Most modern adult women are sexually active. If there is only one sexual partner, permanent and reliable, you can refuse to use condoms and switch, for example, to oral contraceptives, which are more convenient and cheaper. The main thing is to choose the right drug. One of these drugs, which are oral hormonal contraceptives and are popular among Russian women, are the “Jess” and “Jess Plus” birth control pills, produced by Bayer.
Comparison of the effectiveness of Jess and Jess plus
The effectiveness of Jess is quite similar to Jess Plus - this means that the ability of the medicinal substance to provide the maximum possible effect is similar.
For example, if the therapeutic effect of Jess is more pronounced, then using Jess plus even in large doses will not achieve this effect.
Also, the speed of therapy - an indicator of the speed of the therapeutic effect - is approximately the same for Jess and Jess Plus. And bioavailability, that is, the amount of a drug reaching its site of action in the body, is similar. The higher the bioavailability, the less it will be lost during absorption and use by the body.
Special packaging
Manufacturers took care of forgetful women, and specially developed such packaging so that they could easily navigate not only in the order of administration, but also correlate it with the days of the week.
The fold-out packaging contains a blister containing 24 pink tablets containing the active ingredient and 4 orange tablets containing the placebo effect.
There is also a block of stickers of 7 strips, each of which starts with one of the days of the week, and then the rest follow in order. When a woman starts taking Jess, she must determine the current day of the week and select the strip that starts with it. The sticker is transferred to the front of the blister above the first row of tablets, starting from the starting one. This way you can always find out by the days of the week whether the required dose was taken, how many days were missed and when to start drinking the next package.
Comparison of security between Jess and Jess Plus
The safety of a drug includes many factors.
At the same time, Jess’s is quite similar to Jess’s plus. It is important where the drug is metabolized: drugs are excreted from the body either unchanged or in the form of products of their biochemical transformations. Metabolism occurs spontaneously, but most often involves major organs such as the liver, kidneys, lungs, skin, brain and others. When assessing the metabolism of Jess, as well as Jess Plus, we look at which organ is the metabolizing organ and how critical the effect on it is.
The risk-benefit ratio is when the prescription of a drug is undesirable, but justified under certain conditions and circumstances, with the obligatory observance of caution in use. At the same time, Jess does not have any risks when used, just like Jess Plus.
Also, when calculating safety, it is taken into account whether only allergic reactions occur or possible dysfunction of the main organs. In other matters, as well as the reversibility of the consequences of using Jess and Jess Plus.
Drug Jess
The drug Jess in the tablets has 2 active components - ethinyl estradiol and drospirenone. Additional components of the tablets that play a supporting role are:
- corn starch;
- lactose monohydrate;
- Magnesium stearate.
The surface of the tablets is coated with a film coating, which contains the following ingredients:
- hypromellose;
- titanium dioxide;
- talc;
- dye.
The tablets of the medicinal product are light pink in color, have a round shape, and are biconvex. The package contains 28 pcs.
Jess is a monophasic oral contraceptive that can have antiandrogenic and antimineralocorticoid effects on a woman’s body. The contraceptive suppresses the ovulation process and promotes thickening of cervical secretions, which complicates the penetration of sperm through the cervical canal.
Indication for use is the prevention of unwanted pregnancy. The drug can be prescribed to treat moderate acne and to eliminate severe symptoms accompanying premenstrual syndrome.
Contraindications to the use of contraception are:
- the presence of venous and arterial thrombosis or thromboembolism and conditions preceding them;
- cerebrovascular disorders;
- migraine;
- diabetes mellitus, accompanied by disturbances in the functioning of the vascular bed;
- pancreatitis with hypertriglyceridemia;
- severe liver pathologies, the presence of liver failure;
- malignant neoplasms in the liver;
- malignant hormone-dependent diseases;
- presence of adrenal insufficiency;
- vaginal bleeding of unknown etiology;
- pregnancy;
- breastfeeding period;
- the presence of high sensitivity to the compounds included in the drug.
Contraindications to the use of the drug Jess are: the presence of venous and arterial thrombosis or thromboembolism and conditions preceding them.
Gynecologists prescribe Jess with caution to women in the postpartum period, as well as to those patients who have experienced aggravation of existing pathologies during pregnancy.
Such violations may be:
- cholelithiasis;
- cholestasis;
- otosclerosis;
- porphyria;
- herpes and some others.
When using the drug, a woman may experience the following side effects:
- nausea;
- irregular periods;
- bleeding from the genitals of unknown etiology;
- pain in the mammary glands;
- migraine;
- depressed mood and its swings;
- decreased libido;
- erythema multiforme.
