Hormonal contraceptives: reliable protection against unwanted pregnancy

Most modern adult women are sexually active. If there is only one sexual partner, permanent and reliable, you can refuse to use condoms and switch, for example, to oral contraceptives, which are more convenient and cheaper. The main thing is to choose the right drug. One of these drugs, which are oral hormonal contraceptives and are popular among Russian women, are the “Jess” and “Jess Plus” birth control pills, produced by Bayer.

Comparison of the effectiveness of Jess and Jess plus

The effectiveness of Jess is quite similar to Jess Plus - this means that the ability of the medicinal substance to provide the maximum possible effect is similar.
For example, if the therapeutic effect of Jess is more pronounced, then using Jess plus even in large doses will not achieve this effect.

Also, the speed of therapy - an indicator of the speed of the therapeutic effect - is approximately the same for Jess and Jess Plus. And bioavailability, that is, the amount of a drug reaching its site of action in the body, is similar. The higher the bioavailability, the less it will be lost during absorption and use by the body.

The onset of puberty is associated with activation of the hypothalamic-pituitary system, followed by activation of the ovaries, which are the main source of estrogens - hormones that form the female-type phenotype, or feminization. In addition to influencing the development of sexual characteristics, estrogens play an extremely important role in the functioning of the cardiovascular, nervous, musculoskeletal and immune systems of the body. Due to estrogen, the skin looks smooth and toned, the hair on the head is long and elastic, and the nails are shiny and strong. The role of estrogen in sexual life is invaluable. Thanks to them, libido is formed, the glands of the genitourinary tract function and attractant pheromones are produced that attract the opposite sex. The secretion of the sweat glands is also under the direct control of estrogens [3].

The biochemical precursors of estrogens are androgens, 50% of which are synthesized in the ovaries and adrenal glands, and the second half are formed in adipose tissue. The role of androgens in the physiology of the female body has received less attention compared to estrogens and progesterone, but their influence on the functioning of almost all body systems and participation in the development of many pathological conditions is very significant and diverse. By binding to the receptors of the limbic system of the brain, androgens form libido and influence initiative in actions and aggressiveness in behavior. Under the influence of androgens, linear growth and closure of the epiphyses in tubular bones occurs. In the bone marrow, androgens stimulate the mitotic activity of stem cells, in the kidneys - the production of erythropoietin; in the liver - blood proteins. An increase in muscle mass, hair growth, and the functioning of apocrine and sebaceous glands are androgen-dependent processes [4, 5, 7].

The bulk of testosterone circulating in the blood (about 80%) is bound to sex hormone-binding globulin (SHBG), approximately 17-19% is bound to albumin, and only 1-3% circulates in a free state (biologically active testosterone) [5]. Hyperandrogenism (HA) is one of the most common causes of not only menstrual irregularities, chronic anovulation (35%) and, as a consequence, infertility, but also a wide range of cosmetic problems such as seborrhea, hypertrichosis and acne of varying severity [1, 6— 8].

Acne (acne vulgaris) is a chronic inflammatory skin disease that affects up to 85-90% of adolescents; a severe course of the process is observed in 5-10%. Approximately more than 40% of patients demonstrate nosogenic psychoemotional disorders, predominantly of the depressive spectrum, as a result of persistence of the disease due to inadequate therapy [2, 6].

In the pathogenesis of acne, the initial link is hereditarily determined GA, which can manifest itself in the form of an absolute increase in the amount of hormones (AGA) or in the form of increased sensitivity of receptors to a normal or reduced amount of androgens in the body [6]. Conditions of relative GA are more often observed. In the cells of the sebaceous glands - sebocytes, testosterone, under the influence of the enzyme 5α-reductase type I, transforms into the most active metabolite - dihydrotestosterone, which is a direct stimulator of the growth and maturation of sebocytes, the formation of sebum. The main causes of relative GA are:

1) increased activity of the enzyme 5α-reductase type I;

2) increased density of nuclear dihydrotestosterone receptors;

3) an increase in the free fraction of testosterone in the blood as a result of a decrease in the synthesis of SHSH in the liver.

Up to 80% of women with acne note an increase in the number of non-inflammatory and inflammatory rashes in phase II of the cycle (10-12 days before the onset of bleeding). This is due to microedema of the skin (narrowing of the mouth of the pilosebaceous follicle - SVF), aggravation of the key link in the pathogenesis of acne - follicular hyperkeratosis and, as a consequence, aggravation of the outflow of sebum. Pathogenetically, this condition is explained by stimulation of the renin-aldosterone-angiotensin system by estrogen and progesterone, followed by sodium and water retention [6, 8].

