Oral contraceptives: myths and fears of consumers

What types of birth control pills do pharmacies offer, and how do these drugs work?

Oral contraceptives are divided into two groups. Progestin preparations, popularly known as “mini-pills,” contain substances similar to progesterone, the hormone of pregnancy and the second phase of the menstrual cycle.

Combined oral contraceptives (COCs) contain both gestagens and estrogenic substances (synthetic or natural estradiol).

Depending on the combination of hormones, these drugs are high-dose, low-dose and micro-dose.

Remedies where doses of hormones are distributed according to phases of administration are divided into monophasic, biphasic and triphasic. In monophasic preparations, each tablet has the same dose of progestogen and estrogen. In biphasic preparations, the package contains two types of tablets with the same dose of estrogen, but the amount of progestogen varies depending on the phase of the menstrual cycle. Triphasic contraceptives include three types of pills with different ratios and doses of hormones.

If we talk about the principle of operation, combined oral contraceptives inhibit the process of ovulation in the ovaries, increase the thickness of the mucus of the cervical canal, and change the structure of the endometrium of the uterus. The “mini-pill” has a contraceptive effect due to changes in the physical properties of the endometrial mucosa, which lines the uterus from the inside, and cervical mucus. In this way, a “double” contraceptive effect is achieved: it is almost impossible for sperm to reach the egg, since the mucus in the cervix is ​​thick and impenetrable. But if the sperm does reach the target, then the fertilized egg simply does not attach to the wall of the uterus.

Pros and cons of taking mini pills

There are no ideal contraceptives, they all have both pros and cons.

Benefits of the mini drink

• Quick effect - when taken regularly, the tablets begin to act within 3-4 hours.
• No side effects and a mild effect on the body as a whole. Even in nursing women, lactation does not decrease and the taste of milk does not change.
• Do not affect blood clotting.
• Regular use allows you to feel protected at any time. There is no need to take the pill immediately before sexual intercourse.
• Mini-drinks do not reduce libido, do not increase emotionality, and do not stimulate nervousness.
• Progestin-only birth control may be used before surgery.
• After stopping taking the mini-pill, the ability to conceive is restored within a month.
• Menstruation passes without severe pain.

Disadvantages of progestin contraceptives:

• A slight weight gain is possible.
• Taking your pills daily requires punctuality.
• The effectiveness of the mini-pill is slightly lower than that of combined oral contraceptives.
• Not suitable for all women.
• They do not have a pronounced therapeutic effect, while combined contraceptives are prescribed both for prophylactic purposes and as medications.

Side effects and contraindications

Possible side effects (occurs in 1-7% of women)::

• Chronic thrush is getting worse.
• The menstrual cycle changes.
• The sensitivity of the mammary glands increases.
• The skin's sensitivity to ultraviolet radiation increases; sunbathing is undesirable.

Mini-pills are contraindicated for use if a woman has:

• Epilepsy.
• Bleeding of unknown origin.
• Malignant tumors.
• Hepatitis.
• Kidney pathologies.

While taking the mini-drink, you should contact your doctor immediately if you notice signs such as:

• A long delay in menstruation is a possible pregnancy.
• Bleeding, heavy menstruation (hygiene products are changed every hour) - hormonal imbalance.
• Pain in the pelvic area (a sign of ectopic pregnancy).

If conception occurs as a result of violation of the frequency of taking the drug, then you need to stop taking the mini-pill. If you decide to leave the pregnancy, then no problems will arise - such pills do not affect the formation of the fetus.

How effective is hormonal contraception compared to condoms and IUDs?

In theory, oral contraceptives provide an effectiveness of over 99%, but in practice, with “typical use” the effectiveness can decrease to 91% [1]. The risk of pregnancy increases if a woman does not take the pill at the same time, misses a day or two, or experiences a “side effect” in the form of vomiting. Some antibiotics can also reduce the effectiveness of hormones.

The IUD is also said to be more than 99% effective and can remain in the body for up to 10 years, depending on the type. One of the disadvantages is that the IUD may be rejected due to individual intolerance.

Condoms are the only means of contraception that, in addition to controlling pregnancy, provides protection against many sexually transmitted diseases. Male condoms are considered 98% effective, female condoms (inserted into the vagina) - 95%.

Brief facts

Modern COCs are highly safe and are the most effective means of contraception. But when prescribing them, it is necessary to take into account a number of criteria, and the doctor must carefully evaluate the indications and possible risks. Particular attention is paid to the patient’s presence of high blood pressure, obesity, diabetes mellitus, migraines, and the presence of blood coagulation diseases in the woman and her blood relatives. Be sure to take into account smoking, which has an extremely negative effect on the condition of blood vessels and the likelihood of complications.

