possible pregnancy increases depending on the number of missed days.

If one day of admission is missed (the time between doses is less than 36 hours), it is necessary to take the missed tablet as soon as possible. In this case, over the next 7 days, you need to use additional contraception, such as a condom (in case the missed pill fell on the 1st or 3rd week of the cycle).

If you are taking Jeanine continuously for the second week and missed one day of taking, drink the missed pill as soon as possible, even if you have to drink 2 pills at once. Additional contraception in this case is not required.

If, after taking Jeanine for 21 days and canceling the intake from the 22nd day of the menstrual cycle, menstruation did not start within 3-4 days, then it is necessary to exclude pregnancy, as well as diseases of the genitourinary system in a woman.

Overdose symptoms

An overdose of Jeanine is extremely rare in medical practice, but it is still impossible to completely exclude it from the list of possible conditions. With proper administration, an overdose is impossible, since the drug is eliminated from the body within 48 hours almost completely.

In some diseases, an overdose is still possible. These include glomerulonephritis and pyelonephritis, amyloidosis of the kidneys, polycystic kidney disease, chronic hepatitis, fatty liver hepatosis, chronic cholecystitis in the stage of decompensation and other diseases that cause changes in the organs of the gastrointestinal tract and the genitourinary system of a woman. Symptoms of an overdose of Jeanine begin gradually, and often women do not associate them with taking the drug. Specific symptoms of an overdose would be nausea, occasional vomiting, and abdominal pain.

To eliminate an overdose, it is necessary to stop taking the drug. Overdose symptoms are very similar to other diseases. You need to contact a specialist who, upon examination, will make sure that this condition is caused precisely by an overdose, and prescribe the necessary treatment.

Side effects

Combined contraceptives have many side effects. This is due to their influence on many body systems. But often the correct prescription of the desired drug, as well as taking the instructions accordingly, minimizes possible side effects.

Some side effects were observed in some women while taking Janine during the study of the drug. On the part of the gastrointestinal tract, nausea and pain in the lower abdomen were most often noted. Vomiting or loose stools, flatulence, intestinal colic, constipation were rare.

On the part of the genitourinary system, pain and enlargement of the mammary glands, an increased amount of vaginal discharge are observed in equal proportions. The phenomenon of secretions from the mammary glands is rare.

In a healthy woman, the discharge has a clear or slightly cloudy color, odorless and various impurities. With various diseases of an inflammatory nature or with a hormonal failure, the discharge changes its character. The color varies from brown to green depending on the pathogen. The smell becomes unpleasant.

Pathological impurities, such as blood, will indicate a serious health disorder. Do not confuse blood smearing, which is periodically possible with the use of Jeanine, with bloody impurities in the discharge.

From the side of the central nervous system, the most common manifestations of side effects of the drug are headache, bad mood. But these side effects are more likely to be associated with excessive attention to one's condition, as well as focusing on small things.

On the part of the system of organs of vision, intolerance to eye lenses is rare, or rather unpleasant sensations when wearing them. Some women report weight gain. Most note its decline, which greatly pleased them. Allergic reactions are observed quite rarely and are rather associated with additional and auxiliary substances that are part of the drug.

When should you not take Jeanine?

The most dangerous side effect of Jeanine is the formation of blood clots, their movement in the body, which, if they enter the pulmonary system, can cause thromboembolism. There are women's health conditions in which it is strictly forbidden to use Jeanine. Diseases that are contraindications for taking contraceptives include:

• allergic reaction;
• pathology of the blood coagulation system;
• previous diseases: myocardial infarction, cerebral stroke, pulmonary embolism, thrombophlebitis of the vessels of the lower extremities, vascular thrombosis, varicose veins;
• the presence of chronic diseases: angina pectoris, diabetes mellitus in the stage of decompensation, cases of transient ischemic attacks;
• migraine, especially in combination with focal neurological symptoms;
• diabetes mellitus and its complications;
• a health condition in which the risk of thromboembolic disease is very high: obesity, sedentary lifestyle, frequent long-term travel in airplanes, addiction to alcohol, smoking;
• hypertension with high blood pressure;
• surgical interventions that are accompanied by immobilization of one of the parts of the body for longer than 3-5 days;
• persistent disorders of lipid metabolism;
• liver diseases that cannot be corrected by diet;
• high risk of cancer;
• severe pathology of the hormonal system of the body;
• instability of the menstrual cycle of unclear etiology;
• possible pregnancy;
• lactation period.

Is it possible to take Jeanine with other pharmacological preparations?

Combined oral contraceptives significantly affect all functions of the body's systems, so the combination with other drugs with constant use can adversely affect the state of health and, most importantly, increase the possibility of unwanted side effects.

Preparations that contain St. John's wort, as well as barbiturates, rifampicin, felbamate, increase the excretion of the drug from the body, which reduces its concentration and significantly reduces its properties as a contraceptive.

Medicines that fight HIV infection and conventional antiviral drugs can adversely affect the liver, so the drug will be removed from the body more slowly. Delaying the drug can lead to a large number of side effects, as well as exacerbate the unwanted effects of taking both drugs.

Another method of contraception should be used while taking antibiotics, as antibiotic therapy reduces the effectiveness of COCs, which may increase the risk of pregnancy.

The abundance of female hormones has a positive effect on the mood of a woman, the condition of her skin, hair, nails. Usually, while taking Jeanine, women note a decrease in fatigue during the working day, improved sleep, and an increase in libido. One of the most popular reviews is the reduction of headaches, which quite often accompanies young girls during the day. The positive effect of taking Janine in all cases is visible in the state of the girl's nervous system.

Taking combined contraceptives is also justified for certain diseases of the female reproductive system. These diseases include:

• endometriosis;
• irregular menstrual cycle;
• precancerous diseases of the uterus and accessory organs;
• polycystic ovaries;
• diseases of the mammary glands, which are associated with a violation of the hormonal background.

With endometriosis, the contraceptive drug Jeanine is very often prescribed. Endometriosis is characterized by abnormal growth of endometrial cells of the uterine cavity beyond its limits. Depending on the degree of growth of this tissue, categories of severity of the disease are distinguished. Jeanine reduces pain and bleeding during menstruation, and also improves health.

conclusions

Summarizing all of the above about the combined contraceptive drug of German origin Jeanine, and also taking into account all the knowledge about the rules and instructions for use and prescription, it is necessary to summarize the analysis of the effect of this drug on the woman's body.

