Everything you need to know about hormonal contraception
Hormonal contraceptionOf course, it is already difficult to surprise someone, but in the myths that surround this topic, it is easy to get lost. In the US, up to 45% of women 15-44 years old prefer hormonal contraception, while in Russia only 9.5% of women have ever used it. With the help of Valentina Yavnyuk, a gynecologist and endocrinologist, we figured out how she works, what medical properties she has, whether she is a danger to a woman’s health, and what is feminism.
What is hormonal contraception
A distinctive feature of the modern world is a large-scale movement to free the individual from various cultural, religious and social stereotypes. A significant part of this process is associated with the attainment by women of reproductive freedom. This means that the right of a woman to control her own body is returned to a woman: to live such a sexual life that suits her, and independently decide on whether to become pregnant or terminate an unwanted pregnancy. In many ways, it was the emergence and development of hormonal contraception that allowed women to take control of their bodies.
Hormonal contraception is a way to protect against unwanted pregnancy, which a woman can fully regulate independently. At the same time, its effectiveness is higher than all other protection options - while observing the rules of use, of course. So, a possible pregnancy becomes something that partners can consciously choose. However, such contraceptives do not protect against genital infections - here the only way to protect yourself is a condom.
All hormonal contraceptives work as a whole on the same principle: they suppress ovulation and / or do not allow the egg to consolidate on the surface of the uterine mucosa. This is due to the fact that the body constantly receives a small amount of synthetic sex hormones. The suppression of ovulation plunges the ovaries into an artificially induced, controlled "sleep": they shrink in size and the follicles stop throwing out the egg cells for much reason.
How hormones work
Hormones are substances that actively influence all functions of the human body. Yes, in most cases they help to improve the quality of the skin and hair, stabilize weight and have many non-contraceptive benefits. Nevertheless, in no case can you take hormones yourself, without consulting your doctor. In addition, these preparations should not be prescribed by a cosmetologist or gynecologist without referral to a consultation with a gynecologist-endocrinologist.
Sex hormones are the biologically active substances of our body that are responsible for the development of male or female sex characteristics. We have two types of them: estrogens are produced by the ovaries and from the beginning of puberty they form the female signs of the body, they are responsible for libido and menstruation. Progestogens are produced by the corpus luteum of the ovaries and the adrenal cortex and provide the possibility of conception and continuation of pregnancy, which is why they are called "pregnancy hormones".
It is these two types of hormones that ensure our monthly cycle, during which an egg cell matures in the ovary, ovulation occurs (when the egg cell leaves the ovary) and the uterus is prepared for bearing. If fertilization does not occur, after ovulation, the egg dies, and the endometrium, that is, the mucous membrane of the uterus, begins to reject, which leads to the beginning of menstruation. Despite the opinion that menstruation is a "ruptured egg", in fact, the bleeding causes precisely the rejection of the mucous membrane. An unfertilized egg cell does indeed come out with it, but it is too small to see.
The main estrogen of the female body is the hormone estradiol, produced in the ovaries. A high concentration of estradiol in the blood in the middle of the cycle leads to the fact that the pituitary gland is actively activated in the brain. The pituitary gland triggers ovulation and the production of the main progestogen, progesterone, in case of pregnancy. Hormonal contraceptives work like this: they suppress the ovulatory activity of the pituitary gland, which controls all this complex process from above, and maintains a stable level of the pregnancy hormone progesterone. Thus, the pituitary gland rests from reproductive concerns, and the female body experiences a state of so-called false pregnancy: there is no monthly fluctuation of hormones, the eggs calmly “sleep” in the ovary, therefore fertilization becomes impossible.
There is another type of hormonal drugs. The progestin in their composition changes the quantity and quality of vaginal mucus, increasing its viscosity. So sperm becomes more difficult to get into the uterus, and the changed thickness and quality of its coverage eliminates the implantation of the egg and reduce the mobility of the fallopian tubes.
How to start using hormonal contraceptives
It is possible to take hormonal contraceptives from late puberty, when the monthly cycle was established (on average from 16 to 18 years old), until the end of menstruation and the onset of menopause. In the absence of complaints and with regular preventive diagnosis, women are advised to take a break in hormone therapy only if they become pregnant, during pregnancy and lactation. If there are no contraindications, hormonal contraception can be taken for the rest of the time.
Remember that the gynecologist-endocrinologist should carefully collect information about the state of your body for the effective selection of the drug and avoid unnecessary risks. This information includes a medical history — collecting information about thromboembolic diseases, diabetes, hyperandrogenism, and other diseases in your family — and testing. The examination should include a general gynecological examination, examination of the mammary glands, blood pressure measurement, smear collection from the cervix, blood clotting and sugar, and an assessment of the risk factors based on the results.