If the initial link in the pathogenesis of acne is an increase in the intensity of sebum formation, then the key is follicular hyperkeratosis as a result of the predominance of keratinization processes over desquamation processes at the mouth of the SVF.

Acne rashes are represented by a pseudopolymorphic rash, which is characterized by a clear stage in the evolution of elements. Initial skin changes in acne are represented by open and closed comedones (according to the level of obstruction of the SVF duct). The addition of an inflammatory reaction around the comedone leads to its destruction and the subsequent formation of papules and then pustules. The development of an inflammatory reaction in the dermis leads to the formation of nodes, and when they suppurate, cysts [6].

Anti-acne agents used today are represented by both systemic and local drugs that act primarily on one factor in the pathogenesis of acne. Any local anti-acne drugs (retinoids and retinoid-like compounds, azelaic acid, benzoyl peroxide, antibiotics, drugs with zinc) do not guarantee the patient a stable and long-term remission of the process after cessation of therapy [3].

Based on the basics of the etiology and pathogenesis of acne, for the treatment of this disease in women, substances that have a suppressive effect on HA conditions are adequate and pathogenetically justified, i.e. antiandrogens, which have taken a strong position in international algorithms for the management of women with mild to moderate acne [2, 12].

Among the drugs that affect the severity of androgenization, the most widely used are combined oral contraceptives (COCs). All COCs consist of ethinyl estradiol and a progestin component. Based on the amount of ethinyl estradiol, COCs are divided into high-dose (50 mcg/day), low-dose (30-35 mcg/day) and micro-dose (15-20 mcg/day) [1, 10].

The desired actions of ethinyl estradiol include: antigonadotropic (potentiation of the action of gestagens), endometrial proliferation and stimulation of protein synthesis in the liver (in particular, SHSG), blood coagulation factors, high-density lipoprotein apoproteins. Side effects include activation of the renin-angiotensin-aldosterone system with subsequent retention of sodium and water in the body.

The main effect of synthetic gestagens is their gestagenic activity, which consists of an antigonadotropic effect, secretory transformation of the endometrium and maintenance of pregnancy [7, 13].

The optimal combination in COCs used for the treatment of acne and seborrhea is the presence of estrogens in the minimum amount required for the normal course of the menstrual cycle (microdosage, or 0.015-0.02 mg of ethinyl estradiol) and a gestagen, which has progestogenic, antiandrogenic and antimineralocorticoid activity.

At the end of the 90s of the twentieth century, a unique progestogen, drospirenone, was synthesized - a fourth-generation progestogen, a spirolactone derivative, without an ethynyl radical, different from all previously existing progestogens. In terms of its biological effects, drospirenone is as close as possible to endogenous progesterone. In addition to the gestagenic effect, drospirenone has antiandrogenic and antimineralocorticoid properties. Due to its antiandrogenic activity, drospirenone effectively reduces the severity of acne, seborrhea and hirsutism [9, 12].

In 2006, an innovative low-dose COC containing 0.02 mg ethinyl estradiol and 3 mg drospirenone in a regimen of 24 active tablets + 4 placebo tablets appeared - the drug Jess (Bayer HealthCare Pharmaceuticals, Germany).

The drug Jess combines the advantages of a low dose of estrogen (0.02 mg/day compared to the standard dose of 0.03 mg/day) and the innovative progestogen drospirenone. Reducing the dose of estrogen increases the safety of the drug and improves its tolerability.

The anti-acne activity of COC Jess is due to the following mechanisms:

- direct antiandrogenic effect (blockade of androgen receptors);

- indirect antiandrogenic effect;

- antigonadotropic activity;

- stimulation by ethinyl estradiol and drospirenone of the synthesis of SHG by the liver;

- absence of displacement of testosterone from its connection with SHSG (since drospirenone is transported in the blood bound to albumin);

- suppressive effect on the renin-angiotensin-aldosterone system (blockade of aldosterone receptors by drospirenone).

The last property of Jess is very important, especially for women who notice an exacerbation of acne in the second half of the cycle.

In Russia, Jess is a COC registered according to the following indications:

- contraception;

- contraception and treatment of moderate acne;

- contraception and treatment of severe premenstrual syndrome.

Thanks to the antimineralocorticoid effect of drospirenone, Jess prevents sodium and water retention in the body, reducing associated side effects such as breast engorgement and weight gain, thereby improving the tolerability of the drug and the possibility of its long-term use.

