And now, half a century later, the value of the hormonal method is difficult to overestimate. The 200 largest world historians agreed that neither theory of relativity, nor the nuclear bomb, nor even the Internet had an influence of the XX century such as a contraceptive tablet.

Today, 24 types of combined oral contraceptives are registered in Russia. Let's deal with what principle all these drugs are distinguished.

Combined oral contraceptives (COC) are called so because these tablets include two hormones (or rather, their analogues) - estrogen and gestagen. (There are also mini-saws containing one hormone, but now it's not about them.) Estrogen and Gestagen enter the body in different combinations. At that time, when the body does not receive hormones, the woman begins "bleeding", or, in simple, menstruation.

There are three generally accepted classifications COC: according to the estrogen component, in the props and according to the dosing regime for one cycle.

Estrogen component

On this principle, all available types of Kok are divided into two types: Ethinyl estradiol-Content and preparations based on estradiol Valerata, they are NOC (natural oral contraceptives).

Until recently, as an estrogen component was used exclusively ethinyl estradiol (EE), reliable, but rather hard synthetic hormone. Among EE-containing drugs, the following types are distinguished:

Hosted ("Non-Ovlon", "Anteovin") - contain 50 μg of ethinyl estradiol (EE). No longer applied due to the high risk of side effects.

Low volume - contain 30-35 μg EE. There are many such drugs, it is "Yarina", Zhanin, "Marvelon", "Diana-35" and others. A feature of low-volume drugs is a good cycle control with high contraceptive reliability.

Microdosged - containing 15-20 μg EE. This is well acquainted to us "Jess", "Logest", "Mersilon." Despite the slight content of hormones, microdosted drugs are quite reliable. In the adaptation period, cargo bleeding are possible, but contraceptive protection acts regardless of the presence of selections.

In 2009, the first and so far the only drug containing estradiol Valerat as an estrogen component - "Clayra". Estradiol Valerat is chemically identical to hormone produced by a female organism. Its impact is softer than Uh, hence the name "Natural Oral Contraceptive" originated.

Attempts to create a contraceptive drug based on Estradiol Verata were conducted for a long time, but the softness of its exposure was fraught with possible intermenstrual bleeding. In "Clari" to solve this task applied dienogest, reliably regulating the growth of endometrial, and.

Gestagon component

So, estrogen is designed to stabilize the menstrual cycle, and Gestagen warns pregnancy. Initially, as a gestagne component was used testosterone derivatives. Along with a high progestogenic action, they in one degree or another possessed residual androgenic activity. Thus were created Coki, containing levonorgtestrel and other hormones - desogestrel, Gestodenwhich appeared in the 70s and 1980s.

The further evolution of the Gestagenov was aimed at eliminating androgenic activity. As a result, gestagens with antidegenic effect were created: ciproteron Acetate, Dienengest, Chrospirenone. Chrospirenone Among other things, prevents the delay in the excessive fluid in the body, which is observed in some cases against the testosterone derivatives in combination with EE.

Dosing mode

From what doses and in which combination two hormonal components are used, additional non-contraceptive properties of drugs depend.

If all pills in the package contain the same amount of estrogen and gestagenov, the drug is called monophasomic. Such drugs provide good cycle control, with their help it is easy to move the menstruation or go to the prolonged reception (4-5 menstruation per year).

In the 70s was created two-phase Preparation "Anteovin". Now it is no longer applied.

In the late 70s, a new dosing regimen was created - three phase. Now, three different dosages create a similarity of natural hormonal oscillations. The drug "Trvisilar" is very popular today.

As a result of perennial research, a unique dynamic dosing modeThe most repeating natural female cycle. The packaging contains 26 active tablets with a gradual decrease in the dose of estrogen and an increase in the dose of gestagen and 2 placebo tablets. This regime contributes to a more stable profile of bleeding and good tolerability, while possessing high contraceptive reliability. In the class of dynamic dosing mode, only "Clayra" is currently represented. Hopefully, her appearance opens a new era - natural and even more secure contraception.

For many of us, the term "hormonal medicines" sounds threatening. In the concept of most people who are not related to medicine and pharmaceuticals, hormones are pills of monstrous forces that bring the mass of the same monstrous side effects.

What are these fears based on? And if the hormones are so harmful why they are so widely used? Let's try to figure together, which actually represent hormonal pills.

Classification

Hormonal medicines contain hormones or substances that have similarity properties similar to hormones (hormone). The hormones are produced in human endocrine glands and spread with blood flow into various organs and systems, adjusting the vital functions of the body.

Hormonal agents can be divided into hormone preparations:

• pituitary.
  Their number includes chorionic gonadotropin and the famous, probably, every woman oxytocin;

• thyroid gland.
  These funds are used to treat insufficient production of own hormones (for example, under hypothyroidism) and the opposite state - excessive hormone products;

• pancreas.
  The most famous means of this group are insulin preparations;

• parachitoid glands;

• adrenal cortex.
  This group includes glucocorticosteroids that are widely used in many sectors of medicine as anti-inflammatory, antiallergic and painkillers;

• sex hormones: estrogens (main of them - estradiol), gestagens, androgens;

• anabolic agents.

What are hormonal pills treat?

Despite the very wary attitude towards hormonal medicines from patients, one can say boldly that these drugs relate to extremely necessary and important. Often only hormonal agents are able to provide a chronically sick person worthy quality of life, and sometimes keep life itself.

Therapy hormonal pills is necessary for:

- oral contraception;

- replacement hormone therapy in postmenopausal women and the elderly men suffering from testosterone;

- treatment of inflammatory and allergic diseases;

- treatment of hormonal insufficiency.
These pathologies include hypothyroidism, diabetes of the first type, Addison disease and other diseases;

- treatment of many oncological diseases.

Oral contraception. Achievements of modern medicine

The first studies that marked the development of hormonal contraceptives were held back in 1921. In ten years, scientists have already figured out the structure of steroid hormones and found that high doses of sex hormones inhibit, that is, they block ovulation.

The first combined hormonal contraceptive was released in 1960. American pharmacists. It contained truly high doses of hormones, and therefore possessed not only by contraceptive, but also a mass of side effects.

Over time, the situation has changed dramatically. In the 90s of the last century, hormonoids were synthesized, which, along with high activity, have excellent tolerance. Therefore, modern women may not worry about unnecessary kilograms scored due to the reception of hormonal contraceptive pills. This side effect remained in the past along with the shock doses of the active ingredients contained in the first contraceptives.

The effectiveness of all contraceptives is estimated using a pearl index that determines the likelihood of the occurrence of pregnancy for one year with the constant use of drugs. On average, the pearl index of hormonal contraceptives ranges from 0.3% to 2-3%. The maximum value of this indicator reaches 8%.

If a woman has an average fertility and does not pregnant from her husband's toothbrushes, the likelihood of pregnancy rarely exceeds 1%. Of course, provided the daily use of tablets.

However, let's return to classifications. Modern hormonal contraceptives can be:

1. Combined;

2. Non-commissioned (mini-saw);

3. Tablets for emergency contraception.

Let's try to figure out what these groups differ.

1. Combined hormonal contraceptives: Kok

For a ridiculous abbreviation of KOC, very serious medicines are hidden, which are the most popular modern contraceptives. All KOK include two active substances - estrogen and gestagen. Ethinyl estradiol is used as estrogen, and the Levonorgestrel, Northell, Desogestrel and other synthetic hormoneids can be used as a gestagena.

The dose of ethinelstradiol in modern KOK is much lower than the first "slaughter" tablets. Due to this, when taking new drugs, the side effects of estrogen are rarely developed: an increase in weight, diseases of the dairy glands and nausea.

Monophasic Kok have a permanent dose of estrogen and progestin in each of the tablets. Despite the fact that during the menstrual cycle, the concentration of hormones in the body of a woman is impermanent, monophazic contraceptives is a strictly defined dose coming daily.

Two-phase contraceptives contain two types of tablets in one package. The main difference between the second type tablets is an increased content of a guestogen, characteristic and a physiological cycle.

However, three-phase COCs are traditionally considered the most adapted to the menstrual cycle. They include three groups of tablets. The concentration of active ingredients in each group approaches the content of estrogen and gestagennes into a certain phase of the menstrual cycle. The first group of tablets imitates the follicular phase, which lasts 5 days, the second is the periovulattoral, the duration of which is 6 days and the latter - lutein, the long 10-day phase. At the same time, the concentration of estrogen in three-phase KCs as well as in the menstrual cycle is maximum, and the level of the gestagen increases from the first phase to the third.

Pharmacology: How do hormonal contraceptive pills work?

The contraceptive effect of all hormonal contraceptive tablets regardless of the composition and dosage is based on blocking the release of hormones responsible for ovulation and implantation. The ovaries are practically "falling asleep", decreasing in size. Ultimately hormonal pills:

• suppress ovulation;
• change the properties of cervical mucus. As a result of this effect, the cervical canal becomes a real barrier for the odd spermatozoa;
• change the state of the endometrium, as a result of which the "liner" of the inner surface of the uterus does not allow to be implanted with an egg cell if the fertilization still happened.

How to take hormonal contraceptive pills?

The answer to the question of how to take hormonal pills that protect against pregnancy can be expressed by one and only word: regularly. Depending on how the period is calculated - 21 or 28 days - tablets should be used once a day during the entire period of treatment, and better at the same time.

An important question that is worried about the majority of women hosting Kok, - what to do if the patient forgot to take a tablet on time. First, do not panic. The situation is solvable and, in general, quite banal.

Secondly, the missed tablet must be taken immediately after memory recovery. The next tablet is to drink on schedule, even if you have to take two tablets at the same time.

Thirdly, you should estimate the period during which a woman forgot about the need to be protected. The following actions depend on the "limit period".

If the lateness is not more than 12 hours, it is possible to calm down, the efficiency of contraception will remain the same, that is, close to 100%. In the case, if this period lasted more than 12 hours, you will have to use additional prevention methods, for example, barrier or sperm.

Monophasic COF: efficiency and popularity

The most popular and common hormone contraceptives include monophazic drugs. Many gynecologists believe that it is these funds that are the best hormonal pills for women under the age of 35, and the patient reviews confirm.

Monophasic contraceptives contain one color tablets. Despite the fact that a strict application of tablets can be applied on the package (usually in the queue), this does not bear a special semantic load. And if you manage to drink at the very beginning of the cycle of the tablet, designed to use, say, for 25 days, absolutely nothing terrible will happen - after all, all pills have the same composition.

Most Kok, who are saturated by the Russian pharmaceutical market belong to monophasic. The choice of drugs is so large that even experimental gynecologists are sometimes pondered before the prescription of the drug patients. Therefore, we will consider only those hormonal pills, which can be attributed to the category of "new", modern funds.

The German Drug Logest, which produces a well-known company Schering, S.A, contains 20 μg of ethinilastradiol and 75 μg beds. The tool is produced in the package of 21 tablets. Load is a great preparation for young women.

Lindinet

Hormonal Tablets Lindinet 20 are a complete analogue of German Loomest. Preparations have the same composition, and the only difference can be considered the color - Tablets of Lindinet have a pale yellow shell. Manufacturer Lindinet - Hungarian firm Gedeon Richter.

