Yarina and Yarina plus: what's the difference, which is better? "Yarina" or "Janine": which is better, composition of drugs, effectiveness, tips for choosing Change in the date of the onset of menstruation
Yarin's contraceptive pills have a special composition, which causes them an increased interest of gynecologists and their patients. This is a modern high-quality hormonal contraceptive that does not have many side effects of other combined oral contraceptives (COCs). It is produced in Germany by a large company Bayer Pharma.
The action of the drug
The composition of Yarin includes two components for hormonal contraception - ethinylestradiol (estrogenic) and drospirenone (gestagen) in a low dosage (30 μg and 3 mg, respectively). The drug is a monophasic contraceptive, that is, in all the tablets of the package, the ratio of these active ingredients does not change.
Against the background of admission, the likelihood of pregnancy is the same as with other low-dose COCs. The number of unplanned pregnancies during the year among 100 women does not exceed 1. If the patient complies with all the rules for using the drug, the probability of conception approaches 1:500.
Hormonal pills Yarin prevent pregnancy by combining the following effects:
- suppression;
- an increase in the viscosity of the mucus of the cervical canal, which makes it difficult for sperm to enter the uterus;
- inhibition of cyclic processes occurring during the cycle in the endometrium; this creates conditions unfavorable for the implantation of the egg, even if it has been fertilized.
Thus, the drug affects many of the processes necessary for conception, so it effectively prevents pregnancy.
Additional healing effects:
- restoration of regular menstruation;
- decrease ;
- reduction in the amount of blood lost during menstrual or intermenstrual bleeding;
- prevention of iron deficiency anemia in women;
- reduced risk of ovarian and uterine cancer.
Features and indications
There is nothing unusual about Yarina's estrogenic component, ethinyl estradiol. It is necessary for the regulation of the ovaries. Its presence in the composition of the drug causes some typical side effects of COCs, for example, a tendency to thrombosis of the veins.
The peculiarity of the remedy is in its progestogen component. Drospirenone, unlike levonorgestrel and other similar substances, has additional activity:
- has an effect similar to the drug spironolactone; that is, it is a weak diuretic that preserves potassium in the body, but at the same time prevents the appearance of edema and other signs;
- does not cause an increase in body weight with prolonged use;
- has an antiandrogenic effect: prevents or treats acne, excessive oiliness of the skin and hair, hirsutism (appearance of hairs on the face).
These features determine the group of patients for whom Yarina is most suitable. They have the following symptoms:
- swelling, irritability, migraine and other signs of premenstrual syndrome;
- hirsutism phenomena - acne, excessive greasiness of hair and skin, the appearance of unwanted hairs on the face, seborrhea.
Indications for taking Yarina - a must. It can be prescribed even to young girls who have begun their menstrual cycle, without changing the dose and regimen. After menopause, when there are no cycles, you do not need to use Yarina.
How to drink Yarina?
To simulate the natural menstrual cycle, the drug is taken 21 days in a row, 1 tablet. It is advisable to do this at the same time of day, regardless of the meal. After 3 weeks of use, a break of 7 days is necessary.
On what day do menstruation begin when taking Yarin?
Menstruation starts in 2-3 days. Even if they have not stopped by the end of the week break, the 3-week course is started again. In this case, it is not necessary to open a new package, since the content of hormones in all tablets is the same. However, it is more convenient to start using the drug from the next package, so as not to get confused and prevent skipping the pill.
If menstruation does not end within 2 days after the resumption of the course of tablets, you should consult a doctor.
Effect on the menstrual cycle
In the first months of using the drug, some women experience irregular spotting. Adaptation occurs within 3 months of use. If after that the regular cycle has not recovered, you need to contact a gynecologist.
It is especially important to consult a doctor in time if, after several normal cycles, irregular discharge reappears. In such a situation, it is necessary to exclude pregnancy and malignant tumors of the genital organs.
Pregnancy after Yarina may occur in the next cycle after the next menstruation.
Start of reception
About how to take Yarina for the first time, the doctor who prescribed it should tell. There are also detailed instructions in the instructions for use.
You can end your appointment at any time. If pregnancy is not planned, you should start using others.
Missed reception
If the patient forgot to take a pill, the resumption of the use of the medicine depends on how much time has passed since the necessary but missed dose.
The rules for resuming protection are determined by which week of admission the unplanned break occurred.
1st week
- Take the pill as soon as possible. If the patient forgot to use the drug on the previous day, then you will need to take 2 tablets at once (“forgotten” and another).
- Drink subsequent tablets as usual.
- Within a week after this, you must use condoms during sexual intercourse.
- It must be borne in mind that pregnancy can also occur if there was sexual intercourse during the previous week before missing the pill.
2nd week
- The basic rules are the same as when skipping the 1st week.
- If the patient took the drug correctly before the unplanned break during the week, additional contraception is not needed.
- If during the week before the missed the drug was taken in violation of the regimen, as well as if more than one tablet was missed, it is necessary to resume the usual daily intake and use condoms for the next week.
3rd week
At this time, the likelihood of an unplanned pregnancy increases. However, if there were no violations in the regimen during the week before the admission, additional contraception is not needed. Otherwise, the patient chooses one of two options:
- Start taking the medicine as soon as possible, one tablet per day. In this case, do not take a break between packages. In this case, menstruation will not occur. Only small spotting may appear. After completing the next pack, take the usual week-long break.
- Do not take pills for a week, including the "missed" day. This will cause menstruation. After 7 days, start using the medicine from the new package. If after the abolition of Yarina there is no menstruation, it is necessary to consult a doctor, pregnancy may have occurred.
Vomiting or diarrhea in the first 4 hours after taking the pill is considered to be missed. In this case, you need to focus on the rules above, depending on the week in which this happened.
Changing the start date of your period
With the help of the drug, you can shift the timing of the start of the next menstruation. This property can be used in exceptional cases, for example, when traveling to the sea or before a responsible sports performance.
- To prevent menstruation in the current month, Yarina is not canceled after taking the entire package. Immediately, without a week's break, the medication from the next package begins. It can be continued for the required number of days, up to 21. 1-2 days after the end of the use of the medicine, menstruation will begin. In addition, spotting or short-term menstrual-like bleeding is possible while using the second package. The contraceptive effect is not reduced.
- To postpone your period a few days earlier, you should shorten the break between packs by the required number of days in advance. After the completion of the second package, menstruation will begin, that is, menstruation will come as many days earlier as the “free” interval between packages was shorter.
Side effects
6 out of 100 women who take Yarina experience nausea. With the same frequency, patients have chest pain. If these symptoms appear, you should consult a doctor. You may need to select another contraceptive.
The most dangerous side effects are thrombosis, that is, blockage of arteries or veins.
In 1-10% of cases, the following side effects are observed:
- unstable mood, depression, weakening of sexual desire;
- migraine headache;
- irregular bleeding from the vagina.
The development of thrombosis occurs in one in 10,000 women or less. In this case, such pathological conditions may appear:
- thrombosis of the veins of the extremities;
- thromboembolism of pulmonary vessels;
- myocardial infarction;
- ischemic stroke.
In large studies and in practice, conditions have been identified that may be somehow associated with taking Yarina, but occur extremely rarely when using this drug:
- slight increase in risk (for patients older than 40 years);
- an increase in the likelihood of liver tumors of a benign or malignant nature;
- the appearance of erythema nodosum - rounded nodes, usually located on the front surfaces of the legs;
- pancreatitis with a simultaneous high content of triglycerides in the blood;
- arterial hypertension;
- increased symptoms in hereditary angioedema;
- dysfunction of the liver;
- worsening of the course of diabetes;
- ulcerative colitis and Crohn's disease (intestinal disease);
- chloasma (dark spots on the skin);
- manifestations of intolerance, for example, skin allergic rash.
No negative effect on the fetus during early pregnancy was found. However, if this condition is suspected, the medication should be stopped.
Contraindications
For the drug Yarina there are such contraindications:
- previous vascular thrombosis, including deep vein thrombosis, pulmonary embolism, myocardial infarction, ischemic stroke;
- transferred transient ischemic attack;
- ischemic heart disease, including angina pectoris;
- migraine with the appearance of focal neurological symptoms (impaired movements, sensitivity, smell, speech, etc.);
- diabetes complicated by micro- or macroangiopathy (vascular damage);
- factors that increase the risk of vascular thrombosis: atrial fibrillation, valvular heart disease, high blood pressure, surgery with prolonged bed rest or limb immobility, and smoking in women over 35;
- pancreatitis, accompanied by an increase in the level of triglycerides in the blood;
- liver disease with altered liver tests (ALT, AST, alkaline phosphatase, bilirubin);
- liver tumors;
- liver or kidney failure;
- a malignant tumor of the genital organs or the mammary gland, or suspicion of them;
- vaginal bleeding of unknown origin;
- suspicion of pregnancy;
- breast-feeding;
- individual intolerance.
