Question to the expert: What to expect after giving up hormonal contraception
Olga Lukinskaya
RESPONSES TO THE MAJORITY OF US QUESTIONS we used to search online. In the new series of materials we ask such questions: burning, unexpected or widespread - to professionals in various fields.
Questions about contraception seem to be inexhaustible, and the most effective method, hormonal, still causes distrust in many. While some are afraid to start taking hormones, others do not know how to give up on them, without feeling a sea of undesirable effects like the return of PMS or acne. How to avoid such a situation? When do you have to cancel the seemingly suitable COC? Is it true that they are prescribed a short course before the planned pregnancy, and what tests should be taken before the start of the reception? We asked these questions to the expert.
Dmitry Kholodov
gynecologist-reproductologist, head of the reproduction department of the clinic “Father, mother and baby”, Nizhny Novgorod
Combined oral contraceptives are designed to protect against unwanted pregnancy. This is their main and only task - and this is one of the few groups of drugs that are used in completely healthy people, and for a long time. If old OK were feared because they could provoke weight gain or exacerbate depression, then with new ones, on the contrary, their state of health often improves and patients are afraid to stop taking them. In fact, if we are talking about the abolition of modern COC after a long period (a year or more), then a healthy woman should not have any withdrawal syndrome. Another thing - the presence of problems with weight, skin or PMS manifestations even before the appointment of a contraceptive.
Last-generation COCs have additional effects - they prevent fluid retention and regulate the susceptibility of testosterone receptors located in the skin (this helps to reduce the rash). Of course, when taking such drugs, if these conditions were, their improvement will come, and after the abolition of the contraceptive PMS and skin and weight problems can naturally return. The solution is to correct these conditions regardless of the contraceptive intake. As for acne, indeed, some types of contraceptives are registered as drugs for the treatment of acne, and not only a gynecologist, but also a dermatocosmetologist can prescribe them.
Sometimes after the abolition of pills, women complain of hair loss - this is due to hormonal changes: when taking COCs, the life cycle of the hair changes, so that they can grow for a long time and not fall out. After the drug is discontinued, it returns to normal, which creates the appearance of "excessive" loss, although in fact less hair does not become smaller than before. Since there are no pronounced hormonal fluctuations on the background of COC, the mood is also smoothed - and its differences when returning to the natural cycle can be an unpleasant surprise.
Of course, you need to stop taking it, after finishing the already started packaging, not throwing in the middle of the cycle. By and large, the cancellation must also take place under the supervision of a doctor: you must understand what is coming next, switching to another method of contraception or a planned pregnancy.
After the abolition of COC, the concentration of pituitary hormones becomes “correct” for the next couple of cycles, which effectively stimulates ovulation.
There are not so many contraindications to taking KOC. First of all, it is acute thrombosis of large vessels, strokes and heart attacks in the anamnesis. However, no "varicose veins" and "blood clots" are not related to restricting the use of COCs. Oral contraceptives are absolutely contraindicated for women over the age of thirty-five, who smoke more than fifteen cigarettes a day. It happens that a migraine occurs on the background of KOC reception - then a complex algorithm is used. If migraine with aura, then COC is contraindicated, but it is possible to use drugs with progestins only (that is, not combined, but with one hormonal component). True, you need to carefully weigh the possible risks, look at other risk factors for a particular woman. For migraines without aura, the use of a contraceptive depends on age and is not recommended after 35 years.
There is a very detailed guide - "National Medical Eligibility Criteria for Contraception". It should be used by the gynecologist when choosing a contraceptive and consulting for their patients. In order to prescribe a contraceptive, the patient’s desire to use it is enough, and the gynecologist will consult with regard to these eligibility criteria. Tests for "coagulogram", "all hormones" and the like are not required.
For violations of the menstrual cycle, if pregnancy is planned, sometimes COC is sometimes prescribed as a short course. This is done so that the so-called re-play effect begins - full-fledged ovulation (and rapid pregnancy) after drug withdrawal. The bottom line is that a three-month course of COC causes a temporary decrease in pituitary hormone levels; after discontinuation of the drug, the concentration of these hormones becomes “correct” and rhythmic for the next couple of cycles, and this effectively stimulates ovulation. Of course, only a gynecologist can prescribe a contraceptive for this purpose, and only if indicated. In patients with normal ovulation and a regular cycle, the appointment of COC "to increase the chance" for pregnancy does not make sense.
When preparing for pregnancy three to five months before the planned conception, folic acid should be taken - this is the only vitamin that is really necessary for a healthy pregnancy and prevents serious fetal abnormalities. For convenience, patients who do not want to take two drugs - COC and folic acid - have invented contraceptives with its addition. However, after the abolition of the contraceptive and before the end of the first trimester of pregnancy, folate will still have to be taken.
Photo: Studio KIVI - stock.adobe.com, Jacob Kearns - stock.adobe.com