Lindinet 30 differs from its fellow only dosage estrogen (30 μg).

Hormonal tablets Zhanin production Scchering contain 30 μg of ethinyl estradiol and 2 mg of gestagen (dienogest). The Pearl Index at regular zhana reception does not exceed 1%.

The main difference between Zhanina from other KOC - antidrogenic activity, which has a degenegest. Therefore, Zhanin is prescribed to patients with an elevated level of male genital hormones. In addition, hypocholistereminic is proved, that is, a decrease in blood cholesterol levels of dienethest.

The German drug Yarina is one of the most popular monophasic hormonal contraceptives in tablets. The medicine contains 30 μg of ethinyl estradiol and 3 mg of chospirenone.

The properties of Yarina and Zhanina are very similar. Yarina helps to reduce high density lipoproteins and has an antagandogenic effect. Thanks to this quality, Yarina is considered to be a acne tool: hormonal pills are prescribed as part of a comprehensive acne therapy. The drug helps to reduce the production of skin saline and reduce the manifestations of the disease.

To the number of very famous hormonal contraceptives in tablets refers and Diana-35, which releases scring. The preparation contains 35 μg of ethinyl estradiol and 2 mg of the antandrogen gestagen of ciproterone acetate.

Diana has pronounced antagandrogenic activity, which allows you to assign it to treat acne and seborrhea. In addition, Diana-35 is a drug selection for women contraception, which has light manifestations of hirsutism - excessive overexpasses.

In a row of tablets with antandrogenic activity, a popular hormonal contraceptive of Jess is occupied by a special place. It contains 20 μg of ethinyl estradiol and 3 mg of chospirenone. Gestagen, which is part of Jes, levels the side effects of estrogen. In this regard, the remedy is very well tolerated, and swelling and an increase in body weight is practically excluded.

In addition, Chrospirenone softens the manifestations of premenstrual syndrome, including pronounced. To all positive properties of Jes, a favorable effect on cholesterol levels can also be added, which is manifested in an increase in the concentration of high density lipoproteins (HDL). But it is the HDL that the excess cholesterol from the body is removed.

Midyidian Hungarian Hormonal Tablets also includes the Kok Coat Containing Dovers. They differ from Jess only with a higher content of ethinyl estradiol, the dose of which is 30 μg.

Among the lowered COC should also be celebrated Hormonal Tablets Riguevidon, Femoden, Novineet, Miniziston, Microjinon, Regyl.

This list of monophase contraceptives registered in Russia is far from being exhausted. However, they apply much less often, so we will immediately move on to the following categories of Kok.

Table "Monophasic Kok"

Two-phase and three-phase COF: Time is checked

As we have already spoken, two- and three-phase hormonal contraceptives act more physiologically. Nevertheless, most often doctors prefer to use the first group of drugs. What is it caused?

The fact is that changes in the concentration of hormones are conjugate with an inevitable increase in the dose of actors. As a result, the side effects of two-phase and three-phase drugs are more pronounced than low-volume monophasic.

Two-phase COCs are among rarely used drugs. Among them are funds, the names of which are often unusual even for the provision, not to mention the patients, - Anteovin, Nuevele, AFF-Novum, Bi-Nov.

Three-phase contraceptives are better known and popular. However, the disadvantages in the form of standard side effects they are not less pronounced than in two-phase drugs. Three-phase KOC is easy to "calculate" by name, which, as a rule, begins on the "three": triziston, Tsvvilar, three-mercy, three-regal, Trister.

Tablets of two- and three-phase hormone contraceptives are painted in different colors, depending on the composition: in two-phase preparations - in two colors, and in three-phase in three. Take such medicines need strictly according to the scheme. Usually convaluto Kok Pepit with various arroders and other bright marks designed to help a woman to deal with the features of the use of multi-colored tablets. After all, if the color of the tablets is intense, the contraceptive effect decreases.

Useful contraceptives? Benefits Kok

Oral contraceptives are designed not only to carry out a direct, contraceptive effect. They have a lot of others, often no less important indications, including:

- Treatment of disorders of the menstrual cycle and PMS.
The use of COC contributes to the normalization of the cycle, a decrease in blood loss during menstruation, as well as a decrease in premenstrual syndrome;

- Treatment of acne, seborrhea and acne disease.
The complex therapy of dermatological diseases in women often includes COCs with an antagandogenic effect. Hormonal pills significantly reduce the synthesis of sebum, contributing to the decrease in the manifestations of acne. In patients suffering from seborrhea, which take COC, normalizes the level of the skin and the hair loss is noticeably reduced;

- Prevention of benign breast diseases and small pelvis organs.
COP suppress the ovarian stimulation by follicularity immuling and luteinizing hormones. Therefore, regular reception of hormonal contraceptive pills significantly reduces the risk of formal cysts and benign nodes in lactic glands;

- Prevention of ovarian cancer and endometrial carcinoma.
With regular reception of oral contraceptives, the risk of ovarian cancer decreases by as much as 40%. This defense lasts even 15 years after the end of receiving hormonal tablets. The longer you take COC, the longer the anti-cancer action is manifested.

And that is not all. The probability of developing endometrial adenocarcinoma (uterine cancer) in women, which were treated with hormonal contraceptive pills, decreases by 50%. The protective effect is preserved within 15 years after the cessation of KOK.

Negative sides of combined hormones

We are rising, if we say that COC is extremely useful for health preparations. In the process of treatment with hormonal contraceptive pills, sometimes not to avoid adverse effects. To the negative parties COC include:

- The probability of developing side effects, including nausea, breakthrough bleeding, increase sensitivity and breast increase. However, some ladies use hormonal pills just to increase the bust, so sometimes this effect can be attributed to the positive qualities of Kok;

- the need for regular daily use;

- The probability of delay of ovulatory cycles after cancellation COC.

When is hormonal contraceptive under the ban?

There are several states in which the use of any contraceptive hormonal pills is eliminated. These pathologies include:

• cardiovascular diseases;
• deep veins thrombosis;
• sugar diabetes with vascular complications;
• oncological diseases;
• anomalous vaginal bleeding;
• liver diseases;
• age older than 35 years;
• smoking.

Preparations containing in the composition of Chrospirenone - Jess, Angelica and others are contraindicated to patients with kidney diseases, adrenal glands or liver. This is due to the fact that Chrospirenone has an antimineralocorticoid effect.

Hormonal contraceptives and venous failure: incompatibility №1

Many women know that hormonal pills are not recommended for varicose veins and are categorically contraindicated with thrombophlebitis. But the answer to the question is what a similar ban is connected, most patients notic.

It turns out that the constant component of all hormonal contraceptive tablets is estrogen - activates the blood coagulation mechanism, resulting in increasing the risk of blood clots. It is known that modern drugs with a low level of estrogen are associated with a low risk of thromboembolism, while highly rocked hormonal pills - on the contrary.

In addition, the probability of the appearance of thrombus is significantly increased in smokers, patients with elevated cholesterol of blood, severe form of diabetes, hypertension or obesity.

2. Mini drank: special hormonal contraceptives

Under affectionate and usually, a little of the understandable name "mini-saw" hide hormonal contraceptive pills containing only one component - Gestagen. Moreover, the dose of the active substance in mini-saw is really minimal.

Mini-saw hormonal tablets can be prescribed to patients over 35 years old, including after 40, as well as women suffering from diabetes. Even breastfeeding is not an obstacle to the use of these drugs. However, mini-dies have a smaller Pearl index compared to COC. In addition, the drugs of this group may cause intermented bleeding, the appearance of a cyst in the ovaries and even ectopic pregnancy.

Note that the contraceptive effect of mini drank decreases if they take them at different times of the day. This disadvantage often finally inclines the scale of the scales towards the combined hormonal pills.

Among the mini-dies we call several drugs registered in Russia: Northell, Levonorgestrel, Linestrenol.

3. Urgent contraception: when you can not wait

Hormonal preparations of emergency contraception are peculiar ambulance tablets in case of unforeseen circumstances. Hurried, forgot, broke, did not find other verbs in the past time, it may briefly describe the standard reasons why women begin to throw in search of miracle funds from all problems.

And, of course, there are such drugs. They contain high doses of hormones, which either do not allow ovulation if the trouble happened in the first half of the cycle, or change the state of the endometrium if the fertilization still happened.

The most famous emergency contraceptives include postinor, microliness and escapel. Applying these tablets should be used as less as possible - after all, that hormonal splash, which occurs after taking drugs, is akin to impact. And no organism will endure if it is to beat high doses of hormones regularly.

Loose amateur!

All hormonal contraceptive, including in tablets, is exclusively prescription. And it is no coincidence. After all, the incorrectly chosen medicine can easily be the cause of disorders of the menstrual cycle and other gynecological troubles.

Therefore, if you decide to take a hormonal agent, the first person who needs to know about it is an obstetrician-gynecologist. Remember: the right to pick a hormonal contraceptive should be given not to a neighbor, not a friend on the forum and not even a pharmacist, but a doctor.

Menopause: if little estrogen

Unfortunately, menopause brings with them a mass of clinical symptoms, which are difficult not to notice. Classic symptoms of menopause are characterized by the irregularity of the menstrual cycle or the absence of this completely. In 60% of women, a sharp drop in the level of estrogen leads to vascular disorders, which are manifested by tides of heat, sweating and heartbeat.

Possible other, no less bright symptoms. After all, estrogens ensure sufficient moisturizing of the vagina and regulate urination. While the woman's body does not adapt to a new hormonal background, the neurological manifestations of menopause are inevitable: depression, insomnia, mood swings.

An extremely dangerous consequence of occurring menopause is a catastrophic reduction in bone mass. As a result, a disease conjugate with bone fragility is developing - osteoporosis.

If you do not take any action, these manifestations can poison the life of a woman for many years. However, the body can be "fooling" if you enter such necessary estrogens from the outside. And it is possible to do this with hormonal pills, which for some reason are so afraid of some patients. Is there a sheepskin gallery? Let's deal with together.

Add estrogen: Hormonal preparations in tablets

Hormonal tablets that are used during menopause may contain:

• only estrogen;
• combination of estrogen and progesterone;
• combination of estrogen, progesterone and androgen.

Estrogen preparations are most popular. Hormonal pills are constantly taken, that is, daily, or cycles for several weeks.

In most cases, these drugs contain the so-called conjugated estrogen, which is obtained from urine mares. Among them, we note the estheophememinal, Premarin and the Hormoplex. All these drugs are used cyclically within 21 days, followed by a weekly break.

Two-phase products

These tablets consist of two components - estrogen and gestagen.

Divine - The preparation of the production of the Finnish company Orion. The first tablet group contains only estradiol at a dose of 2 mg, and the second is a combination of 2 mg of estradiol valetiaiat and 10mg gestagen (medroxyprogesterone).

Klimontorm - German Medicine Corporation Bayer. The main difference from the divine lies in the Gestagen: as a progesterone-containing component in Klimmonmore uses 0.15 mg of levonorgestrel.

Klimen. Contains the same 2 mg of estradiol and 1 mg of ciproterone (gestagena).

