Almost every woman has felt the need to use contraceptives at least once in her life. And during such a period, many questions arise, namely, which contraceptives to choose, how to take them, whether there are side effects, and much more. Let's look at all the features of birth control and figure out which pills are best to take at a certain age.
Groups of contraceptives for women
The pharmacological market currently offers a wide range of drugs to prevent pregnancy. All of them are divided into the following groups:
- Combined oral contraceptives are based on hormones similar to the action of estrogens, these are progestogen and ethinyl estradiol. There are two-, three- and monophasic drugs.
- Mini-drink. Contains exclusively progestogen. The principle of action is a local effect on the peripheral zones of the reproductive organs. As a result of taking such drugs, there is a change in the biochemical and morphological parameters of the endometrium, so the development of the fertilized egg does not occur. In most women, the ovulation process is suppressed. Effective representatives: Microlut, Laktinet, Exluton, Charozetta.
COCs are divided into 3 groups based on the active substance content in the tablets:
- Monophasic - contain a low level of hormones. Therefore, they are recommended for use by young girls who have not given birth before. And for people who are encountering contraceptives for the first time, such medications will be the most suitable.
- Biphasic - prescribed to young and middle-aged women, especially relevant in the postpartum period. These pills should be taken by those who experience discharge while taking microdosed contraceptives. These drugs have an antiandrogenic effect, therefore they have a positive effect on the skin and prevent unwanted hair growth. These include: Regulon, Marvelon, Siluet.
- Triphasic - characterized by a high content of female hormones. They are prescribed for some gynecological diseases and to restore hormonal levels. Representatives: Trikvilar, Ovidon, Trizeston.
Siluette®
If any of the conditions/diseases or risk factors listed below currently exist, a careful assessment of the expected benefit versus the possible risk of using Siluet® should be carried out for each woman individually before taking the drug. If any of these conditions, diseases, or risk factors worsen, become worse, or appear for the first time, a woman should consult her doctor, who may decide whether to stop taking the drug.
Risk of developing VTE and ATE
The results of epidemiological studies indicate a relationship between the use of COCs and an increased incidence of venous and arterial thrombosis and thromboembolism (such as DVT and PE, myocardial infarction, stroke, cerebrovascular disorders). These diseases are rare. An increased risk is present after initial use of COCs or resumption of use after a break of 4 weeks or more. The greatest risk of developing VTE is observed in the first year of COC use, mainly during the first 3 months.
COCs containing levonorgestrel, norgestimate or norethisterone as a progestogen component have the lowest risk of developing VTE. Other COCs, such as the combination of dienogest and ethinyl estradiol, may have an increased risk of their development compared to levonorgestrel-containing drugs (1.6 times). The choice to use Siluet® can only be made after consultation with the woman to ensure that she fully understands the risk of developing VTE associated with the use of the drug, the effect of the drug on her existing risk factors and that the risk of developing VTE is greatest in the first year use of COCs.
VTE can be life-threatening or lead to death (in 1-2% of cases). It is extremely rare when using COCs that thrombosis of other blood vessels occurs, for example, hepatic, mesenteric, renal, cerebral veins and arteries or retinal vessels.
Symptoms of deep vein thrombosis:
unilateral swelling or swelling along the vein, pain or discomfort in the lower limb only in an upright position or when walking, local increase in temperature, redness or discoloration of the skin of the lower limb.
Symptoms of pulmonary embolism
: difficulty or rapid breathing; sudden cough, including with hemoptysis; sharp pain in the chest, which may intensify with deep inspiration; sense of anxiety; severe dizziness; fast or irregular heartbeat. Some of these symptoms (eg, shortness of breath, cough) are nonspecific and may be misinterpreted as signs of other more common and less severe conditions (eg, respiratory tract infection).
Arterial thromboembolism can lead to stroke, vascular occlusion, or myocardial infarction.
Symptoms of a stroke include
: sudden weakness or loss of sensation in the face, limbs, especially on one side of the body, sudden confusion, problems with speech and understanding; sudden unilateral or bilateral vision loss; sudden disturbance in gait, dizziness, loss of balance or coordination; sudden, severe or prolonged headache for no apparent reason; loss of consciousness or fainting with or without a seizure.
Other signs of vascular occlusion:
sudden pain, swelling and slight cyanosis of the extremities, “acute” abdomen.