The positive aspects of taking Jeanine will undoubtedly be a contraceptive effect on the female body, a change for the better in the hormonal background of a woman, which has a positive effect on her mood, the condition of her skin, hair, nails.

Also, this drug has won a leading position in a number of medicines for the prevention of unwanted pregnancy, because at present, pregnancy planning is the basis of the health of the unborn child and his mother. The tool has proven itself for the treatment of endometriosis, polycystic ovaries, as well as other disorders of the female reproductive system.

The drug has negative effects due to the variety and multiplicity of effects on almost all body systems. Reception Janine can cause side effects from the digestive, reproductive, circulatory systems.

Jeanine's reception is shown to girls with a regular sexual life who have one sexual partner.

Proper adherence to the instructions for taking Jeanine will provide one hundred percent prevention of unwanted pregnancy, as well as reduce the risk of malignant neoplasms in women and facilitate the transition to menopause. Before buying the drug, be sure to consult a gynecologist to rule out a possible pathology of the genitourinary system, as well as assess the hormonal background at the time of the examination.

The contraceptive effect of combined oral contraceptives (COCs) is based on the interaction of various factors, the most important of which are ovulation suppression and changes in cervical secretion. In addition to protection against pregnancy, COCs have a number of positive properties that can be used when choosing a contraceptive method. The menstrual cycle becomes more regular, menstruation becomes less painful, blood loss decreases. The latter reduces the incidence of iron deficiency anemia.
The progestogenic component of Jeanine, dienogest, is a strong progestogen and is considered the only norethisterone derivative with antiandrogenic properties. The presence of an antiandrogenic effect has been proven in clinical studies with the participation of a limited number of patients with the inflammatory form of acne vulgaris. Dienogest has a positive effect on the lipid profile, while increasing the content of HDL. There is evidence to reduce the risk of endometrial cancer and ovarian cancer. In addition, high doses of COCs (50 micrograms of ethinyl estradiol) have been shown to reduce the risk of ovarian cysts, pelvic inflammatory disease, benign breast disease, and ectopic pregnancy.
The results of standard preclinical studies of toxicity after repeated use, genotoxicity, carcinogenicity and reproductive toxicity do not indicate the existence of any specific risk to the human body. However, it should be noted that sex steroids may promote the growth of certain hormone-dependent tissues and pre-existing tumors.
Dienogest
After oral administration, dienogest is rapidly and completely absorbed. The maximum serum concentration is reached within 2.5 hours after a single oral dose and is approximately 51 pg / ml. The absolute bioavailability of dienogest after oral administration is 96%.
Dienogest binds to serum albumin and does not bind to sex hormone-binding globulin (SHBG) or corticoid-binding globulin (GSK). Only 10% of the total concentration of dienogest in the blood serum is in the form of a free steroid, and 90% is non-specifically bound to albumin. The increase in SHBG levels induced by ethinylestradiol does not affect the binding of dienogest to serum proteins.
Dienogest is completely metabolized mainly by hydroxylation and conjugation to form inactive metabolites. These metabolites are rapidly eliminated from the blood plasma so that no active metabolite is noted in it, but only dienogest in an unchanged state. The total clearance is about 3.6 l / h after a single application.
The level of dienogest in the blood serum decreases with a half-life, which is 8.5-10.8 hours. Only a small part of dienogest is excreted by the kidneys in an unchanged state. Metabolites are excreted in the urine and bile in a ratio of about 3:1. The half-life is about 14.4 hours.
The pharmacokinetics of dienogest does not depend on the level of SHBG. With daily intake, the concentration of the substance in the blood serum increases by 1.3 times, reaching an equilibrium state during the first half of the treatment cycle.
Ethinylestradiol
When taken orally, ethinylestradiol is rapidly and completely absorbed. The peak serum concentration of approximately 67 pg / ml is reached within 1.5-4 hours.
Ethinylestradiol binds tightly but not specifically to serum albumin (approximately 98%) and increases serum SHBG concentration.
Ethinylestradiol is metabolized mainly by aromatic hydroxylation, however, a large number of hydroxylated and methylated metabolites are additionally formed, including both free metabolites and conjugates with glucuronides and sulfates. Clearance is 2.3-7 ml / min / kg of body weight.
The level of ethinylestradiol in the blood serum decreases in 2 phases with half-lives of about 1 hour and 10-20 hours, respectively. The substance is not excreted from the body unchanged, ethinylestradiol metabolites are excreted in the urine and bile in a ratio of 4:6. The half-life of metabolites is approximately 1 day.
Based on the variable serum half-life and daily dosing, the steady-state serum concentration of ethinylestradiol is reached after approximately 1 week.

Indications for the use of the drug Jeanine

Contraception.

The use of the drug Jeanine

Dragee should be taken daily according to the order indicated on the blister, at approximately the same time, with a small amount of liquid. The drug is taken 1 tablet per day for 21 days. Reception of the dragee from each subsequent package should be started after the end of the 7-day break in taking the drug, during which, as a rule, menstrual-like bleeding occurs, which usually begins on the 3rd day after taking the last dragee and may not end by the start of taking the dragee from next package.
If hormonal contraceptives were not used in the previous period (last month)
Reception of a dragee should be begun in the 1st day of a menstrual cycle. You can start taking it from the 2-5th day, however, in this case, during the first cycle, it is recommended to additionally use a barrier method of contraception during the first 7 days of taking the drug.
Switching from another combined oral contraceptive (COC)
It is advisable to start taking Janine the day after taking the last active tablet of the previous COC, at least not later than the day after the break in taking the tablets or after taking the placebo tablets of the previous COC.
Switching from a method based on the use of only progestogen (mini-pills, injections, implants) or intrauterine system with progestogen.
You can start taking Janine any day after you stop taking the minipill (in the case of an implant or intrauterine system, on the day of their removal; in the case of an injection, instead of the next injection). However, in all cases, it is recommended to additionally use a barrier method of contraception during the first 7 days of taking the dragee.
After an abortion in the first trimester of pregnancy
You can start using Jeanine immediately. In this case, there is no need to use additional contraception.
After childbirth or abortion in the second trimester of pregnancy
In the case of breastfeeding (see subsection "Pregnancy and lactation") it is necessary to recommend starting taking the drug Janine from the 21st-28th day after childbirth or abortion in the second trimester of pregnancy. With a later start of taking the dragee, you should additionally use a barrier method of contraception during the first 7 days of taking the drug. However, if sexual intercourse has already taken place, then before starting the use of COCs, it is necessary to exclude a possible pregnancy or wait for menstruation.
What to do if you miss a pill
If the delay in taking the dragee does not exceed 12 hours, the effectiveness of the contraceptive effect of the drug does not decrease. Missed pills should be taken as soon as possible. The next dragee from this package is taken at the usual time.
If the delay in taking the missed tablet exceeds 12 hours, contraceptive protection may decrease. In this case, you can follow two basic rules:

