Hormonal contraception: types and selection
Contraceptives based on hormones are less popular than barrier methods of protection, but are not inferior in effectiveness, and are often more effective in preventing unwanted pregnancies. Hormonal Contraception
For women who are in a stable relationship with a man and who do not plan to acquire offspring in the near future, hormonal contraceptives can be the best option for contraception. Throughout the world, more than 70 million women prefer this type of protection.
The hormonal contraceptive suppresses the process of ovulation, making the cervix an insurmountable obstacle to the penetration of spermatozoa. In the event that fertilization did occur, the endometrium of the uterus becomes unsuitable for blastocyst implantation under the influence of hormones.
Pros and cons of hormonal contraception
Before deciding to use hormonal contraceptives, you need to explore their advantages and disadvantages.
Among the positive characteristics are the following:
Effective protection from unwanted pregnancy. Proper use of hormonal contraception provides protection from conception in 95-99% of cases.
The decrease in the severity of premenstrual syndrome. The tension in the mammary glands, weight gain, abdominal pain, mood swings before the onset of menstruation appear to a lesser extent or disappear altogether.
- Normalization of the menstrual cycle. Correctly selected preparation makes the cycle of the woman regular.
- Changing the nature of menstruation. Discharges during menstruation become less painful and plentiful, thereby decreasing the risk of anemia, which is associated with increased blood loss.
- Normalization of body weight. Some hormonal contraceptives positively affect the weight of a woman and help lose weight.
- Treatment of diseases and getting rid of problems associated with violation of the hormonal background. Acne, the rash of skin and hair, hyperandrogenemia and other health problems can be corrected due to hormonal drugs. As a result, women become more attractive, self-confidence arises.
- Prevention of diseases. Oral contraceptives are a means of preventing osteoporosis, endometriosis, mastopathy, reduce the risk of malignant tumors of the mammary glands, uterus, and ovaries, as well as fibroids and ovarian cysts. The appointment of hormonal contraception after surgery helps reduce the risk of inflammation in the internal organs.
- Ease of use. When using oral medications to achieve the optimal contraceptive effect, it is sufficient to take a daily tablet.
- Rapid renewal of fertility after the abolition of contraceptives. “Spent” the ovaries begin to actively produce eggs, so against the backdrop of possible multiple pregnancies.
- Correction of the date of the onset of menstruation. With the help of taking pills, you can monitor the onset of menstruation and shift that day in one direction or another
In addition to the many advantages, hormonal Contraception has significant drawbacks:
- Selection of the necessary protective equipment, which includes hormones, requires obligatory consultation of the gynecologist. The doctor needs the results of blood tests for the level of certain hormones and an introduction to the woman’s history, thus, side effects can be avoided.
- Numerous contraindications to the use of hormonal drugs. They include: age over 45 years, propensity to thrombosis, increased blood coagulability, arterial hypertension, varicose, lactation period, vaginal bleeding of unknown etiology, epilepsy, diabetes mellitus, certain diseases of the kidneys, liver and bile ducts, amenorrhea, chronic heart diseases and blood vessels, smoking, oncological neoplasms.
- Responsibility and self-control are required. Tablets are taken every day at the same time. Omissions and delays lead to a decrease in the contraceptive effect, and it is necessary to use alternative methods of protection for the whole next week, for example, condoms.
- Do not protect against sexually transmitted diseases, hepatitis, and HIV. Hormonal contraceptives are not suitable for women who have unstable intimate relationships. To prevent these diseases, barrier protection must be used.
- The intake of hormonal contraceptives cannot be combined with treatment with certain drugs. Anticonvulsant and anti-tuberculosis drugs significantly reduce the effectiveness of birth control pills.
- The appearance of intermenstrual bleeding. Spaying secretions of unexplained etiology can disturb women in the first months of taking oral contraceptives if these events do not occur within 3-4 months, then to change the drug you need to see a doctor.