In a study assessing the cosmetic aspects of taking an antiandrogenic COC with drospirenone, by the end of 6 months of therapy, a decrease in seborrhea (by 71%), acne (by 75%) and hypertrichosis (Ferryman-Gallwey index - by 43%), increased hydration of the epidermis was demonstrated. by 26% and a decrease in transepidermal fluid loss (by 35%) [12].

The new 24+4 regimen extends the effect of drospirenone by 3 additional days (compared to the standard regimen of other COCs: 21 active tablets and 7 days off), which enhances its antiandrogenic and antimineralkorticoid effects. In addition, the prolonged action of drospirenone provides a more stable hormonal balance and reduces the symptoms observed during breaks in taking standard COCs (during menstruation), such as dysmenorrhea, headache, mood changes.

At the end of 2012, modified forms of drospirenone-containing COCs, Jess Plus and Yarina Plus (Bayer HealthCare Pharmaceuticals, Germany), appeared on the domestic pharmaceutical market. Compared to its predecessors, each tablet (including 4 or 7 placebo tablets, respectively), in addition to ethinyl estradiol (20 or 30 mcg, respectively) and drospirenone (3 mg), contains calcium levomefolate (Metafolin[]) at a dose of 451 mcg - stable and metabolically active calcium salt of folic acid (vitamin B9). Folates are not synthesized in the human body. When supplied with food, they take an active part in DNA synthesis and repair, synoptic transmission and erythropoiesis. There is information about the key role of folic acid in the DNA repair processes of keratinocytes and skin fibroblasts, in particular, after photolysis induced by UV radiation [11]. These data allow us to consider folates as an important component in the prevention of skin photoaging (“endogenous” photoprotector), especially considering the fact that estrogens increase the sensitivity of the skin to UV radiation (Fig. 1).

Figure 1. Folate (B9) in protecting skin components from UV radiation.

The extremely important role of folates during the first month of embryonic development is their effect on the proliferation and differentiation of neural stem cells, i.e. the formation of the neural tube of the embryo - the precursor of the fetal central nervous system. Lack of folic acid in the body of a pregnant woman (when the woman does not yet know that she is pregnant: for 36% of women the first pregnancy is not planned) leads to defects of the neural tube of the embryo - congenital malformations incompatible with life (anencephaly) or leading to disability (spina bifida) . Therefore, for women of childbearing age taking COCs and planning to become pregnant soon, folate intake should be started well before conception to achieve sufficient folate levels during neural tube formation. Considering that 21.1% of women become pregnant after the first cycle of taking COCs, and 45.7% after the third, there was a need to create COCs containing a stable form of folate. Studies have shown that after 24 weeks of daily dosing, Yarina Plus slow release maintains plasma folate concentrations above baseline for 20 weeks in a significant proportion of women [11].

The use of the drugs Yarina Plus and Jess Plus as contraception in women of the childbearing period receiving therapy for severe forms of acne with systemic isotretinoin (Acnecutane) throughout the entire period of treatment (on average 8 months) and 2 months after its completion is especially valuable [3].

The minimum course of acne treatment with both Jess and Jess Plus is 6 months. If contraception is necessary, as well as to maintain skin, hair and nails in optimal condition, in accordance with WHO recommendations (2009), the drug can be used for a long time [2].

Before prescribing Jess Plus to a woman with acne as a basic anti-acne agent, it is necessary to ensure that there are no contraindications both from the gynecological status and from other organs and systems.

A gynecologist-endocrinologist and a dermatocosmetologist can recommend acne therapy with COCs with antiandrogenic effects. The dynamics of skin lesions during treatment are monitored by a dermatocosmetologist, and the absence of contraindications for prescribing a woman a COC with an antiandrogenic effect is assessed by a gynecologist-endocrinologist. Before starting therapy, as well as after its completion, a gynecological examination, examination of the mammary glands and a cytological examination of the epithelium of the vaginal part of the cervix are necessary to exclude morphological signs characterizing dysplastic processes (Papanicolaou smear - PAP smear). If AGA is suspected, an assessment of the blood hormonal profile (LH, FSH, estradiol, progesterone, testosterone, prolactin and DHEA sulfate), ultrasound of the pelvic organs and adrenal glands, and X-ray/tomography of the skull may be required (Fig. 2).