Symptoms of myocardial infarction:
discomfort, pressure, heaviness, a feeling of compression or fullness in the chest or behind the sternum, pain radiating to the back, jaw, left upper limb, epigastric region: cold sweat, nausea, vomiting or dizziness, severe weakness, anxiety or shortness of breath; fast or irregular heartbeat.
Arterial thromboembolism can be life-threatening or fatal.
In women with a combination of several risk factors or high severity of one of them, the possibility of their mutual reinforcement should be considered. In such cases, the degree of increase in the risk of blood clots may be higher than with a simple sum of risk factors. In this case, the combination of dienogest and ethinyl estradiol is contraindicated.
The risk of developing thrombosis (venous and/or arterial), thromboembolism or cerebrovascular disorders increases:
- with age;
- in smokers (with an increase in the number of cigarettes or an increase in age, the risk increases, especially in women over 35 years old);
in the presence of:
— obesity (body mass index 30 kg/m2 or more);
- family history (for example, venous or arterial thromboembolism ever in close relatives or parents under the age of 50 years); in the case of a hereditary or acquired predisposition, the woman should be examined by an appropriate specialist to decide on the possibility of taking a contraceptive;
- dislipoproteinemia;
- arterial hypertension;
- migraine;
— diseases of the heart valves;
- atrial fibrillation;
- prolonged immobilization, extensive surgery, any operation on the lower extremities or major trauma; in these cases, the drug must be stopped (in the case of a planned operation, at least four weeks before it) and not resumed for two weeks after the end of immobilization.
Temporary immobilization (eg, air travel lasting more than 4 hours) may also be a risk factor for the development of venous thromboembolism, especially in the presence of other risk factors.
The possible role of varicose veins and superficial thrombophlebitis in the development of VTE remains controversial. The increased risk of thromboembolism in the postpartum period should be taken into account.
Peripheral circulatory disorders may also occur in 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 frequency and severity of migraine while taking the drug (which may precede cerebrovascular events) is grounds for immediate discontinuation of the contraceptive.
Biochemical indicators indicating a hereditary or acquired predisposition to venous or arterial thrombosis include the following: resistance to activated protein C, hyperhomocysteinemia, antithrombin III deficiency, protein C deficiency, protein S deficiency, antiphospholipid antibodies (anticardiolipin antibodies, lupus anticoagulant).
When assessing the benefit-risk ratio, it should be taken into account that adequate treatment of the relevant condition can reduce the associated risk of thrombosis. It should also be taken into account that the risk of thrombosis and thromboembolism during pregnancy is higher than when taking low-dose COCs (<0.05 mg ethinyl estradiol).
Tumors
The most significant risk factor for the development of cervical cancer (CC) is persistent human papillomavirus infection. There are reports of a slight increase in the risk of developing cervical cancer with long-term use of COCs, but the connection with COC use has not been proven. There is still controversy regarding the extent to which these data are influenced by various factors, in particular cervical screening examinations or characteristics of a woman’s sexual behavior (number of sexual partners or less frequent use of barrier methods of contraception), as well as the cause-and-effect relationship of these factors.
According to a meta-analysis of the results of 54 epidemiological studies, a slight increase (1.24) in the risk of developing breast cancer in women using COCs was identified. The increased risk gradually disappears within 10 years after stopping COC use. Due to the fact that breast cancer is rare in women under 40 years of age, the increase in the number of breast cancer diagnoses in women who are currently taking COCs or have recently taken them is insignificant in relation to the overall risk of developing this disease. Its connection with COC use has not been proven. The observed increase in the risk of developing breast cancer may be due not only to earlier diagnosis of breast cancer, but also to the biological effect of sex hormones or a combination of these two factors. Women who have ever used COCs show earlier clinical stages of breast cancer than women who have never used them.
In rare cases, during the use of COCs, the development of benign, and in extremely rare cases, malignant liver tumors, which in some cases led to life-threatening intra-abdominal bleeding, was observed. If severe abdominal pain, liver enlargement, or signs of intra-abdominal bleeding occur, this should be taken into account when making a differential diagnosis.
Other states
Depressed mood and depression are a known adverse reaction when using hormonal contraceptives (see section "Side effects"). Depression can be a serious disorder and is a known risk factor for suicidal behavior and suicide. Women should be advised to contact their doctor if they experience mood changes or depressive symptoms, including soon after starting contraception.
Women with hypertriglyceridemia (or a family history of this condition) may have an increased risk of developing pancreatitis while taking COCs.