- The occurrence of side effects: headaches, pulling sensation in the abdomen, mood swings, depression or excitability, increased appetite, decreased libido, hair loss, impaired renal function, swelling. Weight gain can be very significant, and increasing blood pressure poses a risk for women prone to hypertension.
- Violation of blood circulation, the risk of blood clots. This side effect is very rare but can lead to a stroke.
- With the improper selection of the hormonal contraceptive means, manifestations of pigmentation spots and acne on the skin are possible.
- The relatively high price of these drugs causes many women to choose other remedies
Classification of hormonal contraception by form
Depending on the method of using hormonal Contraception, they are divided into the following types:
- Oral (tablets);
- Parenteral (ampoules, implants, injections, hormonal patches, rings and intrauterine spirals).
Tablets are very popular, they are taken daily orally (through the mouth), while the necessary concentration of hormones is maintained in the body of the woman, which ensures their contraceptive effect.
In the case of parenteral contraceptives, hormones enter the bloodstream, bypassing the digestive system, and are released gradually after a single injection into the body for a long time
Classification of hormonal contraception by hormonal composition
All hormonal Contraception, depending on their composition, are divided into several groups:
1. Combined – a drug that contains two types of synthetic female hormones (estrogens and gestagens). Within this group of funds, there is a subdivision into:
1.1. Oral combined in the form of tablets (COC):
Single-phase (single-phase). All tablets of single-phase combined preparations from the same package contain the same proportion of the hormonal component, so for 21 days a constant amount of active substances enters the woman’s body.
Two-phase. In one package of the drug are tablets of two kinds, for convenience they are distinguished by different colors. In the first half of the cycle, tablets containing more progestin are taken, and in the second – with a high content of estrogens. Thus, the natural processes occurring during the menstrual cycle are simulated. Such means are preferable to single-phase contraceptives.
Three-phase. In one package, the tablets are divided into 3 groups in different colors but contain 2 types of hormones. This division is even closer to the physiological characteristics of the female body, so such drugs are considered the most suitable of the whole group.
1.2. Injectable combined, which are injected with injections.
1.3. Vaginal ring.
2. Uncombined preparations contain as a hormonal component only gestagens. Elimination of estrogens allowed to avoid many side effects. Thus, non-contraceptive contraceptives can be used by women who have contraindications to taking combined drugs. These contraceptives are available in the form of:
2.1. Tablets, or “mini-drank”;
2.2. Injectable gestagen contraceptives (injections);
2.3. Hypodermic hypodermic implants
Depending on the content of the hormonal component in the contraceptive, they are divided into:
- Microdose – are characterized by minimal side effects, can be used by both mature women over 35 years old, and by young nulliparous girls.
- Low – dose – suitable for women of active childbearing age and those who need treatment of gynecological diseases.
- High – dosage – this group includes single-phase hormonal drugs with a constant content of hormones. As for contraceptives they are rarely used, more often such drugs are prescribed for the treatment of hormonal dysfunctions.
Hormonal contraceptive pills
Thanks to the content of synthetic female sex hormones in tablets of contraceptives, their effectiveness reaches 98-100%.
The multistage mechanism for preventing pregnancy includes the following effects on the woman’s body:
stop or delay the process of maturation of the ovum (ovulation);
change the structure of the endometrium of the uterus, due to which a fertilized egg cannot attach to the wall of the uterus and the development of the embryo does not begin.
Oral hormones are prescribed not only to prevent pregnancy, they are also recommended for the treatment of certain endocrine pathologies. Many women note positive changes in their appearance: the skin is cleared of acne, the condition of their hair and nails improves noticeably.
As a rule, combined hormonal preparations contain in one package 21 tablets, which are designed for daily intake for three weeks. Resume the use of pills need 7 days later (break for menstruation). Some drugs contain 28 tablets, 7 of them are inactive to fill the loss of iron in the body of a woman. Tablets are designed for daily intake, omissions or delays lead to a decrease in the contraceptive effect of these drugs.