In rare cases, side effects may occur such as:
- tumor formation;
- development of erythema nodosum;
- hypertension;
- worsening symptoms of angioedema;
- liver dysfunction;
- changes in insulin resistance;
- Crohn's disease;
- chloasma;
- nonspecific ulcerative colitis.
In case of an overdose, patients may experience nausea and vomiting, and spotting may appear. To eliminate the consequences of a drug overdose, symptomatic therapy is used.
The contraceptive is sold in pharmacies with a doctor's prescription. The price of one package of the drug containing a monthly course of tablets is 800-900 rubles.
Comparison of addiction between Jess and Jess plus
Like safety, addiction also involves many factors that must be considered when evaluating a drug.
So the totality of the values of such parameters as “syndrome o, in Jess” is quite similar to the similar values in Jess plus. Withdrawal syndrome is a pathological condition that occurs after the cessation of intake of addictive or dependent substances into the body. And resistance is understood as initial immunity to a drug; in this it differs from addiction, when immunity to a drug develops over a certain period of time. The presence of resistance can only be stated if an attempt has been made to increase the dose of the drug to the maximum possible. At the same time, Jess's syndrome values are quite low, just like Jess's plus.
The onset of puberty is associated with activation of the hypothalamic-pituitary system, followed by activation of the ovaries, which are the main source of estrogens - hormones that form the female-type phenotype, or feminization. In addition to influencing the development of sexual characteristics, estrogens play an extremely important role in the functioning of the cardiovascular, nervous, musculoskeletal and immune systems of the body. Due to estrogen, the skin looks smooth and toned, the hair on the head is long and elastic, and the nails are shiny and strong. The role of estrogen in sexual life is invaluable. Thanks to them, libido is formed, the glands of the genitourinary tract function and attractant pheromones are produced that attract the opposite sex. The secretion of the sweat glands is also under the direct control of estrogens [3].
The biochemical precursors of estrogens are androgens, 50% of which are synthesized in the ovaries and adrenal glands, and the second half are formed in adipose tissue. The role of androgens in the physiology of the female body has received less attention compared to estrogens and progesterone, but their influence on the functioning of almost all body systems and participation in the development of many pathological conditions is very significant and diverse. By binding to the receptors of the limbic system of the brain, androgens form libido and influence initiative in actions and aggressiveness in behavior. Under the influence of androgens, linear growth and closure of the epiphyses in tubular bones occurs. In the bone marrow, androgens stimulate the mitotic activity of stem cells, in the kidneys - the production of erythropoietin; in the liver - blood proteins. An increase in muscle mass, hair growth, and the functioning of apocrine and sebaceous glands are androgen-dependent processes [4, 5, 7].
The bulk of testosterone circulating in the blood (about 80%) is bound to sex hormone-binding globulin (SHBG), approximately 17-19% is bound to albumin, and only 1-3% circulates in a free state (biologically active testosterone) [5]. Hyperandrogenism (HA) is one of the most common causes of not only menstrual irregularities, chronic anovulation (35%) and, as a consequence, infertility, but also a wide range of cosmetic problems such as seborrhea, hypertrichosis and acne of varying severity [1, 6— 8].
Acne (acne vulgaris) is a chronic inflammatory skin disease that affects up to 85-90% of adolescents; a severe course of the process is observed in 5-10%. Approximately more than 40% of patients demonstrate nosogenic psychoemotional disorders, predominantly of the depressive spectrum, as a result of persistence of the disease due to inadequate therapy [2, 6].
In the pathogenesis of acne, the initial link is hereditarily determined GA, which can manifest itself in the form of an absolute increase in the amount of hormones (AGA) or in the form of increased sensitivity of receptors to a normal or reduced amount of androgens in the body [6]. Conditions of relative GA are more often observed. In the cells of the sebaceous glands - sebocytes, testosterone, under the influence of the enzyme 5α-reductase type I, transforms into the most active metabolite - dihydrotestosterone, which is a direct stimulator of the growth and maturation of sebocytes, the formation of sebum. The main causes of relative GA are:
1) increased activity of the enzyme 5α-reductase type I;
2) increased density of nuclear dihydrotestosterone receptors;
3) an increase in the free fraction of testosterone in the blood as a result of a decrease in the synthesis of SHSH in the liver.
Up to 80% of women with acne note an increase in the number of non-inflammatory and inflammatory rashes in phase II of the cycle (10-12 days before the onset of bleeding). This is due to microedema of the skin (narrowing of the mouth of the pilosebaceous follicle - SVF), aggravation of the key link in the pathogenesis of acne - follicular hyperkeratosis and, as a consequence, aggravation of the outflow of sebum. Pathogenetically, this condition is explained by stimulation of the renin-aldosterone-angiotensin system by estrogen and progesterone, followed by sodium and water retention [6, 8].