When the listed conditions appear against the background of taking Yarina, it must be immediately canceled.
This COC can be taken for fibroids, endometriosis, ovarian cysts and other non-tumor diseases of the genital organs.
Interaction with other drugs
Some medicines can reduce the contraceptive effectiveness of the medicine.
- phenytoin;
- drugs from the barbiturate group;
- carbamazepine, oxcarbazepine;
- rifampicin and rifabutin;
- topiramate or felbamate;
- griseofulvin;
- products based on St. John's wort;
- some medicines for the treatment of HIV infection.
Special rules must be observed when taking antibiotics such as penicillins (Amoxiclav, Oxacillin, Ampicillin and others) and tetracyclines (Doxycycline and others). During treatment with these drugs, as well as within a week after the completion of the course, it is necessary to additionally use condoms.
If during this week, when additional barrier contraception is needed, the pills from the package run out, immediately start the next one, without the usual weekly break.
Yarina and other hormonal contraceptives
The Bayer company, in addition to this drug, produces a similar one - Yarin plus.
What is the difference between Yarina and Yarina plus?
Yarina plus contains another component - calcium levomefolate, which is the active form of folic acid. Its purpose is to reduce the risk of defects in the nervous system of the fetus, if pregnancy still occurs while taking COCs.
Such a medicine is prescribed to patients who receive an insufficient amount of folic acid.
Which is better: Yarina or other COCs (Jess, Janine, Qlaira, Regulon, Belara)?
It is better to get the answer from the gynecologist observing you, since all these drugs have differences in properties and are prescribed in different clinical situations:
Complete analogues in composition, cheaper than Yarina:
- Anabella (Czech Republic) - 1400 rubles for 84 tablets;
- Midiana (Hungary) - 740 rubles for 21 tablets;
- Vidora (Spain) - 625 rubles for 21 tablets;
- Modell Pro (Israel) - 691 rubles for 21 tablets;
- Yamera (India).
The drugs Jess and Dimia practically do not differ from Yarina, except for the amount of ethinylestradiol in them - not 30, but 20 mcg.
Yarina is a rather expensive drug, so you need to make sure its authenticity. To do this, you should take a good look at the tablets from the package. It may contain 1 or 3 blisters of 21 tablets. Each of them has an even light yellow color, covered with a film sheath. On one side, a hexagon is extruded, in which the letters DO are located. You should not take the drug if its external characteristics do not correspond to those indicated, and also if it was sold at a price much lower than the average (about 1000 rubles for 21 tablets).
Endometriosis is considered a common female disease that women may not be aware of for a long time. When a pathology of this kind is detected, gynecologists will prescribe hormonal drugs, the most popular of which are Yarina, Janine and Jess.
The funds are effective developments of the latest generation, so the natural question often arises, which is better for endometriosis Yarina or Zhanin.
What is the hormonal drug Yarina?
Yarina is a drug that is prescribed for the diagnosis of endometriosis. Due to the content of estrogen and progesterone, with regular use, it has the following effect:
- restores hormonal balance;
- stops tissue growth, contributing to the treatment of endometriosis;
- contributes to the restoration of hormonal levels;
- allows the resorption of neoplasms;
- reduces the severity of bleeding during menstruation.
The drug is used in the same way as most oral contraceptives. The standard course involves taking within 21 days and there is a special markup on the package to facilitate control. After the completion of the tablets, a break is made for a seven-day break, after which the course is resumed again.
During a week's rest from the medicine, menstrual bleeding occurs. In some cases, the gynecologist may prescribe a regimen for taking the drug without interruption to achieve the following result:
- stopping menstruation, preventing ovulation;
- blocking the possibility of throwing blood secretions into the pelvic area;
- causing reverse changes in the foci of endometriosis.
The duration of the course of treatment for endometriosis depends on the degree of development of the pathology, but the total duration of therapy does not exceed 6 months.
Yarina, Janine and Jess: features of the action of drugs
Janine and Yarina belong to a group of hormonal contraceptive drugs that are produced by the German manufacturer Bayer and are designed to prevent pregnancy. The medicine is prescribed by doctors if necessary to stop the development of endometriosis.
There is no direct answer to whether Yarina or Zhanin is better for endometriosis, since each case is individual and the appointment of a gynecologist depends on the clinical picture. Both drugs have a similar effect:
- change the course of menstruation with heavy and prolonged bleeding;
- prevent the growth of benign tissue;
- contribute to the reduction of uterine secretion, which prevents conception;
- contribute to the removal of excess fluid;
- neutralize hormones that increase appetite;
- block the nutrition of the endometrium.
Medicines have a number of contraindications, including a tendency to form thrombosis, pregnancy, the presence of oncological formations and a number of other prohibitions.
Due to the fact that both drugs are effective and have a number of contraindications, recommendations for admission should initially be determined by a gynecologist.
What are the similarities and differences in the composition of medicines?
Zhanin and Yarina have in their composition one similar component in the form of ethinylestradiol in the amount of 30 μg. This is where the similarities end and the differences are expressed as follows:
- the active ingredient of Janine is dienogest;
- the active element in Yarin and Jess is drospirenone.
Ethinylestradiol is an artificial analogue of the natural hormone estrogen, due to which the secretion of gonadotropins is blocked, the work of the ovaries on the synthesis of hormones is suppressed and the vaginal secretion thickens, and the growth of endometrial cells is suppressed.
Dienogest is a hybrid compound, has antiandrogenic properties, has a positive effect on lipid content, the development of corticosteroid changes.
Drospirenone prevents weight gain and, by removing water from the body, reduces the problem of swelling. Along with the direct appointment in the form of preventing conception and blocking the development of endometriosis, such an active ingredient helps to relieve the symptoms of PMS in women
Janine and Yarina - what to choose?
Yarina is considered a newer development, which allows you to more effectively cope with pathological changes. The main differences between the drugs:
- Yarina has a shorter absorption time of 1.5 hours, Janine has an indicator of 2 to 2.5 hours;
- the list of Yarina's contraindications is slightly less compared to Zhanin;
- Zhanine is not indicated in case of metabolic disorders and the presence of a tendency to gain extra pounds, Yarina is indicated for the purpose of reducing and normalizing body weight;
- after the end of Yarin's intake, for some time it continues to have a positive effect on the woman's body, Zhanin is effective only during the course of administration.
Gynecologists often prescribe Zhanin if the patient has a negative reaction of the body to Yarin's drug and negative feedback after its use.
It is worth considering that in case of disruption of the digestive tract and problems with the absorption of incoming substances in the stomach, the effectiveness of both drugs can be reduced. Often the effectiveness of hormonal therapy is reduced when taking antibiotics.
What do the reviews say?
The duration of the course of taking Zhanin and Yarina is prescribed by a gynecologist or endocrinologist. In the treatment of endometriosis, Yarina is taken on average for 6 months. After a recurrence of the disease is detected, the possibility of re-treatment should be determined by a gynecologist. The advantage of Zhanin is that it can be prescribed at different stages of endometriosis. In each case, the doctor draws up an individual scheme and, on average, the drug is taken for 2 months, that is, 63 days.
Yarin tablets contain 3 mg and 30 mcg .
Additional substances: titanium dioxide, corn starch, talc, lactose monohydrate, magnesium stearate, hypromellose, macrogol 6000, povidone K25, pregelatinized starch, iron oxide.
Release form
Light yellow tablets engraved with " DO» in a hexagon, 21 tablets in a blister, one or three blisters in a cardboard box.
pharmachologic effect
Contraceptive And estrogen-gestagenic action.
Pharmacodynamics and pharmacokinetics
Pharmacodynamics
The abstract describes the drug as a monophasic low-dose oral combined estrogen-progestogen.
The action of Yarina is carried out by blocking ovulation and increasing the viscosity of cervical mucus.
In women using Yarin contraceptive pills, the menstrual cycle normalizes, menstrual-like painful bleeding is less common, the intensity and duration of bleeding decreases, resulting in a decrease in the likelihood iron deficiency anemia . There is evidence of a reduced risk of ovarian cancer And .
Contraindications
Contraindications to the use of Yarin tablets:
- current and past and thromboembolism (including , ), cerebrovascular changes;
- current and past hypertriglyceridemia ;
- current and past pre-thrombotic conditions (including, ischemic attacks );
- current and past with neurological symptoms;
- with vascular complications;
- risk factors vascular thrombosis , for example, complicated changes in the heart valves, vascular diseases of the brain or heart, surgery followed by prolonged immobilization, smoking after 35 years;
- decompensated or acute insufficiency of kidney function;
- insufficiency of liver function or severe liver disease (before normalization of tests);
- current and past liver tumors;
- hormone-dependent or suspected of them;
- bleeding from the vagina of unknown origin;
- pregnancy or suspected pregnancy;
- hypersensitivity to the components of the drug.