• a break in taking dragees can never exceed 7 days;
• adequate inhibition of the hypothalamus - pituitary - ovaries system is achieved by continuous intake of dragees for 7 days.

Accordingly, the following recommendations should be followed in everyday life:

• 1st week
  The last missed tablet should be taken as soon as possible, even if you have to take 2 tablets at the same time. After that, continue to take the pills at the usual time. In addition, for the next 7 days, you must use a barrier method of contraception, such as a condom. If sexual intercourse took place in the previous 7 days, the possibility of pregnancy should be considered. The more pills missed and the closer the break in taking the drug, the higher the likelihood of pregnancy.
• 2nd week
  It is necessary to take the last missed tablet as soon as possible, even if you have to take 2 tablets at the same time. After that, continue to take the pills at the usual time. Provided that the pills are taken correctly for 7 days before the first pass, there is no need to use additional contraceptives. In another case, or if more than 1 tablet is missed, it is recommended to additionally use a barrier method of contraception for 7 days.
• 3rd week
  The risk of a decrease in reliability increases with the approach of a break in taking pills. However, if the regimen of pills is followed, a decrease in contraceptive protection can be avoided. If one of the following options is followed, then there will be no need to use additional contraceptives, provided that the pills are taken correctly for 7 days before the pass. If this is not the case, you should stick to the first of the following options and use additional methods of contraception for the next 7 days.

It is necessary to take the last missed tablet as soon as possible, even if you have to take 2 tablets at the same time. After that, continue to take the pills at the usual time. Dragee from the next package should be taken immediately after the end of the previous one, that is, there should be no interruptions. It is unlikely that menstrual bleeding will begin by the end of the second pack, although spotting or breakthrough bleeding may occur while taking the dragee.
You may also be advised to stop taking the pills from the current package. In this case, a break in taking the drug should be up to 7 days, including the days of skipping dragees; reception of the dragee should be started from the next package.
If you miss taking the pills and there is no menstrual bleeding during the first usual break in taking the pills, you should exclude the possibility of pregnancy.
Recommendations for disorders of the gastrointestinal tract
In severe violations of the gastrointestinal tract, incomplete absorption of the drug is possible; in this case, additional contraception should be used.
If vomiting occurs within 3-4 hours after taking the pills, it is advisable to use the recommendations regarding skipping the pills. If the patient does not want to change the usual regimen of the drug, she needs to take additional (s) pills from another package.
How to change the time of your period or how to delay your period
To delay the appearance of menstruation, you should continue to take Janine pills from a new package and do not take a break in taking the drug. If desired, the reception period can be continued until the end of the second package. However, breakthrough bleeding or spotting cannot be ruled out. The usual intake of the drug Jeanine is restored after a 7-day break in taking the dragee.
To shift the time of the onset of menstruation to another day of the week, it is recommended to shorten the break in taking pills by the desired number of days. It should be noted that the shorter the break, the more often the absence of menstrual-like bleeding and breakthrough bleeding or spotting is noted during the reception of the pills from the second package (as in the case of delayed menstruation).

Contraindications to the use of the drug Jeanine

COC should not be used in the presence of at least one of the following conditions or diseases. If any of these conditions or diseases occur for the first time during the use of COCs, the drug should be stopped immediately.
Venous or arterial thrombotic/thromboembolic events (e.g. deep vein thrombosis, pulmonary embolism, myocardial infarction) or cerebrovascular disorders at present or in history.
The presence or history of prodromal symptoms of thrombosis (for example, transient cerebrovascular accident, angina pectoris).
Migraine with a history of focal neurological symptoms.
Diabetes mellitus with vascular damage.
The presence of severe or multiple risk factors for venous or arterial thrombosis may also be a contraindication (see).
Current pancreatitis or history of pancreatitis if associated with severe hypertriglyceridemia.
Current or history of severe liver disease until liver function tests return to normal.
Diagnosed or history of liver tumors (benign or malignant).
Diagnosed or suspected malignant tumors (for example, genital or breast) that are dependent on sex hormones.
Vaginal bleeding of unknown etiology.
Diagnosed or suspected pregnancy.
Hypersensitivity to the active substances or to any of the components of the drug.

Side effects of Jeanine

The most serious side effects associated with the use of COCs are described in the section.
Other undesirable effects have been reported with the use of COCs, but their relationship with the use of COCs has not been confirmed or refuted:

Organs and systems	Frequent (≥1/100)	Uncommon (≥1/1000 and ≤/100)	Single (≤1/1000)
			contact lens intolerance
	Nausea, abdominal pain	Vomiting, diarrhea
The immune system			Hypersensitivity
Study	Weight gain		Weight loss
Metabolism and malnutrition		Fluid retention
Mental disorders	Depression, mood disorder	Decreased libido	Increased libido
Reproductive system and mammary glands			Changes in vaginal secretion, the appearance of secretion from the mammary glands
Skin and subcutaneous tissues		Skin rashes, urticaria	Erythema nodosum, exudative erythema multiforme

