Cilest
Oral contraceptives DO NOT protect against HIV infection (AIDS) and other sexually transmitted diseases.
Before prescribing an oral contraceptive to a patient, it is recommended that a complete medical history be obtained and a thorough physical examination be performed.
Examinations must be repeated periodically in accordance with the standards of quality gynecological care.
Before prescribing an oral contraceptive to a patient, you need to find out what herbal remedies she is taking, as well as read the information in the package inserts for the drugs that the woman will take simultaneously with the oral contraceptive.
If undiagnosed, persistent, or recurrent abnormal vaginal bleeding is present, malignancy must be excluded.
After hepatitis, an oral contraceptive can be prescribed 3 months later (in severe cases, 6 months later) after the results of liver function tests have normalized.
Thromboembolic and other vascular complications
It has been established that the use of oral contraceptives increases the risk of thromboembolic complications and thrombosis. Case-control studies have shown that the relative risk in women using oral contraceptives compared with those not using these drugs is 3:1 for a first episode of superficial vein thrombosis, 11:4 for deep vein thrombosis or thromboembolism pulmonary artery and 6:1.5 in women with diseases predisposing to thromboembolic complications. Studies have demonstrated that the relative risk is somewhat lower, about 3:1 for new cases and about 4.5:1 for new cases requiring hospitalization. The risk of thromboembolic complications associated with the use of oral contraceptives does not depend on the duration of use of these drugs and disappears after stopping their use,
In women using oral contraceptives, the relative risk of postoperative thromboembolic complications is increased by 2-4 times. The relative risk of venous thrombosis in women with diseases predisposing to this complication is 2 times higher than in women without such diseases. If possible, oral contraceptives should not be taken at least 4 weeks before and 2 weeks after elective surgery, which is associated with an increased risk of thromboembolism, and during prolonged immobilization and recovery.
In the early postpartum period, the risk of thromboembolic complications is also increased, and therefore women who decide not to breastfeed can begin taking oral contraceptives no earlier than 3 weeks after birth.
After an induced or spontaneous abortion that occurs at or after the 20th week of pregnancy, hormonal contraceptive use can be started either on the 21st day after the abortion or on the first day of the first spontaneous menstrual period, whichever comes first.
The relative risk of arterial thrombosis (eg, stroke, myocardial infarction) increases in the presence of other predisposing factors, such as smoking, hypertension, hyperlipidemia, obesity, diabetes mellitus, a history of preeclampsia, and advanced age. These severe vascular complications have been observed in women who took oral contraceptives containing 50 mcg or more of estrogen.
The risk of vascular complications is probably less with oral contraceptives containing lower doses of estrogen and progestogen, but this assumption has not yet received firm evidence.
The risk of serious cardiovascular side effects increases with age and in heavy smokers. This risk is very high in women who smoke over 35 years of age. Women using oral contraceptives should be strongly advised to quit smoking.
Increased blood pressure has been reported in women taking oral contraceptives. Studies have shown that with long-term use of estrogen in doses of 50 mcg or more, the likelihood of high blood pressure increases with age. For many women, after stopping oral contraceptives, blood pressure normalizes. It was not possible to detect differences in the incidence of hypertension between women who had previously taken oral contraceptives and women who had never taken such drugs.
In women with arterial hypertension (persistent blood pressure level 140-159/90-99 mm Hg), before starting to take an oral contraceptive, it is necessary to normalize blood pressure. In case of severe increase in blood pressure, oral contraceptive use should be stopped.
There are reports of retinal thrombosis associated with the use of oral contraceptives. Oral contraceptives should be discontinued in the event of unexplained transient, partial or complete loss of vision; the appearance of blurred vision or diplopia; swelling of the optic nerve nipple or changes in the retinal vessels. In such situations, it is necessary to immediately implement appropriate diagnostic and therapeutic actions.
Liver neoplasms
Benign and malignant liver tumors (adenomas and hepatocellular carcinoma) occur rarely. Case-control studies have shown that the risk of these tumors may increase with oral contraceptive use and depend on the duration of use. Rupture of benign liver adenomas can cause death due to internal bleeding.
Genital and breast cancer
The incidence of breast, endometrial, ovarian and cervical cancer in women using oral contraceptives has been the subject of numerous epidemiological studies. There are conflicting results, but most studies have shown that oral contraceptive use is not associated with an overall increase in the risk of breast cancer. Some authors have reported an increased relative risk of breast cancer, especially in young women. This increased relative risk has been shown to depend on the duration of oral contraceptive use.