If any of the above disorders develop for the first time while taking the medicine, it should be canceled immediately.
Yarin Hormonal Tablets should be taken with extreme caution in the presence of any of the following conditions or diseases:
- risk factors for thrombosis: smoking , arterial hypertension, dyslipoproteinemia , extensive trauma, migraine , prolonged immobilization, heart valve defects, surgical interventions, hereditary predisposition to develop thrombosis ;
- other diseases that can provoke changes in the peripheral circulation or superficial phlebitis ;
- hypertriglyceridemia;
- hereditary genesis;
- liver disease;
- postpartum period;
- diseases that have arisen or become complicated during pregnancy or the past reception of sex hormones ( porphyria , jaundice , pregnant, cholelithiasis, otosclerosis, Sydenham's chorea ).
Side effects
As with other combined contraceptives, Yarina's side effects are very rarely possible, such as thromboembolism or thrombosis .
Side effects of Yarina:
- from the side genital area: discharge from the vagina or mammary glands, pain and enlargement of the mammary glands;
- from the side digestion: vomiting, abdominal pain, nausea, ;
- from the side vision: discomfort when using contact lenses;
- disorders on the part nervous activity: mood deterioration, mood changes, weakening or strengthening libido , migraine ;
- leather: erythema nodosum , rash, , erythema multiforme ;
- on the part of metabolism: weight change, water retention in the body;
- other disorders: .
Application instruction of Yarina (Way and dosage)
Tablets should be taken orally in order, according to the instructions on the package, at the same time, every day, with water.
Yarina tablets, instructions for use
The drug is taken 1 tablet per day for 3 weeks. Taking tablets from the next pack should be started after a seven-day break with a usually developing " withdrawal bleeding ". It starts about 3 days after the last tablet and can continue until the use of tablets from a new blister.
Start of reception
How to take Yarina for the first time?
In the absence of the use of any hormonal contraceptives in the previous month, the use of the drug begins on the 1st day of the menstrual cycle. It is also acceptable to start using on the 2-5th day of the menstrual cycle, but in this case, you need to use a barrier method of contraception in the 1st week of admission.
If the patient switches from another oral combined contraceptives, contraceptive patch or vaginal ring , then it is advisable to start using the drug on the day following the last tablet of the "old" drug, but no later than the next day after the standard 7-day break (for products containing 21 tablets) or after taking the final inactive tablet (for products including 28 tablets ). When using a vaginal ring or contraceptive patch, the drug should be started on the day the patch or ring is removed, but no later than the day the new ring or patch is inserted.
Transition from contraceptive ( , containing only gestagen ) to Yarina can be done on any day (without a temporary break). Transition from implant containing only gestagen , or progestogen-releasing intrauterine contraceptive - on the day of its removal. Transition from injection form – from the date on which the following procedure is to be carried out. In all of the above cases, you need to use a barrier method of contraception in the 1st week of admission.
After childbirth or performance in the second trimester, the medication should be started no earlier than 4 weeks after the last birth (provided that the mother is not breastfeeding) or an abortion. If the use is started later, you need to use a barrier method of contraception in the 1st week of admission. But if the patient has already had sexual intercourse, pregnancy should be excluded or the 1st menstruation should be excluded before the start of Yarina's use.
After an abortion in the 1st trimester of pregnancy, it is allowed to start taking the medication - on the day of the abortion. When this condition is met, the patient does not need additional methods of contraception.
Missed pills
less than 12 hours late , contraceptive protection is not reduced. A woman needs to take the pill as soon as possible, the next pill is taken at the usual time.
If the medicine was taken with over 12 hours late , contraceptive protection is reduced. The more pills missed, the greater the chance of pregnancy. If 1 tablet is missed, the chance of getting pregnant is minimal. If you are late for more than 12 hours, follow the recommendations below.
The pass was made in the first 7 days of taking the drug
You should take the last missed tablet as soon as possible, even if you need to take 2 tablets together. The next tablet is taken at the usual time. It is recommended to use a barrier method of contraception for another week. If sexual intercourse has taken place within 7 days before missing the tablet, the possibility of pregnancy must be considered.
The pass was made on the 8-14th day of taking the drug
You need to take the last missed tablet as soon as possible, even if you need to take 2 tablets together. The next tablet is taken at the usual time. If the patient has taken the pills correctly over the past 7 days, then there is no need to use additional contraceptive measures. Otherwise, or if you miss 2 or more tablets, you must additionally use barrier methods of contraception for another week.
The pass was made on the 15-21st day of taking the drug
The risk of pregnancy increases due to the upcoming temporary break in taking the drug. The patient must perform one of the following two options. In this case, if during the last week the pill regimen was observed, then there is no need to use additional methods of contraception.
- You need to take the last missed pill as soon as possible, even if it means taking 2 pills at the same time. Subsequent tablets from the current package are consumed as usual until they run out. The next pack should be started without interruption. Until the pills from the second pack run out, withdrawal bleeding is unlikely, but breakthrough bleeding and spotting during the use of the pills cannot be ruled out.
- You need to stop using the pills from the current blister and start a seven-day break, and then start taking the medicine from the new blister. If the patient violated the pill regimen and during the seven-day break she did not develop withdrawal bleeding, pregnancy should be excluded.
For vomiting and diarrhea
When vomiting or within four hours after taking the tablets, their absorption may not be complete. In such a case, additional contraceptive measures should be taken, and it is also necessary to focus on the above recommendations when skipping pills.
How to change the first day of the menstrual cycle?
To postpone the 1st day of menstruation, you need to continue taking Yarina from a new package without a seven-day break and take the pills as much as necessary. This may result in spotting or bleeding.
Overdose
The list of symptoms that occur with an overdose: vomit , bleeding from the vagina , nausea .
Overdose therapy is symptomatic. There is no electoral.
Interaction
The use of drugs that stimulate the work of hepatic microsomal cells can cause an increase in genital excretion, which causes breakthrough bleeding or weakening the reliability of contraception. These drugs include , barbiturates, and others.
Arterial thromboembolism can lead to death.
Risk of occurrence thrombosis And thromboembolism increases:
- in smokers;
- with age;
- with obesity;
- in the presence of thromboembolism ever with immediate family or parents;
- with prolonged immobilization, surgical intervention, operations on the lower extremities (in these situations, it is advisable to stop the use of combined contraceptives and not resume it within 15 days after immobilization is completed);
- at arterial hypertension ;
- at dyslipoproteinemia ;
- with diseases of the heart valves;
- at migraine ;
- at atrial fibrillation .
Increased frequency and severity of seizures migraine during the period of use of combined contraceptives may be a reason to stop taking them.
Rarely, against the background of the use of combined contraceptives, the appearance of benign liver tumors was observed, and extremely rarely - malignant ones.
In patients with hypertriglyceridemia increase in the likelihood of developing pancreatitis when taking medications such as Yarina.
In women with hereditary angioedema exogenous estrogens capable of causing or worsening the course of the disease.
While taking combined contraceptives, irregular bleeding or spotting may occur, especially during the first months of use. Therefore, the assessment of irregular bleeding of any nature should be carried out only after the completion of an adaptation period of approximately 3 cycles.
If the above bleeding is repeated, then it is necessary to conduct an examination and examination to exclude malignant tumors or pregnancy.
Which is better: Midian or Yarina?
and Yarina are complete analogues in composition and quantitative ratio of components in the preparation. Reviews indicate the absence of cardinal differences in the effect of these two funds. Midian is cheaper in cost. The choice should be made on the basis of economic considerations and individual tolerance.
Which is better: Novinet or Yarina?
and Yarina differ somewhat in active ingredients, but not in the mechanism of action. At a cost, Novinet is almost 2 times cheaper, and in addition to the contraceptive effect, it reduces the risk of developing iron deficiency anemia . The choice is made based on the recommendations of the doctor and economic considerations.
Which is better: Yarina or Regulon?
and Yarina are analogues and only slightly differ in the structure of active substances. The mechanism of action is identical. Reviews do not record differences in the incidence of side effects. The price of Regulon is about 2 times lower than the price of the described medicine.
Which is better: Yarina or Klaira?
unlike Yarina, it has a lower concentration of hormonal components and is recommended for more mature women. Drug prices are comparable. The choice is based on the recommendations of the attending physician and individual indications.
Diana 35 or Yarina - which is better?
And Yarina is analogous in terms of the mechanism of action and the effect it has. However, it is worth noting that the former has a lower concentration of hormonal components and a higher price. Side effects and therapeutic effect depend on individual characteristics.
Yarina and Yarina Plus
Differences Yarina and consist in the fact that the last drug contains additionally calcium levomefolate reducing the deficit folate in the body of a woman and fetus in case of an unplanned pregnancy. Drug prices are comparable.