In addition, Russian gynecologists have no less popular and other hormonal replacement pills, among which Cyclo Proginov, Femoston, Divitren, Angelik.

Three phase hormonal tablets

These drugs are designed for continuous use and include three groups of tablets: the first and third contain estrogens, and the latter in a smaller dose, and the second group includes a combination of estrogen and gestagen.

In Russia, only two three-phase drug - Tsisikvent and Tsisikvent Forte are registered.

Replacement hormonal pills: contraindications and side effects

Hormonal therapy during menopause is contraindicated in breast cancer or endometrial, severe liver diseases, thrombophlebitis, endometriosis, moma.

Among the side effects of hormone therapy, we note the mood differences, the heat of the mammary glands and intermenstrual bleeding.

And last. Before appointing substitution hormone pills, a thorough examination of a woman is carried out, which includes the overall urine analysis, analysis on the level of sugar and lipid blood profile, ultrasound of the small pelvis organs, ECG, cytological examination of the cervical scaffle and mammography. And if replacement therapy is not contraindicated, the benefits of it significantly exceeds the risk.

Hormones for the treatment of inflammation: why do glucocorticoids need?

A separate group of hormonal tablets is glucocorticosteroids (GK). They possess three properties at the same time: anti-inflammatory, antiallergic and painkillers. This unique triad is the basis for the widespread use of glucocorticoids in almost all areas of medicine.

Synthetic hormonal tablets containing HC are constantly accepted with autoimmune diseases, including multiple sclerosis and rheumatoid arthritis.

It is impossible to do without hormonal tablets containing GK, in the treatment of allergic diseases, including bronchial asthma. Glucocorticoids are able to reduce the inflammatory response and counteract the activity of immune cells, which are involved in the pathological process. Most often, the GC is inhaled inhalation, but in some severe cases, hormonal drugs are used in tablets and ampoules.

Glucocorticoids will certainly be included in the treatment chart of oncological diseases. Their main purpose is to reduce the side effects of chemotherapy. In addition, hormonal pills are able to promote in the destruction of cancer cells in lymphoblastic leukemia, Hodgkin lymphoma, non-Hodgkinsky lymphoma and multiple myeloma.

Glucocorticoids in tablets

Most often several tableted glucocorticoids are used.

The drug effectively reduces inflammation, suppressing leukocyte functions. Interestingly, the anti-inflammatory effect of dexamethasone is 30 times higher than the activity of another GK - hydrocortisone.

Dexamethasone in tablets is shown for hormonal treatment of Addison, hypothyroidism, bronchial asthma, rheumatoid arthritis, nonspecific ulcerative colitis, eczema, malignant tumors in running stages.

Dosage of dexamethasone is selected individually.

The drug is an analogue of the hydrocortisone. Prednisolone is able to influence all stages of the inflammatory process and to have a pronounced anti-inflammatory effect.

The testimony for the use of prednisolone tablets is indeed a lot - hormonal treatment is prescribed with systemic red lupus, multiple sclerosis, diseases of the joints, bronchial asthma, oncological diseases, adrenal insufficient, allergies, autoimmune pathologies and many others.

The drug production of the Polish Phaffa plant contains GK Triamcinolone at a dose of 4 mg. The main testimony of Paulcourtolon includes diseases of the joints, allergic pathologies that are difficult to amenable to therapy, rheumatic, dermatological, hematological, oncological and other diseases.

Side effects of glucocorticoids

GK possess really unique qualities. Therefore, glucocorticoids could be called healing drugs if it were not for side effects. Due to the large number of unfavorable phenomena due to the treatment, the long-term use of these funds may even be dangerous.

We list the most common side effects of hormonal tablets of glucocorticoid groups:

• decrease in immunity;
• increased blood sugar levels. With long-term treatment of GK, the development of diabetes is possible;
• reduction of calcium suction, which can lead to osteoporosis - a dangerous disease of bone tissue;
• amyotrophy;
• an increase in cholesterol and triglycerides in the blood;
• changes in mood, depression, memory violation, in severe cases - psychosis;
• gastritis and peptic disease;
• impairment of the menstrual cycle, reduced libido;
• slow healing of wounds;
• increase weight.

Another extremely unpleasant side of corticosteroids - cancellation syndrome: after stopping the long-term reception of hormonal pills, there is a chance of pronounced side effects. To avoid such a development of events, medications need to be canceled smoothly, gradually reducing the dose for a certain time.

Hormonal failure: when without pills can not do?

The most common pathologies requiring permanent reception of hormonal drugs include thyroid disease.

The failure of the thyroid gland - hypothyroidism - a common disease, in which the production of hormones is reduced. The treatment is based primarily in compensation for lack of hormones. For this purpose, hormonal pills are prescribed, which includes Levothyroxin sodium.

Levothyroxin sodium is a thyroxine left leaving. It is a synthetic analogue of the thyroid hormone. Tyroxin is a first-line medication in hypothyroidism, eutheroid zob, and also after removal or resection of the thyroid gland.

Despite the fact that thyroxine is a hormonal medicine, when appointing the correct dosage according to the readings of side effects is practically no.

Hormones in oncology: when the medicines saves life

Hormonal therapy in oncology Along with chemotherapy belongs to the main drug treatment methods for cancer. Hormone treatment is used for several types of hormonally sensitive tumors, including breasts, prostate, endometrial (uterine cancer) and adrenal cortex.

Most of the drugs that are used to treat hormonally dependent tumors, inhibit, that is, they block the selection of hormones. Such drugs include one of the most famous drugs for the treatment of breast cancer - tamoxifen.

Many funds can reduce the production of other hormones, which are responsible for the growth of malignant education. Often hormonal treatment - almost the only opportunity to deal with the tumor and extend the life of the patient.

Hormonal pills are a whole pharmaceutical world in which there is a place and efficiency, and uniqueness, and side effects. And unleash this tangled tangle of complex concepts, testimony and contraindications can exclusively doctors. Then the right assigned tool turns out to be the right way to full-fledged life.

Monophause oral contraceptive

Active substances

Ethinylestradiol (Ethinylestradiol)
- Levonorgestrel (LEVONORGESTREL)

Release form, composition and packaging

Shell-covered tablets Pink colour.

Auxiliary substances: monohydrate lactose - 35.19 mg, corn starch - 9.9 mg, cornstorming starch - 6.6 mg, 25 000 - 2.75 mg, magnesium stearate - 440 μg, sucrose - 19.374 mg, Pisidone 700,000 - 190 μg, macrogol 6000 - 2.148 mg, calcium carbonate - 8.607 mg, talc - 4.198 mg, glycerol 85% - 137 μg, titanium dioxide - 274 μg, iron oxide yellow dye - 14 μg, gland dye red - 8 μg, Mountain glycolic wax - 50 μg.

21 pcs. - Blister (1) - packs cardboard.
21 pcs. - Blister (3) - Cardboard packs.

pharmachologic effect

Monophasic combined oral contraceptive drug.

The contraceptive effect of the minisiston 20 Theme is based on the interaction of various factors, the most important of which are inhibition of ovulation and a change in the viscosity of the cervical mucus.

In addition to contraceptive action, combined oral contraceptives have a positive impact that should be considered when choosing a family planning method. The menstrual cycle becomes more regular, less often painful menstruation are observed, the intensity of menstrual bleeding is reduced, as a result of which the risk of developing iron deficiency anemia is reduced.

Pharmacokinetics

Levonorgestrel

Suction

After taking inside, the levonorgestrel is absorbed quickly and completely. C max in serum is 2 ng / ml and is achieved by approximately 1 h. The absolute bioavailability of the Levonorgestrel is approaching 100%.

Distribution

Levonorgestrel is associated with serum and globulin connecting sex hormones (GSSS). Approximately 1.5% of the overall concentration of Levonorgestrel are in serum in free form, 65% is associated with GHSS. The ratio of the fractions of the drug (free, associated with albumin and the associated with GSSS) depends on the blood content of GSSS. Ethinyl Estradiol increases the content of GHSS, so the fraction associated with the GSPS increases, while the free and associated albumin fractions are reduced.

The accumulation in the body of the Levonorgestrel with daily reception occurs almost completely in the second phase of removal. C SS is achieved by 3-4 days. The Pharmacokinetics of Levonorggestrel depends on the concentration of GSSS in the blood. When receiving a minizestone 20 phem, the GSPS concentration increases by about 70%, due to the fact that the drug contains ethinyl estradiol.

The overall concentration of the levonorgestrel in serum is linearly increasing with an increase in its specific binding ability. The level of levonorgestrel in serum serum does not change after 1-3 regular reception courses due to the fact that the HSPS induction ends. Upon reaching C SS, the level of levonorgestrel in serum is 3-4 times higher than after one-time reception.

Approximately 0.1% dose of levonorestrel is highlighted with breast milk.

Metabolism

Biotransformation occurs on the shared paths of metabolism steroids. Biologically active substances among metabolites are not detected.

Election

Levonorgestrel is not displayed in unchanged form. The metabolites of the levonorgestrel are derived with urine and bile in the ratio of approximately 1: 1. T 1/2 is about 24 hours. Reducing the concentration of the drug in blood serum has a two-phase character. T 1/2 in the first phase is 30 minutes, T 1/2 in the second phase - 20 hours. The rate of metabolic clearance from plasma is approximately 1.5 ml / min / kg.

Ethinyl estradiol

Suction

After the intake, the ethinyl estradiol is absorbed quickly and completely. C Max is approximately 60-70 PKG / L and is achieved after 1-2 hours. During the absorption and "first passage" through the liver of ethinyl estradiol, it is largely metabolized, which leads to a decrease in the individual fluctuations in its bioavailability during oral administration.

The absolute bioavailability of ethinyl estradiol is approximately 40-60%.

Distribution

It has been established that the apparent V d of ethinyl estradiol is approximately 5 l / kg, and the rate of its metabolic clearance from blood plasma is approximately 5 ml / min / kg. Ethinyl estradiol is highly (98%), although nonspecific, albumin binds to albumin.

About 0.02% of the daily dose of ethinyl estradiol is distinguished with breast milk.

Metabolism and elimination

Ethinyl estradiol is metabolized during suction and "first passage" through the liver.

The concentration of ethinyl estradiol in the blood serum decreases, and the decrease is two-phase character. T 1/2 in the first phase is about 1 h, t 1/2 in the second phase - 10-20 hours. Ethinyl estradiol is not displayed in free form. Ethinyl estradiol metabolites are removed by the kidneys and the liver in the ratio of 40:60. T 1/2 - about 24 hours.

Due to the relatively large T 1/2 of the drug in the final phase of removal, the content of the drug in the plasma when C SS is achieved by 30-40% higher than after its use for 5-6 days.

Pharmacokinetics in special clinical cases

Reception of other drugs can influence the systemic bioavailability of ethinyl estradiol. However, the interactions with high doses were not detected. With long-term intake, the ethinyl estradiol induces an increase in the synthesis of corticosteroid-binding globulin (KSG) and GHSS, and the degree of induction of the synthesis of the GSSP depends on the type and dose of the received gestagen at the same time.

Indications

- contraception.

