In the modern world, there is a great choice of everything and everyone, including contraceptives. Moreover, each manufacturer praises its means of protection, usually emphasizing only the advantages and keeping silent about the disadvantages.
It is quite difficult to independently understand such a flow of diverse and sometimes contradictory information, but in this article we will try to objectively highlight all the pros and cons of the main means of contraception.
To begin with, it is worth noting that there are quite a few methods of contraception, but only 2 of them are used for long-term protection against pregnancy: intrauterine devices and hormonal contraceptives .
Intrauterine devices: advantages and disadvantages
Intrauterine devices are:
- hormonal
- non-hormonal
Hormonal IUDs have all the advantages and disadvantages of non-hormonal IUDs and, in addition, include the advantages and disadvantages of hormonal contraceptives.
The hormonal intrauterine device deserves separate consideration.
In this article, we will consider in detail the principles of operation, advantages and disadvantages of only non-hormonal IUDs.
Non-hormonal intrauterine devices: mechanisms of action
Mechanisms of action of the spiral:
- the spiral affects the composition of cervical mucus , making it thicker, which makes it difficult for sperm to move into the uterus
- affects the sperm themselves , reducing their motility
- enhances peristalsis of the fallopian tubes (i.e., accelerates the movement of the egg through the tubes), and with accelerated movement, the egg enters the uterus without having time to mature. An immature egg is not able to implant (embed itself) in the uterus.
- if fertilization does occur, it prevents the fertilized egg from attaching to the walls of the uterus
The latter property allows the use of an intrauterine device as a means of emergency contraception , which is much safer for the body than the use of special emergency contraceptive pills containing large doses of hormones.
Advantages of non-hormonal intrauterine devices
- High degree of protection
– above 95% - Can serve as emergency contraception (however, it must be installed no later than 120 hours (5 days) after unprotected intercourse)
- Long service life from 3 to 10 years
depending on the composition of the spiral - occur immediately
after removal of the IUD. - Does not affect a woman’s hormonal levels (there are no problems such as decreased libido, menstrual irregularities, amenorrhea, breast tenderness, mood swings, depression, headaches, nausea, which are inherent in hormonal drugs)
- Suitable during lactation (nursing mothers)
- Instant effectiveness
(starts working immediately after administration) - Suitable for women with certain diseases when hormonal contraceptives are contraindicated
Disadvantages of non-hormonal intrauterine devices
- Insertion and removal is possible only by a gynecologist
- It is necessary to check the presence of IUD threads
in the vagina after each menstruation in order to notice spontaneous
loss of the IUD (this happens quite rarely) - More abundant and longer periods in the first few months
after installation of the device - Possible development of endometriosis of the pelvic organs (rare)
- Increased risk of developing inflammatory diseases of the uterus and appendages
- Installation of the IUD is not recommended for nulliparous
women
Contraindications for installing a spiral
- pregnancy
- inflammatory diseases of the pelvic organs
- malignant growths in the cervix or uterine body
- bleeding of unknown etiology (the cause has not been established)
- deformation of the uterine cavity for various reasons
What happens if endometriosis is not treated?
If before each menstruation a woman is forced to take more and more painkillers, this is a signal that the disease is already progressing. In this case, treatment is necessary not only because of the increasing discomfort, but also because the developing lesions can lead to chronic inflammation.
Pills in hand
If you have advanced endometriosis to such an extent, you won’t be able to get away with just a pelvic ultrasound and tests. A more accurate and expensive diagnosis will be required - laparoscopy. This method involves a minimally traumatic, but still surgical intervention in the body, allowing you to search for and evaluate foci of endometriosis in real time. During laparoscopy, the doctor may also take material for histopathological examination.
After making a diagnosis, the gynecologist decides on therapy. At this late stage of the disease, the most commonly used drugs contain only one hormone, progestin, which causes (temporary) atrophy of the endometrium and, therefore, a complete absence of menstruation.