So, COCs can boast the following features:

• The potential benefit significantly outweighs the total risks in patients under 40 years of age.
• Provides a reduction in the risk of developing a number of cancers.
• They increase the risk of thrombotic complications, but it remains at a low level and is almost completely eliminated with proper history taking when the gynecologist selects a contraceptive method. As a result, the likelihood of vascular accidents when taking COCs is many times lower than during pregnancy, air travel, or smoking.
• When planning surgery, the drug should be discontinued at least 4 weeks before surgery. In this case, it is necessary to finish the started course to the end.
• The first use of COCs increases the risk of vascular complications, as does taking rest breaks. The latter are extremely undesirable, and long-term use of drugs for more than 12 months reduces the likelihood of such undesirable consequences and increases the beneficial effect of COCs on the body.
• The occurrence of nausea, rare headaches, acyclic bleeding, and discomfort in the mammary glands during the first months is a normal reaction of the body to the start of taking hormonal drugs.
• The appearance of symptoms of vascular complications should be a reason to immediately consult a doctor.
• Does not protect against STDs.
• Allows a woman to independently control the onset of pregnancy, regardless of the man.

Thus, COCs can bring both tangible health benefits and harm due to incorrect selection or ignoring contraindications. Therefore, it is important to find “your” gynecologist who will help you choose the right method of contraception, and when choosing a COC, he will take into account all the individual characteristics of the patient and select a drug with the optimal type and content of hormones.

0 0 votes

Article rating

Is it possible to choose oral contraceptives on your own?

Oral contraceptives are prescription drugs that cannot be dispensed in pharmacies without a doctor's prescription. When choosing hormonal contraceptives, the woman’s age, the severity of symptoms of premenstrual syndrome, the number of pregnancies, a history of abortions, the regularity of sexual activity and the presence of diseases of the pelvic organs are taken into account. What works for some may cause health problems for others. So, if the decision to purchase oral contraceptives has been made, you need to visit a doctor.

When the cycle is regular, and the pills are needed only to avoid an unplanned pregnancy, it is enough to undergo a standard examination in a gynecological chair and talk with a doctor. In some cases, you may need a general and biochemical blood test, as well as an ultrasound of the mammary glands and pelvic organs.

Diagnosis before selecting contraceptives

The patient’s complaints about changes in health status become indications for a full diagnosis. In addition to general laboratory tests, the gynecologist prescribes a study on blood biochemistry and hormonal composition of the blood, determination of hemostasis (blood formation), and also proceeds to instrumental diagnostics:

• Ultrasound of the pelvic organs;
• Colposcopy;
• Survey mammography.

It is important for the doctor to differentiate the pathology from other diseases. Typically described adverse reactions are signs of inflammatory processes, benign and malignant neoplasms of the genitourinary system, diseases of the blood, gastrointestinal tract, cardiovascular system, and brain. Other highly specialized specialists are involved in the work of the gynecologist.

Is it worth taking a break from hormones?

At the dawn of the use of hormonal contraceptives, they contained large amounts of hormones (50 mcg or more). Long-term use of such drugs suppressed the work of the ovaries, and in order for the ovaries not to “forget” how to work, a break was taken from taking the pills for 6–9 months. Now this need has disappeared: most manufacturers have managed to significantly reduce the dosage of hormones. While taking COCs, the physiological processes of follicle maturation continue in the ovaries, preserving the most genetically complete eggs until the drug is discontinued. So it is possible to take birth control pills without interruption for as long as there is a need for contraception [2].

“Pauses” in taking oral contraceptives without the consent of a doctor are fraught with disruption of the hemostatic system, lipid and carbohydrate metabolism. In addition, an unplanned pregnancy may occur.

Effect on insulin sensitivity

In Italy in 2009, studies were conducted on the effect of COCs on the sensitivity of cell receptors to insulin. The effects of contraceptive pills containing low doses of ethinyl estradiol and progestins with antiandrogenic properties (CMA and desogestrel) were evaluated.

Their results showed that when using COCs with CMA for six months, there is no change in carbohydrate metabolism, while lipid metabolism improves. The opposite results were obtained for drugs containing desogestrel. This makes contraceptives containing chlormadinone acetate (CMA) preferable for a wide range of patients as a contraceptive.

At the same time, COCs based on CMA do not lead to weight gain while maintaining the same level of physical activity and nutrition . This was proven by several year-long observations and the results of surveys of more than 2.5 thousand women.