Contraindications

The drug should not be used if there are any states / diseases listed below. If any of these states develop for the first time on the background of its admission, the drug must be immediately canceled:

- the presence of thrombosis (venous and arterial) currently or in history (for example, deep vein thrombosis, pulmonary artery thromboembolism, myocardial infarction, cerebrovascular disorders);

- currently or a history of states preceding thrombosis (for example, transient ischemic violations of cerebral circulation, angina);

- diabetes mellitus with vascular complications;

- the presence of severe or multiple risk factors for venous or arterial thrombosis;

- the presence of currently or a history of severe forms of liver diseases (as long as the hepatic test indicators are normalized);

- the presence of currently or in the 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 unclear genes;

- pregnancy or suspicion of it;

- lactation (breastfeeding);

- Increased sensitivity to the components of the drug.

Dosage

Drying should be taken in the order specified on the package, every day approximately at the same time, drinking a small amount of water. The drug should be taken by 1 dragee / day continuously within 21 days. The reception of each of the following packaging begins after a 7-day break, during which the cancellation bleeding is observed (menstrual bleeding). It usually begins on the 2-3rd day of receiving the last drage and may not end until the new packaging is started.

For absence of reception of any hormonal contraceptives in the previous month Reception of the drug starts in the 1st day of the menstrual cycle (i.e. in the 1st day of menstrual bleeding). It is allowed to start receiving on the 2nd -5 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 receiving dragee from the first packaging. In the absence of reception of any hormonal contraceptives in the previous month.

For transition from combined oral contraceptives Reception of the drug should be started the day after receiving the last dragee with the active components of the previous drug, but in no case later than the next day after the usual 7-day break in the reception (for drugs containing 21 dragees) or after receiving the last inactive dragee (for Preparations containing 28 dragee in the package).

For transition from contraceptives containing only gestagens ("mini-saw", injectable forms, implant), The drug can be started to apply without a break. For transition from "Mini-saw" - Any day without a break. For using injecting forms of contraceptives The drug is starting to take from the day when the following injection should be made. For transition from implant - On the day of his removal. In all cases, it is necessary to use an additionally barrier method of contraception during the first 7 days of receiving dragee.

After abortion in the first trimester of pregnancy A woman can start receiving 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 Reception of the drug should be started on the 21-28th day. If the reception started later, it is necessary to use an additional barrier method of contraception during the first 7 days of receiving the dragee. However, if a woman lived in a sex life between birth or abortion and the beginning of the drug, then the pregnancy should be excluded or it is necessary to wait for the first menstruation.

Missed Dragee A woman should take as soon as possible, the following dragee is accepted at normal time.

If the derage is less than 12 hours, the reliability of contraception is not reduced.

The reliability of contraception can be reduced. It should be borne in mind that the reception of the dragee should never be interrupted by more than 7 days and that 7 days of continuous delivery are required to achieve an adequate suppression of the function of the hypothalamic-pituitary-ovarian system.

If the delay in the reception of the dragee was more than 12 hours in time of the first week Treatment of the drug, then the woman should accept the last missed drage as soon as possible as soon as you remember (even if it means receiving two dragees at the same time). The next dragee is accepted during normal time. Additionally, use the barrier method of contraception over the next 7 days. If a woman lived in a sex life during the week before passing the dragee, it is necessary to take into account the risk of developing pregnancy. The more the dragees are missing and the closer this pass to the 7-day break in the reception of the dragee, the higher the risk of pregnancy.

If the delay in the reception of the dragee was more than 12 hours during the second week Treatment of the drug, then a woman should take the last missed drage as soon as possible as soon as you remember (even if you need to take two dragees at the same time). The next dragey is accepted at normal time. Provided that the woman took the dragee correctly for 7 days preceding the first missed dragee, there is no need to use additional contraceptive measures. Otherwise, as well as when you pass two or more dragee, you must additionally use barrier methods of contraception (for example, a condom) within 7 days.

If the delay in the reception of the dragee was more than 12 hours during the third week Treatment of the drug, the risk of reduction of reliability is inevitable due to the upcoming break in the reception of the dragee. The woman should strictly stick to one of the two following options (at the same time, if within 7 days preceding the first missed dragee, all the dragee was taken correctly, there is no need to use additional contraceptive methods):

- A woman should take the last missed drage as soon as possible as soon as you remember (even if it means receiving two dragees at the same time). The next dragey is taken at regular time until the dragee from the current packaging is completed. The next package should be started immediately. Bleeding cancellation is unlikely until the second packaging is over, but we can marine allocations and breakthrough bleeding during the reception of the dragee.

- A woman can also interrupt the reception of dragee from the current packaging. Then she should take a break for 7 days, including the day of the passage of the dragee and then start receiving a new packaging. If the woman missed the reception of the dragee, and then during the break in the reception of the dragee she has no bleeding cancellation, it is necessary to exclude pregnancy.

If a woman had vomot In the range of 3 to 4 hours after receiving dragee, suction may not be complete and additional contraceptive measures should be taken. In these cases, it is necessary to focus on the recommendation when passing the dragee. If a woman does not want to change the normal method of receiving the drug, it should accept additional dragee (or a few dragee) from another packaging if necessary.

In order to Delay the beginning of menstruationThe woman should continue the reception of a new packaging without a break. Dragee from this new packaging can be taken as long as they are not completed. Against the background of taking the drug from the second packaging, women can be marked with oscillations from vagina or breakthrough uterine bleeding. Then they make a 7-day break, after which the regular reception of the drug is renewed.

In order to move the day of the menstruation on the other day of the week, the woman should shorten her closest break in the reception of dragee for as many days she wants. The shorter the interval, the higher the risk, that it will have oscillations and breakthrough bleeding during the reception of the second packaging (just as in the case when it would defer the beginning of menstruation).

Side effects

In rare cases, the following side effects may be observed.

From the digestive system: nausea, vomiting.

From the side of the sexual system: Changes in vaginal secretion.

From the endocrine system: the tension and pain of the mammary glands, the increase in the mammary glands, the allocation of the secret of them; Changes in body weight, change of libido.

From the CNS: Reduced / change the mood, headache, migraine.

Others: Bad portability of contact lenses, fluid delay in the body, allergic reactions.

Sometimes chlorism can develop, especially in women with pregnant women in the history.

Overdose

About serious side effects in overdose was not reported.

Symptoms: Nausea, vomiting, cargo bleeding (girls).

Treatment: Conduct symptomatic therapy. No specific antidote.

Medicinal interaction

With the simultaneous use of the minisiston 20 with drugs induced by microsomal liver enzymes (phenythine, barbiturates, prison and rifampicin, and maybe with oxarbazepine, topiramate, felbamate, griseofullvin), cliens of ethinyl estradiol and levonorgestrel increases, which can lead to a decrease in reliability Contraception and development of breakthrough bleeding.

With the simultaneous use of the minizeston 20, with and tetracycles, there is a decrease in ethinyl estradiol levels and, accordingly, a decrease in the contraceptive effect and the development of breakthrough bleeding.

It should be borne in mind that women taking any of the above-mentioned drugs with a short course, in addition to the miniziston 20, the FEM should use barrier methods of contraception during the concomitant reception of drugs and within 7 days after their cancellation.

During the reception of rifampicin and within 28 days after its cancellation, in addition to the minizeston, 20 The FEM should use the barrier method of contraception. If the accompanying assignment of the drug has begun at the end of the packaging of the minizestone package 20, the next package must be started without a regular break in the reception.

special instructions

Before starting the application, the Miniziston 20 FEM must be carried out by a general student examination (including the mammary glands and cytological examination of cervical mucus), eliminate pregnancy, violations by the rolling blood system. With prolonged use of the drug, test surveys should be carried out at least 1 time per year.

The woman should be informed that the miniziston 20 by the FEM is not protected from HIV infection (AIDS) and other sexually transmitted diseases.

If you have risk factors, you should carefully assess the potential risk and expected benefit from therapy and discuss it with a woman before it decides to start receiving the drug. When weighing, strengthening or at the first manifestation of risk factors, it may be necessary to cancel the drug.

A number of epidemiological studies revealed some increase in the frequency of development of venous and arterial thrombosis and thromboembolism when receiving combined oral contraceptives.

When taking combination contraceptive drugs, the venous thromboembolism (VTE) is possible, which is manifested in the form of deep veins and / or lung thromboembolism. The approximate frequency of VTE when administering oral contraceptives with low dose of estrogen (less than 50 μg of ethinyl estradiol) is up to 4 cases per 10,000 women per year compared with 0.5-3 cases per 10,000 women per year in women who do not accept contraceptives. At the same time, the frequency of VTE when receiving combination oral contraceptives is less than the BTE frequency associated with pregnancy (6 cases per 10,000 pregnant women per year).

In women who take combination contraceptive drugs, extremely rare cases of thrombosis of other blood vessels (hepatic, mesenterical, renal arteries and veins, arteries and veins of the retina of the eye) are described. The connection of these cases with the reception of combined oral contraceptives is not proved.

The patient should be informed that in the development of symptoms of venous or arterial thrombosis, it is necessary to immediately consult a doctor. These symptoms include one-sided pain in the leg and / or swelling, sudden severe breast pain with irradiation into the left hand or without irradiation, sudden shortness of breath, a sudden cough attack, any unusual, strong, long-term headache, frequency and severity of migraine, sudden partial or complete loss of vision, diplopy, inseparable speech or aphasia, dizziness, collapse with / without partial seizure, weakness or very significant loss of sensitivity, suddenly appearing on one side or in one part of the body, motor disorders, symptom complex "acute" belly.

It should be borne in mind that the risk of developing venous or arterial thrombosis and / or thromboembolism increases with age; in smokers (with an increase in the number of cigarettes or raising age risk increases, especially in women older than 35 years); in the presence of family anamnesis (i.e., venous or arterial thromboembolism ever has close relatives or parents in a relatively young age); In case hereditary predisposition is supposed, the woman should be examined by the relevant specialist to address the possibility of receiving combined oral contraceptives; obesity (body mass index of more than 30 kg / m 2); dlypoproteinemia; arterial hypertension; diseases of the heart valves; atrial fibrillation; long immobilization; serious surgical intervention; Any operation on the legs or with extensive injury (in these situations it is desirable to stop using the drug / in the case of a planned operation, at least 4 weeks before it /) and not to resume reception within 2 weeks after the end of immobilization.

An increased risk of thromboembolism in the postpartum period should be taken into account.

It should be borne in mind that the risk of thrombosis during pregnancy is higher than when receiving combined oral contraceptives.

Circulatory disorders can also be observed in diabetes mellitus, a systemic red lupus, hemolytic uremic syndrome, Crohn's disease, Nyak, sickle cell anemia.

Increasing the frequency and severity of migraine while using combined oral contraceptives (which may precede cerebrovascular disorders) may be the basis for immediate cessation of these drugs.

The biochemical parameters should also be taken into account, which may indicate the predisposition to thrombosis: resistance to activated protein C, hypergomocysthenemia, deficiency of antitrombin III, protein C, protein S, the presence of antiphospholipid antibodies (antibodies to cardiolipin, lupus anticoagulant).