During this period, there can be no talk of any pregnancy. Side effects cannot be avoided either. Therefore, do not delay the diagnosis and treatment of this pathology. Contact your gynecologist while you can still get by with simple birth control pills.
MAKE AN APPOINTMENT
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Abortion and contraception clinic in St. Petersburg - department of the medical gynecological association "Diana"
Make an appointment, tests or ultrasound via the contact form or by calling +8 (812) 62-962-77. We work seven days a week from 09:00 to 21:00.
We are located in the Krasnogvardeisky district, next to the Novocherkasskaya, Ploshchad Alexander Nevsky and Ladozhskaya metro stations.
The cost of a medical abortion in our clinic is 3,300 rubles. The price includes all pills, an examination by a gynecologist and an ultrasound to determine the timing of pregnancy.
Birth control pills: advantages and disadvantages
Birth control pills (oral contraceptives) are the most common method of hormonal contraception.
Oral contraceptives use synthetic hormones that are similar in action to those produced by the body itself.
The composition of birth control pills must include the hormone gestagen , which provides protection against pregnancy.
Based on their composition, oral contraceptives are divided into:
- gestagenic (contain only the hormone gestagen)
- combined (contain two hormones: gestagen and estrogen (needed to control the menstrual cycle))
Principles of action of oral contraceptives
Birth control pills:
- suppress or inhibit ovulation
- affect the composition of the cervical mucus of the cervix, making it more viscous and thick, which prevents the passage of sperm into the uterus
- affects the endometrium (mucous lining) of the uterus so that a fertilized egg cannot implant in it
- progestin tablets additionally reduce the mobility of the fallopian tubes , which slows down the movement of the egg through them and, as a result, the likelihood that the sperm will have time to fertilize decreases
Benefits of birth control pills
- High degree of protection – up to 99% when used correctly
- It is possible to become pregnant in the next cycle after stopping oral contraceptives, but it is recommended to wait 3 months
- Can be used by nulliparous women
- Can be used to treat hormonal imbalances and some gynecological diseases
Disadvantages of birth control pills
Many disadvantages of oral contraceptives arise from their principle of action:
- mood swings
- nausea , sometimes vomiting
- breast tenderness
- weight gain (may be caused by fluid retention or changes in carbohydrate-fat metabolism)
- decreased libido
- worsening acne (quite rare)
- increased removal of microelements from the body . If there is a lack of microelements in the body, serious diseases can occur. When taking oral contraceptives, it is important to take vitamin complexes .
- deterioration in glucose absorption (rare)
- headache
- spotting (especially typical for oral contraceptives with one progestogen hormone)
- the hormone estrogen in combined birth control pills increases blood clotting (hypercoagulation), which leads to unpleasant consequences: the risk of thrombophlebitis, heart attack, stroke , and existing cardiovascular problems are aggravated.
- the need to take pills at the same time according to a strictly established schedule , otherwise the risk of becoming pregnant increases sharply
- To avoid negative consequences,
a gynecologist should
prescribe
birth control pills after conducting all the necessary studies
Depending on the type of gestagen (about a dozen different gestagens are used in pharmaceuticals) and on the presence or absence of estrogens (ethinyl estradiol is usually used) various side effects may be observed in oral contraceptives. The list of all side effects is indicated in the instructions for the tablets.
Contraindications to the use of birth control pills
- pregnancy
- presence of malignant tumors
- thrombosis or thromboembolism - the occurrence of blood clots in blood vessels
- previous heart attacks, strokes
- bleeding disorders
- cardiovascular diseases
- diabetes
- liver diseases
- smoking
- postpartum period less than 6 months
Conclusion
The use of birth control pills requires increased responsibility and self-organization, because the effectiveness of this method depends on the regularity of use.
The contraceptive effect does not occur immediately, but within a week after starting treatment.