Mini-pills are taken daily without interruption. They are prescribed to patients who are contraindicated with estrogens. These drugs do not affect the production of milk, so they are considered a good remedy for lactating women.
The advantage of oral contraceptives is the rapid restoration of fertility after withdrawal of their intake. This is the convenience of planning pregnancy with the use of such contraceptives.
The disadvantage of oral contraceptives are side effects and contraindications, so they can be prescribed only by a gynecologist after examination and familiarization with anamnesis of a woman. To determine the appropriate drug will require the results of tests for certain hormones, as well as a general and biochemical blood test. A doctor can direct a woman to an ultrasound of the pelvic organs, mammary glands, and a coagulogram
Contraceptives intended for injection include long-acting progestins. The effect of these drugs is similar to that of oral contraceptives based on progestin components.
For intramuscular administration, DMPA and NET-EN are currently used. The first is a suspension that provides a contraceptive effect for three months after a single dose.
The oil solution of NET-EN is also administered intramuscularly, but the effect of this contraceptive lasts 2 months. The gestagen from the muscle tissue slowly enters the bloodstream, which provides a contraceptive effect.
This method is convenient but has many shortcomings. Until the end of the drug, introduced into the body of a woman, eliminate side effects will be difficult. In addition, when injections are used, menstrual irregularities, fatigue, dizziness, flatulence, weight gain and other side effects are often observed. The negative point of such contraception is the increased risk of cancer of the endometrium of the uterus and breast. After the end of the hormones, the recovery of a woman’s fertility can take more than 12 months. To update the childbearing function, it is recommended to stop the drug administration 9-12 months before the pregnancy planning period.
Means of injection contraception have the same contraindications as progestogen oral contraceptives. The increased risk of serious complications makes it inappropriate and dangerous to use these drugs for women of young and reproductive age.
Implantation contraception is an innovation in medical practice. To date, the most famous means of this type are Norplant and Capronor. Implants are plastic flexible ampoules the size of a match that contains the hormone levonorgestrel (gestagen).
They are designed for subcutaneous injection, for this, they are placed under the skin in the inner surface of the forearm, using local anesthesia, for up to five years, all the while hormones protect the woman from unwanted pregnancy. At the same time, two to six such ampoules can be used. After the expiration of this term, the implant must be removed or replaced with a new implant. You can get rid of capsules at any time, but you can not allow the expiration of the drug, while the woman quickly restores fertility.
Due to the fact that this method of contraception prevents the passage of hormones through the liver, it is possible to avoid such side effects as various hemodynamic and metabolic pathologies associated with a violation of protein and fat metabolism, blood coagulation, and hypertension. Despite this, implants have the same contraindications as other hormonal Contraception, so before they are introduced, a visit to the gynecologist is necessary.
Transdermal contraception in the domestic market of pharmacological agents is represented by the hormonal patch of Eur. This tool has an action similar to COC and can be prescribed not only as a contraceptive but also for the treatment of cycle disorders, anovulation, infertility and hormonal imbalance.
Adhesive plaster adheres to the skin in the abdomen, buttocks, scapula or shoulder once a week and for seven days gives off a constant amount of ethinyl estradiol and norelgestromin. Hormones are absorbed through the skin and enter the blood plasma. The choice of the site of application of the patch does not affect its effectiveness, but the skin on this site should be dry, clean and free of signs of damage. This method of using the contraceptive allows you not to think about regular intake of tablets, while the effectiveness of the method reaches 99.4%.
The patch can be pasted on any convenient day or the first day of menstruation. In the first week, it is necessary to additionally use other contraceptives and then replace the patch every 7 days with a new one. After a three-time change of the patch (21 days of continuous use), one week break should be done. Excess of this term is associated with the likelihood of ovulation.
Despite the ease of use, the hormone patch should only be used after consultation with a gynecologist. This tool has contraindications, and its use is associated with a risk of side effects. Experts do not recommend using transdermal contraception in the postpartum, lactation period, menopause and adolescents under 18 years.