Special instructions for the use of the drug Jeanine

If any of the following conditions/risk factors are present, the benefits and risks associated with the use of COCs should be analyzed on a patient-by-patient basis and discussed with her before she decides to take COCs. If any of the conditions or risk factors listed below worsen, worsen, or occur for the first time, it is recommended to consult a doctor. The doctor must decide whether to stop the use of COCs.
Circulatory disorders
Based on the results of epidemiological studies, there is an association between COC use and an increased risk of venous, arterial, thrombotic and thromboembolic diseases such as myocardial infarction, stroke, deep vein thrombosis and pulmonary embolism. These conditions rarely occur.
Venous thromboembolism (VTE), manifested as venous thrombosis and/or pulmonary embolism, may occur with any COC. The risk of venous thromboembolism is highest during the 1st year of COC use. The incidence of VTE in women taking oral contraceptives with low-dose estrogens (≤0.05 mg ethinyl estradiol) is up to 4 cases per 10,000 women/year compared with 0.5-3 cases per 10,000 women/year in women who do not using oral contraceptives. The frequency of VTE associated with pregnancy is 6 cases per 10,000 women/year.
Thrombosis of other blood vessels, such as arteries and veins of the liver, kidneys, mesenteric vessels, vessels of the brain or retina, has been reported extremely rarely in women using COCs. There is no consensus regarding the relationship of these complications with the use of COCs.
Symptoms of venous or arterial thrombotic / thromboembolic events or stroke can be: unilateral pain in the lower extremities or their swelling; sudden severe chest pain radiating to the left arm; sudden shortness of breath; sudden onset cough; any unusual severe prolonged headache; sudden decrease or complete loss of vision; diplopia; speech disorder or aphasia; vertigo; collapse with or without partial epileptic seizure; weakness or very pronounced sudden numbness of one side or one part of the body; dysmotility; acute abdomen.
Factors that increase the risk of venous or arterial thrombotic/thromboembolic events or stroke:

• age;
• tobacco smoking (in combination with heavy smoking and with age, the risk increases, especially in women over the age of 35);
• family history (for example, cases of venous or arterial thromboembolism in siblings or parents at a relatively early age). If a hereditary predisposition is suspected, the woman should be referred to an appropriate specialist for advice before deciding whether to use any COC;
• obesity (body mass index over 30 kg/m2);
• dyslipoproteinemia;
• hypertension;
• pathology of the heart valves;
• atrial fibrillation;
• prolonged immobilization, radical surgery, any surgery on the lower extremities, significant trauma. In these cases, it is recommended to stop the use of COCs (for elective operations at least 4 weeks before they are carried out) and not to restore it earlier than 2 weeks after complete remobilization.

There is no consensus on the possible role of varicose veins and superficial thrombophlebitis in the development of venous thromboembolism.
It is necessary to take into account the increased risk of thromboembolism in the postpartum period.
Other diseases that may be associated with serious circulatory disorders include diabetes mellitus; systemic lupus erythematosus; hemolytic uremic syndrome; chronic inflammatory bowel disease (Crohn's disease or ulcerative colitis) and sickle cell anemia.
An increase in the incidence of migraine or its exacerbation during the use of COCs (which may be a precursor to cerebrovascular accident) may require urgent discontinuation of COCs.
Biochemical parameters characteristic of a hereditary or acquired tendency to venous or arterial thrombosis include: CRP resistance, hyperhomocysteinemia, antithrombin III deficiency, protein C deficiency, protein S deficiency, antiphospholipid antibodies (anticardiolipin antibodies).
When analyzing the risk/benefit ratio, the clinician should take into account that adequate treatment for the conditions mentioned above can reduce the associated risk of thrombosis, as well as the fact that the risk of pregnancy-associated thrombosis is higher than with COCs. at low doses (≤0.05 mg ethinyl estradiol).
Tumors
The most important risk factor for developing cervical cancer is the persistence of papillomavirus. The results of epidemiological studies indicate an additional increase in this risk with long-term use of COCs. This statement is controversial because it is not completely clear how the results of studies take into account concomitant risk factors, such as taking a cervical smear and sexual behavior, including the use of barrier methods of contraception.
The results of a meta-analysis based on data from 54 epidemiological studies indicate a slight increase in the relative risk (RR = 1.24) of developing breast cancer in women using COCs. This increased risk gradually disappears within 10 years after the end of COC use. Since breast cancer is rarely diagnosed in women under 40 years of age, the increase in the number of breast cancer diagnoses in women who currently use or have recently used COCs is insignificant relative to the overall risk of developing breast cancer. The results of these studies do not provide evidence for the existence of a causal relationship. The increased risk may be due to both the earlier diagnosis of breast cancer in women using COCs, the biological effect of COCs, or a combination of both factors. A trend has been noted that breast cancer detected in women who have ever taken COCs is clinically less pronounced than in those who have never taken COCs.
In isolated cases, benign, and even less often, malignant liver tumors were noted in women using COCs, which sometimes led to the development of life-threatening intra-abdominal bleeding. If there are complaints of severe pain in the epigastric region, liver enlargement or signs of intra-abdominal bleeding in differential diagnosis, the possibility of a liver tumor in women taking COCs should be taken into account.
Other states
Women with hypertriglyceridemia or a family history of this disorder are at risk of developing pancreatitis when taking COCs.
Although a slight increase in blood pressure has been reported in many women taking COCs, a clinically significant increase in blood pressure is a single occurrence. However, if prolonged, symptomatic hypertension (hypertension) occurs while taking COCs, it may sometimes be more appropriate to discontinue COCs and treat hypertension (hypertension).
The occurrence or exacerbation of the following diseases during pregnancy and with the use of COCs has been reported, but their relationship with the use of COCs is not conclusively established: jaundice and / or itching associated with cholestasis, formation of gallstones, porphyria, systemic lupus erythematosus, hemolytic-uremic syndrome, Sydenham's chorea, herpes of pregnancy, hearing loss associated with otosclerosis.
In acute or chronic liver dysfunction, it may be necessary to stop taking COCs until liver function tests return to normal. In case of recurrence of cholestatic jaundice, which first occurred during pregnancy or previous use of sex hormones, COC should be discontinued.
Although COCs may affect peripheral insulin resistance and glucose tolerance, there is no evidence of the need to change the therapeutic regimen in diabetic women taking low-dose COCs (containing ≤0.05 mg ethinyl estradiol). However, diabetic women should be closely monitored while taking COCs.
Crohn's disease and ulcerative colitis may be associated with COC use.
Occasionally, chloasma may occur, especially in women with a history of chloasma of pregnancy. Those prone to developing chloasma should avoid exposure to direct sunlight or ultraviolet radiation while taking COCs.
medical examination
Before starting or restoring the use of the drug Janine, a complete medical examination should be carried out and the patient's history should be studied in detail, taking into account contraindications (see) and warnings (see). When using COCs, it is recommended to conduct periodic examinations, which is very important, since contraindications (for example, transient circulatory disorders, etc.) or risk factors (for example, a family history of venous or arterial thrombosis) may first occur already during the period of COC use. The frequency and nature of these examinations should be based on the norms of medical practice, taking into account the individual characteristics of each woman, however, special attention is paid to the examination of the pelvic organs, including the standard analysis of the cytology of the cervix, abdominal organs, mammary glands, determination of blood pressure.
It is necessary to warn the patient that oral contraceptives do not protect against HIV infection (AIDS) and other sexually transmitted diseases.
Reduced efficiency
The effectiveness of combined oral contraceptives may decrease if a tablet is missed, gastrointestinal dysfunction or the use of other drugs.
Cycle control
When taking oral contraceptives, intermenstrual bleeding (spotting or breakthrough bleeding) may occur, especially during the first few months of treatment. With this in mind, the examination with the appearance of any intermenstrual bleeding should be carried out only after a period of adaptation of the body to the drug, which is approximately 3 cycles.
If menstrual irregularities continue or recur after several normal cycles, non-hormonal causes of bleeding should be considered and appropriate investigations carried out to exclude the presence of tumors and pregnancy. Diagnostic measures can include curettage.
In some patients, menstrual-like bleeding may not occur during a break in taking the drug. When taking COCs as directed, pregnancy is unlikely. However, if the contraceptive is taken irregularly or if menstrual bleeding is absent for 2 cycles, pregnancy must be excluded before continuing to take the COC.
During pregnancy and breastfeeding
The drug is contraindicated for use during pregnancy. If pregnancy occurs during the period of use of the drug Janine, the drug should be discontinued. However, the results of studies do not indicate an increased risk of congenital pathologies in children born to mothers who took COCs during pregnancy, as well as the existence of a teratogenic effect when unintentionally taking COCs in early pregnancy.
COCs can affect lactation, since under their influence the amount of breast milk may decrease, as well as its composition may change. With this in mind, COCs are not recommended for breastfeeding.
The active ingredients that make up the drug and / or their metabolites are excreted in small amounts with breast milk, but there is no evidence of their negative impact on the health of the infant.
Influence on the ability to drive vehicles and work with mechanisms
No influence noted.