Figure 2. Algorithm for interaction between specialists in the treatment of acne in women. It is necessary to explain to the woman the regimen of taking the drug, the features of contraception during the 1st month of use, possible side effects during the first two cycles, as well as what the patient should do if she misses taking the next pill depending on the day of the cycle [2].

We observed 47 women aged 16–32 years with acne of II–III severity. In 19 women, the pathological process was localized only on the face, in 28 - on the face and torso. COC Jess (43 women) and COC Jess Plus (4) were prescribed on a continuous basis (the first tablet - on the 1st day of menstruation and over the next 23 days - 1 tablet, followed by placebo tablets (Jes) for 4 days. or 4 tablets with Metafolin (Jess Plus) for a period of 6 months. By the end of the 3rd month, in the whole group there was a regression of non-inflammatory elements by 46%, inflammatory elements by 55% compared to the initial indicators. The level of sebum secretion decreased by 31%. By the end of the treatment period, non-inflammatory and inflammatory elements regressed by 85 and 89%, respectively, compared to the initial level; sebum secretion decreased by 56%. A state of clinical cure was achieved in 22 (46.8%) patients (Fig. 3 , 4),

Figure 3. Patient Zh., 20 years old. a - before treatment; b — after 6 months of therapy with COC Jess.

Figure 4. Patient Sh., 22 years old. a - before treatment; b — after 5 months of therapy with COC Jess Plus. significant improvement - in 18 (38.3%), improvement - in 7 (14.9%). Excellent tolerability of therapy was noted; no side effects were recorded. An examination by a gynecologist after 6 months did not reveal any pathology in any woman. PAP smear after 6 months of therapy was negative in all patients. Of particular note is the decrease in the patients’ body weight by 1.7±0.3 kg by the end of the 6th month of therapy, which is explained by the antimineralocorticoid effect of the drugs. During the course of treatment, most women noted an improvement in the condition of the hair on their heads, a decrease in the growth of vellus hair in areas “inherent” to men, as well as the disappearance of emotional lability.

Based on our own many years of experience in treating acne with anti-androgenic drugs, it should be concluded that the clinically significant anti-acne effect of COCs appears no earlier than 3-4 months of therapy, which dictates the advisability of prescribing external anti-acne agents to some patients, in particular, the anti-acne line of medicinal cosmetics [2], on during the first half of the course of therapy (first 2-3 months).

Thus, joint observation of patients with acne by a gynecologist-endocrinologist and a dermatocosmetologist made it possible to develop a new direction for taking COCs Jess and Jess Plus:

1. Elimination of acne and seborrhea.

2. Improved hair condition.

3. Improving skin quality indicators (increasing hydration and skin turgor due to estrogen stimulation of hyaluronic acid synthesis; reducing the level of moisture evaporation from the surface of the epidermis).

4. Suspension of hypertrichosis (decrease in the Ferriman-Gallwey index).

5. Normalization of eating behavior.

6. Prevents fluid retention in the body (unlike other COCs).

7. Stabilization or reduction of body weight.

8. Improvement in general well-being (more than 85%).

9. Relief of psycho-emotional lability.

10. Photoprotection of epidermal structures due to metafolin.

[]Calcium levomefolate (Metafolin) is registered and supplied by Merck & Cie, Switzerland. Metafolin is a registered trademark of Merck KGaA, Germany.

Comparison of security between Jess and Jess Plus

The safety of a drug includes many factors.

At the same time, Jess’s is quite similar to Jess’s plus. It is important where the drug is metabolized: drugs are excreted from the body either unchanged or in the form of products of their biochemical transformations. Metabolism occurs spontaneously, but most often involves major organs such as the liver, kidneys, lungs, skin, brain and others. When assessing the metabolism of Jess, as well as Jess Plus, we look at which organ is the metabolizing organ and how critical the effect on it is.

The risk-benefit ratio is when the prescription of a drug is undesirable, but justified under certain conditions and circumstances, with the obligatory observance of caution in use. At the same time, Jess does not have any risks when used, just like Jess Plus.

Also, when calculating safety, it is taken into account whether only allergic reactions occur or possible dysfunction of the main organs. In other matters, as well as the reversibility of the consequences of using Jess and Jess Plus.

Mini-pills: a powerful little agent

The next group of drugs is progestin-only hormonal tablets (mini-pills or mini-pill contraceptives). This is a short-acting, reversible oral contraceptive containing low doses of norethindrone. This is an ideal contraception for women for whom estrogen supplements are contraindicated.

Among them:

• nursing mothers;
• overweight women;
• persons with individual estrogen intolerance and premenopausal women.