There are reports of some increase in the risk of developing the cervical cancer in the long-term use of combined oral contraceptives. However, the connection with the reception of combined oral contraceptives is not proved. Contradictions are preserved as to the extent to which these data are associated with screening for the pathology of the cervix or with the features of sexual behavior (more rare application of barrier methods of contraception).

The meta analysis of epidemiological studies showed that there is a slightly elevated relative risk of developing breast cancer diagnosed in women who used combined oral contraceptives. His connection with the reception of combined oral contraceptives has not been proven. The observed risk increase may also be a consequence of the earlier diagnosis of breast cancer in women applying combined oral contraceptives. In women, ever used combined oral contraceptives, earlier stages of breast cancer are detected than 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 intra-abdominal bleeding life. In the case of severe pain in the abdomen, the increase in liver or signs of intra-abdominal bleeding, this should be considered when conducting a differential diagnosis.

In women with hyperitrigliseridemia (or the presence of this state in a family history), it is possible to increase the risk of pancreatitis development during the reception of combined oral contraceptives.

Although a slight increase in blood pressure was described in many women who take combined oral contraceptives, clinically significant increases were rarely noted. Nevertheless, if during the reception of combined oral contraceptives, a persistent, clinically significant increase in blood pressure is developing, these drugs should be canceled and the treatment of arterial hypertension should be canceled. The reception of combined oral contraceptives can be continued if normal blood pressure values \u200b\u200bare achieved by hypotensive therapy.

The following states, as reported, develop or deteriorate both during pregnancy and when taking combination oral contraceptives, but their connection with the reception of combined oral contraceptives is not proven: jaundice and / or itchy associated with cholestasis; the formation of stones in the bustling bubble; Porphyry; System red lupus; hemolytic uremic syndrome; chorea; herpes of pregnant women; Hearing loss associated with otoklerosis. Cases of crown disease and non-specific ulcerative colitis are also described against the background of the use of combined oral contraceptives.

Acute or chronic disorders of the liver function may require the abolition of combined oral contraceptives until the functions of the liver function return to normal. Recurrent cholestatic jaundice, which develops for the first time during pregnancy or previous reception of sex hormones, requires stopping the reception of combined oral contraceptives.

Although combined oral contraceptives can influence insulin resistance and glucose tolerance, there is no need to change therapeutic regime in patients with diabetes mellitus using low-volume combined oral contraceptives (less than 50 μg of ethinyl estradiol). However, women with diabetes should be carefully observed during the reception of combined oral contraceptives.

Sometimes chlorism can develop, especially in women with pregnant women in the history. Women with a tendency to chloazma during the reception of combined oral contraceptives should avoid long staying in the sun and the effects of ultraviolet radiation.

The reception of combined oral contraceptives can influence the results of some laboratory tests, including the indicators of the liver, kidney function, thyroid gland, adrenal glands, the level of transport proteins in plasma, carbohydrate indicators, coagulation parameters and fibrinolysis. Changes usually do not go beyond the boundaries of normal values.

Against the background of the reception of combined oral contraceptives, irregular bleeding (oscillations), especially during the first months of application may be marked. Therefore, the assessment of any irregular bleeding should be carried out only after the period of adaptation constituting approximately three cycles. If irregular bleeding is repeated or developing after preceding regular cycles, a thorough examination should be conducted to eliminate malignant neoplasms or pregnancy.

Some women during a break in the reception of dragee may not develop cancellation. If combined oral contraceptives were taken as indicated, it is unlikely that the woman is pregnant. Nevertheless, if before that, the combined oral contraceptives were taken irregularly or, if there are no two bleeding in a row, pregnancy should be excluded until the preparation continue to receive the drug.

Impact on the ability to driving vehicles and control mechanisms

Not found.

Pregnancy and lactation

The drug is not prescribed during pregnancy. If pregnancy is detected during the reception of the minizeston 20 chases, the drug is immediately canceled. However, extensive epidemiological studies did not reveal any increased risk of development defects in children born by women who received sex hormones before pregnancy or teratogenic action, when sex hormones were taken by negligence in early pregnancy.

The reception of combined oral contraceptives can reduce the amount of breast milk and change its composition, therefore, their use is not recommended during lactation. A small amount of genital steroids and / or their metabolites can be released with breast milk, but there is no confirmation of their negative impact on the health of the newborn.

When violations of the liver function

Reception of the drug during jaundice or severe forms of liver diseases (as long as hepatic tests are not normalized), benign or malignant liver tumors (currently or anamnesis).

Conditions of vacation from pharmacies

The drug is released by the prescription.

Terms and Storage Terms

The drug should be stored in an inaccessible place for children. Shelf life - 3 years.

Registration Certificate Owner:
Gedeon Richter, PLC. (Hungary)
Representation:
Gideon Richter OJSC
Active substances:
Ethinyl Estradiol + Gestoden
ATX code:
Moisen system and sex hormones (G)\u003e Sex hormones and sexual system modulators (G03)\u003e Hormonal contraceptives for system use (G03A)\u003e Progestorates and estrogens (fixed combinations) (G03AA)\u003e Gestoden and estrogen (G03AA10)
Clinical and Pharmacological Group:
Monophause oral contraceptive
Release form, composition and packaging
The drug is released on the recipe of tab., Pok. Shell, 20 μg + 75 μg: 21 or 63 pcs.
Reg. №: RK-LS-5-№ 014072 from 03.06.2014 - Existing
Tablets covered with light yellow shell, round, double-screwed.

1 tab.
Ethinyl estradiol 20 μg
Guestful 75 μg
Auxiliary substances: Sodium Calcium Edetat, magnesium stearate, silicon Dioxide colloidal anhydrous, poveney, starch corn, lactose monohydrate.

The composition of the shell: quinoline yellow (E104), Pisidone, titanium dioxide (E171), macrogol 6000, peeled talc, calcium carbonate, sucrose.

21 pcs. - Packaging cell contour (1) - packs cardboard.
21 pcs. - Packaging cell contour (3) - packs cardboard.

The description of the drug Lindinet 20 is based on officially approved instructions for the use of the drug and made in 2015.

pharmachologic effect
Combined oral contraceptive drug. The action is due to the suppression of the production of gonadotropins. It prevents ovulation, changes the viscosity of the cervical mucus, making it difficult to penetrate the sperm into the uterine cavity, causes changes in endometrial, making it difficult to implantation, i.e. prevents conception.

In addition to contraceptive action, a number of other positive effects have a number of other positive effects.

Impact on menstrual cycle

Regulates the menstrual cycle, reduces blood loss and iron during menstruation, reduces the radiance frequency.

Actions related to braking ovulation

Reduces the frequency of development of functional ovarian cysts and ectopic pregnancy.

Other actions

Reduces the frequency of development of fibroaden and fibrous cyst of the mammary glands, infections of a small pelvis, endometrial cancer, improves the condition of the skin with acne.

Pharmacokinetics
Guestful

Suction

After receiving inside quickly and completely absorbed from the gastrointestinal tract. After one-time intake, Cmax is achieved after 1 h and is 2-4 ng / ml. Bioavailability make up about 99%.

Distribution

Guestborn binds to albumin and globulin connecting sex hormones (GSPG). 1-2% is in a plasma in free form, 50-75% specifically binds to the GSPG. The increase in the level of the GSPG in the blood caused by the ethinyl estradiol affects the level of gestode: the fraction associated with the GSPG is growing, and the fraction associated with albumin is reduced. Apparent VD - 0.7-1.4 l / kg. Pharmacokinetics general depends on the level of the GSPG. The concentration of GSPG in the blood plasma under the action of estradiol increases 3 times. With a daily reception, the concentration of gesthene in the blood plasma increases by 3-4 times and in the second half of the cycle reaches the saturation state.

Metabolism and elimination

Guestborn is completely metabolized by means of well-known paths of metabolism of steroid hormones. The average plasma clearance is 0.8-1 ml / min / kg. The concentration of the serum is reduced by two-phase. T1 / 2 in the terminal phase is 12-20 hours. Guestborn is removed with urine and bile only in the form of metabolites, in the 6: 4 Size. T1 / 2 metabolites - about 1 day.

Ethinyl estradiol

Suction

After taking inside, the ethinyl estradiol is absorbed quickly and almost completely. Cmax in blood serum is achieved after 1-2 hours after taking and amounts to 30-80 pg / ml. Absolute bioavailability due to pre-consistent conjugation and primary metabolism - about 60%.

Distribution

Fully (about 98.5%), but nonspecificly binds to albumin and induces an increase in the level of GSPG in serum. Apparent VD - 5-18 l / kg.

CSS is installed to 3-4 day of the drug intake, and it is 20% higher than after one-time reception.

Metabolism

It is subjected to aromatic hydroxylation with the formation of hydroxylated and methyl metabolites, which are present in the form of free metabolites or in the form of conjugates (glucuronides and sulfates). Metabolic clearance from blood plasma is about 5-13 ml.

Election

Two-phase serum concentration is reduced. T1 / 2 in the terminal phase - about 16-24 hours. Ethinyl estradiol is released only in the form of metabolites, in a 2: 3 ratio with urine and bile. T1 / 2 metabolites - about 1 day.

Indications for use
- oral contraception.
Dosing mode
Assign 1 tab. / Sut for 21 days, if possible at the same time of the day. Receiving tablets from the following packaging should be started after a 7-day interruption, during which the cancellation should begin. Usually bleeding begins on 2 or 3 days after receiving the last tablet and it may not end before receiving tablets from the following packaging.

Reception of the drug Lindinet 20 for the first time

The first tablet of the drug Lindinet 20 should be taken on the first day of the menstrual cycle. The use of the drug can also be started from the 2nd to the 5th day of menstruation, but in this case it is necessary to use additional non-correctional contraception measures during the first 7 days of reception of the tablets during the first cycle.

Transition from a combined oral contraceptive

The first tablet of the drug Lindinet 20 should be taken the day after taking the last active (hormone-containing) tablet of the previous drug, but no later than the next day after receiving ordinary tablets (or receiving placebo tablets) from the previous packaging.

Transition from progestugen-containing drugs (mini-saw, injection, implant, navy)

The transition from mini-saw can be started on any day of the menstrual cycle; in the case of an implant or IUD - on the day of their removal; In the case of injections - per day when it is necessary to make the following injection. At the same time, in the first 7 days of reception of Lindinet 20, it is necessary to apply an additional method of contraception.

After abortion in the first trimester of pregnancy

Acceptance of the contraceptive can be started immediately after an abortion, while there is no need to apply the additional method of contraception.

After childbirth or after abortion in the II trimester of pregnancy

Women, not breastfeeding, can start taking the drug for 21-28 days. With a later start of reception of the drug in the first 7 days, it is additionally necessary to apply the barrier method of contraception. In the case when the sexual contact took place before contraception, before starting the drug, pregnancy should be deleted or postpone the start of reception to the first menstruation.

Missed tablets

When receiving a tablet, the missed tablet must be taken as quickly as possible. If the interval in the reception of the tablets was less than 12 hours, the contraceptive effect of the drug is not reduced, and in this case there is no need to apply the additional method of contraception. The remaining tablets should be taken at normal time.