Jeanine or Yarina - which is better?
and Yarina are analogues. According to statistics, Yarina demonstrates a greater ability to provoke side effects. The prices of drugs are almost equal.
children
Alcohol compatibility
Alcohol is not a contraindication for taking Yarina and does not reduce its contraceptive properties.
During pregnancy and lactation
The drug is not prescribed for detected pregnancy and lactation.
If pregnancy was detected during the use of Yarina, then the medicine should be immediately canceled. Studies have not found an increased risk of developmental defects in newborns whose mothers took sex hormones before the development of pregnancy or in its early stages. At the same time, the use of combined contraceptives can reduce the volume of breast milk and change its composition, so the use of such drugs is not recommended until breastfeeding is completed.
Jeanine (ethinylestradiol + dienogest) is a combined oral contraceptive from the German pharmaceutical company Bayer Schering Pharma AG. The products of this company are known all over the world. Suffice it to say that Anovlar, the first oral contraceptive in Europe, is also a merit of Bayer Schering Pharma AG. Since then, work on the development of effective and safe contraceptives has advanced significantly. Research has evolved in two directions: determining the optimal dose of estrogen and creating improved next-generation progestins. The crown of this work was the development of dienogest, an innovative progestin, which is the active ingredient in the contraceptive Jeanine. Unlike progestins of earlier generations, dienogest does not contain an ethynyl group, which excludes the possibility of its effect on cytochrome-dependent liver enzymes. In addition to this, dienogest has a very short half-life, so it does not accumulate in the body. The innovativeness of the composition gives Janine a high degree of contraceptive reliability, the ability to have a positive effect on the menstrual cycle (reduce the intensity and reduce the duration of bleeding, eliminate their pain), which, in turn, minimizes the risk of developing iron deficiency anemia. Dienogest is devoid of androgenic properties (what other gestagens "sin" with). Moreover, it has the most positive effect on hair and skin (reduces the size of the sebaceous glands, suppresses excessive secretion of sebum), which gives Jeanine not only a therapeutic, but also an aesthetic effect. The results of multicenter, randomized, placebo-controlled clinical trials have demonstrated the high efficacy and favorable safety profile of Zhanin.
The same was confirmed by post-marketing studies conducted after the release of the drug on the global pharmaceutical market.
The contraceptive action of Jeanine is realized through several physiological patterns that complement each other, the key of which are the obstruction of ovulation and the increase in the density of cervical mucus in the epithelium of the cervical canal, due to which spermatozoa cannot penetrate the egg. Rules for taking the drug - every day at approximately the same time in strict accordance with that indicated in the leaflet. The beginning of the reception should coincide with the beginning of the menstrual cycle. Duration of admission - 3 weeks. Multiplicity of reception - once a day. A new pack of Jeanine must be started seven days after the previous one has ended. Skipping the next dose within 12 hours does not reduce contraceptive protection. In this case, the next dose should be taken as soon as possible. If more than 12 hours late, the contraceptive effect is reduced. A decrease in the contraceptive effect also occurs in case of vomiting and diarrhea within 4 hours after taking the drug. Janine is not indicated for women during menopause. Before prescribing the drug, it is necessary to collect comprehensive anamnestic data about the woman and her family, conduct a series of diagnostic studies, including measuring blood pressure, heart rate, determining BMI, examining the mammary glands, and a Papanicolaou test. The need for additional laboratory and instrumental studies is determined individually in each case.
Pharmacology
Low-dose monophasic oral combined estrogen-progestogen contraceptive drug.
The contraceptive effect of Jeanine is mediated through complementary mechanisms, the most important of which are the suppression of ovulation and the change in the viscosity of the cervical mucus, making it impermeable to spermatozoa.
When used correctly, the Pearl Index (an indicator that reflects the number of pregnancies in 100 women taking a contraceptive during the year) is less than 1. If pills are missed or used incorrectly, the Pearl index may increase.
The gestagenic component of Zhanin - dienogest - has antiandrogenic activity, which is confirmed by the results of a number of clinical studies. In addition, dienogest improves the lipid profile of the blood (increases the amount of high density lipoproteins).
In women taking combined oral contraceptives, the menstrual cycle becomes more regular, painful periods are less common, the intensity and duration of bleeding decreases, resulting in a reduced risk of developing iron deficiency anemia. In addition, there is evidence of a reduced risk of endometrial cancer and ovarian cancer.
Pharmacokinetics
Dienogest
Suction
After oral administration, dienogest is rapidly and completely absorbed from the gastrointestinal tract. C max is reached after 2.5 hours and is 51 ng / ml. Bioavailability is approximately 96%.
Distribution
Dienogest binds to serum albumin and does not bind to sex steroid-binding globulin (SHBG) and corticoid-binding globulin (CBG). In the free form is about 10% of the total concentration in the blood serum; about 90% - non-specifically associated with serum albumin. The induction of SHBG synthesis by ethinylestradiol does not affect the binding of dienogest to serum protein.
The pharmacokinetics of dienogest is not affected by the level of SHBG in the blood serum. As a result of daily administration of the drug, the level of dienogest in serum increases by about 1.5 times.
Metabolism
Dienogest is almost completely metabolized. Serum clearance after a single dose is approximately 3.6 l/h.
breeding
T1 / 2 is about 8.5-10.8 hours. A small part of dienogest is excreted by the kidneys in an unchanged state. Metabolites are excreted in the urine and bile in a ratio of about 3:1 with a T 1/2 equal to 14.4 hours.
Ethinylestradiol
Suction
After oral administration, ethinylestradiol is rapidly and completely absorbed. C max in blood serum is reached after 1.5-4 hours and is 67 pg / ml. During absorption and "first pass" through the liver, ethinylestradiol is metabolized, resulting in its oral bioavailability averaging about 44%.
Distribution
Ethinylestradiol is almost completely (approximately 98%), although non-specifically bound to albumin. Ethinylestradiol induces the synthesis of SHBG. The apparent V d of ethinylestradiol is 2.8-8.6 l / kg.
C ss is achieved during the second half of the treatment cycle.
Metabolism
Ethinylestradiol undergoes presystemic conjugation, both in the mucosa of the small intestine and in the liver. The main metabolic pathway is aromatic hydroxylation. The rate of clearance from blood plasma is 2.3-7 ml / min / kg.
breeding
The decrease in the concentration of ethinylestradiol in the blood serum is biphasic; the first phase is characterized by T 1/2 of the first phase - about 1 hour, T 1/2 of the second phase - 10-20 hours. It is not excreted unchanged from the body. Metabolites of ethinylestradiol are excreted in the urine and bile in a ratio of 4:6 with a T 1/2 of about 24 hours.
Release form
Dragee white, smooth.
Excipients: lactose monohydrate - 27.97 mg, potato starch - 15 mg, gelatin - 1.5 mg, talc - 1.5 mg, magnesium stearate - 0.5 mg.
Shell composition: sucrose - 23.6934 mg, dextrose - 1.65 mg, macrogol 35,000 - 1.35 mg, calcium carbonate - 2.4 mg, polyvidone K25 - 0.15 mg, titanium dioxide (E171) - 0.74244 mg, carnauba wax - 0.01416 mg.
21 pcs. - blisters (1) - packs of cardboard.
21 pcs. - blisters (3) - packs of cardboard.
Dosage
Dragee should be taken orally in the order indicated on the package, every day at about the same time, with a small amount of water. Janine ® should be taken 1 tablet / day continuously for 21 days. Reception of each next pack begins after a 7-day break, during which withdrawal bleeding (menstrual-like bleeding) is observed. It usually starts on the 2-3rd day after taking the last pill and may not end before the start of a new package.
Start taking Jeanine
In the absence of taking any hormonal contraceptives in the previous month, Zhanin is started on the 1st day of the menstrual cycle (i.e. on the 1st day of menstrual bleeding). It is allowed to start taking it on the 2nd-5th day of the menstrual cycle, but in this case it is recommended to use a barrier method of contraception during the first 7 days of taking the pills from the first package.
When switching from combined oral contraceptives, a vaginal ring, a transdermal patch, Janine should be taken the next day after taking the last active dragee from the previous package, but in no case, no later than the next day after the usual 7-day break in taking (for drugs containing 21 tablets) or after taking the last inactive tablet (for preparations containing 28 tablets per package). When switching from a vaginal ring, a transdermal patch, it is preferable to start taking Janine on the day the ring or patch is removed, but no later than the day a new ring or patch is to be inserted or pasted.
When switching from contraceptives containing only gestagens ("mini-pill", injectable forms, implant) or from a progestogen-releasing intrauterine contraceptive (Mirena), a woman can switch from taking "mini-pill" to Jeanine ® on any day (without interruption), from an implant or intrauterine contraceptive with a progestogen - on the day of its removal, from an injectable contraceptive - on the day when the next injection should be made. In all cases, it is necessary to use an additional barrier method of contraception during the first 7 days of taking the dragee.