Interactions with Jeanine

Interactions between oral contraceptives and other medicinal products may cause breakthrough bleeding and/or loss of contraceptive effectiveness. The following interactions are reported in the literature.
Hepatic metabolism: possible interaction with drugs that induce microsomal enzymes, which may cause an increase in the clearance of sex hormones (for example, phenytoin, barbiturates, primidone, carbamazepine, rifampicin, and possibly also oxcarbazepine, topiramate, felbamate, ritonavir, griseofulvin and drugs containing St. John's wort).
Interaction with enterohepatic circulation: the results of some clinical studies suggest that the enterohepatic circulation of estrogens may be reduced when taking certain antibiotics that reduce the concentration of ethinylestradiol (for example, antibiotics of the penicillin and tetracycline series).
When treating with any of the above drugs, you should temporarily use a barrier method in addition to taking COCs or choose another method of contraception. When treating with microsomal enzyme-inducing drugs, the barrier method should be used throughout the entire period of treatment with the respective drug and for a further 28 days after stopping its use. When treated with an antibiotic (with the exception of rifampicin and griseofulvin), the barrier method should be used for another 7 days after the antibiotic is discontinued. If the barrier method is still applied, and the pills in the PDA pack have already run out, taking the pills from the next pack should be started without the usual break.
Oral contraceptives may interfere with the metabolism of other drugs. With this in mind, the concentrations of active substances in blood plasma and tissues (for example, cyclosporine) may change.
Note. To establish the potential for interactions with drugs that are prescribed simultaneously with COCs, it is recommended that you read the instructions for medical use of these drugs.
Impact on laboratory results
Taking contraceptives may affect the results of certain laboratory tests, including biochemical parameters of liver, thyroid, adrenal and kidney function, indicators of proteins (carriers) contained in blood plasma, such as sex hormone-binding globulin and lipid/lipoprotein fractions, parameters carbohydrate metabolism, as well as parameters of coagulation and fibrinolysis.

Overdose of the drug Jeanine, symptoms and treatment

No serious adverse effects due to overdose have been reported. Overdose symptoms may occur: nausea, vomiting, and in young patients, slight bleeding from the vagina. There are no specific antidotes, treatment should be symptomatic.

Storage conditions of the drug Jeanine

At a temperature not higher than 25 °C.

List of pharmacies where you can buy Jeanine:

• Saint Petersburg

Jeanine is a low-dose monophasic combined oral contraceptive with an antiandrogenic effect. The drug contains ethinylestradiol and dienogest. Jeanine contraceptive pills are available in the form of dragees, the quantitative content of the drug in the package is 21 pcs.

Auxiliary components are: lactose, starch, gelatin, glucose, povidone, titanium dioxide.

Jeanine has a contraceptive effect by changing the viscosity of the mucus. When using the drug, ovulation is suppressed, and the cervical mucus becomes impermeable to spermatozoa.

Dienogest is a progestogen component of the drug Janine and contributes to the provision of antiandrogenic effects and improves the lipid profile of the blood. When using the drug, an increase in high-density lipoproteins (“good” cholesterol) is observed.

In patients who use low-dose monophasic oral contraceptives, including Janine, the development of such positive effects is observed:

• The menstrual cycle is normalized.
• Reducing the intensity and duration of bleeding.
• Elimination of painful sensations during the next menstruation.
• Reducing the risk of iron deficiency anemia.

According to the results of clinical studies, against the background of the use of Jeanine birth control pills, the number of cases of endometrial and ovarian cancer has decreased.

Indications for use

The main indication for the use of the drug Jeanine is the provision of a contraceptive effect.

Thanks to its multicomponent composition, Jeanine can be used in the complex therapy of breast diseases, including mastopathy.