If the interval amounted to more than 12 hours, the contraceptive effect of the drug may decrease. In such cases, a woman should take a missing tablet as soon as she remembers about it, even if you have to take 2 tablets at the same time. Next, you should take tablets at normal time. The following 7 days require the use of an additional method of contraception. If less than 7 tablets remained in the package, then to the receiving tablets from the following packaging are proceeding without interruption. In such cases, the cancellation occurs only at the end of the second packaging, however, oscillations or breakthrough bleeding are possible.

If, upon completion of the reception of tablets from the second packaging of bleeding, the cancellation does not occur, then before continuing the reception of the contraceptive, the presence of pregnancy should be eliminated.

Measures taken in case of vomiting

If in the first 3-4 hours after taking the next tablet there is vomiting, the tablet is not completely absorbed. In such cases, in accordance with the instructions described in the "Missed Tablets" paragraph.

If the patient does not want to deviate from the usual contraceptive mode, the missed tablets should be taken from another packaging.

Changing the start date of menstruation

For menstrual bleeding begins earlier than usual when receiving tablets, it is recommended to reduce the break between the reception of the tablets on the desired number of days. The shorter the break in the reception of the drug is, the more likely it is that menstrual-like bleeding will occur, and breakthrough or cargo bleeding will appear during the reception of the drug from the following packaging.

To delay the menstruation, the drug intake should be continued from the new packaging without a 7-day break in the drug intake. Menstruation can be delayed, if necessary, so long as required until the tablets from the second packaging are completed. When taking tablets from the second packaging, breakthrough bleeding or weeding sections may appear. Regular reception of the drug Lindinet 20 can be resumed after the usual 7-day break.

Side effect
Determination of the frequency of adverse reactions: very often (≥1 / 10), often (from ≥1 / 100 to<1/10), нечасто (от ≥1/1000 до <1/100), редко (от ≥1/10 000 до <1/1000), очень редко (<1/10 000). Со стороны нервной системы: часто — головная боль, головокружение, мигрень; очень редко — обострение хореи. Психические нарушения: часто — изменение настроения, депрессия, нервозность, раздражительность, снижение или повышение либидо. Со стороны органа слуха: редко — отосклероз. Со стороны органа зрения: редко — непереносимость контакнтых линз; очень редко — неврит зрительного нерва, тромбоз артерии сетчатки глаза. Со стороны пищеварительной системы: часто — тошнота, рвота, боль в животе; нечасто — снижение/повышение аппетита; очень редко — заболевания желчного пузыря, желчнокаменная болезнь, панкреатит, гепатоцеллюлярная карцинома, аденома печени. Со стороны сердечно-сосудистой системы: нечасто — артериальная гипертензия; редко — тромбоз, эмболия; инсульт, инфаркт миокарда. Со стороны половой системы и молочной железы: очень часто — прорывные кровотечения, мажущие выделения между менструациями; часто — вульвовагинальный кандидоз, болезненность и нагрубание молочных желез; нечасто — рак молочной железы. Со стороны обмена веществ: часто — задержка жидкости; редко — нарушение толерантности к глюкозе, гиперлипидемия, гипертриглицеридемия. Со стороны кожи и подкожных тканей: часто — акне; нечасто — хлоазма (мелазма). Аллергические реакции: редко — анафилактические реакции. Прочие: часто — снижение/увеличение массы тела; очень редко — обострение системной красной волчанки, гемолитико-уремичесикй синдром. Применение пероральных контрацептивов связано с повышенным риском развития следующих состояний: — артериальные и венозные тромботические и тромбоэмболические осложнения, включая инфаркт миокарда, инсульт, тромбоз вен и эмболию легочной артерии; — интраэпителиальная неоплазия шейки матки и рак шейки матки; — рак молочной железы. Неврит зрительного нерва может привести к частичной или полной потере зрения. Применение пероральных контрацептивов может усугубить течение существующего заболевания желчного пузыря и ускорить развитие болезни у женщин, ранее не имевших симптомов заболевания. Противопоказания к применению - беременность и подозрение на нее; - влагалищное кровотечение неясной этиологии; - артериальные или венозные тромбозы в настоящее время или в анамнезе; - наличие серьезных факторов риска развития тромбоза или эмболии (нарушения системы свертывания крови, пороки сердца, фибрилляция предсердий); - наличие продромальных симптомов тромбоза в анамнезе (например, транзиторная церебральная ишемическая атака, стенокардия); - сердечно-сосудистые нарушения (патология клапана (клапанов) сердца, аритмии); - тяжелая артериальная гипертензия; - доброкачественная или злокачественная опухоль печени в анамнезе, тяжелое заболевание печени (до нормализации параметров функциональных проб печени); - диагностированные или подозреваемые злокачественные опухоли матки или молочных желез или другие эстрогензависимые новообразования; - сосудистая офтальмопатия; - мигрень с очаговой неврологической симптоматикой; - герпес беременных в анамнезе; - серповидно-клеточная анемия; - гиперлипидемия; - диабетическая ангиопатия; - детский и подростковый возраст до 18 лет; - наследственная непереносимость фруктозы, дефицит лактазы lapp, мальабсорбция глюкозы-галактозы; - повышенная чувствительность к компонентам препарата. Применение при беременности и кормлении грудью До начала приема препарата Линдинет 20 следует исключить беременность. Если беременность наступила в период применения препарата, необходимо немедленно прекратить прием пероральных контрацептивов. Обширные эпидемиологические исследования не обнаружили ни повышенного риска развития врожденных пороков развития у новорожденных, родившихся у женщин, принимавших пероральные контрацептивы до беременности, ни тератогенного действия (в частности, пороков сердца и аномалий развития конечностей) в случаях, когда пероральные контрацептивы непреднамеренно принимались на ранних сроках беременности. Небольшое количество активного вещества выделяется с грудным молоком, что может вызвать у новорожденных такие побочные эффекты, как желтуха и увеличение молочных желез. В период кормления грудью не рекомендуется принимать пероральные контрацептивы, т.к. это может привести к сокращению количества грудного молока и к изменению его состава. Применение при нарушениях функции печени Противопоказано применение препарата при доброкачественных или злокачественных опухоль печени в анамнезе, тяжелых заболеваниях печени (до нормализации параметров функциональных проб печени). Применение у детей Противопоказано применение препарата в детском и подростковом возрасте до 18 лет. Особые указания Нарушения кровообращения Применение контрацептивов связано с повышенным риском развития инфаркта миокарда. Риск выше у курящих женщин, имеющих дополнительные факторы риска развития заболеваний коронарных сосудов, таких как артериальная гипертензия, повышенное содержание холестерина в крови, патологическое ожирение и сахарный диабет. Курение увеличивает риск серьезных сердечно-сосудистых осложнений, связанных с применением пероральных контрацептивов. Риск повышается с возрастом, а также в случае выкуривания большого количества сигарет (риск является довольно существенным у женщин старше 35 лет). Женщинам, принимающим пероральные контрацептивы, следует рекомендовать отказаться от курения. Женщинам с факторами риска развития сердечно-сосудистых заболеваний следует назначать пероральные контрацептивы с осторожностью. Было доказано, что прием пероральных контрацептивов повышает риск развития цереброваскулярных заболеваний (ишемического и геморрагического инсульта). Также сообщалось о повышении АД у женщин, принимающих пероральные контрацептивы. Повышение АД обычно наблюдается у женщин старшего возраста и у тех, кто принимает пероральные контрацептивы в течение длительного времени. Полученные данные показывают, что частота развития артериальной гипертензии возрастает в зависимости от количества эстрогенов. Женщинам, которые ранее страдали от артериальной гипертензии или заболеваний, связанных с артериальной гипертензией или нарушением функции почек, следует рекомендовать использовать другой метод контрацепции. Необходимо тщательно следить за состоянием таких пациенток, если они решили принимать пероральные контрацептивы. В случае значительного повышения АД следует прекратить прием пероральных контрацептивов. У большинства женщин повышенное АД нормализуется после отмены пероральных контрацептивов. Различий в частоте развития артериальной гипертензии между женщинами, ранее принимавшими и не принимавшими пероральные контрацептивы, нет. Венозный и артериальный тромбоз и тромбоэмболия Применение комбинированных пероральных контрацептивов связано с повышенным риском венозных и артериальных тромботических и тромбоэмболических осложнений. Для каждой конкретной комбинации эстроген/прогестаген следует назначать тот режим дозирования, который содержит минимальное количество эстрогена и прогестагена, одновременно обеспечивает низкий процент неудач и соответствует потребностям пациентки. Венозный тромбоз и тромбоэмболия Применение любых комбинированных пероральных контрацептивов влечет за собой повышенный риск венозной тромбоэмболии (ВТЭ) по сравнению с таковым без применения комбинированных пероральных контрацептивов. Дополнительный риск венозной тромбоэмболии наиболее высок в течение первого года применения комбинированных пероральных контрацептивов. Этот риск меньше риска ВТЭ, связанного с беременностью, который составляет 60 случаев на 100 000 беременностей; ВТЭ приводит к летальному исходу в 1-2% случаев. Частота развития ВТЭ для комбинированных пероральных контрацептивов, содержащих левоноргестрел и менее 50 мкг этинилэстрадиола, составляет приблизительно 20 случаев на 100 000 женщин за год применения. Частота развития ВТЭ для комбинированных пероральных контрацептивов, содержащих гестоден, приблизительно 30-40 случаев на 100 000 женщин за год применения. Влияние относительного риска на количество дополнительных случаев выше у женщин в течение первого года применения комбинированных пероральных контрацептивов. Эпидемиологические исследования не подтвердили, что женщины, принимающие комбинированные пероральные контрацептивы, содержащие дезогестрел или гестоден и 0.02 мг этинилэстрадиола, имеют меньший риск развития ВТЭ, чем женщины, принимающие комбинированные пероральные контрацептивы, содержащие дезогестрел или гестоден и 0.03 мг этинилэстрадиола. Факторы риска артериальной и/или венозной тромбоэмболии — возраст; — курение (интенсивное курение и возраст старше 35 лет значительно повышают риск развития артериальной и/или венозной тромбоэмболии); — наследственная предрасположенность (например, артериальная или венозная тромбоэмболия у братьев и сестер или родителей в сравнительно молодом возрасте). При наличии наследственной предрасположенности, до принятия решения о приеме пероральных контрацептивов, женщину следует направить на прием к специалисту; — ожирение (ИМТ >30 kg / m);

- dislipoproteinemia;

- arterial hypertension;

- Plok valve of the heart;

- atrial fibrillation;

- long-term immobilization (because the risk of thromboembolism is elevated in the postoperative period, it is recommended to stop the reception of oral contraceptives at least 4 weeks before the planned operation and return to their reception not earlier than 2 weeks after returning to normal motor activity).

Because The period immediately after delivery is associated with an increased risk of thromboembolism, the use of the drug Lindinet 20 should be started not earlier than on the 28th day after childbirth or abortion in the II trimester of pregnancy.

Arterial thrombosis and thromboembolism

Lindinet 20 increases the risk of arterial thrombotic and thromboembolic complications. The complications described include myocardial infarction and cerebrovascular disorders (ischemic and hemorrhagic stroke, transient ischemic attack). The risk of developing arterial thrombotic and thromboembolic complications is higher in women with additional risk factors.