An additional advantage of drugs of this kind is a decrease in the concentration of matrix metalloproteinases. This ensures the prevention of the development of oxidative stress and the progression of endothelial dysfunction, which reduces the likelihood of cardiovascular complications and latent infectious diseases.

How do oral contraceptives affect libido?

According to some studies, the level of sexual desire and pleasure in women who take COCs, although not significantly, decreases [3]. The explanation for this is this: the pills change the level of not only estrogen and progesterone, but also androgens - these hormones are responsible for the receptivity of the psychosexual areas of the central nervous system. However, only 15% of women report such negative side effects. In addition, it is impossible to unambiguously associate the level of androgens with sexual desire, since for some, libido decreases when taking pills, while for others it remains the same. The psychological factor should not be discounted. Having ceased to be afraid of an unwanted pregnancy, a woman can, on the contrary, begin to have sex more often and more willingly. Libido also directly depends on the phase of the cycle. The peak of desire usually coincides with ovulation.

Side effects that should alert you

The following side effects should not be ignored in any case:

• Menstrual irregularities, bleeding, spotting, recurring after 2 cycles of taking the pills.
• Headache that does not go away on its own without analgesics.
• Primary or chronic thrush.
• Swelling of the legs, faces, indicating metabolic and kidney problems.
• Permanent decrease in libido.
• Hair loss.

These symptoms indicate an excess of sex hormones, so these pills need to be replaced.

Who should not take birth control pills?

Contraindications for taking COCs, in accordance with WHO recommendations [1], include a body mass index of more than 30, venous thrombosis, pregnancy, breastfeeding, and smoking more than 20 cigarettes per day. Since smoking itself increases the risk of blood clots, most doctors will refuse to prescribe hormonal contraceptives for women who smoke after 35 years of age. Also, alcoholism and the use of psychoactive substances can have a negative effect while taking contraceptives.

Also, combined oral contraceptives should not be taken by diabetics with vascular disorders or more than 20 years of experience, as well as by people with gallbladder disease, coronary heart disease or complications with the valve apparatus. In addition, the use of COCs is limited for hepatitis, liver tumors, and breast cancer. Most studies have failed to make a reliable connection between the use of hormonal contraceptives and the occurrence of breast cancer. Statistics show [4] that women with a history of breast cancer, late menopause, giving birth after forty years, or who have never given birth are at risk.

There are fewer restrictions on taking the mini-pill. They should not be taken by pregnant women, or by breastfeeding women earlier than six weeks after giving birth, or by women with breast cancer, hepatitis, tumors or cirrhosis of the liver.

Side effects when taking a hormonal drug: dangerous and safe contraception

Many women are afraid to take such medications, having read horror stories about the side effects. But before drawing conclusions, you need to understand what the concept of “side effect” means and what can be expected if any are described in the instructions for the drug.

The first thing you need to know is that side effects are described for any medicine, but their mention does not mean that such effects occur in absolutely everyone who starts taking the pills. And even if they exist, they are not in the full spectrum. Statistics show that side effects really bother no more than 10% of patients. And again, each person has no more than 1-2 types of violations.

Side effects of oral contraceptives can again be absolutely safe or, on the contrary, lead to serious changes in the body. All side effects are divided into:

• Short-term
  - such problems are inevitable, they are associated with addiction to the hormonal drug. This may include: breast swelling, nausea, etc. In just a couple of weeks, not a trace remains of them.
• Warnings
  - you need to pay attention to them. These are any, even the mildest, side effects that do not go away within 2 months, bleeding between critical days, abdominal pain, changes in the shape and volume of the abdomen, significant changes in weight and sexual behavior. With such symptoms you need to go to a gynecologist.
• Dangerous side effects of birth control pills require abandoning this method of contraception. This includes all types of severe complications associated with changes in the composition and properties of the blood, for example, increased sugar, sudden changes in blood pressure, deterioration of vision, poor health, etc., affecting a woman’s life.

Usually, if contraception is prescribed by a doctor, only short-term side effects occur, because the gynecologist takes into account and clarifies all possible contraindications in advance. When you take hormonal medications on your own, you can expect anything, so you need to monitor your health especially carefully.

Do hormonal drugs have a therapeutic effect?

Birth control pills can indeed be prescribed not only for the contraceptive effect [5]. Due to the mechanisms of their action, hormones reduce the symptoms of premenstrual syndrome and premenstrual dysphoric disorder. COCs have worked well for problems such as hirsutism (increased male pattern hair growth), acne and in some cases alopecia. If a woman has endometriosis or cysts on the ovaries, the gynecologist may also suggest taking hormonal medications to alleviate the patient’s condition.