If the initial link in the pathogenesis of acne is an increase in the intensity of sebum formation, then the key is follicular hyperkeratosis as a result of the predominance of keratinization processes over desquamation processes at the mouth of the SVF.
Acne rashes are represented by a pseudopolymorphic rash, which is characterized by a clear stage in the evolution of elements. Initial skin changes in acne are represented by open and closed comedones (according to the level of obstruction of the SVF duct). The addition of an inflammatory reaction around the comedone leads to its destruction and the subsequent formation of papules and then pustules. The development of an inflammatory reaction in the dermis leads to the formation of nodes, and when they suppurate, cysts [6].
Anti-acne agents used today are represented by both systemic and local drugs that act primarily on one factor in the pathogenesis of acne. Any local anti-acne drugs (retinoids and retinoid-like compounds, azelaic acid, benzoyl peroxide, antibiotics, drugs with zinc) do not guarantee the patient a stable and long-term remission of the process after cessation of therapy [3].
Based on the basics of the etiology and pathogenesis of acne, for the treatment of this disease in women, substances that have a suppressive effect on HA conditions are adequate and pathogenetically justified, i.e. antiandrogens, which have taken a strong position in international algorithms for the management of women with mild to moderate acne [2, 12].
Among the drugs that affect the severity of androgenization, the most widely used are combined oral contraceptives (COCs). All COCs consist of ethinyl estradiol and a progestin component. Based on the amount of ethinyl estradiol, COCs are divided into high-dose (50 mcg/day), low-dose (30-35 mcg/day) and micro-dose (15-20 mcg/day) [1, 10].
The desired actions of ethinyl estradiol include: antigonadotropic (potentiation of the action of gestagens), endometrial proliferation and stimulation of protein synthesis in the liver (in particular, SHSG), blood coagulation factors, high-density lipoprotein apoproteins. Side effects include activation of the renin-angiotensin-aldosterone system with subsequent retention of sodium and water in the body.
The main effect of synthetic gestagens is their gestagenic activity, which consists of an antigonadotropic effect, secretory transformation of the endometrium and maintenance of pregnancy [7, 13].
The optimal combination in COCs used for the treatment of acne and seborrhea is the presence of estrogens in the minimum amount required for the normal course of the menstrual cycle (microdosage, or 0.015-0.02 mg of ethinyl estradiol) and a gestagen, which has progestogenic, antiandrogenic and antimineralocorticoid activity.
At the end of the 90s of the twentieth century, a unique progestogen, drospirenone, was synthesized - a fourth-generation progestogen, a spirolactone derivative, without an ethynyl radical, different from all previously existing progestogens. In terms of its biological effects, drospirenone is as close as possible to endogenous progesterone. In addition to the gestagenic effect, drospirenone has antiandrogenic and antimineralocorticoid properties. Due to its antiandrogenic activity, drospirenone effectively reduces the severity of acne, seborrhea and hirsutism [9, 12].
In 2006, an innovative low-dose COC containing 0.02 mg ethinyl estradiol and 3 mg drospirenone in a regimen of 24 active tablets + 4 placebo tablets appeared - the drug Jess (Bayer HealthCare Pharmaceuticals, Germany).
The drug Jess combines the advantages of a low dose of estrogen (0.02 mg/day compared to the standard dose of 0.03 mg/day) and the innovative progestogen drospirenone. Reducing the dose of estrogen increases the safety of the drug and improves its tolerability.
The anti-acne activity of COC Jess is due to the following mechanisms:
- direct antiandrogenic effect (blockade of androgen receptors);
- indirect antiandrogenic effect;
- antigonadotropic activity;
- stimulation by ethinyl estradiol and drospirenone of the synthesis of SHG by the liver;
- absence of displacement of testosterone from its connection with SHSG (since drospirenone is transported in the blood bound to albumin);
- suppressive effect on the renin-angiotensin-aldosterone system (blockade of aldosterone receptors by drospirenone).
The last property of Jess is very important, especially for women who notice an exacerbation of acne in the second half of the cycle.
In Russia, Jess is a COC registered according to the following indications:
- contraception;
- contraception and treatment of moderate acne;
- contraception and treatment of severe premenstrual syndrome.
Thanks to the antimineralocorticoid effect of drospirenone, Jess prevents sodium and water retention in the body, reducing associated side effects such as breast engorgement and weight gain, thereby improving the tolerability of the drug and the possibility of its long-term use.