It should be cautious to appoint Lindinet 20 women with risk factors for the development of thrombotic and thromboembolic complications.

Examples of risk factors contributing to the development of thrombotic and thromboembolic complications:

- smoking;

- hereditary and acquired thrombophilia;

- arterial hypertension;

- hyperlipidemia;

- obesity;

- age.

Women suffering from migraine and host combined oral contraceptives have an increased risk of stroke.

The use of the drug should be immediately discontinued when symptoms indicating the development of thrombosis: severe pain in the chest, which can be given to the left hand, unusual pain in the leg, swelling of the leg, sharp pain during breathing or cough, the appearance of sputum with blood.

Biochemical parameters indicating the presence of hereditary or acquired predisposition to venous or arterial thrombosis include the following: resistance to activated protein C (APS), hypergomocysthenemia, deficiency of antithrombin III, Protein deficiency, protein deficiency, antiphospholipid antibodies (anti-kardolypin antibodies, Wolved anticoagulant).

Tumors

Some studies have reported on increased risk of cervical cancer in women who have taken combined oral contraceptives for a long time, but this information is controversial. Sexual behavior and other risk factors, such as human papilloma virus (HPV), can also influence the development of cervical cancer.

The meta-analysis of 54 pharmaco-epidemiological studies showed that the relative risk of breast cancer is somewhat higher in women taking combined oral contraceptives (OR \u003d 1.24). This increased risk is gradually decreasing within 10 years after the cessation of the reception of combined oral contraceptives. However, these studies have not confirmed the presence of a causal relationship between disease and drug intake. In women taking oral contraceptives, breast cancer is diagnosed at an earlier stage than those who do not apply them.

The relationship between the formation of benign liver tumors and the reception of oral contraceptives is established, although such benign tumors are rare. With the break of these tumors, intraperitoneal bleeding is observed, which can lead to a fatal outcome.

In rare cases, it was reported on the development of malignant liver tumors in women, long-term oral contraceptives. In patients who have an anamnesis indication on cholestatic jaundice or itching during pregnancy, as well as patients who previously taking combined oral contraceptives, the risk of developing the described diseases above. If such patients receive Lindinet 20, careful monitoring of their condition is needed, and when the pathological state is returned, the use of the drug must be discontinued.

Other states

In rare cases, thrombosis of the vessels of the retinal of the eye when receiving oral contraceptives was reported. In the case of an inexplicable partial or complete loss of vision, the appearance of an exophthalma or diplopia, the swelling of the optic nerve or damage to the retinal vessels, it is necessary to cancel oral contraceptives and assign an additional medical examination.

Previous studies indicated the relative risk of gallbladder diseases in women who take oral contraceptives and preparations containing estrogen. However, recent studies have shown that the relative risk of the development of gallbladder diseases can be minimal in women receiving low-base oral contraceptives.

The emergence of migraine or strengthening of migraine attacks, as well as the appearance of a new type of headache, repeating, constant or very strong, requires stopping the reception of oral contraceptives.

The drug Lindinet 20 should be canceled immediately in case of the appearance of a generalized itch or epileptic seizures.

Effect on carbohydrate and lipid metabolism

There are reports of violation of glucose tolerance in women receiving oral contraceptives. Therefore, it is necessary to carefully monitor the state of women suffering from diabetes and receiving oral contraceptives.

A small amount of women during the use of oral contraceptives is observed persistent hyperitriglyceridemia. When applying some progestogen-containing drugs, a decrease in the concentration of HDL has been reported. Because Estrogen increases HDL cholesterol, the cumulative effect of oral contraceptives on the metabolism of lipids depends on the relationship between estrogen and progestogen doses, and the type of progestogen, as well as the absolute amount of the progestogen used in the oral contraceptive.

It should be carefully monitoring the condition of women suffering from hyperlipidemia if they decided to accept oral contraceptives. There are reports that in women suffering from hereditary hyperlipidemia and receiving oral contraceptives containing estrogen, there is a significant increase in the concentration of triglycerides in the plasma, which can lead to pancreatitis.

Menstrual violations

When applying the drug, especially during the first 3 months, irregular menstruation (separating selection or breakthrough bleeding) can be observed.

If irregular menstruation persists for a long time or develop after the regular cycle has been established, it should be noted that this phenomenon may have a non-immortal cause. In this case, to eliminate the possibility of developing malignant neoplasm or pregnancy, it is necessary to hold a gynecological examination. If the pathological condition is excluded, it is possible to recommend the use of oral contraceptives of another type.

In some cases, a 7-day break in contraception is not accompanied by bleeding. In cases where the use of the contraceptive was carried out not on the prescription, or when at the end of receiving all tablets from the current packing of bleeding is not before continuing the use of the contraceptive from the following packaging, pregnancy should be eliminated.

Medical examination and subsequent observation

Prior to the use of oral contraceptives, a family and personal history of the patient should be collected, to conduct a general medical and gynecological examination, including the measurement of blood pressure, laboratory tests, the examination of the mammary glands and the organs of the small pelvis, as well as the cytological analysis of the cervical smear; In the future, these procedures should be repeated periodically.

It should be informed for the patients that this drug does not protect against HIV infection (AIDS) and other sexually transmitted diseases.

Function of the liver

In the case of an acute or chronic violation of the liver function, it is necessary to stop taking the drug until the functional liver samples are normalized. In patients with disturbed liver function, the metabolism of steroid hormones may be insufficient.

Affective disorders

Women from which severe depression develops during the use of oral contraceptives, the drug should be discontinued. Such patients must be recommended to use an alternative method of contraception, should also be attempted to determine whether these symptoms arise as a result of the use of drugs for oral contraceptive. It should be carefully followed by the state of women who suffered from depression earlier; If the attacks are renewed, one should stop accepting oral contraceptive.

The concentration of folate in serum can decrease due to the use of oral contraceptives. This may have a clinical meaning if soon after the cessation of oral contraceptives, a woman becomes pregnant.

Chloasm

The emergence of chloasma is particularly often observed in women who have an intention on the chloazma of pregnant women. Women predisposed to chloasm should be avoided while staying in the sun, as well as ultraviolet radiation during the use of oral contraceptives.

Other

In addition to the states listed above, increased precautionary measures should be taken in the case of reversible sclerosis, epilepsy, chores, intermittent porphyria, seizures, impaired kidney function, obesity, systemic red lupus and uterine misa.

Patients with such rare hereditary diseases such as fructose intolerance, glucose-galactose malabsorption, or insufficiency of isomaltase, should not be applied.

Impact on the ability to driving vehicles and control mechanisms

Given the possibility of developing such side effects as dizziness, violation of vision, care must be taken when managing the vehicle and working with mechanisms.

Overdose
Symptoms: nausea, vomiting, young girls - small vaginal bleeding.

Treatment: Conducting symptomatic therapy.

Medicinal interaction
The interaction between ethinyl estradiol and simultaneously used drugs can lead to an increase or decrease in the concentration of ethinyl estradiol in plasma.

The decrease in the concentration of ethinyl estradiol in the plasma can lead to an increase in the number of breakthrough bleeding and disorders of the menstrual cycle, sometimes there is also a decrease in the contraceptive effect of the drug Lindinet 20. Therefore, in the case of the simultaneous use of ethinyl estradiol and drugs that reduce the concentration of ethinyl estradiol in plasma, in addition to the use of the drug Lindinet 20 It is recommended to use non-correlated methods of contraception (for example, condoms, spermicides). If a long-term use of drugs containing such active substances should be considered the possibility of refusing to use hormonal contraceptives as the main method of contraception.

After stopping the reception of drugs that reduce the concentration of ethinyl estradiol in the blood, it is recommended to use additional non-membrane contraception methods for at least 7 days. After the cessation of drugs that can cause the induction of microsomal liver enzymes and lead to a decrease in the concentration of ethinyl estradiol in serum, it is recommended to use additional non-correctional methods of contraception for a longer period. Sometimes, depending on the dose, the duration of treatment and the rate of removal of the drug, which causes the induction of enzymes, can pass the week before the induction of the liver enzymes will completely stop.

Active substances that can reduce ethinyl estradiol concentration in blood serum:

- any active substance that reduces the transit time on the gastrointestinal tract, and, therefore, reduces the absorption of the drug;

- substances that induce microsomal liver enzymes, for example, rifampicin, rifabutin, barbiturates, prison, phenylbutazone, phenytoin, dexamethasone, griseofullvin, topiramate, some protease and modafinyl inhibitors;

- Hypericum Perforatum (St. John's wort) and ritonavir (due to the ability to induce microsomal liver enzymes);

- Some antibiotics (for example, ampicillin and other penicillins, tetracyclines), because They reduce the hepatic intestinal recycling of estrogen.

Active substances that can increase the concentration of ethinyl estradiol in serum:

- Atorvastatin;

- preparations, which are also subjected to sulfatization in the tract wall, for example, ascorbic acid (vitamin C) and paracetamol;

Toleandomycin when sharing with oral contraceptives can increase the risk of internal cholestasis.

Ethinyl estradiol can influence the metabolism of other drugs, inhibiting the liver microsomal enzymes or causing conjugation of drugs in the liver, in particular, glucuronidation. Thus, the concentrations of other drugs in the plasma and tissues may increase (for example, concentrations of cyclosporine, theophylline, corticosteroids) or decrease.

Assigning any drugs should take into account information on their sharing in order to establish possible reactions of interaction.

Changes in the results of laboratory studies

The use of oral contraceptives may affect the results of some laboratory studies, among which tests for determining the function of the liver, thyroid gland, adrenal glands, kidneys, lipoprotein and carrier proteins, as well as the parameters of carbohydrate exchange, coagulation and fibrinolysis.

Usually, the changes do not go beyond the reference values \u200b\u200band remain within the normal range.

Conditions of vacation from pharmacies
The drug is released by the prescription.
Terms and Storage Terms
The drug should be stored in the original packaging, in the place protected from light and moisture, inaccessible to children at temperatures from 15 ° to 25 ° C. Shelf life - 3 years.

Unplanned pregnancy often ends with an abortion. This method adversely affects health, so it is necessary to use effective methods of contraception. One of the best ways to prevent pregnancy today is recognized as the use of oral contraceptives, which contain synthetic analogues of female sex hormones.

The effectiveness of modern contraceptive pills reaches 100%. In many cases, due to it, the healing effect is achieved. Oral hormonal contraceptives (OK) apply more than 40 years. During this time, they were constantly studied and improved. Combined OK, in which the content of hormones is significantly reduced, and the contraceptive efficiency is stored.

How does hormonal contraception operate

The contraceptive tablets "turn off" ovulation, while cyclic bleeding resembling menstruation. The follicle does not grow, it does not ripen the egg, it does not come out of the ovaries, so the pregnancy is impossible. In addition, the mucus is thickened in the cervix, and the endometrium changes, which prevents the attachment of the fertilized egg in the case of pregnancy.

