29.11.2020

Hormonal contraceptives prolonged action

Prolonged contraception called the introduction of hormonal drugs in the female body at one time, which prevents the occurrence of unwanted pregnancy for a long time. That is, in contrast, hormonal contraceptive tablets to be taken daily, hormonal contraceptives long-term are entered once in 3 months – 5 years.

In prolonged hormonal contraceptives of new generation contains estrogens and progestins. In the previously developed drugs have only a progestin component.

Types of prolonged hormonal contraception

To hormonal contraception of prolonged action are:

  • injectable contraceptives;
  • subcutaneous hormone implants;
  • transdermal hormonal contraceptives (birth control patch);
  • vaginal hormonal ring;
  • intrauterine device with hormone levels.

It is important

Each kind of prolonged contraception has certain advantages and disadvantages and is chosen by the doctor individually a particular woman.

Injectable contraceptives

This type of hormonal contraception long-acting refers to Depo-provera. The composition of the drug is medroxyprogesterone acetate in the amount of 150 mg. Hormonal agent injected intramuscularly every 3 months on day 5 of the cycle. The main property of the drug to slow its release from the muscle depot.

Depo-provera is suitable for use in the event:

The mechanism of action of this drug is to suppress the production of pituitary hormones, which leads to a delay of follicular maturation and inhibition of ovulation. In addition, Depo-provera provokes the thickening of the mucus in the cervical canal, which hinders the penetration of sperm into the uterine cavity. Also, this contraceptive alters the state of the endometrium, causing failure of implantation and reduces motility of the fallopian tubes, resulting in transport of the fertilized egg to the uterus slows down.

Advantages of injectable contraception:

  • high contraceptive efficacy (98%);
  • ease of use;
  • the duration of the action;
  • the reduced risk of ectopic pregnancy and inflammation of the uterus and appendages;
  • the absence of the primary pass through the liver (reduces the risk of metabolic changes).

The disadvantages of injectable contraceptives include:

  • the development of amenorrhea;
  • the probability of occurrence of acyclic bleeding;
  • long-term recovery of fertility (up to 7 months);
  • the impossibility of the cessation of contraceptive protection at any time with the woman to get pregnant;
  • the need for regular visits to a medical institution for the re-administration of the drug.

Depo-provera may cause the following side effects:

Subcutaneous implants

This method prolonged hormonal contraception is the drug Norplant, which includes 6 capsules, each containing levonorgestrel in a dosage of 36 mg. the Drug is implanted into the skin of the shoulder or the forearm on the inside. After surgical incision a trocar, which is performed under local anesthesia, under the skin, in the form of a fan, are all capsules of the drug. The wear time capsules should not exceed 5 years. After this period of time the capsule is retrieved clip through minimal incision (about 4 mm). After the injection, the patient should see a gynecologist 3 months later and then annually.

The mechanism of action Norplant is:

  • in blocking ovulation through the inhibition of production of pituitary gonadotropins luteinizing and follicle stimulating hormones;
  • the structural changes in the mucosa of the uterus is the development of atrophy makes implantation impossible;
  • to increase the thickness of cervical mucus and the difficulty of penetration of sperm into the uterine cavity;
  • in the suppression of activity of enzymes involved in penetration of the sperm into the egg.

To side effects of the drug include:

It is important

Removing capsule is made in the case of pregnancy or if the patient wishes to become pregnant. Fertility is restored immediately after removing Norplant.

Advantages to using Norplant include:

  • prolonged contraceptive effect;
  • the possibility of removal of the capsule at any time at the request of the patient
  • reducing the probability of occurrence of ectopic pregnancy;
  • reducing the risk of inflammatory diseases of sexual sphere;
  • the contraceptive effect is 99%.
Birth control patch

One of the types of prolonged hormonal contraception is a contraceptive transdermal system that was in Russia as the patch Evra. This patch has 3 layers, body color and size 4 by 4 cm. the Outer layers of plaster made of polyester, and the medium located between them, contains hormones. Hormonal composition of middle layer: ethinyl estradiol at a dose of 600 µg and norelgestromin at a dosage of 6 mg. the Outer layer is protective layer of the hormonal patch, and the interior must be removed before you can stick on the skin. Duration of use one of the patch is 7 days, so within one cycle consumes 3 patch. After using 3 patches you should take a break for a week, during which begins menstrualnopodobnoe selection. When wearing the patch every day in the organism enters norelgestromin 150 mcg and 20 mcg of ethinyl estradiol, which corresponds to the receiving micro-dose COC.

It is important

If necessary (business trip, exam) it is possible to prevent the appearance menstrualnopodobnoe discharge, applying the adhesive continuously without a 7-day interval.

Attach the patch on the skin of the lower abdomen, buttocks, outer side of the shoulder or upper back.