Contraindications

The use of the drug Jeanine is contraindicated in the presence of one of the following conditions:

The development of thrombosis and thromboembolism (including the presence of these diseases in the patient's history), including pulmonary embolism, myocardial infarction, stroke, deep vein thrombosis and cerebrovascular disorders.

The presence of conditions that precede the development of thrombosis.

With migraine, which is accompanied by the development of focal neurological symptoms.

With diabetes mellitus, which is complicated by vascular disorders.

With pancreatitis, which is accompanied by severe hypertriglyceridemia.

With liver failure and severe liver disease. In case of normalization of liver tests, Janine can be taken with the approval of a doctor.

When identifying and hormone-dependent malignant neoplasms or if they are suspected.

With the development of bleeding from the vagina of unknown origin.

With increased sensitivity to the main or auxiliary components of the drug.

With the development of any of the listed diseases while taking the drug Jeanine, it is necessary to stop the use of the dragee and consult a doctor immediately.

Use with extreme caution

Jeanine should be used with extreme caution and after carefully balancing the potential benefit against the perceived risk in the presence of the following conditions:

• Risk factors that may contribute to the development of thrombosis: smoking, obesity, arterial hypertension, migraine, major surgery, heart valve disease, hereditary predisposition to the development of thrombosis.
• Other diseases that can contribute to the development of peripheral circulatory disorders: diabetes mellitus, Crohn's disease and ulcerative colitis, lupus erythematosus, sickle cell anemia.
• With hereditary angioedema.
• With an increased level of triglycerides in the blood plasma.
• With liver diseases.
• In the postpartum period.

Use during pregnancy and breastfeeding

If pregnancy is suspected, as well as during breastfeeding, the use of Jeanine is contraindicated.

In the event that pregnancy is detected during the use of the drug Janine, the drug should be stopped immediately.

According to the results of extensive epidemiological studies, there was no increased risk of developing any defects in children whose mother took sex hormones before pregnancy.

There is also no increased risk of developing toxic effects if the drug was taken through negligence at an early stage of pregnancy.

When using the drug Jeanine during lactation, the risk of a decrease in the amount of breast milk increases and its composition changes. Sex steroids or their compounds can be excreted in breast milk.

Mode of application

Jeanine must be taken in the order indicated by the numbers on the package. Reception of a dragee is carried out daily, approximately at the same time of day. The medicine should be taken with a small amount of water.

Dragees are taken without interruption for 21 days. Reception of the next package can begin after a 1-week break. During this time, withdrawal bleeding should develop. Bleeding begins a few days after taking the last pill.

How to start taking the drug

In the event that in the previous month there was no intake of any hormonal drugs, then Janine's medication should begin on the first day of the menstrual cycle. As needed, you can start taking pills in the period from 2 to 5 days of the cycle, but in this case there is a need to use barrier methods of contraception.

In the event that a transition is made from other contraceptives (this group includes combined oral contraceptives, vaginal rings and transdermal patches), then Janine should be taken the next day after taking the last pill from the previous package.

If switching from vaginal rings or transdermal patches, Janine should be started on the day the ring is removed or the patch is removed.

When switching from contraceptives, which contain only gestagens (these include Mirena, mini-drank), then Zhanin's reception can begin on any day. In this case, the use of barrier methods of contraception for 1 week is required.

How to take the missed dragee?

In the event that the drug was missed, then additional recommendations must be followed.

If the skip time is less than 12 hours, then the contraceptive effect of the drug will not decrease. In this case, you should take the drug as soon as possible. Further reception is carried out according to the usual scheme.

If the skip time is more than 12 hours, then the contraceptive effect is reduced. In this case, the use of dragees should not be suspended for more than 1 week. In order to suppress the hypothalamic-pituitary-ovarian regulation, 1 week of continuous medication is required.

• Pass at 1 week of admission. Taking the drug in the first week should be carried out as soon as possible, even if this means taking two tablets at once. Further reception is carried out according to the usual scheme. In the future, it is necessary to use barrier methods of contraception for the next 7 days.
• Pass for 2 weeks. Taking the drug in the second week: you should take the missed tablet as soon as possible, even if this means taking two tablets at once. In the event that during the first week the drug was taken in accordance with the manufacturer's recommendations, then the use of barrier methods of contraception is not required.
• 3 week pass. Week 3: Increased risk of reduced efficacy as drug break approaches. You should take the missed pill as soon as possible, even if it means taking two pills at the same time. When the pills from the current package run out, you should immediately start taking a new package. In this case, the development of bleeding is unlikely, but spotting spotting may be observed.

In the event that a pass was made to take the drug Janine and bleeding is not observed during the break, then it is necessary to exclude the possibility of pregnancy.

In the event that within 3-5 hours after taking the drug, a woman has vomiting or diarrhea, then it is necessary to use additional contraceptive measures. It is also necessary to adhere to the recommendations regarding the usual skipping of dragees.

If a woman wants to change the start date of the next menstruation, she should take pills from a new package without interruption. Reception can be carried out for as long as it is necessary to delay the next menstruation. Against the background of using the drug from a new package, not intense spotting may be observed.

Side effects

Against the background of the use of Janine dragees, the following undesirable side reactions may develop:

Most often, patients note the development of headache, soreness and coarsening of the mammary glands.

Infrequently, the drug can contribute to the development of vulvovaginitis, candidiasis, increased appetite, decreased mood, the development of dizziness and migraine, increased or decreased blood pressure, abdominal pain, nausea, vomiting, diarrhea, acne and rash, itching, intermenstrual bleeding, swelling of the mammary glands , the development of dysmenorrhea, ovarian cysts, increased fatigue, poor health, weight gain.

In rare cases, the drug can contribute to the development of cystitis, fungal infections, candidiasis, herpetic lesions of the oral cavity, influenza, bronchitis, sinusitis, uterine fibroids, anemia, allergic reactions, anorexia, depression, mental disorders, insomnia, aggression, ischemic stroke, cerebrovascular disorders, dystonia, dryness and irritation of the mucous membranes of the eyes, visual acuity disorders, sudden loss of hearing, tinnitus, cardiovascular disorders, tachycardia, palpitations, thrombosis, thrombophlebitis, hot flashes, varicose veins, pain in the veins, gastritis, enteritis, dyspepsia, allergic and atopic dermatitis, eczema, psoriasis, dandruff, seborrhea, hirsutism, orange peel, myalgia, back and limb pain, cervical dysplasia, menstrual irregularities.