Although slight increases in blood pressure have been described in many women taking COCs, clinically significant increases have rarely been observed. However, if a persistent clinically significant increase in blood pressure develops while taking COCs, these drugs should be discontinued and treatment of arterial hypertension should be initiated. The drug can be continued if normal blood pressure values are achieved with antihypertensive therapy. The following conditions have been reported to develop or worsen both during pregnancy and while taking COCs, but their relationship with COC use has not been proven: jaundice and/or pruritus associated with cholestasis; formation of gallstones; porphyria; systemic lupus erythematosus; hemolytic-uremic syndrome; chorea; gestational herpes; hearing loss associated with otosclerosis. Cases of worsening epilepsy, Crohn's disease and ulcerative colitis have also been described during the use of COCs.
In women with hereditary forms of angioedema, exogenous estrogens may cause or worsen symptoms of angioedema.
Acute or chronic liver dysfunction may require discontinuation of COCs until liver function tests return to normal. Recurrence of cholestatic jaundice, which developed for the first time during a previous pregnancy or previous use of sex hormones, requires discontinuation of COC use.
Although COCs may have an effect on insulin resistance and glucose tolerance, there is usually no need to adjust the dose of hypoglycemic drugs in diabetic patients using low-dose COCs (<0.05 mg ethinyl estradiol). However, patients with diabetes mellitus should be carefully monitored while taking COCs.
Chloasma can sometimes develop, especially in women with a history of pregnancy chloasma. Women with a tendency to chloasma while taking Siluet® should avoid prolonged exposure to the sun and exposure to ultraviolet radiation.
Preclinical safety data
Preclinical data from routine repeated-dose toxicity, genotoxicity, carcinogenicity and reproductive toxicity studies do not indicate a particular risk to humans. However, it should be remembered that sex hormones can promote the growth of certain hormone-dependent tissues and tumors.
Laboratory tests
Taking Siluet® may affect the results of some laboratory tests, including indicators of liver, kidney, thyroid, adrenal function, the concentration of transport proteins in the blood plasma, indicators of carbohydrate metabolism, parameters of blood coagulation and fibrinolysis. Changes usually do not go beyond normal values.
Reduced efficiency
The effectiveness of Siluet® may be reduced in the following cases: if you miss taking pills, gastrointestinal disorders or as a result of drug interactions.
Frequency and severity of menstrual-like bleeding
While taking Siluet®, irregular bleeding may occur (“spotting” spotting and/or “breakthrough” uterine bleeding), especially during the first months of use. Therefore, any irregular bleeding should be assessed only after an adaptation period of approximately three cycles.
If irregular bleeding recurs or develops after previous regular cycles, careful evaluation should be performed to rule out malignancy or pregnancy.
No regular menstrual bleeding
Some women may not develop bleeding during a break in taking pills. “ooContraindications” and “With caution.”
— Local compaction in the mammary gland.
- Concomitant use of other medications (see also “Interaction with other medications”).
- If prolonged immobilization is expected (for example, a cast is applied to the lower extremity), hospitalization or surgery is planned (at least four weeks before the proposed operation).
- Unusually heavy bleeding from the vagina.
- Missed a pill in the first week of taking the pack, and had sexual intercourse seven days or less before.
— Absence of regular menstrual-like bleeding two times in a row or suspicion of pregnancy (you should not start taking the drug from the next package before consulting your doctor).
You should stop taking the tablets and consult your doctor immediately if there are possible signs of thrombosis, myocardial infarction or stroke: unusual cough; unusually severe pain behind the sternum, radiating to the left arm; unexpected shortness of breath; unusual, severe and prolonged headache or migraine attack; partial or complete loss of vision or double vision; slurred speech; sudden changes in hearing, smell, or taste; dizziness or fainting; weakness or loss of sensation in any part of the body; severe abdominal pain; severe pain in the lower limb or sudden swelling of any of the lower limbs.
How to choose the right birth control pills
In no case is it recommended to choose and start a course of taking contraceptives on your own. This should only be done by a doctor.
Before prescribing a contraceptive method, the specialist collects the patient’s medical history, takes into account the presence of any diseases in the present or future and pays attention to the individual characteristics of the body.
The next stage is a complete examination of the woman, the doctor evaluates the constitution, body weight, skin condition and blood pressure level. Additionally, he prescribes instrumental and laboratory tests, it is especially important to conduct ultrasound and mammography.
Also, when choosing contraceptives, be sure to take into account:
- Breasts, their shape and structure.