In a study assessing the cosmetic aspects of taking an antiandrogenic COC with drospirenone, by the end of 6 months of therapy, a decrease in seborrhea (by 71%), acne (by 75%) and hypertrichosis (Ferryman-Gallwey index - by 43%), increased hydration of the epidermis was demonstrated. by 26% and a decrease in transepidermal fluid loss (by 35%) [12].
The new 24+4 regimen extends the effect of drospirenone by 3 additional days (compared to the standard regimen of other COCs: 21 active tablets and 7 days off), which enhances its antiandrogenic and antimineralkorticoid effects. In addition, the prolonged action of drospirenone provides a more stable hormonal balance and reduces the symptoms observed during breaks in taking standard COCs (during menstruation), such as dysmenorrhea, headache, mood changes.
At the end of 2012, modified forms of drospirenone-containing COCs, Jess Plus and Yarina Plus (Bayer HealthCare Pharmaceuticals, Germany), appeared on the domestic pharmaceutical market. Compared to its predecessors, each tablet (including 4 or 7 placebo tablets, respectively), in addition to ethinyl estradiol (20 or 30 mcg, respectively) and drospirenone (3 mg), contains calcium levomefolate (Metafolin[]) at a dose of 451 mcg - stable and metabolically active calcium salt of folic acid (vitamin B9). Folates are not synthesized in the human body. When supplied with food, they take an active part in DNA synthesis and repair, synoptic transmission and erythropoiesis. There is information about the key role of folic acid in the DNA repair processes of keratinocytes and skin fibroblasts, in particular, after photolysis induced by UV radiation [11]. These data allow us to consider folates as an important component in the prevention of skin photoaging (“endogenous” photoprotector), especially considering the fact that estrogens increase the sensitivity of the skin to UV radiation (Fig. 1).
Figure 1. Folate (B9) in protecting skin components from UV radiation.
The extremely important role of folates during the first month of embryonic development is their effect on the proliferation and differentiation of neural stem cells, i.e. the formation of the neural tube of the embryo - the precursor of the fetal central nervous system. Lack of folic acid in the body of a pregnant woman (when the woman does not yet know that she is pregnant: for 36% of women the first pregnancy is not planned) leads to defects of the neural tube of the embryo - congenital malformations incompatible with life (anencephaly) or leading to disability (spina bifida) . Therefore, for women of childbearing age taking COCs and planning to become pregnant soon, folate intake should be started well before conception to achieve sufficient folate levels during neural tube formation. Considering that 21.1% of women become pregnant after the first cycle of taking COCs, and 45.7% after the third, there was a need to create COCs containing a stable form of folate. Studies have shown that after 24 weeks of daily dosing, Yarina Plus slow release maintains plasma folate concentrations above baseline for 20 weeks in a significant proportion of women [11].
The use of the drugs Yarina Plus and Jess Plus as contraception in women of the childbearing period receiving therapy for severe forms of acne with systemic isotretinoin (Acnecutane) throughout the entire period of treatment (on average 8 months) and 2 months after its completion is especially valuable [3].
The minimum course of acne treatment with both Jess and Jess Plus is 6 months. If contraception is necessary, as well as to maintain skin, hair and nails in optimal condition, in accordance with WHO recommendations (2009), the drug can be used for a long time [2].
Before prescribing Jess Plus to a woman with acne as a basic anti-acne agent, it is necessary to ensure that there are no contraindications both from the gynecological status and from other organs and systems.
A gynecologist-endocrinologist and a dermatocosmetologist can recommend acne therapy with COCs with antiandrogenic effects. The dynamics of skin lesions during treatment are monitored by a dermatocosmetologist, and the absence of contraindications for prescribing a woman a COC with an antiandrogenic effect is assessed by a gynecologist-endocrinologist. Before starting therapy, as well as after its completion, a gynecological examination, examination of the mammary glands and a cytological examination of the epithelium of the vaginal part of the cervix are necessary to exclude morphological signs characterizing dysplastic processes (Papanicolaou smear - PAP smear). If AGA is suspected, an assessment of the blood hormonal profile (LH, FSH, estradiol, progesterone, testosterone, prolactin and DHEA sulfate), ultrasound of the pelvic organs and adrenal glands, and X-ray/tomography of the skull may be required (Fig. 2).
Figure 2. Algorithm for interaction between specialists in the treatment of acne in women. It is necessary to explain to the woman the regimen of taking the drug, the features of contraception during the 1st month of use, possible side effects during the first two cycles, as well as what the patient should do if she misses taking the next pill depending on the day of the cycle [2].