Vaginal contraceptive ring refers to one of the newest contraceptive methods. It is an elastic transparent latex ring 4 mm thick and 5.4 cm in diameter. The size of such rings is universal and will suit any woman due to the fact that in the body it takes anatomical shape.
To date, the only representative of this form of contraceptives is Nova Ring, which is produced in the Netherlands. Depending on the name of the Nova Ring 1 or Nova Ring 3 in the package means can be one or three rings.
Under the skin of the contraceptive, 2 types of female hormones in low concentration (estrogen and progestogen) are included. Under the influence of the heat of the human body, these substances begin to release, acting locally on the uterus and the ovaries. Effects on the liver, intestines and other organs can be avoided, thereby reducing the severity of some side effects.
The ring is inserted into the vagina from the first to the fifth day after the onset of menstruation, strictly following the instructions. With the correct location of the remedy, it is not felt by a woman. The ring remains in the body of the woman for 21 days, then it should be removed and a break for a week. On the eighth day, a new ring is already in use.
The optimum protective effect is achieved in a week after the application of this method. Within seven days it is better to use other methods additionally. You can not remove the ring from the vagina for more than 3 hours, it significantly reduces its contraceptive effect.
Despite all the advantages of this innovative contraceptive method, the Ring of Nova Ring has a number of contraindications. Women who use this remedy may experience side effects in the form of headaches and mood changes, nausea, abdominal pain, and mammary glands. At sexual contacts sometimes there is a sensation of dryness and burning in the vagina, there is a risk of cystitis and cervicitis.
The history of the use of intrauterine contraception dates back several centuries. Modern spirals have changed not only their form but also the mode of action. Now contraceptives of this type provide a mechanical effect and contain hormones that further interfere with the onset of pregnancy.
The most popular hormonal spirals at the moment are Mirena and Levonova. These hormonal IUDs are analogs of conventional spirals, but additionally in the plastic container they contain levonorgestrel, therefore, in addition to exposure to the foreign body, they perform the functions of birth control pills
Every day, the spiral secretes a small amount of the hormone that immediately enters the blood, thus avoiding side effects in the form of nausea and weight gain. A number of contraindications significantly restricts the range of women for whom this type of contraception is possible. A hormonal intrauterine device can provoke cycle disorders, menstruation becomes abundant, or vice versa, lean, sometimes they can disappear altogether. In addition, such women often have intermenstrual bleeding.
Like conventional IUDs, hormonal analogs are picked up and installed by the gynecologist during menstruation. The duration of use of the intrauterine device should not exceed five years. During this time, the spiral provides a high effectiveness of the contraceptive effect. The establishment of a hormonal IUD helps to facilitate the transition to menopause for women over forty. To nulliparous women, this method of contraception is not recommended.
How are hormonal Contraception selected?
The main rule in selecting a specific type of hormonal contraception is to seek help from a specialist. Obstetrician-gynecologist appoints a certain remedy taking into account all risk factors (a history of the disease, age, hormonal background) and the way of life of a woman.
The means of hormonal contraception often have the following contraindications:
- thromboembolic diseases;
- the period of breastfeeding (with the appointment of combined contraceptives);
- oncological tumors of mammary glands and reproductive system;
- renal and hepatic insufficiency, cirrhosis, acute hepatitis;
- diabetes mellitus ;
- headaches of a neurological nature.
This is an incomplete list of contraindications when selecting a specific contraceptive, an individual approach must be followed. For this, the gynecologist conducts an examination and directs to an ultrasound diagnosis to exclude possible contraindications. Sometimes consultation of a mammologist and a biochemical blood test are required. If a woman is completely healthy, then the results of hormone analyzes will not help determine the contraceptive option.
Depending on the woman’s desire, she is offered various types of hormonal drugs. Among oral contraceptives, the choice is huge, the gynecologist can recommend this or that suitable preparation, but the patch and ring are only available in one form, so there will not be a problem of choice.
If a woman has a history of sexual diseases and endocrine pathologies, the doctor should take into account the therapeutic effect of the use of hormonal Contraception in her recommendations.