- Type of hair growth on the genitals.
- Growth.
- Health status of skin and hair.
- Peculiarities of the flow of menstruation.
- Presence of chronic diseases.
Compatibility with other drugs
The contraceptive effectiveness of Silhouette OC may be reduced by concomitant use of antiepileptic drugs, rifampicin, HIV drugs and St. John's wort.
Antifungals, verapamil, macrolide antibiotics (erythromycin, clarithromycin), diltiazem, and grapefruit juice may increase blood levels and cause side effects.
This information confirms that before prescribing this OC, it is necessary to undergo examination by a gynecologist; consultation with a neurologist, cardiologist, therapist and other specialists is often required. In the absence of contraindications and serious illnesses, the drug is tolerated normally. It is an effective contraceptive and is often prescribed to patients with symptoms of hyperandrogenism (excessive facial hair growth, oily skin, dandruff, etc.). )
How to take birth control
The nature and rules for taking COCs are specified in the instructions for the drug. This information can also be obtained from your doctor.
As a rule, the package includes a blister of 21 tablets, but there are exceptions. Taking the drug should begin at the start of menstruation and continue daily until the tablets run out. Afterwards, it is important to take a break for 7 days and resume taking it again.
If a dose is missed for some reason, you should immediately take the pill.
For more reliable protection against pregnancy, you need to use condoms.
Side effects
Taking medications to prevent pregnancy may cause the following side effects:
- Headache, dizziness.
- Weight gain.
- Cessation of menstruation.
- Swelling of the limbs.
- Breast pain.
- Flatulence.
- Disorders of the skin.
- Nausea.
- Decreased appetite.
- Profuse bleeding.
- Pressure changes.
- Disturbance of consciousness.
- Allergic reactions.
- Heavy breathing.
If such symptoms occur, the use of tablets should be stopped.
Operating principle
Silhouette birth control pills have two main mechanisms of action:
- inhibition of ovulation;
- increasing the viscosity of cervical secretions, which prevents sperm from entering the uterus from the vagina.
Only one in a hundred women taking the drug for a year will become pregnant.
The specificity of Silhouette lies in its ability to reduce the level of male sex hormones androgens, which are also produced by women. This is how the antiandrogenic effect of the drug is realized:
- acne disappears;
- The severity of seborrhea (dandruff) is reduced.
One of the ingredients of the drug, dienogest, is a modern synthetic gestagen. Unlike many substances of this type, they do not have side effects such as weight gain or swelling.
Additional features of the drug Silhouette:
- long-term use reduces the likelihood of progression of atherosclerosis, increases the level of “good” cholesterol - high-density lipoproteins in the blood;
- The menstrual cycle is normalized, menstruation becomes less painful;
- The intensity and duration of menstruation are reduced, so the likelihood of iron deficiency anemia is reduced;
- the likelihood of uterine and ovarian cancer is reduced.
The main indication for use of Silhouette is contraception.
Contraindications for contraception
Contraindications to the use of any group of contraceptives are:
- Breastfeeding.
- Diseases of the cardiovascular system.
- Pregnancy.
- Kidney diseases.
- Oncological processes in the body.
- Overweight.
- Severe form of hypertension.
- Liver pathologies.
- Diabetes mellitus.
- Preparation for surgery.
- Uterine bleeding of unknown origin.
Contraindications
Under the following conditions, Silhouette OC should not be prescribed and its use should be discontinued immediately:
- signs of vascular disease;
- Chest pain when exerting;
- sudden severe shortness of breath or dizziness, episode of loss of consciousness;
- migraine;
- a month before surgery, after which there is little mobility and up to 2 weeks after complete recovery;
- diabetic angiopathy;
- increased blood pressure to 180/100 or more;
- bleeding disorders, high cholesterol, or liver and triglyceride test results;
- Any liver tumors, including pre-existing and benign tumors;
- suspected genital or breast cancer;
- Vaginal bleeding of unknown cause;
- Pregnancy, including possible pregnancy;
- lactation;
- intolerance to lactose, glucose, galactose.
Birth control pills for women over 40
For women who have crossed the age limit of 40 years, it is necessary to use contraceptives with small doses of the active substance and take into account all individual characteristics.
As contraception you can use:
- Janine.
- Novinet.
- Divina.
- Microlute.
- Excluton.
- Trisiston.
- Silest.
The above medications should be used after consultation with a specialist. It is important to follow the dosage and administration regimen, excluding any omissions.