Women who used the drug Jeanine most often reported the development of such complications:

• Venous thromboembolic complications.
• Arterial thromboembolic complications.
• cerebrovascular complications.
• arterial hypertension.
• Hypertriglyceridemia.
• Tumors of the liver.
• Deterioration of the course of systemic and chronic diseases.

An increase in the frequency of diagnosing breast cancer has also been reported.

In case of an overdose of the drug, nausea, vomiting, diarrhea, and spotting may develop. A doctor's examination and symptomatic treatment is required.

Additional Information

Against the background of the use of oral contraceptives, changes in laboratory parameters of carbohydrate metabolism, adrenal and thyroid hormones, as well as coagulation parameters can be observed. As a rule, the changes do not go beyond the acceptable limits.

A woman should inform the attending physician who prescribes the use of Jeanine about all concomitant diseases. Hormone replacement therapy should be undertaken only after a careful balance of benefits and harms.

Before prescribing such a drug, the doctor should familiarize himself with the patient's history, identify the presence of hereditary pathologies and conduct a comprehensive examination (measurement of blood pressure and heart rate, determine the body mass index). A gynecological examination includes an examination of the mammary glands, as well as a cytological scraping from the cervix.

The doctor should warn the patient that taking Jeanine is not able to protect against HIV infection and other sexually transmitted diseases.

The effectiveness of the drug is reduced in case of skipping pills, with the development of vomiting, diarrhea, as well as incorrect drug interactions.

Against the background of the use of hormonal contraceptives, the regularity and intensity of bleeding may vary (from spotting to more abundant and prolonged). Evaluation of the effect of the drug on bleeding can be carried out after a period of adaptation of the body to a new drug. The duration of the period can be 2-4 cycles.

If the patient continues to complain of irregular bleeding after 2-4 cycles, then a comprehensive examination is required to exclude malignant neoplasms or pregnancy.

The risk of developing thromboembolism increases during the first year of using the drug. In patients who take low-dose oral contraceptives, the risk of developing thromboembolism is several times higher than in women who do not take such drugs.

In women with a history of a hereditary form of angioedema, the symptoms of the disease may be aggravated by the use of Zhanin.

The ability of the drug to influence psychomotor reactions and vehicle control has not been identified.

drug interaction

In the case of simultaneous administration, the use of oral combined contraceptives can increase the concentration of cyclosporine and reduce the concentration of lamotrigine in plasma and tissues.

Simultaneous use of antifungal drugs, verapamil, macrolides, antidepressants and grapefruit juice can increase the concentration of dienogest in blood plasma.

If it is necessary to combine Zhanin with antibacterial drugs (excluding rifampicin and griseofulvin), barrier methods of contraception should be used for 1 week after antibiotics have been discontinued.

Analogues and cost

The cost of the drug Jeanine for the period of autumn 2016 was formed as follows:

• Jeanine dragee No. 21 - 900-1200 rubles.
• Jeanine dragee No. 63 - 2050-3400 rubles.

Analogues of the drug Jeanine are such drugs: Diecyclen and Siluet. If necessary, the replacement of the drug should be carried out only in agreement with the attending physician.

Janine is a popular contraceptive. In addition to the contraceptive effect, the use of the drug gives good results in the treatment of a large number of gynecological problems. Tablets do not harm a woman's health and can be used for many years, you can learn more from the reviews on the site.

This is a unique monophasic drug, in its composition it has synthetic analogues of female hormones, due to which contraceptive effect. The action of Janine tablets is no different from similar contraceptive drugs. The use of the drug in adolescents should be under the strict supervision of a gynecologist until the age of 18.

It is forbidden to take a contraceptive without a doctor's prescription, reviews on the Internet are only a method of research, and not a guide to action!

Release form

Jeanine contraceptive is produced in the form of milky, white or cream-colored pills for oral administration. The composition includes two main substances:

• ethinylestradiol;
• Dienogest (analogous to progesterone);

As well as excipients:

The cardboard pack contains 21 tablets packed in a blister. The package may contain one or three blisters. Also inside the package is an insert-instruction for use. In order not to become a victim of fakes, check out the reviews and appearance of Janine tablets on the Internet, photos will help you not to make a mistake.

The action of the drug

The main action of drugs and is carried out through the action of complementary mechanisms. Including an increase in the density of cervical mucus and inhibition of ovulation. Due to this, she does not miss sperm.

Proper use is a prerequisite for the use of the drug. Therefore, before starting the course, it is necessary to study the instructions and reviews. Otherwise, skipping pills or errors in the course can lead to an increase in the Pearl index.

Dienogest- the main progestogen component of janine tablets, the antiandrogenic activity of which is confirmed by clinical studies. It also increases the level of high density lipoproteins. Eliminates acne by inhibiting the activity of male hormones.

In addition to all of the above, the use of Janine tablets alleviates premenstrual syndrome in women. Long-term use normalizes the cycle, reduces pain, reduces the intensity and duration of discharge.

The drug is rapidly absorbed by the gastrointestinal tract after application, and dienogest is completely metabolized in the body. A certain amount of the component is excreted from the body in an unchanged state along with metabolites through urine and bile in a ratio of 3:1. Also, ethinylestradiol metabolites are excreted in the urine in a ratio of 4:6. Ethinylestradiol itself is completely absorbed in the body of a woman.

When choosing a drug, operate not only with reviews on the Internet, but also with the recommendations of your doctor.

It is necessary to take the drug strictly according to the instructions, 21 days 1 tablet per day. It is necessary to drink dragees with clean water. After consuming 1 pack, a seven-day break is required, during which the so-called withdrawal period is possible. These are menstrual-like discharges that begin a day or two after the last pill intake and can last until the start of the next package.

The drug janine is prescribed to women if any hormonal preparations were not taken in the previous months. In this case, the first tablet is consumed on the first day of bleeding. You can start on the second - fifth day of menstruation, but then the next seven days you need to use barrier contraception.