After an abortion in the first trimester of pregnancy, a woman can start taking the drug immediately. In this case, the woman does not need additional methods of contraception.
After childbirth or abortion in the II trimester of pregnancy, it is recommended to start taking the drug on the 21-28th day after childbirth or abortion in the II trimester of pregnancy. If the reception is started later, it is necessary to use an additional barrier method of contraception during the first 7 days of taking the pills. However, if a woman has already had a sexual life, pregnancy should be excluded before taking Zhanin, or it is necessary to wait for the first menstruation.
Taking missed pills
If the delay in taking pills is less than 12 hours, contraceptive protection is not reduced. A woman should take the missed pill as soon as possible, the next pill is taken at the usual time.
If the delay in taking the pill was more than 12 hours, contraceptive protection may be reduced.
In this case, you can be guided by the following two basic rules:
- the drug should never be interrupted for more than 7 days;
- to achieve adequate suppression of the hypothalamic-pituitary-ovarian system requires 7 days of continuous intake of dragees.
Accordingly, if the delay in taking active dragees was more than 12 hours (the interval from the moment of taking the last active dragee is more than 36 hours), the following can be recommended:
First week of taking the drug
It is necessary to take the last missed tablet as soon as possible, as soon as the woman remembers this (even if this requires taking two tablets at the same time). The next dragee is taken at the usual time. Additionally, a barrier method of contraception (such as a condom) must be used for the next 7 days. If sexual intercourse took place within a week before skipping the dragee, the likelihood of pregnancy should be considered. The more pills missed, and the closer they are to a break in taking active substances, the greater the likelihood of pregnancy.
Second week of taking the drug
It is necessary to take the last missed tablet as soon as possible, as soon as the woman remembers this (even if this requires taking two tablets at the same time). The next dragee is taken at the usual time. Provided that the woman has taken the pill correctly within 7 days preceding the first missed pill, there is no need to use additional contraceptive measures. Otherwise, as well as skipping two or more pills, you must additionally use barrier methods of contraception (for example, a condom) for 7 days.
Third week of taking the drug
The risk of pregnancy increases due to the upcoming break in taking pills. A woman must strictly adhere to one of the two following options. Moreover, if during the 7 days preceding the first missed tablet, all the tablets were taken correctly, there is no need to use additional contraceptive methods.
1. It is necessary to take the last missed tablet as soon as possible, as soon as the woman remembers it (even if this requires taking two tablets at the same time). The next dragee is taken at the usual time until the dragees from the current package run out. The next pack should be started immediately without interruption. Withdrawal bleeding is unlikely until the second pack is finished, but spotting and breakthrough bleeding may occur while taking the pills.
2. A woman can also stop taking the dragee from the current package. Then she should take a break for 7 days, including the day she skipped the dragee, and then start taking a new package.
If a woman misses taking the pills, and then during the break in taking she does not have withdrawal bleeding, pregnancy should be excluded.
If a woman has had vomiting or diarrhea up to 4 hours after taking active pills, absorption may not be complete and additional contraceptive measures should be taken. In these cases, you should be guided by the recommendations when skipping the dragee.
Changing the start date of the menstrual cycle
To delay the onset of menstruation, a woman should continue taking the pills from the new Jeanine package immediately after all the pills from the previous one have been taken, without interruption in the reception. Dragees from this new package can be taken for as long as the woman wishes (until the package runs out). While taking the drug from the second package, a woman may experience spotting or breakthrough uterine bleeding. Resume taking Janine from a new package after the usual 7-day break.
To move the day of the start of menstruation to another day of the week, a woman should shorten the next break in taking pills by as many days as she wants. The shorter the interval, the higher the risk that she will not have withdrawal bleeding and will have further spotting and breakthrough bleeding during the second pack (just as she would like to delay her period).
Additional information for special categories of patients
For children and adolescents, Jeanine ® is indicated only after the onset of menarche.
After the onset of menopause, the drug Janine ® is not indicated.
Jeanine ® is contraindicated in women with severe liver disease until liver function tests are normal.
Janine® has not been specifically studied in patients with impaired renal function. Available data do not suggest a change in treatment in these patients.
Overdose
Serious violations in case of overdose have not been reported.
Symptoms: nausea, vomiting, spotting or metrorrhagia.
Treatment: carry out symptomatic therapy. There is no specific antidote.
Interaction
Interactions of oral contraceptives with other medicinal products may result in breakthrough bleeding and/or reduced contraceptive reliability.
The following types of interaction have been reported in the literature.
Effect on hepatic metabolism
The use of drugs that induce microsomal liver enzymes can lead to an increase in the clearance of sex hormones. These drugs include phenytoin, barbiturates, primidone, carbamazepine, rifampicin; there are also suggestions for oxcarbazepine, topiramate, felbamate, griseofulvin and preparations containing St. John's wort.
HIV protease inhibitors (eg ritonavir) and non-nucleoside reverse transcriptase inhibitors (eg nevirapine) and combinations thereof also have the potential to interfere with hepatic metabolism.
Effects on enterohepatic circulation
According to separate studies, some antibiotics (eg, penicillins and tetracyclines) can reduce the enterohepatic circulation of estrogen, thereby lowering the concentration of ethinyl estradiol.
While taking any of the above medicines, a woman should additionally use a barrier method of contraception (for example, a condom).
Substances that affect the metabolism of combined hormonal contraceptives (enzyme inhibitors)
Dienogest is a cytochrome P450 (CYP)3A4 substrate. Known inhibitors of CYP3A4, such as azole antifungals (eg, ketoconazole), cimetidine, verapamil, macrolides (eg, erythromycin), diltiazem, antidepressants, and grapefruit juice, may increase dienogest plasma levels.
While taking drugs that affect microsomal enzymes, and within 28 days after their withdrawal, you should additionally use a barrier method of contraception.
While taking antibiotics (with the exception of rifampicin and griseofulvin) and within 7 days after their withdrawal, you should additionally use a barrier method of contraception. If the period of using the barrier method of protection ends later than the pills in the package, you need to move on to the next package of Jeanine without the usual break in taking the pills.
Oral combined contraceptives may interfere with the metabolism of other drugs, leading to an increase (eg, cyclosporine) or a decrease (eg, lamotrigine) in plasma and tissue concentrations.
Side effects
When taking combined oral contraceptives, irregular bleeding (spotting or breakthrough bleeding) may occur, especially during the first months of use. While taking the drug Janine ® in women, other undesirable effects were observed, indicated in the table below. Within each group, allocated depending on the frequency of an undesirable effect, undesirable effects are presented in order of decreasing severity.
Determining the frequency of adverse reactions: often (≥1 / 100 and<1/10), нечасто (≥1/1000 и <1/100), редко (≥1/10 000 и <1/1000). Для дополнительных побочных реакций, выявленных только в процессе постмаркетинговых наблюдений и для которых оценку частоты провести не представляется возможным, указано - частота неизвестна.