Progestin-type drugs are generally recommended to women after 35 years of age, overweight, heavy smokers and nursing mothers. Abstain from estrogen is necessary for those with a tendency to thrombosis, hypertension or after a stroke, heart attack or coronary heart disease.
The psycho-type of a woman should also be taken into account when prescribing hormonal Contraception. If a woman is distinguished by attentiveness and concentration, tablets will suit her, forgetful ladies should choose their implant, plaster or vaginal ring better.
Contraceptive hormonal drugs do not protect against sexually transmitted diseases, hepatitis, and HIV infection, so they can only be used with a regular sexual partner, in other cases, barrier contraceptives are additionally used.
Young, nulliparous girls are recommended to have micro-dosed contraceptives. Mature women who already have children – funds with the low dosage of hormones. Medium dosage medications can be prescribed to women in late reproductive age, and high-dosage contraceptives require special attention, with their help usually prevent unwanted pregnancies during the treatment of endocrine disorders.
Possible reaction and side effects of hormonal contraception
At the moment, the ideal contraceptive is not invented. Side effects of hormonal Contraception are determined by the properties of their active components. The composition of these drugs and remedies include gestagens and estrogens.
The main side reactions when using gestagenic contraceptives are the following:
- fast fatiguability;
- decreased libido;
- depressive state;
- skin rashes;
- weight gain;
- cholestatic jaundice;
- increased aggregation of platelets;
- the tension in the mammary glands.
Combined contraceptives containing both types of hormones are capable of provoking the following conditions:
- migraine attacks, headache;
- nausea, vomiting;
- thrombophlebitis, thrombosis;
- dysmenorrhea, amenorrhea;
- cholelithiasis, cholestatic jaundice, liver adenoma;
- hyperpigmentation on the skin;
- deficiency of certain vitamins.
For women over 35, there is a risk of myocardial infarction and stroke if there are risk factors such as hypertension, diabetes, smoking, and obesity.
After the beginning of taking the hormonal drug, the establishment of hormone-containing BCM or implants, a two-month adaptation period begins. Sometimes during this time, some women may have spotting, nausea, headaches, chest pain, decreased sexual desire, and body weight may change. Such phenomena should not be pronounced and interfere with the normal life of a woman. If side effects persist for two months, this indicates a need for a change of protective equipment.
General principles of hormonal contraception and body reaction
According to doctors and pharmacists, hormonal Contraception is safe for prolonged use, do not affect the woman’s genital function, and stopping them does not lead to a “withdrawal syndrome”. Despite this, there is a possibility of occurrence of adverse reactions, besides, due to vital circumstances and planning of pregnancy, a woman has a need to refuse the use of hormonal contraception.
After a short course of hormone intake, which lasted 3-4 months, the body recovers quickly, and there is no need to take a break, you can plan pregnancy immediately after the end of the drug package
Long-term use of hormonal contraception (more than 6 months) provides for the restoration of fertility for 2-3 cycles after the complete abolition of the use of these funds. Prolonged reception of hormones leads to thinning of the endometrial layer of the uterus, which worsens the conditions for normal implantation of the fetal egg and significantly increases the risk of abortion at the earliest possible time.
Continuous use of hormonal Contraception for 5-15 years leads to the fact that the body of a woman cannot independently recover quickly and tune into cyclical processes. In this case, the cancellation should be gradual, for this, you can go to low-dose funds and in the future refuse to use them. If for many years, a woman has been taking mini-pills, the new scheme will take into account the daily intake of a half-tablet of the drug, and then its complete cancellation. In the second case, additional means of protection should be used for sexual intercourse.
Women planning pregnancy should know that taking hormonal drugs leads to a deficiency of folic acid, so after the abolition of contraceptives, it is necessary to diversify the diet and take a complex of vitamins, including this important component.
To soberly assess all the risks of possible side effects during the use of hormonal contraceptives or when they are canceled, you need to seek advice from a gynecologist.