If a woman decides to switch to Janine after using the vaginal ring, oral contraceptives, transdermal patch. tablets should be taken one day after the previous drug, but no later than the last day of the seven-day break. When switching from a ring or patch, it is best to start taking pills immediately after removal and no later than the day the new ring or patch is inserted.

If the previous method of contraception was mini-pill, implant, injectable forms or Mirena, then a woman can switch to Janine any day, without a break from the mini-pill, and on the day of removal or the next injection. In all these cases, within a week after taking the starter pill, janine must be additionally protected by the barrier method.

If a woman has had an abortion in the third trimester of pregnancy, the use of dragees can begin immediately without additional protection.

After a postponed childbirth or abortion in the second trimester of pregnancy, the use of the drug occurs 21–28 days after the procedure. If more than 28 days have passed since the abortion or childbirth, then additional barrier contraception is required after the start of the course for seven days.

Persons under 18 years of age should be taken with extreme caution. In the first year of using the drug, carefully monitor your well-being.

If you forgot to take the drug

Delay in taking medications less than 12 hours does not reduce the effectiveness of protection, but the next dragee needs to be drunk as soon as possible. The next pill is taken as scheduled at the right time. A delay greater than 12 hours cancels the protective effect. (This refers to an interval of about 36 hours after taking the previous dragee.

Principles of taking contraceptives Jeanine:

• Adequate contraceptive effect is achieved within seven days after the start;
• Do not interrupt the drug for more than seven days;

So, what if the medicine has not been taken for more than 12 hours? It all depends on the period of taking the dragee and the stage of the course. In the first, second and third weeks of taking the drug, various measures are necessary. The closer the missed pill is to the seven-day break, the greater the likelihood of pregnancy. So, what if I missed a dragee?

• Starting week of medication. The next dragee should be taken as quickly as possible, even if it requires drinking a couple of pieces at once. The subsequent administration of the drug is carried out at the standard time and during the week it is necessary to additionally use barrier contraception.
• The second week of taking the drug. It is necessary, as in the previous case, to take the next dragee as soon as the woman remembers this. The next pill is taken as usual. If during the previous seven days before the first missed pill, the woman took pills regularly, there is no need to use barrier contraception. However, if there was a recent break or this is not the first pass, additional barrier contraception must be used.
• Third week of taking the drug. The risk of pregnancy is very high due to the upcoming break in the course. Therefore, a woman has two options for action in such a situation. The first option includes the standard prim rules for being late. The next dragee is taken at the standard time, before the end of the pack. Then you must immediately start drinking dragees from the next package, that is, cancel the seven-day break. Breakthrough bleeding and spotting may occur during this time, and withdrawal periods are possible but unlikely. The second option is to interrupt the course of taking the drug for 7 days, including the missed day. Then you need to start taking a new pack.

Please note: if during the break between packs a woman does not experience withdrawal bleeding, and there were missed pills in the previous month, it is necessary to consult a gynecologist and exclude pregnancy.

Nuances and features of taking the drug

If, after taking the drug, a woman had bouts of vomiting or diarrhea in the interval of 4 hours, absorption, most likely, did not occur completely. Must use barrier contraception. Further, be guided by the recommendations in the instructions, section. what to do when skipping a dragee.

By taking Janine, a woman can control the day of her next period. If it is necessary to delay the day of the start of the discharge, the woman should continue the course of the drug immediately without a break between packs. At this time, spotting and breakthrough uterine bleeding are possible. You can take medicines until the package runs out. The next pack must be started after a weekly interval.

If it is necessary to change the day of the week of the onset of menstruation, it is necessary to reduce the dragee break by the required number of days. The shorter the interval, the greater the likelihood of spotting and withdrawal bleeding at the beginning of the course of the next pack.

The price of the drug may vary depending on your region and country of residence. The average price in Ukraine is UAH 246; The price in Russia is 573 rubles.

Contraindications and side effects

The drug should not be taken by women with liver disease until the problem is resolved. This the main contraindication for taking pills. And:

• Jeanine is contraindicated in children under 18 years of age; shown only after the onset of the first menstruation;
• Not indicated for women after menopause;

Among other things, the drug has a number of side effects that you need to discuss with your doctor. Perhaps you will be assigned an analogue.

Janine side effects:

Starting for the first time taking the drug janine, you need to carefully monitor your well-being. If one of the following diseases is present, the drug is contraindicated, and if they occur during the reception, the use of the drug should be immediately discontinued. They may provoke the development of complications.

Janine during pregnancy and breastfeeding

Jeanine is contraindicated pregnant and lactating women, and if pregnancy was detected while taking a contraceptive, the drug should be stopped immediately. However, studies have not identified fetal developmental disorders due to the use of hormonal contraceptives in the period before pregnancy or in the early stages.

The use of janine oral contraceptives or analogues can lead to a decrease in the amount of breast milk. In addition, some hormones can be excreted in breast milk.

special instructions

The use of janine, similar drugs prohibited without a doctor's prescription. They can adversely affect a woman's health, so a full medical examination is necessary before starting the course. In zhanin, the composition has a unique formula, and, in addition to the contraceptive function, it eliminates many gynecological problems. However, taking synthetic hormones, if there are certain factors, is a risky business.

A woman who decides to use oral contraceptives must understand that they do not protect against HIV infection and other sexually transmitted diseases.

If you are in doubt about the choice of contraceptives, it is recommended to read the reviews on the Internet. Or you can read reviews on our website. They will help you weigh the pros and cons.

The drug janine

At the beginning of the use of the drug Janine, contraindications were frightened. Was it worth it for a long time? But after a detailed medical examination, she nevertheless decided and was satisfied.

Angela Kerch

I had never taken hormonal contraceptives before, I was very afraid to start. The Internet is full of different rumors on this topic, there is something to be afraid of. But now I'm extremely happy! My cycle returned to normal, and the discharge became less intense. Particularly pleased with the possibility of adjusting the cycle.

Tatiana Sumy

I have had problems with my menstrual cycle since childhood. In addition to being unstable, I was constantly in severe pain. But with the beginning of the course, I was pleasantly surprised by the changes, in addition to excruciating pain and heavy discharge, I got rid of the monthly acne that had always accompanied me these days.

Olga, Sevastopol