| Often (≥1/100 and<1/10) | Infrequently (≥1/1000 and<1/100) | Seldom (≥1/10,000 and<1/1000) | Frequency unknown |
| Infections and contagion | |||
| Vaginitis/vulvovaginitis Vaginal candidiasis or other vulvovaginal infections | Salpingoophoritis (adnexitis) Urinary tract infections Cystitis Mastitis cervicitis Fungal infections Candidiasis Herpetic lesions of the oral cavity Flu Bronchitis Sinusitis Upper respiratory tract infections Viral infections | ||
| Benign, malignant and unspecified tumors (including cysts and polyps) | |||
| uterine fibroids Breast lipoma | |||
| Blood and lymphatic system | |||
| Anemia | |||
| Endocrine system | |||
| virilization | |||
| Metabolism | |||
| Increased Appetite | Anorexia | ||
| Psychiatric disorders | |||
| Decreased mood | Depression Mental disorders Insomnia Sleep disorders Aggression | Mood changes Decreased libido Increased libido |
|
| Nervous system | |||
| Headache | Dizziness Migraine | Ischemic stroke Cerebrovascular disorders Dystonia | |
| sense organs | |||
| Dryness of the mucous membrane of the eyes Irritation of the mucous membrane of the eyes Oscillopsia Sudden hearing loss Noise in ears Dizziness Hearing loss | Contact lens intolerance (discomfort when wearing them) | ||
| The cardiovascular system | |||
| Arterial hypertension Arterial hypotension | Cardiovascular disorders Tachycardia, including increased heart rate Thrombosis/thromboembolism of the pulmonary artery Thrombophlebitis diastolic hypertension Orthostatic circulatory dystonia tides Phlebeurysm Vein pathology Pain in the veins | ||
| Respiratory system | |||
| Bronchial asthma Hyperventilation | |||
| Digestive system | |||
| Abdominal pain, including upper and lower abdominal pain, discomfort/bloating Nausea Vomit Diarrhea | Gastritis Enteritis Dyspepsia | ||
| Dermatological reactions | |||
| acne Alopecia Rash, including macular rash Itching, including generalized itching | Atopic dermatitis/neurodermatitis Eczema Psoriasis Hyperhidrosis Chloasma Impaired pigmentation/hyperpigmentation seborrhea Dandruff hirsutism Pathological skin changes Orange peel Vascular asterisks | Erythema multiforme | |
| allergic reactions | |||
| Manifestations of allergic reactions, including allergic dermatitis | Hives erythema nodosum |
||
| Musculoskeletal system | |||
| Back pain Feeling of discomfort in the muscles and bones Myalgia Pain in the limbs | |||
| Reproductive system and mammary glands | |||
| Breast pain, discomfort, breast engorgement | Abnormal withdrawal bleeding, including menorrhagia, hypomenorrhea, oligomenorrhea, and amenorrhea Intermenstrual bleeding, including vaginal bleeding and metrorrhagia An increase in the size of the mammary glands, swelling and a feeling of fullness of the mammary glands Swelling of the mammary gland Dysmenorrhea Discharge from the genital tract/discharge from the vagina ovarian cysts Pain in the pelvic area | cervical dysplasia Adnexal cysts Pain in the uterine appendages Breast cysts Fibrocystic mastopathy Dipareunia Galactorrhea Menstrual irregularities | Discharge from the mammary glands |
| General symptoms | |||
| Fatigue Asthenia Bad feeling | Chest pain Peripheral edema Flu-like symptoms Inflammation Temperature rise Irritability | Fluid retention | |
| Survey results | |||
| Changes in body weight (increase, decrease and fluctuations in body weight) | An increase in the level of TG in the blood Hypercholesterolemia | ||
| Congenital and genetic disorders | |||
| Detection of an additional mammary gland / polymastia | |||
In women receiving combined oral contraceptives, the following undesirable effects have been reported: venous thromboembolic complications, arterial thromboembolic complications, cerebrovascular complications, arterial hypertension, hypertriglyceridemia, changes in glucose tolerance or effects on insulin resistance of peripheral tissues, liver tumors (benign or malignant), disorders liver function, chloasma.
In women with hereditary angioedema, exogenous estrogens may exacerbate symptoms.
The occurrence or aggravation of conditions for which the relationship with the use of combined oral contraceptives has not been clearly proven: jaundice and / or itching associated with cholestasis, the formation of gallstones, porphyria, systemic lupus erythematosus; hemolytic-uremic syndrome, Sydenham's chorea, herpes of pregnancy, otosclerosis with hearing impairment, Crohn's disease, ulcerative colitis, cervical cancer.
In women using combined oral contraceptives, there is a very small increase in the incidence of breast cancer. Because breast cancer rarely occurs in women under 40 years of age, given the overall risk of developing breast cancer, the additional number of cases is very small. The relationship with the use of combined oral contraceptives is not known.
Indications
- contraception.
Contraindications
Janine ® should not be used in the presence of any of the conditions/diseases listed below. If any of these conditions develop for the first time while taking it, the drug should be immediately discontinued.
- the presence of thrombosis (venous and arterial) at present or in history (for example, deep vein thrombosis, pulmonary embolism, myocardial infarction, cerebrovascular disorders);
- the presence or history of conditions preceding thrombosis (for example, transient ischemic attacks, angina pectoris);
- diabetes mellitus with vascular complications;
- the presence or history of migraine with focal neurological symptoms;
- the presence of severe or multiple risk factors for venous or arterial thrombosis (including complicated valvular heart disease, atrial fibrillation, cerebrovascular disease or coronary artery disease, uncontrolled arterial hypertension, major surgery with prolonged immobilization, smoking over the age of 35 years);
- liver failure and severe liver disease (before normalization of liver tests);
- the presence or history of pancreatitis with severe hypertriglyceridemia;
- the presence or history of benign or malignant liver tumors;
- identified hormone-dependent malignant diseases of the genital organs or mammary glands or suspicion of them;
- vaginal bleeding of unknown origin;
- pregnancy or suspicion of it;
- breastfeeding period;
- hypersensitivity to the components of the drug.
Carefully
The potential risk and expected benefit of using combined oral contraceptives should be carefully weighed in each individual case in the presence of the following diseases / conditions and risk factors:
- risk factors for thrombosis and thromboembolism (smoking, obesity, dyslipoproteinemia, arterial hypertension, migraine, valvular heart disease, prolonged immobilization, major surgery, extensive trauma, hereditary predisposition to thrombosis / thrombosis, myocardial infarction or cerebrovascular accident at a young age in whom - or from the next of kin/);
- other diseases in which peripheral circulatory disorders may occur (diabetes mellitus, systemic lupus erythematosus, hemolytic uremic syndrome, Crohn's disease, UC, sickle cell anemia, phlebitis of superficial veins);
- hereditary angioedema;
- hypertriglyceridemia;
- liver disease;
- diseases that first arose or worsened during pregnancy or against the background of a previous intake of sex hormones (for example, jaundice, cholestasis, gallbladder disease, otosclerosis with hearing loss, porphyria, herpes pregnant, Sydenham's chorea);
- postpartum period.
Application features
Use during pregnancy and lactation
Jeanine ® is not prescribed during pregnancy and during breastfeeding.
If pregnancy is detected while taking Janine, the drug should be discontinued immediately. However, extensive epidemiological studies have not found an increased risk of malformations in children born to women who received sex hormones before pregnancy, or teratogenicity when sex hormones were inadvertently taken early in pregnancy.
Taking combined oral contraceptives can reduce the amount of breast milk and change its composition, therefore, their use is contraindicated during lactation. Small amounts of sex steroids and/or their metabolites may be excreted in milk.
Application for violations of liver function
If abnormal liver function occurs, Zhanin may need to be temporarily discontinued until laboratory parameters return to normal. With the development of cholestatic jaundice or cholestatic pruritus (first encountered during pregnancy or previous use of sex hormones), Janine ® should be discontinued.
Application for violations of kidney function
Janine's intake may affect the biochemical parameters of kidney function.special instructions
Before starting or resuming the use of the drug Janine ®, it is necessary to familiarize yourself with the history of life, the family history of the woman, conduct a thorough general medical (including measurement of blood pressure, heart rate, determination of body mass index) and gynecological examination, including examination of the mammary glands and a cytological examination of a scraping from the cervix (test Papanicolaou), exclude pregnancy. The volume of additional studies and the frequency of follow-up examinations is determined individually. In general, follow-up examinations should be carried out at least once a year.
A woman should be informed that Jeanine ® does not protect against HIV infection (AIDS) and other sexually transmitted diseases.
If any of the conditions, diseases and risk factors listed below are currently present, then the potential risk and expected benefit of using combined oral contraceptives should be carefully weighed in each individual case and discussed with the woman before she decides to start taking drug. With weighting, strengthening, or at the first manifestation of risk factors, drug withdrawal may be required.
Diseases of the cardiovascular system
The results of epidemiological studies indicate a relationship between the use of combined oral contraceptives and an increase in the incidence of venous and arterial thrombosis and thromboembolism such as deep vein thrombosis, pulmonary embolism, myocardial infarction, cerebrovascular disease) when taking combined oral contraceptives. These diseases are rare.
The risk of developing venous thromboembolism (VTE) is highest in the first year of taking these drugs. An increased risk is present after the initial use of oral contraceptives or the resumption of use of the same or different combined oral contraceptives (after a break between doses of 4 weeks or more). Data from a large prospective study in 3 groups of patients show that this increased risk is predominantly present during the first 3 months.
The overall risk of VTE in patients taking low-dose combined oral contraceptives (< 50 мкг этинилэстрадиола), в 2-3 раза выше, чем у небеременных пациенток, которые не принимают комбинированные пероральные контрацептивы, тем не менее, этот риск остается более низким по сравнению с риском ВТЭ при беременности и родах. ВТЭ может привести к летальному исходу (в 1-2% случаев).
Venous thromboembolism (VTE), manifested as deep vein thrombosis or pulmonary embolism, can occur with any combined oral contraceptive.
Very rarely, when using combined oral contraceptives, thrombosis of other blood vessels occurs, for example, hepatic, mesenteric, renal, cerebral veins and arteries or vessels of the retina. There is no consensus regarding the relationship between the occurrence of these events and the use of combined oral contraceptives. Symptoms of deep vein thrombosis (DVT) include: unilateral swelling of the lower extremity or along a vein in the leg, pain or discomfort in the leg only when standing or walking, localized fever in the affected leg, redness or discoloration of the skin on the leg.