Non-hormonal contraceptives

Their second name is spermicides. When she does not have regular sex life, non-hormonal contraceptives will provide her with an excellent service. Their action is of a local nature and their effectiveness is not inferior to hormonal pills, so it is better to choose them from all the available options. Ten minutes before sexual intercourse, 1 tablet should be inserted as deep as possible into the vagina.

There are some disadvantages:

• It is undesirable to use constantly so as not to disturb the sexual microflora. It is worth comparing your condition before and after using the pill;
• It is not allowed to take a bath or shower immediately after sexual intercourse and a couple of hours before it.

But these tablets also have many advantages:

• non-hormonal medications do not cause hormone imbalance;
• they are convenient to use;
• they have almost no contraindications, except for individual sensitivity to certain components that cause allergic pathologies;
• the price of the pills is affordable for most women. New birth control pills can be purchased without a prescription.

A woman who has been taking COCs for a long time then cannot get pregnant - is this a myth or true?

The so-called “ovarian sleep”, or hyperinhibition syndrome, is reversible [6]. There is no reliable data yet that would prove that a woman taking oral contraceptives has a reduced supply of eggs. Moreover, hormonal therapy is used to treat infertility, because after discontinuation of the drug and recovery, the ovaries work more actively. Taking birth control pills in the past does not affect the course of pregnancy and fetal development. In most cases, the risks and side effects of taking hormonal contraceptives are significantly lower than those of terminating an unwanted pregnancy.

Sources

1. World Health Organization, Medical eligibility criteria for contraception. 2015 // https://www.who.int/publications/i/item/9789241549158
2. JJ Speidel, CC Harper, WC Shields, The potential of long-acting reversible contraception to decrease unintended pregnancy // Contraception. 2008 Sep;78(3):197-200 // https://pubmed.ncbi.nlm.nih.gov/18692608/
3. Z. Pastor, K. Holla, R. Chmel, The influence of combined oral contraceptives on female sexual desire: A systematic review.// The European Journal of Contaception &Health Care. 2013; 18 // https://www.tandfonline.com/doi/abs/10.3109/13625187.2012.728643?journalCode=iejc20&
4. N. Wentzensen, A. Berrington de Gonzalez, The Pill's gestation: from birth control to cancer prevention. // Lancet Oncology. 2015 Sep; 16(9):1004-6 // https://www.sciencedirect.com/science/article/abs/pii/S1470204515002119?via%3Dihub
5. R. Burkman, J. Schlesselman, M. Zieman, Safety concerns and health benefits associated with oral contraception. // Am J Obstet Gynecol. 2004 Apr; 190(4 Suppl):5-22 // https://pubmed.ncbi.nlm.nih.gov/15105794/
6. T. Girum, A. Wasie, Return of fertility after discontinuation of contraception: a systematic review and meta-analysis. // Contracept Reproad Med. 2021 Jul;3:9 // https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6055351/

Copper intrauterine devices (IUDs)

This method is also used in emergency cases and is a drug that must be injected into the uterus within 5 days after sexual intercourse. For some reason, women call copper-containing contraceptives pills, although in fact this device does not look like a pill at all.

The action is based on a change in the composition of the mucous membrane, which leads to damage to the egg and sperm. The effectiveness of this method of emergency contraception is 99%, but only if the timing and technique of administration are observed. The only contraindication to the use of copper-containing contraceptives is pregnancy, so you must first undergo a pelvic ultrasound.

Emergency abortion pills

If a woman is already pregnant and completely excludes the possibility of childbirth, you can use special means to terminate the pregnancy. But it is important to understand that such tablets will act without serious harm to health only for up to 6 weeks.

Arguments for taking hormonal birth control pills

Contraceptives in pill form have some advantages over other forms of contraception, namely:

• Possibility of using drugs at any age.
• High efficiency (up to 99%) and quality of medicines.
• No fear of unplanned pregnancy.
• With proper selection and administration, regularity and painlessness of the menstrual cycle are guaranteed.
• Cosmetic effect (reduction of hair growth, disappearance of acne and oily skin).
• The ability to conceive after discontinuation of the drug is restored after 2-6 menstrual cycles;
• Therapeutic effect (treatment of fibroids, mastopathy, ovarian cysts, endometriosis).

One of the main disadvantages of taking contraceptives is temporary weight gain. This effect is associated with an increase in appetite. To avoid weight gain, you just need to tune in and take control of yourself by limiting calories or portions.

Birth control pills are considered throughout the world to be a very effective means of preventing unwanted pregnancy. The main condition is the correct selection of the drug and compliance with the conditions of administration.

CLICK TO BOOK AN ULTRASOUND, TEST OR DOCTOR CONSULTATION