What are the types of hormonal contraception
There are several types of hormonal contraception: they differ in the method of use, regularity, composition and dosage of hormones. Oral contraceptives - one of the most popular. For example, in the States it accounts for about 23% of all methods of contraception. These are pills that are taken every day with a break depending on the properties of a particular drug. The tablets are of two types: mini-pills contain only synthetic gestagen (they can be used by nursing mothers), and combined oral contraceptives (COCs) contain synthetic estrogen and one of the types of synthetic gestagens - depending on the evidence and the state of the body, you may be needed certain substances.
Oral contraceptives have the lowest dosage of hormones with high effectiveness of protection against unwanted pregnancy. Recently found a natural analogue of estrogen - estradiol valerate. The drug based on it has the lowest concentration of the hormone to date, while maintaining the contraceptive effect. The only negative pills - the need to take them every day at the same time. If this condition seems difficult, then it is worth choosing a method that requires less attentiveness, since violation of the admission rules leads to an increased risk of pregnancy and possible complications.
The lifestyle of a modern woman often not only does not imply permanent pregnancy, but also requires her to withstand a large social burden.
Mechanical contraceptives are placed on or under the skin, as well as inside the vagina or uterus. They constantly release a small concentration of hormones, and they need to be changed periodically. The patch is fixed on any part of the body and changes once a week. The ring is made of elastic transparent material and for a month is inserted into the vagina, almost like a tampon. There is also a hormonal intrauterine system or a helix that only a doctor injects - but it serves up to five years. Hormonal implants are installed under the skin - and they can also work out for almost five years.
There are also hormonal injections, which are also introduced for a long time, but in Russia they are practically not used: they are mostly popular in poor countries where women do not have access to other methods - injections are highly effective and not too costly. The disadvantage of this method is that it cannot be canceled: the plaster can be removed, the ring removed, the spiral removed and the tablets stopped drinking - but the injection action cannot be stopped. At the same time, implants and spirals are also inferior to rings, tablets and patches in mobility, since they can only be removed with the help of a doctor.
What is treated with hormonal contraceptives
Due to the fact that hormonal contraceptives help stabilize the hormonal background of the female body, they have not only contraceptive, but also therapeutic, that is, non-contraceptive effect. Gynecologists and endocrinologists believe that modern women suffer from environmental and social reproductive dissonance - in other words, the dramatic difference between how we live and how our ancient biological mechanism works. The lifestyle of a modern woman often not only does not imply a permanent pregnancy, but also requires her to withstand a large social burden. Since contraception appeared, the number of woman’s monthly cycles has increased significantly over the course of her life. Monthly hormonal adjustment is associated not only with the monthly risk of symptoms of premenstrual syndrome or dysphoric disorder, but also depletes the strength of the body as a whole. A woman has the right to spend these energy resources at her discretion on any other kind of constructive activity - and hormonal contraceptives help in this.
Due to the action described above, hormonal contraceptives treat the symptoms of premenstrual syndrome and are even able to cope with the manifestation of a more severe form of it - premenstrual dysphoric disorder. And due to the combined estrogen-progestin contraceptives endocrinologists correct hyperandrogenism - an excess of male hormones in a woman's body. This excess can lead to a violation of the cycle, infertility, heavy menstruation and their absence, obesity, psycho-emotional problems and other serious conditions. Due to hyperandrogenism, we may be disturbed by other problems: hirsutism (increased male-type hair growth), acne (inflammation of sebaceous glands, acne), and many cases of alopecia (hair loss). The effectiveness of COC in the treatment of these diseases is quite high.
After consulting with your doctor, some pills can be taken in such a mode that even the bleeding will not be canceled.
Hormonal contraceptives treat abnormal uterine bleeding - this is a general designation for any abnormalities of the menstrual cycle: a change in frequency, irregularity, too much or too long bleeding, and so on. The causes of such failures and the severity of the condition may be different, but hormonal contraceptives are often prescribed as part of a comprehensive treatment. In the absence of contraindications, it is likely to choose a coil: it daily releases a gestagen into the uterine cavity, which effectively causes changes in the uterus integument, due to which it corrects heavy menstrual bleeding. The risk of developing ovarian cancer and uterine cancer with hormonal contraceptive use decreases as the ovaries shrink and rest, as during pregnancy. In this case, the longer the reception lasts, the lower the risk.
Hormonal drugs are designed mainly to mimic the monthly cycle, so there is a monthly withdrawal bleeding - "monthly" amid a break between the cycles of the drug for several days. Good news for those who can not stand monthly: after consulting with your doctor, some pills can be taken in such a mode that there will be no bleeding.
Who should not take hormonal contraceptives
According to WHO, there is an impressive list of contraindications that cannot be ignored. Combined contraceptives should not be taken by pregnant women, non-breastfeeding mothers earlier than three weeks after delivery and breastfeeding - six months after delivery, smoking after thirty-five years, hypertensive patients with thromboembolic diseases or their risk, diabetics with vascular disorders or experience of more than twenty years, and also for breast cancer, gallbladder disease, coronary heart disease or valve complications, for hepatitis, liver tumors.