Symptoms of pulmonary embolism (PE) are as follows: difficulty or rapid breathing; sudden cough, incl. with hemoptysis; sharp pain in the chest, which may worsen with a deep breath; sense of anxiety; severe dizziness; fast or irregular heartbeat. Some of these symptoms (eg, shortness of breath, cough) are nonspecific and may be misinterpreted as symptoms of other more or less severe events (eg, respiratory tract infection).
Arterial thromboembolism can lead to stroke, vascular occlusion, or myocardial infarction. Symptoms of a stroke: sudden weakness or loss of sensation in the face, arm or leg, especially on one side of the body, sudden confusion, problems speaking and understanding; sudden unilateral or bilateral loss of vision; sudden disturbance of gait, dizziness, loss of balance or coordination of movements; sudden, severe or prolonged headache with no apparent cause; loss of consciousness or fainting with or without an epileptic seizure. Other signs of vascular occlusion: sudden pain, swelling and slight blueness of the extremities, acute abdomen.
Symptoms of a myocardial infarction include: pain, discomfort, pressure, heaviness, a feeling of tightness or fullness in the chest, arm, or chest; discomfort with irradiation to the back, cheekbone, larynx, arm, stomach; cold sweat, nausea, vomiting or dizziness, severe weakness, anxiety, or shortness of breath; fast or irregular heartbeat.
Arterial thromboembolism can be fatal.
The risk of developing thrombosis (venous and / or arterial) and thromboembolism increases:
- with age;
- in smokers (with an increase in the number of cigarettes or an increase in age, the risk increases, especially in women over 35 years old);
- with obesity (body mass index more than 30 kg / m 2);
- if there is a family history (for example, venous or arterial thromboembolism ever in close relatives or parents at a relatively young age). In the case of a hereditary or acquired predisposition, a woman should be examined by an appropriate specialist to decide on the possibility of taking combined oral contraceptives;
- with prolonged immobilization, major surgery, any operation on the legs or major trauma. In these situations, it is advisable to stop the use of combined oral contraceptives (in the case of a planned operation, at least four weeks before it) and not resume taking within two weeks after the end of immobilization;
- with dyslipoproteinemia;
- with arterial hypertension;
- with migraine;
- with diseases of the heart valves;
- with atrial fibrillation.
The question of the possible role of varicose veins and superficial thrombophlebitis in the development of venous thromboembolism remains controversial. An increased risk of thromboembolism in the postpartum period should be taken into account.
Peripheral circulatory disorders can also occur in diabetes mellitus, systemic lupus erythematosus, hemolytic uremic syndrome, chronic inflammatory bowel disease (Crohn's disease or ulcerative colitis), and sickle cell anemia.
An increase in the frequency and severity of migraine during the use of combined oral contraceptives (which may precede cerebrovascular disorders) may be grounds for immediate discontinuation of these drugs.
Biochemical indicators indicating a hereditary or acquired predisposition to venous or arterial thrombosis include: resistance to activated protein C, hyperhomocysteinemia, lack of antithrombin III, protein C deficiency, protein S deficiency, antiphospholipid antibodies (anticardiolipin antibodies, lupus anticoagulant).
When evaluating the risk-benefit ratio, it should be taken into account that adequate treatment of the relevant condition can reduce the risk of thrombosis associated with it. It should also be borne in mind that the risk of thrombosis and thromboembolism during pregnancy is higher than when taking low-dose oral contraceptives (< 50 мкг этинилэстрадиола).
The most significant risk factor for cervical cancer is persistent papillomavirus infection. There are reports of a slight increase in the risk of developing cervical cancer with long-term use of combined oral contraceptives. However, the relationship with the use of combined oral contraceptives has not been proven. Controversy remains as to the extent to which these data are related to screening for cervical pathology or to sexual behavior (more rare use of barrier methods of contraception).
A meta-analysis of 54 epidemiological studies showed that there is a slightly increased relative risk of developing breast cancer diagnosed in women who used combined oral contraceptives. The increased risk gradually disappears within 10 years after stopping these drugs. Due to the fact that breast cancer is rare in women under 40 years of age, the increase in the number of breast cancer diagnoses in women currently taking combined oral contraceptives or who have recently taken it is insignificant in relation to the overall risk of this disease. Its relationship with the use of combined oral contraceptives has not been proven. The observed increase in risk may also be due to earlier diagnosis of breast cancer in women using combined oral contraceptives. In women who have ever used combined oral contraceptives, earlier stages of breast cancer are detected than in women who have never used them.
In rare cases, against the background of the use of combined oral contraceptives, the development of liver tumors was observed, which in some cases led to life-threatening intra-abdominal bleeding. In the event of severe pain in the abdomen, liver enlargement, or signs of intra-abdominal bleeding, this should be taken into account when making a differential diagnosis.
Other states
In women with hypertriglyceridemia (or a family history of this condition), there may be an increased risk of developing pancreatitis while taking combined oral contraceptives.
Although a slight increase in blood pressure has been described in many women taking combined oral contraceptives, clinically significant increases have been rare. However, if a persistent, clinically significant increase in blood pressure develops while taking combined oral contraceptives, these drugs should be discontinued and treatment of arterial hypertension should be initiated. Taking combined oral contraceptives can be continued if normal blood pressure values are achieved with antihypertensive therapy.
The following conditions have been reported to develop or worsen both during pregnancy and when taking combined oral contraceptives, but their relationship with taking combined oral contraceptives has not been proven: jaundice and / or itching associated with cholestasis; the formation of stones in the gallbladder; porphyria; systemic lupus erythematosus; hemolytic uremic syndrome; chorea of Sydenham; herpes of pregnant women; hearing loss associated with otosclerosis. Cases of Crohn's disease and non-specific ulcerative colitis have also been described with the use of combined oral contraceptives.
In women with hereditary forms of angioedema, exogenous estrogens may cause or worsen the symptoms of angioedema.
Acute or chronic liver dysfunction may require the withdrawal of combined oral contraceptives until liver function returns to normal. Recurrent cholestatic jaundice, which develops for the first time during pregnancy or previous use of sex hormones, requires discontinuation of combined oral contraceptives.
Although combined oral contraceptives may have an effect on insulin resistance and glucose tolerance, there is no need to change the therapeutic regimen in diabetic patients using low-dose combined oral contraceptives (less than 50 micrograms of ethinyl estradiol). However, women with diabetes should be closely monitored while taking combined oral contraceptives.
Occasionally, chloasma may develop, especially in women with a history of chloasma of pregnancy. Women with a tendency to chloasma while taking combined oral contraceptives should avoid prolonged exposure to the sun and exposure to ultraviolet radiation.
The effectiveness of combined oral contraceptives may be reduced by missing pills, vomiting and diarrhea, or as a result of drug interactions.
Effect on the menstrual cycle
While taking combined oral contraceptives, irregular bleeding (spotting or breakthrough bleeding) may occur, especially during the first months of use. Therefore, evaluation of any irregular bleeding should be done only after an adaptation period of approximately three cycles. If irregular bleeding recurs or develops after previous regular cycles, a thorough examination should be carried out to exclude malignant neoplasms or pregnancy.
Some women may not develop withdrawal bleeding during the pill break. If combined oral contraceptives were taken as directed, it is unlikely that the woman is pregnant. However, if combined oral contraceptives have been taken irregularly before, or if there are no consecutive withdrawal bleedings, pregnancy should be excluded before continuing to take the drug.
Impact on lab test scores
Taking combined oral contraceptives may affect the results of some laboratory tests, including liver, kidney, thyroid, adrenal function, plasma transport proteins, carbohydrate metabolism, coagulation and fibrinolysis parameters. Changes usually do not go beyond the boundaries of normal values.
Preclinical safety data
Preclinical data obtained in the course of standard studies for the detection of toxicity with repeated doses of the drug, as well as genotoxicity, carcinogenic potential and toxicity to the reproductive system, do not indicate a particular risk to humans. However, it should be remembered that sex steroids may promote the growth of certain hormone-dependent tissues and tumors.
Influence on the ability to drive vehicles and control mechanisms
In the article we will figure out which is better - "Yarina" or "Zhanin".
Endometriosis is often called the disease of civilization. Pathology has been known for a long time, but endometriosis has become widespread along with the advent of effective oral contraceptives. In the period when OCs had not yet been invented, a woman gave birth many more times, which significantly reduced the number of menstruations during the reproductive period. To date, the number of menstruations during this period averages about 400. This indicator creates an intense burden on the woman's body and her reproductive system, which leads to the development of endometriosis, which can lead to serious complications, including infertility.
According to medical research, every tenth woman in the modern world suffers from endometriosis, which makes this pathology the third most common. The pharmaceutical industry is constantly looking for new ways to fight disease. One of the most modern, but already proven drugs are Yarina and Zhanin. What's better? Let's find out.
It should be noted that it is wrong to compare these two drugs, since each performs its functions and is intended for certain conditions of a woman. In some cases, the gynecologist can give the patient the right to choose a medication, listing the most suitable options. Consider the key features of each of the two hormonal agents.