A meta-analysis of 54 epidemiological studies shows that women who currently use combined oral contraceptives or have taken them in the previous 10 years have a slightly increased risk of breast cancer. It is not possible to determine from these data whether the increased risk of earlier diagnosis of breast cancer in women who have ever used oral contraceptives is due to the biological effects of hormonal contraceptives, or a combination of the two. This meta-analysis also suggests that the age at which women stop taking combined oral contraceptives is an important risk factor for breast cancer: the older the age, the more often they are diagnosed with breast cancer. The duration of use of oral contraceptives is not so important.
Before prescribing an oral contraceptive to a woman, the possibility of an increased risk of breast cancer should be discussed with her and the risk weighed against the benefits of combined oral contraceptives.
Some epidemiological studies have shown that long-term use of oral contraceptives is accompanied by an increased risk of cervical neoplasms. The relationship of these data to the use of combined oral contraceptives has not been proven. It should be noted, however, that the extent to which these data may be due to differences in sexual behavior and other factors is uncertain.
Metabolic effects
Oral contraceptives may reduce glucose tolerance. This effect has been shown to be directly dependent on the dose of estrogen. In addition, progestogens can increase insulin secretion and cause insulin resistance, and this effect varies between progestogens. However, it should be noted that in women without diabetes, oral contraceptives most likely do not affect fasting blood glucose levels. Given the above, it is necessary to closely monitor the condition of women with impaired glucose tolerance or diabetes mellitus who are taking oral contraceptives.
A small percentage of women develop persistent hypertriglyceridemia while taking oral contraceptives. Changes in serum triglyceride and lipoprotein levels have been observed in women using oral contraceptives.
Headache
If migraine occurs or worsens, or if a new type of headache appears that is recurrent, persistent, or severe, you should stop taking the oral contraceptive and find out the cause of the headache.
Menstrual irregularities
Women using oral contraceptives, especially in the first 3 months of taking them, may experience intermenstrual bleeding, spotting and/or amenorrhea. Non-hormonal causes of such disorders should be considered and, if necessary, appropriate diagnostic procedures should be performed to exclude malignancy or pregnancy.
Some women may experience amenorrhea or oligomenorrhea while taking an oral contraceptive, especially if these conditions were observed before starting to use the contraceptive drug.
Chloasma
While taking oral contraceptives, chloasma sometimes occurs, in particular in women with a history of chloasma during pregnancy. Women who are prone to developing chloasma should avoid exposure to the sun and ultraviolet radiation while using oral contraceptives. Chloasma often does not disappear completely.
Reviews of the book “Everything I Never Said” by Celeste Ing
The book made a strange impression on me... On the one hand, I categorically do not like novels about how children die (no matter how, truly or morally), and I would not have chosen such a novel for myself; it came to me by accident. On the other hand, it was written very well, which is why I read it. The plot is as old as time - ambitious parents force their child to live their life. Exorbitant selfishness, which they are not even aware of, completely obscures from them not only the real picture of the world - their home, family, children, relationships, but also encourages them to commit absolutely stereotyped actions, justified to themselves by the banal phrases “I don’t want they treated you like they treated me,” and yet this is precisely what completely determines and guides the lives of their three children - Lydia, who died at the very beginning of the book, and the shy son Ned, and absolutely abandoned, and therefore living in half words, half emotions, or rather , by the instincts of the younger Hannah, who determines her mother’s mood by turning her head and acutely senses that something terrible has happened to her older sister. By the second chapter, you already want to shout “come to your senses, stop,” but the mechanism has already been launched and is spinning at full speed and does not allow you to retreat a single step from the program. The eldest daughter, Lydia, was chosen as the main victim, who will have to fulfill the parental program “you must live the life that did not happen to me.” She fulfills it conscientiously, gradually losing herself, killing in herself who she could be, or rather who she wanted, if she had the opportunity to want. Moreover, she has no opportunity to turn away from this path. At a young age, they experienced the departure of their mother, who decided to give herself one last chance and build her life differently. She left her family for two months, explaining her departure only to herself - “I have the right to try again (to become a doctor, not a housewife). But fate did not give her this chance either. The third pregnancy confused the plans. It was this short period of her absence, when the children were abandoned not only by their mother, but also by their father, who could not pull himself together and existed like an amoeba, enormous stress from his own acute uselessness to anyone, from the fact that their children's world had collapsed and how no one said to live on, subordinating all subsequent events to the fact that “you have to do as mom says, then everything will be fine.” They abandon their self, and the worst thing is that they are fully aware of what they are doing - this makes it even sadder. And all this is against the backdrop of America in the 50s and 60s, with its outright racial prejudices and male chauvinism. Still the same cocktail. It cannot be said that the story was drawn out or complex, although, frankly speaking, a couple of times I was tempted to leave it - in some places the story is too hopeless. But the author skillfully holds the reader, interweaving the storyline from one character to another, although there are incredibly few events in the book. In general, I advise and recommend reading it, especially for those who have children.