The useful influence of oral contraceptives on the woman's body is as follows:

• stabilization of the menstrual cycle, while the amount of blood released is reduced. It helps to adjust the iron deficiency anemia that occurs in many women;
• reduction in abdominal pain during ovulation with and manifestations;
• increase the protective properties of the mucus of the cervical canal, which doubles the frequency of infections of the uterus and appendages;
• reducing the frequency and associated scraping;
• reducing the risk of developing mastopathy when taking monophazic oral contraceptives, especially containing transgestainenes with low androgenic activity;
• suppression of the production of androgen in the ovaries, helping to treat acne, seborrhea, girsutism and other manifestations of virile syndrome. This is especially characteristic of contraceptive pills containing progestogens with an antagandogenic effect or low androgenic activity;
• raising bone density, improving calcium assimilation, which prevents the development of osteoporosis.

The composition of oral contraceptives, classification and their name

Combined oral contraceptives contain an estrogen and progestogenic component. Progestogens warn pregnancy, and estrogen causes endometrial proliferation, imitating its normal development, and irregular uterine bleeding is excluded. In addition, it replaces its own estrogens in the body, which cease to be produced in the ovaries when using oral contraception.

Active estrogen, contained in most contraceptive drugs - ethinyl estradiol. The progestogen component is submitted by 19 - Northestosterone derivatives: Norethisteron, Levonorgestrel, Northestrel. Modern progestogens are created: Dienenegest, Chrospirenone, Desostrell, Nortestimat, Gestoden. They have a minimal androgen effect, do not cause weight gains, do not affect the exchange of fats in the body.

After childbirth, it is recommended to take medicines only with a progestogen component (mini-saw), since estrogens suppress milk isolation. Pure gestage preparations are also shown to women who need to limit estrogen flow (patients with hypertension, diabetes, obesity). These include microlo, excluton, charokette (contains desogestrel).

If oral contraceptives contain less than 35 μg of estrogen, they are called "low-volume". In microstrosy contraceptive tablets, the concentration of estrogen is reduced to 20-30 μg. Highly loomed preparations with the content of ethinyl estradiol 50 μg are used mainly in therapeutic purposes.

What is the difference between monophasic, two- and three-phase drugs?

Oral contraceptives are divided into monophasic, two-phase and three-phase.

• In the monophasic content of both components equally in all pills.
• Two-phase contain permanent dose of estrogen and the changing concentration of progestogen, which increases in the second phase of the cycle. At the same time, the total dose of estrogen is somewhat larger than in monophazic preparations, and progestogennes are less.
• Three-phase contraceptives have a changing ratio of components that imitating a normal menstrual cycle.

List of most common monophasic contraceptives:

• substroached: Femoden, containing desogestrel - marvelon and regular relative;
• microdosted: Logest, containing Desogestrel - Mersilon and nineteen.

List of new generation hormone contraceptives with three-phase structure:

• Three-mercy (contains desogestrel);
• Trial;
• Trisilest.

Contraceptive tablets with antiandogenic effect are in its composition a progestogenic component with an anti-sandrogenic effect (Diana-35, Zhanin) or with a strong progesterone-like influence (three-mercy, regular, nineteen). Preparations with a desogestrel content are often used to treat hyperandrode in adolescents.

Chrospirenone is a fourth-generation progestogenic component, which has a significant anti-estrogenic, antagandogenic, antigonadotropic effect. It does not cause any serious side effects. Chrospirenone, in particular, is part of such a microdosted monophasic preparation as Dimia. It is especially indicated by patients with unstable arterial pressure. This drug very effectively removes signs of premenstrual syndrome.

Classification of oral contraceptives depending on the composition and phasinity of the action:

Fixed combinations of estrogen and progestogenis:

1. Northell + Estrogen (Zyklo Proginova)
2. Levonorgestrel + Estrogen (Microjinon, Miniziston 20 FEM, Oralcon, Riguevidon)
3. Desogestrel + Estrogen (Marvelon, Mersilon, Novinet, Regulon)
4. Gestoden + Estrogen (Gestrell, Lindinet, Logest, Femoden)
5. Northesa + Estrogen (Silest)
6. Chrospiren + Estrogen (Viosa, Dalarla, Jess, Dimia, Midiana, Model Pro, Model Trend, Yarina)
7. Nomegastrol + Estrogen (Zoeli)
8. Dienenoyst + Ethinyl Estradiol (Diecyclen, Zhanin, Silhole)

Progestogens and estrogens in combinations for consistent reception:

1. Levonorgestrel + estrogen (three-regrol, triesstrel, trivilar)
2. Desogestrel + estrogen (three-mercy)

Progestogen:

1. Linestrenol (EXLUTON)
2. Levonorgestrel (Postinor, Escapel, Eskinor-f)
3. Desogestrel (Lortinet, Model Mom, Charozetta)

Preparations for emergency contraception - Levonorgestrel.

Which of the listed funds is better to choose for permanent reception? It is impossible to answer this question uniquely. Different drugs will be more effective in different situations.

Selection of hormonal oral contraceptives

The purpose of hormonal contraceptives is carried out by a gynecologist after examining and accounting for many factors: the age of the patient, such as the contraceptive, dosage and type of progestogenic component, dose of estrogen.

The best contraceptive tablets of the new generation contain in its composition such progestains, as Gested, Desogestrel, Northestimat, Chrospirenone.

How to choose contraceptive pills depending on age:

1. For women under the age of 35 years, low-volume or microdosted monophazic contraceptives, as well as three-phase, including a desogestrel or understreagnene, are preferred.
2. Women after 35-40 years will come more monophazic drugs with desogestrel or neighborhood, pure progestins or microdosisted means.

The names of contraceptive tablets should be clarified by the doctor, because in the recipe, most likely, only active substances will be indicated. The specific name of the drug does not have the right to write in the recipe now.

How to take contraceptive pills

For permanent reception, for many years, the "21 + 7" scheme was used by doctors. Now the "24 + 4" mode is obtained, that is, 24 days of reception, break in the reception 4 days.

During the break, bleeding, resembling menstruation, usually occurs. It can begin 2-3 days after stopping the reception and continue during the first days of receiving a new packaging.

There are modes that allow to shift the life of the beginning of this bleeding or reduce the number of such cycles during the year. These modes can be used briefly, for example, when traveling to sports competitions or on vacation, in front of a surgical operation and so on. Modes for long-term admission can be assigned during treatment, anemia, as well as with the peculiarities of the life of a woman, including sports and professional activities. At the same time, a woman has no monthly for weeks.

Long-term reception of oral contraceptives without a break is used in diseases of genital organs, for example,. In addition, it increases the reliability of contraception and does not harm health.

Schemes for receiving hormonal contraceptives

Tablets are used inside, once a day, at the same time, drinking with a small amount of water. For convenience, many modern contraceptives are available in special packages that facilitate the counting of days. When receiving the drug, you need to follow the clear rules specified in the instructions. Most often, it is recommended to take the following tablet as soon as possible and use barrier methods of contraception during this cycle.

Pregnancy after stopping the reception may occur in different times - from month to year. It depends on the state of the health of the woman, its hormonal background, the function of the ovaries. Reception of oral contraceptives in cycles preceding pregnancy is safe for the future child. If pregnancy is suspected, the immediate cancellation of oral contraceptives is needed. However, their use in the early stages will also not cause the fruit of harm.

In some cases, short-term reception of contraceptives for 3 months is used to stimulate ovulation after their cancellation, which increases the chance to get pregnant. This property of hormonal contraceptives is used to treat infertility.

How long can you take contraceptive pills?

With regular observation in the gynecologist, good tolerability and efficiency, such drugs are used for several years. If necessary, the medicine can be changed, but the method of hormonal contraception itself has proven itself to treat and prevent female diseases.

Emergency contraception

Cases of its use are not uncommon, especially if the woman uses primitive prevention methods (interrupted sexual intercourse). It happens that the condom is torn or violence occurs. The names of emergency contraceptive pills should know every woman. Most often apply to the means as postinor, Escapel, Eskinor-F.

You need to take them in the first 72 hours after sexual intercourse. Repeat the same drugs in the current menstrual cycle is not recommended. For pregnancy protection, barrier methods of contraception should be applied. In the case of a repeated unprotected intercourse during the cycle, only emergency non-coronal contraception applies using Danazole preparation. Its efficiency is significantly lower than Levonorggestrel.

Side Effects and Contraindications

One of the main myths about contraceptive pills are the opinion that they are able to cause a malignant tumor. Modern oral contraceptives do not cause cancer. In contrast, in women using this method of contraception for 3 years, the endometrium cancer frequency is reduced twice, the frequency of cancer of the ovaries or intestines is one third.

Side effects are most often expressed weakly. At the beginning of the reception, they arise in a third of the patients, then these phenomena are observed in each tenth woman.

Side effects of oral contraceptives:

1. Clinical:

• A) common;
• B) causing cycle disorders.

2. Welfings dependent hormones.

Common side effects include headache and dizziness, depression, a sense of voltage in lactic glands, weight gain, irritability, stomach pain, thrombophlebitis, reduction of glucose tolerance, skin rash and other symptoms. Allergies to the components of the drug are not excluded. Hair loss When taking such funds, it is rare, it is associated with insufficient antidrogenic drug activity and requires a change in the drug to more efficiently.

Menstrual violations include intermenstrual separating sections when receiving hormonal contraceptives, as well as the absence of menstruation. If the side effects do not pass within 3 months, you need to replace the drug to another.

Amenorrhea after receiving hormonal contraceptives arises due to endometrial atrophy, passes independently or is treated with estrogen.

Heavy consequences after receiving contraceptives are rare. These include thrombosis and thromboembolism, including deep veins or pulmonary artery. The risk of these complications is lower than during pregnancy. However, oral contraceptives are relatively contraindicated, if there are at least one risk factor of thrombosis: smoking, obesity, arterial hypertension.

Application is contraindicated in the following cases:

• arterial and venous thrombosis;
• transferred transient ischemic attack;
• coronary artery disease;
• sugar diabetes with vascular complications;
• migraine with focal neurological symptoms;
• combination of risk factors thrombosis;
• severe diseases of the liver and pancreas;
• tumors of liver, genitals, mammary glands;
• uterine bleeding obscure causes;
• pregnancy;
• for combined drugs - lactation.

If you avoid using contraceptive tablets with such contraindications, then the likely harm from hormonal contraceptives is significantly less than their real benefits.

If a woman does not want or can not take hormonal ok, for pregnancy protection, it can use non-flameless contraceptive tablets of a new generation. It is necessary to clearly understand that the spermicidal agents for local applications are understood under them, that is, vaginal pills. They need to be introduced into the vagina in front of the sexual act. These drugs not only kill spermatozoa, but also have an anti-inflammatory effect. Unfortunately, the contraceptive effectiveness of such drugs is less, the chance to get pregnant when used is 20-25%. From this group, Vaginal Tablets Pharmatex, Benatex, Gynecotex are most often used.

In modern gynecology, hormonal contraception is considered the "gold standard" for protection against unwanted pregnancy. Modern means are effective, well tolerated, not only contraceptive, but also the healing effect. An independent choice of contraceptive pills is difficult. To discuss the issues of pregnancy protection, you must consult a doctor.