Restrictions on the use of progestogen contraceptives less. They should not be taken again by pregnant women who are breastfeeding earlier than six weeks after delivery, with breast cancer, hepatitis, tumors or cirrhosis of the liver. The combination of some antibiotics, sleeping pills, anticonvulsants with hormonal contraception may also be undesirable: inform your doctor about taking other drugs.
Are hormonal contraceptives dangerous?
Hormones have an impact not only on the reproductive system, but also on the entire body as a whole: they change some metabolic processes. Therefore, hormones have contraindications based on possible side effects. Since the days of the first and second generations of high-dose hormonal contraceptives, there are many horror stories about weight gain, body hair, strokes, chemical dependence and other unfortunate consequences of taking a large concentration of hormones. In new generations, the concentration of hormones is reduced tenfold and other substances are often used than before. This allows them to be used even for non-contraceptive medicinal purposes - therefore, it is wrong to transfer stories about the first generations of drugs onto them.
The most common side effect of hormonal contraception is an increase in blood clotting, which can lead to a risk of thromboembolic diseases. At risk are smoking women and women whose relatives had any thromboembolic complications. Since smoking in itself increases the risk of blood clots, smoking women after thirty-five years, most doctors refuse to prescribe hormonal contraceptives. The risk of thrombosis is usually higher in the first year of admission and in the first six months after the cancellation of hormones, which is why, contrary to popular belief, you should not take frequent interruptions in hormonal intake: they are not recommended to be taken less than a year and come back to them earlier than after a year's break so as not to cause damage health Thrombosis prevention, in addition to quitting smoking, is a mobile lifestyle, the consumption of a sufficient amount of fluid and an annual blood test for homocysteine and coagulogram.
While taking hormones, other types of intoxication can have a negative effect: the use of alcohol and various psychoactive substances, including marijuana, psychedelics and amphetamines, can provoke problems with pressure, blood vessels of the heart and brain. If you are not going to reduce the use of toxic substances while taking hormonal contraception, you should inform your endocrinologist about your habits in order to avoid unnecessary risks.
The risks of cervical cancer when taking contraceptives increase when a woman has a human papillomavirus, chlamydia, or a high risk of contracting sexually transmitted infections — that is, neglecting barrier contraception with non-regular partners. Hormone pregnancy progesterone suppresses the body's immune response, so women who fall into this risk group can take hormonal contraceptives, but it is necessary to undergo cytological examination more often - in the absence of complaints every six months. There is no convincing evidence that modern contraceptives increase the risk of liver cancer, although the first generations of drugs due to the high dosage had a bad effect on her health. Many women are afraid that taking drugs will cause breast cancer. Most studies have failed to establish a reliable link between the use of hormonal contraceptives and the occurrence of breast cancer. Statistics show that women with a history of breast cancer, late menopause, childbirth after forty or not giving birth are at risk. In the first year of the use of HA, these risks increase, but disappear as far as they are taken.
There are no data that would prove that a woman taking hormonal contraceptives, reduces the supply of eggs
It is believed that taking hormonal contraceptives can lead to depression. This can happen if the gestagen that is part of the combined contraceptive is not suitable for you: you should contact your doctor with this problem in order to change the combination drug - most likely it will help. But in general, depression and even observation by a psychiatrist is not a contraindication for taking contraceptives. Тем не менее оба врача обязательно должны быть оповещены о препаратах, которые вы употребляете, потому что некоторые из них могут ослаблять действие друг друга.
Существует миф о том, что гормональные контрацептивы из-за торможения репродуктивной системы приводят к бесплодию, последующему невынашиванию беременности и патологиям плода. Это не так. Так называемый сон яичников, или синдром гиперторможения, обратим. At this time, the ovaries are resting, and the whole body is in a hormonally flat state of "false pregnancy." There is no evidence that would prove that a woman taking hormonal contraceptives, reduces the supply of eggs. Moreover, hormonal therapy is used to treat infertility, because after withdrawal of the drug and recovery, the ovaries work more actively. Acceptance of hormonal contraceptives in the past does not affect the course of pregnancy and fetal development. In most cases, the risks and side effects from taking hormonal contraceptives are much lower than from interrupting an unwanted pregnancy.
Also, hormonal contraceptives do not cause amenorrhea, the pathological termination of menstruation. After discontinuation of the drug, it often takes at least three months for the menstruation to recover (if it is not more than six months, it is better to see a doctor). The hormonal contraceptive withdrawal syndrome is a condition that occurs after the termination of hormonal intake, when the body returns to a constant monthly hormonal adjustment. In the first six months after the cancellation, the body may storm, and therefore during this period it is better to be seen by an endocrinologist. Without medical necessity, hormone intake in the middle of the cycle cannot be interrupted: sudden interruptions contribute to uterine bleeding and cycle disturbances.
In the endocrinological environment there is a poetic idiom that characterizes the status of "balanced" women's health: the harmony of hormones. Modern hormonal contraceptives still have contraindications and side effects, but with proper selection, adherence to the rules of admission and a healthy lifestyle, they can not only eliminate the risk of unwanted pregnancy, but also significantly improve the quality of life of a modern woman - freeing her strength for the desired activity.
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