Charosetta

The basis of pharmacology of this type is desogestrel (75 mcg). An ideally mild product that is instantly absorbed, forming the biologically active metabolite etonogestrel. The half-life is up to 30 hours. The order of taking the tablets is indicated on the package.

Lactinet

Desogestrel is contained in the same dose as the previous drug. It does not have a negative effect on weight; if selected correctly, it even promotes weight loss. A good option for women undergoing lactation. One of the most common side effects is smearing with blood, which goes away within 3 months from the start of use.

Exluton

Contains linestrenol 500 mcg. Normalizes hormonal balance, has a beneficial effect on a woman’s sensuality and libido. Suitable for use by nursing mothers.

Comparison of addiction between Jess and Jess plus

Like safety, addiction also involves many factors that must be considered when evaluating a drug.

So the totality of the values ​​of such parameters as “syndrome o, in Jess” is quite similar to the similar values ​​in Jess plus. Withdrawal syndrome is a pathological condition that occurs after the cessation of intake of addictive or dependent substances into the body. And resistance is understood as initial immunity to a drug; in this it differs from addiction, when immunity to a drug develops over a certain period of time. The presence of resistance can only be stated if an attempt has been made to increase the dose of the drug to the maximum possible. At the same time, Jess's syndrome values ​​are quite low, just like Jess's plus.

Types of hormonal contraceptives

The most famous are oral medications in the form of tablets, but there are other types of medications designed to change hormonal levels in the body. Among them:

• plasters - patches with specialized impregnation;
• injections - injections to prevent fertilization of the egg;
• vaginal rings and intrauterine devices ;
• Implants are hormonal contraceptives that are installed by a doctor in a gynecological office.

In combined monophasic oral contraceptives, the dose of estrogen and progestin remains constant, while in multiphasic preparations it changes during one cycle.

Reduced doses of multiphase OCs reduce some side effects. These include unpleasant symptoms such as breast tenderness, nausea, bloating, bleeding and conditions such as venous thromboembolism. Due to complications associated with taking OCs, their use is contraindicated in patients with severe symptoms of hypertension, coronary heart disease, or a history of stroke.

At the Harmony clinic, experienced specialists receive patients who want to individually select an effective means of contraception. After the examination and examination, the doctor writes out recommendations for preventing unwanted pregnancy. Since the products are selected taking into account the personal characteristics of the patients, the effectiveness is very high, and adverse reactions are minimal.

Comparison of Jess side effects and Jess plus

Side effects or adverse events are any adverse medical event that occurs in a subject after administration of a drug.

Jess Plus has more adverse events than Jess. This implies that the frequency of their occurrence is low in Jess Plus and low in Jess. Frequency of manifestation is an indicator of how many cases of an undesirable effect from treatment are possible and registered. The undesirable effect on the body, the strength of influence and the toxic effect of drugs are different: how quickly the body recovers after taking it and whether it recovers at all. When using Jess Plus, the body's ability to recover faster is higher than that of Jess.

Side effects of the contraceptive

Most often, women complain of the following side effects:

• chest pain;
• nausea;
• migraine;
• uterine bleeding;
• decreased libido;
• mood swings;
• depression;
• emotional instability, etc.

If the side effects are pronounced and do not disappear for a long time, you must inform your gynecologist about them so that he can prescribe another, more suitable drug.

In general, hormonal contraceptives do not have the best reputation, and they can cause serious side effects, including cysts, problems with the cardiovascular system, thrombosis, and others. Therefore, if any obvious changes or problems arise, you need to tell your doctor.

What is the NuvaRing ring, how does it work and are there any side effects when using it?

When you need Atrican tablets, and what you can replace them with, in this article.

What is a cytogram: .

Comparison of ease of use of Jess and Jess Plus

This includes dose selection taking into account various conditions and frequency of doses. At the same time, it is important not to forget about the release form of the drug; it is also important to take it into account when making an assessment.

The ease of use of Jess is approximately the same as Jess Plus. However, they are not convenient enough to use.

The drug ratings were compiled by experienced pharmacists who studied international research. The report is generated automatically.