Oral contraceptives affect hormonal levels, which leads to both simply unpleasant and dangerous side effects. However, they can be used in the treatment of certain gynecological diseases.
Intrauterine devices do not affect a woman’s hormonal background; their contraceptive effect is based on the physical properties of the components and appears immediately after installation.
Spontaneous loss of the IUD is possible, so it is necessary to check the presence of IUD threads in the vagina. It is also quite common to experience increased menstrual flow in the first months after installation. In addition, intrauterine devices increase the risk of developing inflammatory processes.
Both methods of contraception are highly effective.
The installation and removal of the IUD is carried out by a gynecologist. After some time, a re-examination is required, and if nothing worries you, further observation by a gynecologist is not necessary.
The selection and prescription of contraceptive pills should be carried out only by a gynecologist. Taking the wrong pills can lead to serious side effects. It is advisable to constantly monitor the condition of the body in order to promptly identify a lack of microelements or the development of concomitant diseases and correct their negative manifestations.
Silhouette
Use during pregnancy and breastfeeding
Siluet® is contraindicated during pregnancy.
If pregnancy occurs while taking Siluet®, use of the drug should be stopped immediately. The available information regarding the use of the drug Siluet® during pregnancy is too limited to draw conclusions about the negative effects of the drug Siluet® on pregnancy, the health of the fetus and the newborn. Extensive epidemiological studies have not revealed an increased risk of developmental defects in children born to women who took sex hormones for contraception before pregnancy or through negligence in early pregnancy.
The drug Siluet® is contraindicated for use in breastfeeding women.
Use for liver dysfunction
Use caution in case of liver dysfunction.
Use for renal impairment
With caution in case of impaired renal function.
special instructions
Before starting or resuming taking Siluet®, it is necessary to obtain an anamnesis (including family history), and it is also necessary to exclude pregnancy. It is necessary to measure blood pressure and conduct a general examination, taking into account contraindications and precautions. It is necessary to explain to the woman the need to carefully read the instructions for use of the drug Siluet® and follow the recommendations contained therein. The nature of medical examinations, including general medical and gynecological examinations, is determined by the attending gynecologist individually for each woman and is carried out at varying frequencies, but at least once every 6 months. A woman should be warned that oral contraceptives do not protect against HIV infection (AIDS) or any other sexually transmitted disease.
Reduced efficiency
A decrease in the effectiveness of the combination of ethinyl estradiol and dienogest occurs in the case of, for example, a missed dose, gastrointestinal disorders or when taking concomitant therapy.
Change in bleeding pattern
The use of the drug Siluet®, especially in the first three cycles, may be accompanied by the appearance of acyclic spotting/bleeding from the vagina, which can be considered as an adaptation period.
If irregular bleeding is persistent or appears after previous normal regular cycles, non-hormonal causes should be considered and malignancy and pregnancy excluded. In this case, you need to consult a gynecologist.
Some women have "acute belly" bleeding.
The risk of venous thromboembolic complications increases:
- with age;
- in the presence of a family history (venous thromboembolism that has ever occurred in close relatives and parents at a relatively young age); if a congenital predisposition is possible, the woman should be referred to a specialized specialist to decide on the prescription of the drug Siluet®;
- during prolonged immobilization, after major surgery, any surgery on the lower extremities or after serious trauma. In these cases, it is preferable to stop taking the tablets (for elective operations at least four weeks in advance) and not resume until two full weeks have passed after remobilization. If the drug has not been discontinued in advance, antithrombotic therapy should be prescribed;
- for obesity (BMI more than 30 kg/m2).
There is no consensus on the role of varicose veins or thrombophlebitis of superficial veins in the occurrence and development of venous thrombosis.
The risk of arterial thromboembolic complications or the risk of stroke in women using the combination of ethinyl estradiol and dienogest is increased:
- with age;
- in the presence of dyslipoproteinemia;
- in the presence of arterial hypertension;
- for diseases of the heart valves;
- with atrial fibrillation;
- when smoking: smokers increase the risk of severe cardiovascular complications (such as myocardial infarction, stroke); The risk increases with age and the number of cigarettes smoked.