We observed 47 women aged 16–32 years with acne of II–III severity. In 19 women, the pathological process was localized only on the face, in 28 - on the face and torso. COC Jess (43 women) and COC Jess Plus (4) were prescribed on a continuous basis (the first tablet - on the 1st day of menstruation and over the next 23 days - 1 tablet, followed by placebo tablets (Jes) for 4 days. or 4 tablets with Metafolin (Jess Plus) for a period of 6 months. By the end of the 3rd month, in the whole group there was a regression of non-inflammatory elements by 46%, inflammatory elements by 55% compared to the initial indicators. The level of sebum secretion decreased by 31%. By the end of the treatment period, non-inflammatory and inflammatory elements regressed by 85 and 89%, respectively, compared to the initial level; sebum secretion decreased by 56%. A state of clinical cure was achieved in 22 (46.8%) patients (Fig. 3 , 4),
Figure 3. Patient Zh., 20 years old. a - before treatment; b — after 6 months of therapy with COC Jess.
Figure 4. Patient Sh., 22 years old. a - before treatment; b — after 5 months of therapy with COC Jess Plus. significant improvement - in 18 (38.3%), improvement - in 7 (14.9%). Excellent tolerability of therapy was noted; no side effects were recorded. An examination by a gynecologist after 6 months did not reveal any pathology in any woman. PAP smear after 6 months of therapy was negative in all patients. Of particular note is the decrease in the patients’ body weight by 1.7±0.3 kg by the end of the 6th month of therapy, which is explained by the antimineralocorticoid effect of the drugs. During the course of treatment, most women noted an improvement in the condition of the hair on their heads, a decrease in the growth of vellus hair in areas “inherent” to men, as well as the disappearance of emotional lability.
Based on our own many years of experience in treating acne with anti-androgenic drugs, it should be concluded that the clinically significant anti-acne effect of COCs appears no earlier than 3-4 months of therapy, which dictates the advisability of prescribing external anti-acne agents to some patients, in particular, the anti-acne line of medicinal cosmetics [2], on during the first half of the course of therapy (first 2-3 months).
Thus, joint observation of patients with acne by a gynecologist-endocrinologist and a dermatocosmetologist made it possible to develop a new direction for taking COCs Jess and Jess Plus:
1. Elimination of acne and seborrhea.
2. Improved hair condition.
3. Improving skin quality indicators (increasing hydration and skin turgor due to estrogen stimulation of hyaluronic acid synthesis; reducing the level of moisture evaporation from the surface of the epidermis).
4. Suspension of hypertrichosis (decrease in the Ferriman-Gallwey index).
5. Normalization of eating behavior.
6. Prevents fluid retention in the body (unlike other COCs).
7. Stabilization or reduction of body weight.
8. Improvement in general well-being (more than 85%).
9. Relief of psycho-emotional lability.
10. Photoprotection of epidermal structures due to metafolin.
[]Calcium levomefolate (Metafolin) is registered and supplied by Merck & Cie, Switzerland. Metafolin is a registered trademark of Merck KGaA, Germany.
Comparison of Jess side effects and Jess plus
Side effects or adverse events are any adverse medical event that occurs in a subject after administration of a drug.
Jess Plus has more adverse events than Jess. This implies that the frequency of their occurrence is low in Jess Plus and low in Jess. Frequency of manifestation is an indicator of how many cases of an undesirable effect from treatment are possible and registered. The undesirable effect on the body, the strength of influence and the toxic effect of drugs are different: how quickly the body recovers after taking it and whether it recovers at all. When using Jess Plus, the body's ability to recover faster is higher than that of Jess.
Side effects of the contraceptive
Most often, women complain of the following side effects:
- chest pain;
- nausea;
- migraine;
- uterine bleeding;
- decreased libido;
- mood swings;
- depression;
- emotional instability, etc.
If the side effects are pronounced and do not disappear for a long time, you must inform your gynecologist about them so that he can prescribe another, more suitable drug.
In general, hormonal contraceptives do not have the best reputation, and they can cause serious side effects, including cysts, problems with the cardiovascular system, thrombosis, and others. Therefore, if any obvious changes or problems arise, you need to tell your doctor.
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Comparison of ease of use of Jess and Jess Plus
This includes dose selection taking into account various conditions and frequency of doses. At the same time, it is important not to forget about the release form of the drug; it is also important to take it into account when making an assessment.
The ease of use of Jess is approximately the same as Jess Plus. However, they are not convenient enough to use.
The drug ratings were compiled by experienced pharmacists who studied international research. The report is generated automatically.
Last update date: 2020-12-04 13:43:27