Last update date: 2020-12-04 13:43:27

Hormonal patch: stick it on and go

The action of hormonal contraceptives of this kind is really as simple as possible. Externally, this patch is similar to a classic adhesive plaster; it is easily applied to the skin, fixed with a sticky layer and adheres flawlessly, despite clothing and simple hygiene procedures. The advantages of using such a patch are as follows :

• no need to interrupt sex to attach a sticker to your body;
• no need to be examined before use. However, remembering that this remedy is hormonal, you should use it with caution for the first time;
• reduces the flow of menstrual blood in those who suffer from heavy bleeding;
• reduces pain during menstruation;
• The sticker is changed according to the instructions provided by the manufacturer. One patch is applied once a week, this procedure is repeated for 3 weeks. Then 1 week - break;
• after final removal, the woman quickly returns to normal and can plan a pregnancy on the recommendation of a doctor.

Studies have shown that the patches are not inferior to combination oral contraceptives and mini-pills. It is enough to print the product and stick it on the cleansed skin of the shoulder, abdomen or buttocks.

The operating principle of this product is as follows:

• preventing the ovaries from producing eggs;
• thickening of the mucous layer in the cervix, which complicates the penetration of sperm into the organ and makes fertilization impossible;
• thinning of the uterine mucosa, which prevents the introduction of the egg into the endometrial layer.

The use of hormonal contraceptives in the form of patches has shown effectiveness in 91% of cases. Despite the good result, do not forget that the sticker does not provide protection against sexually transmitted infections, and therefore is recommended for use with other protective means. The disadvantage of this method of contraception is that it is noticeable, can become saturated with dust and look untidy on the skin. Not suitable for people with sensitive skin as it may cause irritation.

In what cases is the drug not suitable?

Before starting to take the drug, you should discuss any individual contraindications with your doctor. Against the background of its use, some painful conditions may intensify.

Contraindications for taking Jess

• Individual intolerance to one of the components of the drug or an allergic reaction.
• Venous or arterial thrombosis that has occurred previously or currently exists. Manifestations of this condition include myocardial infarction, stroke, pulmonary embolism, and cerebrovascular disorders.
• If there are conditions that precede the development of thrombosis or can develop into it: transient ischemic attacks, angina pectoris.
• In women with a diagnosed hereditary tendency to thrombosis of arteries or veins with a deficiency of antithrombin III, a lack of protein C or S, an increased concentration of homocysteine ​​in the blood, the presence of antibodies to phospholipids (to cardiolipin, as well as lupus anticoagulant).
• In conditions that increase the risk of thrombosis: surgery, leg injuries, prolonged bed rest.
• Diagnosed migraine with focal neurological symptoms in history or currently. The concentration of estrogen plays a role in the pathogenesis of migraine development. In some cases, with an increased amount of the hormone, migraine symptoms intensify. If it is preceded by an aura, the risk of ischemic stroke increases. Therefore, women suffering from migraines are prescribed progestin contraceptives (mini-pills).
• Diabetes mellitus at the stage when vascular complications have developed (damage to the microvessels of the retina, kidneys, limbs, heart).
• Pancreatitis, in which there is a marked increase in blood triglycerides.
• Acute liver diseases, chronic diseases in the acute stage, conditions accompanied by liver failure. The drug may be taken if liver tests are normalized in women with acute diseases.
• Acute renal failure or severe kidney pathologies.
• Insufficiency of adrenal function.
• Malignant and benign liver tumors in history or currently.
• Diagnosed with malignant hormone-dependent tumors in the past or present, especially of the reproductive organs and mammary glands.
• Unknown cause of vaginal bleeding. In some cases, the appearance of bloody discharge may be associated with a tumor process. The use of hormones often accelerates the progression of pathology.
• Pregnancy or suspicion of it.
• Breastfeeding period.

The drug contains lactose, so it is not used for lactase deficiency, lactose intolerance, or glucose-galactose malabsorption syndrome.

There are relative contraindications that must be taken into account in each case individually and the possible risk of deterioration of the condition must be weighed against the benefits of using the drug. So, take Jess with caution when:

• Hereditary predisposition to thrombosis. It is determined by the presence of such a disease in close relatives. The younger the age when the vascular accidents occurred, the higher the likelihood of recurrence in the patient while taking Jess.
• Controlled arterial hypertension, migraine without focal neurological symptoms, congenital and acquired heart valve defects.
• Hereditary angioedema is a disease associated with deficiency of the complement system, which is manifested by sudden swelling of the extremities and larynx, which leads to suffocation.
• Diseases with possible impairment of peripheral circulation: uncomplicated diabetes mellitus, systemic lupus erythematosus, Crohn's disease, ulcerative colitis, hemolytic-uremic syndrome, sickle cell anemia, phlebitis of the superficial veins.
• Other liver diseases that are not listed in absolute contraindications. You should always take into account that the condition may worsen while taking COCs or go from remission to exacerbation.
• Hypertriglyceridemia is a condition of increased concentration of triglycerides in the blood. It can be complicated by acute cardiovascular diseases and acute pancreatitis.
• Jaundice that developed during pregnancy, itching due to cholestasis, cholelithiasis. And also Sydenham's chorea, herpes, porphyria that arose during pregnancy.
• In the postpartum period, if less than 21-28 days have passed since birth. No breastfeeding is also necessary.