The presence of one severe or several risk factors for the development of venous or arterial diseases, respectively, may also be a contraindication. The possibility of using anticoagulant therapy should also be considered. Women receiving Siluet® should be advised to contact their doctor if symptoms of thrombosis are suspected. In case of suspected or proven thrombosis, the drug should be discontinued. In this case, women need to use other suitable methods of contraception due to the teratogenic effect of anticoagulant drugs (coumarins).
The increased risk of thromboembolism during the postpartum period must be taken into account.
Other conditions associated with adverse vascular reactions include diabetes mellitus, systemic lupus erythematosus, hemolytic uremic syndrome, and chronic inflammatory bowel disease (Crohn's disease or ulcerative colitis).
An increase in the frequency and severity of migraine when taking a combination of ethinyl estradiol and dienogest (which may be a harbinger of cerebrovascular accident) may be an indication for immediate discontinuation of the drug.
Tumors
Some epidemiological studies have reported an increased risk of cervical cancer with long-term use of the combination of ethinyl estradiol and dienogest (more than 5 years). However, controversy remains about the extent to which these cases are related to sexual behavior and other factors, such as human papillomavirus (HPV).
Studies have shown a slight increase in the relative risk (RR = 1.24) of developing breast cancer in women who used COCs. The increased risk gradually decreases over 10 years after stopping these drugs.
In rare cases, the development of benign liver tumors has been observed during the use of a combination of ethinyl estradiol and dienogest, and in even more rare cases, malignant ones. In some cases, these tumors have led to life-threatening intra-abdominal bleeding. If severe pain appears in the upper abdominal region, liver enlargement and signs of intraperitoneal bleeding in women taking combinations of ethinyl estradiol and dienogest, liver tumors should be excluded.
Other states
Women with a current or history of hypertriglyceridemia are at increased risk of developing pancreatitis when using the combination of ethinyl estradiol and dienogest. Although slight increases in blood pressure have been described in many women taking combinations of ethinyl estradiol and dienogest, clinically significant increases have been reported rarely. However, if women with arterial hypertension experience a stable increase in blood pressure while taking COCs, or if sudden increases in blood pressure do not respond to antihypertensive therapy, the drug should be discontinued. If possible, treatment can be continued if normal blood pressure values are achieved with antihypertensive therapy.
Acute or chronic liver disease may require discontinuation of Siluet® until liver function tests return to normal. Recurrent cholestatic jaundice, which develops for the first time during pregnancy or previous use of sex hormones, requires discontinuation of the combination of ethinyl estradiol and dienogest.
Although the combination of ethinyl estradiol and dienogest may have an effect on tissue resistance to insulin and glucose tolerance, there is usually no need to adjust the treatment regimen in patients with diabetes. However, women with diabetes should be under close medical supervision while taking Siluet®.
The use of a combination of ethinyl estradiol and dienogest may worsen the course of Crohn's disease and ulcerative colitis.
Chloasma may appear periodically, especially in women with a history of chloasma during pregnancy. Women prone to chloasma should avoid prolonged sun exposure and exposure to ultraviolet radiation while taking Siluet®.
Laboratory research
The use of contraceptive steroids may affect the results of some laboratory tests, including biochemical indicators of liver, thyroid, adrenal and kidney function, as well as plasma levels of transport proteins, for example, corticosteroid-binding globulin and lipid/lipoprotein fractions, parameters of carbohydrate metabolism, as well as coagulation and fibrinolysis. Changes usually remain within normal limits.
Impact on the ability to drive vehicles and operate machinery
The drug Siluet® does not affect the ability to drive a car or use complex equipment. When using the drug, the possibility of visual impairment or dizziness should be taken into account.