After that we will be able to understand what is better - "Yarina" or "Zhanin".
Endometriosis: description
The endometrium is a membrane in the uterine cavity, the main function of which is to ensure the proper attachment of a fertilized egg. When conception does not occur at the right time, the resulting tissue is rejected by the body and comes out in the form of menstrual bleeding.
Under certain circumstances, endometrial cells also attach to the tissues of the ovaries, fallopian tubes, and other organs. Part of the endometrium passes through the uterus to the peritoneum, where it is disposed of. In medical practice, cases have been recorded when particles of the endometrium entered the kidneys, liver or lungs and took root there.
After the endometrium takes root in tissue that is located outside the uterine cavity, it begins to work under the influence of hormones produced by the woman's ovaries. A similar pathological process, caused by the appearance of foci of a "working" endometrium in atypical places, is called endometriosis. The main signs of pathology are spotting, appearing outside of menstrual bleeding, as well as pain in the lower abdomen. Sometimes, against the background of endometriosis, bleeding of the uterus opens.
If timely treatment of pathology is not carried out, the endometrium begins to grow uncontrollably and spread throughout the body, which can lead to serious consequences, provoking infertility or pregnancy outside the uterus.
Women often ask: "Which is better - "Yarina" or "Zhanin" for endometriosis?
Similarities and differences between drugs
Both drugs are made on the basis of hormonal substances. They are made in Germany and are designed to prevent unplanned pregnancy.
Which is better - "Yarina" or "Zhanin"?
As for the composition, the main active ingredient, ethinylestradiol, is identical for both drugs, the amount of which in one tablet is 30 μg. However, both drugs are combined and each has its own additional active ingredient. The composition of "Janine" includes dienogest, and in "Yarin" an additional component is represented by drospirenone. Excipients also differ, including their dosages.
Another difference between the drugs is the dosage form. If "Janine" is produced in the form of a film-coated dragee, then "Yarina" is a tablet preparation.
"Janine" for the treatment of endometriosis
And what is better for endometriosis - "Yarina" or "Zhanin"?
The main purpose of oral contraceptives is to prevent unwanted pregnancy. The combination of active ingredients in "Zhanina" in the totality of its properties allows you to achieve this goal. Ethinylestradiol is a synthesized analog of natural estrogen. Its action is similar to the original substance, it inhibits the production of gonadotropins by the brain, as well as the function of the ovaries in the synthesis of hormones, which leads to a thickening of the vaginal secretion. However, first of all, the hormone blocks the growth of endometrial tissue.
Feedback on the use of "Janina" is mostly positive.
Dienogest
Dienogest in the composition of the drug is a hybrid substance that has the properties of norterstosterone and progestins. The substance has an antiandrogenic effect, and also positively affects the amount of lipids in the blood, preventing the development of hormonal disorders.
The scheme of application of "Zhanin" depends on the purpose of therapy. To achieve a contraceptive effect, the drug is taken for three weeks with a seven-day break between courses. During the break, withdrawal bleeding occurs, resembling menstrual bleeding.
This is confirmed by the instructions and reviews for "Zhanin".
Instruction
The main advantage of "Zhanin" over other hormonal contraceptives is that this drug can be prescribed at various stages of the development of endometriosis, both at the first signs and in advanced cases. At the same time, for each patient, the therapeutic regimen is selected individually. Most often, pills are prescribed for 63 days without interruption, one pill a day at the same time. Then there is a break of seven days, during which withdrawal bleeding occurs. The beginning of the discharge depends on the characteristics of each organism. Further treatment with the drug is determined by the doctor, however, in most cases, the described course is enough to stop the growth of the endometrium.
When it comes to treating advanced and difficult cases of endometriosis, the doctor may prescribe 84 days of continuous use, after which there will be a break for withdrawal bleeding.
Adverse reactions
"Janine", like any other drug, can cause a number of adverse reactions. In general, the drug is well tolerated by patients, but in some cases the following conditions are possible:
- Violation of psycho-emotional stability, manifested by nervousness, depression and irritability.
- Soreness and tension in the mammary glands.
- Headache.
- Violation of the gastrointestinal tract, accompanied by nausea, diarrhea, flatulence, etc.
- Increase in body weight.
Adverse reactions appear both at the initial stage of treatment with the drug, and after the end of the course.
"Janine" or "Yarina" - which is better according to reviews? More on this at the end of the article.
"Yarina" in the treatment of endometriosis
"Yarina" is a combination drug that is distinguished by a reduced content of hormones. The action of the drug is due to the properties of its main components - ethinyl estradiol and drospirenone.
The contraceptive effect of Yarina is due to several processes. Against the background of taking pills, the process of ovulation is inhibited, at the same time the structure of the cervical secret changes. The mucus thickens and becomes viscous, so the spermatozoa are unable to enter the uterine cavity. In addition, like Zhanin, Yarina inhibits the growth of the endometrial layer.
Drompyrenone
Drompirenone in the composition of the drug has an antimineralcorticoid effect, it prevents weight gain, as well as the accumulation of excess fluid. Similar properties of the hormonal component in the composition of "Yarina" help to relieve the severity of the symptoms of PMS.
The main difference between Yarina and other contraceptives is its beneficial effect on a woman's appearance. The antiandrogenic properties of the tablets help fight acne, as it helps to reduce the activity of the sebaceous glands.
For medicinal purposes, tablets are taken to normalize the cycle of menstruation, including to reduce the duration of bleeding and its intensity. In addition, the drug is used to treat anemia of the hemorrhagic type, which occurs in a chronic form, as well as to eliminate pain during menstruation.
"Yarina": instructions and adverse reactions
The drug is considered one of the most effective hormonal medicines for the treatment of endometriosis. "Yarina" has the following effect:
- Inhibition of the production of gonadotropins by the pituitary gland.
- Suppression of the production of hormones of the reproductive system by the ovaries.
- Neutralization of endometrial changes of a proliferative nature.
Reception of "Yarina" helps to prevent cyclic processes, and in the course of long-term use of the drug it is possible to achieve atrophy. Thus, the work of endometrial foci is suppressed.
"Yarina" is produced in packs of 21 tablets. The regimen for achieving a contraceptive effect is no different from Zhanina. The drug is drunk for three weeks at the same time, then a seven-day break is made. You should start taking the pills on the first day of the new cycle, that is, when menstruation begins. During the break, withdrawal bleeding occurs. On the eighth day, a new package of the drug begins.
Also on sale is Yarina Plus. Its application is exactly the same. The only difference is that the composition of the plus drug additionally includes calcium levomefolate, which is a biologically active form of folic acid. This medicinal substance is intended to eliminate the deficiency of folate in the body of a woman.
If a tablet was missed for any reason, it should be taken as soon as possible. If more than 12 hours have passed since the time of ingestion, it should be protected for one week by barrier methods.
In the treatment of endometriosis, doctors prescribe a continuous intake of two cycles of Yarina. That is, as soon as one package ends, the next day you need to move on to another. Thus, it is possible to achieve relief of the growth of endometrial tissues. In addition, treatment with these tablets helps prevent blood from entering the peritoneum and the growth of endometrial foci.
You should familiarize yourself with the reviews of women about Yarin in advance.
The doctor himself determines how many continuous courses the patient should take. It depends on the severity of the symptoms of endometriosis. However, the maximum duration of admission is six months. If after this period there was a re-growth of endometrial tissue, do not re-use the drug. In this case, the specialist selects another drug.
The most common adverse reactions to taking "Yarina" in the form of pain in the head, soreness and swelling of the mammary glands, as well as the following symptoms:
- Nausea.
- Decreased libido.
- Mood swings, depression.
- Migraine.
- Bleeding.
- Thromboembolism of arteries and veins.
People often ask which is better - "Jess" "Yarina" or "Janine". The drugs "Jess" and "Dimia" practically do not differ from "Yarina", except for the amount of ethinylestradiol in them - not 30, but 20 mcg.
Contraindications to taking these drugs
Before you start taking contraceptives, you must take into account that there are contraindications to any of the hormonal drugs. Restrictions for taking oral contraceptives are the same for all drugs and are in the following conditions:
- A history of thromboembolism or a tendency to form blood clots.
- Diabetes.
- Neoplasms in the organs of the reproductive system or mammary glands, regardless of their origin.
- Pregnancy and breastfeeding.
- Dysfunctional disorders of the kidneys and liver.
- Tendency to develop depression.
At the consultation with the doctor, the patient must be told about all the existing diseases. This will help to avoid unwanted reactions from the body and the severe consequences of taking a hormonal drug.
Before choosing a drug, you should consult with your doctor. He will tell you which tool to prefer. It is also worth focusing on your own feelings, if side reactions occur from taking the medication or there is no effect, then it is worth replacing it.
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