If conditions arise that force you to stop taking Jess or Jess Plus, you must use non-hormonal contraception until you consult your doctor.

Combination with pregnancy and lactation

In pregnant women, the use of hormonal drugs is prohibited. If, while using a contraceptive, a suspicion of pregnancy arises as a result of non-compliance with the instructions, you must immediately stop taking hormones and consult a doctor.

Studies have not revealed a negative effect of low-dose oral contraceptives on conception or child development if they were taken before pregnancy or due to negligence in the early stages.

The drug is contraindicated for lactating women. For those who want to combine breastfeeding and hormonal contraception, gynecologists recommend the drug Lactinet or the Nova-ring hormonal vaginal ring.

How to take Jess correctly?

The general rules are as follows:

1. On the first day of menstruation, take the first tablet, indicated by number 1 on the package.
2. Every day, at approximately the same time, take the next numbered tablet. It is washed down with a small amount of water.
3. You should not skip taking a pill.
4. You cannot change the numbering of the tablets; you should move strictly according to the numbers.
5. The packaging is designed for 28 days.
6. After finishing one package, start the next one the next day.

Menstruation when taking Jess begins 2 days after switching from active tablets to placebo. They do not stop immediately after switching to new packaging, but can last another 2-3 days.

There are some features of using the drug after certain conditions:

• Switching to Jess after another oral contraceptive, hormonal ring or patch: the first tablet is taken the day after stopping the previous drug. If you are switching from a patch or vaginal ring, then take the tablet on the same day that the new patch is to be applied.
• Switching from the mini-pill: can be done any day, without interruption.
• Removal of the intrauterine device: switch to Jess on the same day, but during the first 7 days you need to use additional barrier methods of contraception.

How to take Jess for the first time after an abortion?

This depends on the timing of the abortion. Women who had an abortion before 12 weeks take the pill on the day of the procedure. If an abortion was performed before 21 weeks for medical reasons, as well as after childbirth, Jess is taken on days 21-28. If you start taking hormones later, you need to use barrier contraceptives for 7 days. Those women who had sexual intercourse before taking it should make sure that they are not pregnant and wait until their first menstruation.

Special packaging

Manufacturers took care of forgetful women, and specially developed such packaging so that they could easily navigate not only in the order of administration, but also correlate it with the days of the week.

The fold-out packaging contains a blister containing 24 pink tablets containing the active ingredient and 4 orange tablets containing the placebo effect.

There is also a block of stickers of 7 strips, each of which starts with one of the days of the week, and then the rest follow in order. When a woman starts taking Jess, she must determine the current day of the week and select the strip that starts with it. The sticker is transferred to the front of the blister above the first row of tablets, starting from the starting one. This way you can always find out by the days of the week whether the required dose was taken, how many days were missed and when to start drinking the next package.

Indications for immediate cessation of hormonal contraceptive use

• sensory disorders, visual impairments;
• migraines, frequent headaches;
• epileptic seizures;
• detection of tumors of unknown etiology;
• growth of uterine fibroids;
• jaundice, pregnancy, suspected thrombophlebitis.

Studies have shown that taking hormonal contraceptives in premenopausal women increases the risk of developing cervical cancer, but reduces the likelihood of endometrial and ovarian cancer. To choose the most suitable method of contraception, make an appointment at the Harmony clinic. We are located at: Rostov-on-Don, st. Krasnoarmeyskaya, 170 (2nd floor).

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Intrauterine device and subdermal implant

When considering all types of hormonal contraceptives, the intrauterine device (IUD) cannot be overlooked. The small contraceptive device is often T-shaped. A doctor inserts it into a woman's uterus to prevent pregnancy. Non-hormonal IUDs and hormonal modifications are available

The material from which these contraceptives are made is varied. It can be plastic, copper, silver and even gold. The price of intrauterine devices varies widely. These are long-term monitoring devices that can remain in place for 3-5 years or more. It all depends on the type and brand. The efficiency is very high and is 99% . As for the implant, it is inserted subcutaneously into the forearm area and is effective for 3 years. The principle of action is the same, due to the content of progestin.