Contraindicated wearing the transdermal system on the skin of the thoracic region. Contraceptive reliably fixed to the skin, the beginning of its use should coincide with the first day of the cycle. After removal of the patch new you need to post on another site.

The benefits of using Evra transdermal system:

  • the minimum content of hormones;
  • convenience and lack of complexity in use;
  • no need to involve medical staff and daily monitoring;
  • resistance to impact of external factors (insolation, humidity);
  • the minimum number of side effects;
  • normalization of the cycle;
  • the elimination of the symptoms of premenstrual syndrome;
  • the lack of passage of hormones through the liver and digestive tract;
  • rapid restoration of fertility;
  • use in patients of different ages.

The disadvantages of the use of Evra patches include:

  • cause itching (in about 20% of women) in the area of the attachment patch;
  • visibility on the skin as an aesthetic flaw;
  • the possibility of adverse events;
  • transdermal peeling system (frequent contact with water);
  • the possibility of pregnancy while unnoticed by the woman loss of plaster for 2 days;
  • the lack of protection from sexual infections.

The application of the patch Evra may develop the following adverse reactions:

  • CNS: dizziness, headache, paresthesia and hyperesthesia, convulsions, tremor, depression, emotional lability, sleep disorders;
  • cardiovascular system: rises in blood pressure, edema and varicose veins of the lower extremities;
  • Gastrointestinal tract: loss or gain of appetite, nausea, vomiting, abdominal pain, constipation, diarrhea, flatulence;
  • reproductive system: pain during intercourse, failures cycle, hypoactive sexual desire, the appearance of functional ovarian cysts;
  • metabolic disorders: weight gain, increased cholesterol and triglycerides in the blood;
  • skin reactions: itching and rashes on the skin, acne, alopecia, dry skin, hyperhidrosis.
Vaginal contraceptive ring

One of the new means of prolonged hormonal contraception is the vaginal ring NuvaRing. The contraceptive looks like a smooth, transparent and flexible ring that is inserted into the vagina in the 1 5th day of the cycle. One of the vaginal ring, which due to its elasticity can change shape, taking up the best position according to individual body features, set in 3 weeks. NuvaRing does not cause discomfort and pain. In a vaginal ring included ethinyl estradiol at a dosage of 2.7 mg etonogestrel in the amount of 11.7 mg. Daily of contraceptive ethinyl estradiol is allocated in the amount of 15 µg of etonogestrel and at a dose of 120 mcg.

The mechanism of action of the contraceptive NuvaRing are similar to the mechanism of action of COC is inhibition of oocyte maturation and blocking of ovulation. In addition, the contraceptive increases the thickness of cervical mucus, which hinders the penetration of sperm into the uterine cavity. With the introduction of the vagina sheath ring heats up and reaches the temperature of the human body. Due to the heating of sheath contraceptive becomes permeable, and the hormones containing in the ring are released, exerting a direct influence on the uterus and ovaries. Thus, the hormones immediately get to the inside sexual organ, bypassing the bloodstream, digestive tract and liver.

The introduction of a vaginal ring made by myself. A woman can choose any comfortable position. Contraceptive, you can enter in a horizontal position, squatting or standing with his back pressed against the wall and his leg. The introduction of a ring is clean hands. To facilitate its introduction ring should compress, which reduces its diameter to try and deeply into the vagina to establish a contraceptive. NuvaRing should be removed on the 22nd day of wearing. After removing the contraceptive should take a week break, during which begins menstrualnopodobnoe reaction. But the 8th day is installed a new vaginal ring.

The advantages of using NuvaRing include:

  • ease of use (change of contraceptive is 1 in 28 days);
  • minimal effect of hormones on the body (local effect);
  • no load on the liver and digestive tract;
  • no effect on body weight;
  • normalization of the menstrual cycle;
  • reducing pain during menstruation;
  • reduced likelihood of cancer of the ovaries or uterus;
  • rapid restoration of fertility;
  • good tolerability;
  • minimal risk of side effects.

The disadvantages of using the vaginal ring:

  • the unusual method of contraception (psychological discomfort);
  • a large list of contraindications;
  • the lack of protection from sexually transmitted infections and AIDS.

Possible side effects while using the vaginal ring:

  • the development of vaginitis, cervicitis, cystitis, urethritis;
  • increased appetite and subsequent weight gain;
  • the weakening of the libido;
  • emotional lability;
  • the emergence of dizziness, headache;
  • disorders of vision;
  • a rise in blood pressure, occurrence of tides;
  • diarrhoeal disorders (nausea, constipation, diarrhea, flatulence, abdominal pain);
  • the appearance of skin rashes, acne, itching;
  • myalgias and muscle cramps;
  • feeling a foreign object in the vagina;
  • spontaneous expulse ring.

Sozinova Anna Vladimirovna, doctor obstetrician-gynecologist

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