Jess or another drug?

The pharmacy chain offers a large number of combined oral contraceptives. At first glance, they are analogous to Jess in composition, but this is not always the case. Only a doctor can determine what is best for a particular patient. Many of the drugs have additional effects or, despite the same composition, a different dosage. You can compare some trade names with each other. So, Jess or...

...Yarina

The composition of the drugs is similar, but in Yarin the dosage of active ingredients is increased to 30 mcg ethinyl estradiol and 3 mg drosperinone. It also has a nathianrogenic effect, but more pronounced than Jess. Therefore, it is recommended for severe PMS, as well as significant signs of hyperandrogenism. The purposes of prescribing the drugs are the same.

Switching from Jess to Yarina may be necessary if the medicine with a lower dosage does not reduce the severity of PMS and swelling. A reverse switch may be required in cases where the side effects of Yarina are bothersome. It has been found that sometimes when the dosage is reduced, the severity of the undesirable effect also decreases.

...Dimia

The drugs are complete analogues in composition. The only difference is that Dimia is a generic version of Jess. Those. This hormonal product is produced under license from the pharmaceutical company that developed Jess, but by a different company. She did not participate in the development and did not incur material costs, so the cost of the generic is lower than the original drug. Sometimes there are differences in the preparation of raw materials and some technological aspects, so many consider generics to be less effective. Both of these COCs are recommended for use at a young age in nulliparous adolescents, as they are the safest.

...Klaira

The differences between them are significant. Qlaira belongs to three-phase hormonal agents. Its packaging contains five types of tablets. The first type contains only estradiol valerate. The second type is supplemented with dienogest, a progestin component. In the third type, the combination is similar, but the dose of gestagens is increased. The fourth type of tablet (1 piece) also contains only estrogen. The last two are placebos. There are 28 pieces in total.

Dienogest in Qlaira also has an antiandrogenic effect. Qlaira is recommended for women with increased concentrations of estrogen in the blood, as well as heavy, prolonged menstruation. Most often these are patients over 40 years of age. The estrogen component also combats age-related changes such as vaginal dryness.

...Janine

A doctor will help you make the right choice of hormonal medication, because both drugs are monophasic oral contraceptives. But in Janine’s composition, drospirenone is replaced by dienogest, another form of gestagen, which also has an antiandrogenic effect. Some women report more pronounced side effects from taking Janine. Therefore, you can try to replace COCs if you are intolerant to one of them.

...Logest

The composition uses gestodene as a gestagenic component. But it does not have the additional effects characteristic of Jess. Therefore, it is used only for the purpose of contraception. Can be used in teenage girls after the onset of their first menstruation.

...Diana-35

It has contraceptive, estrogenic, antiandrogenic and gestagenic effects. This is ensured by the composition of the drug, which includes ethinyl estradiol in a dose increased to 35 mcg, and cyproterone acetate. While using Diane-35, weight gain may occur. Additional effects are used for acne, androgenetic alopecia, seborrheic dermatitis, hirsutism, i.e. more pronounced manifestations of hyperandrogenism.

...Regulon

Contains ethinyl estradiol and desogestrel. The latter has weak antiandrogenic and anabolic activity. When using Regulon, side effects such as decreased libido, depressed mood, and depression are less pronounced. It is not typical for him to have spotting in the middle of the cycle. But there may be some weight gain and engorgement of the mammary glands.

The choice of hormonal drug should be made by the doctor, based on the patient’s condition, her lifestyle, and existing diseases. It is also necessary to take into account the following features, in which some COCs are especially effective, while others can only increase undesirable manifestations:

• for acne you need to choose Jess, Yarina, Diana-35, Dimia;
• if there is engorgement of the mammary glands, you need to reduce the dosage of ethinyl estradiol to 20 mcg, which is possible in Jess and Dimia;
• Three-phase contraceptives, for example, Qlaira, cope with vaginal dryness;
• with decreased libido, bleeding in the middle of the cycle, Qlaira, Lindinet, Yarina, Femoden, Regulon, Rigevidon, Janine are needed;
• Novinet, Miniziston, Mercilon will help with heavy menstruation;
• absence of menstruation – three-phase COC.

Combined oral contraceptives are a means of preventing unwanted pregnancy, but they are unable to protect against sexually transmitted infections. Therefore, when having unprotected sex with a new partner, you should use a condom.