Contraceptive pills: names, composition, choice, use. Reviews of the contraceptive Jess

I hope that my review will be useful and even instructive in some way. for those who drank, drinks,

plans to drink or stop taking hormonal oral contraceptives- contraceptives

tablets. I decided to do all this not only at the call of my body, but also after reading a scientific book on

medicine "Killer Hormones"(full list of authors: S.A. Krasnova, L.G. Makarova, K.M. Kapustin,

V.S. Tundaleva). The title sounds creepy, the contents of the book itself are even more creepy, but if you

medical education, you will still understand what we are talking about. It is forbidden to disclose here

With the help of this book, I solved the problems of canceling hormonal oral contraceptives. Internet

replete with all sorts of terrifying articles about the dangers of hormonal pills (including contraceptives)

Vova), at one point not only did I become afraid to drink, but I also wanted to get pregnant. I

I personally quit taking hormonal pills three times. It is true what they say that God loves the Trinity!

From the third I did it once and I invite you to share this joy with me.

After reading the book “Killer Hormones,” I not only understood how each hormone “works” in our

body, but also how psychosomatic disorders can affect the production of hormones. This

hormones responsible for the thyroid gland, mammary gland and ovaries. And now I don't have

no desire to stuff your body with hormones from the outside. And here is my sad story...

With my example, you can understand how the drugs themselves and their dosage can affect the body.

I've been drinking OK since I was 19 years old, that's about 5 years with short breaks. Saw 3 types of tablets:

Each drug has its own indications and contraindications, its advantages and side effects, but

women's health is much more important than all these pills and all the "delights" of their use.

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It all started with a slight hormonal imbalance and skin problems. I think that few people in their youth

age, the skin is ideal, but 2-3 pimples did not bother me, but my gynecologist was very embarrassed

and a mammologist. I had to start taking oral contraceptives even though in their direct

action ( protection against pregnancy ) I didn't need it. I passed the expensive tests and moved on.

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My first contraceptive was Diane-35.

ethinyl estradiol 35 mcg, cyproterone acetate 2 mg

Monophasic oral contraceptive - this means that on each day of the cycle with each tablet

The dosage of the drug is the same. The drug is a combination drug, and this in turn

means it uses two (or more) types of hormones. Low-dose drug.

Pros: Yes, my skin has become clearer, I forgot about oily skin and pimples. Hair began to grow faster

my teeth became better, I forgot to even think about visiting the dentist. Hair above the upper lip too

didn't grow at all. The weight decreased because the appetite also decreased. Breasts have become the same size

more. I forgot what heavy sweating in the heat is. About the fact that the pain disappeared on the first day

“Red days of the calendar” I am generally silent. The cycle is not by the day, but by the hour, it does not flood. If consider,

that before there was heavy bleeding and severe pain (to the point that my legs gave out). By

for women, no inflammation or problems. Now I felt confident any day.

Efficiency increased, mood improved, and self-confidence appeared. Libido

it was also great. The drug does not have any negative impact on blood clotting and health in general.

Minuses: Large skin pigmentation when tanning, freckles. Cuperosis. My legs swelled a little in the heat,

green wreaths on the legs in the heat (then disappeared), a small amount of cellulite appeared. Stopped growing

endometrium (this is the main disadvantage): 3-8 mm.

What happened after the cancellation?

Morning and evening hot flashes, headache, severe pain on the first day of menstruation, acne, chills.

Six months of daily headaches, hot flashes, depression and drowsiness forced me to return

to receive "Diana-35". I was like a drug addict who was going through withdrawal without another dose. Vitamins

and hormone replacement therapy (Remens and other drugs) did not give any positive results

result. "This is the result of drug withdrawal, this is not a disease and we cannot prescribe treatment,

just endure it,” all the specialists to whom I turned said. I endured this horror somewhere...

then for six months and in desperation I went for another package of Diane-35. It went away with the first pill...

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I was not lucky enough to try “Yarina” once.

ethinyl estradiol 30 mcg, drospirenone 3 mg

Monophasic low-dose combined oral contraceptive. The doctor prescribed it for me

at random, arguing that Diane-35 is too “strong” and the dosage needs to be reduced a little.

Pros: None.

Minuses: Hot flashes, heat throughout the body (even though the body temperature was 36.6), chest pain,

loss of consciousness, dizziness. It was a terrible 8 days, although you shouldn’t do this, but on the 8th day

cycle, I stopped taking pills from the blister pack. I almost stuck my fins together, it was very bad, it even seemed

that I'm dying. I was glad that I quit the appointment. A couple of days later, my period began.

What happened after the cancellation?

After the withdrawal, the doctors prescribed another drug, “Jess (Jazz)”.

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“Jess (Jazz)” ​​took place for more than six months.

ethinyl estradiol 20 mcg, drospirenone 3 mg

Monophasic low-dose combined oral contraceptive with placebo tablets.

The doctor most likely prescribed them for me, because they had just appeared at that time and I was going on them

It’s a pity that experiments are carried out on them, and even more so for people. My experiment with “Jess”

failed miserably. A couple of wen appeared in the chest, which the same doctor confused with ultrasound

fibroadenoma and suggested surgery. I was ready to break this stupid

the doctor to pieces, even despite all her titles and merits, it is clear that all this was bought with such

flayer treatment methods, and prescribing “Jess” to everyone is money laundering from patients.

Pros: the same as when taking Diane-35.

Minuses: the cost is 2 times higher than that of Diane-35, the antiandrogenic effect is not clearly expressed,

small acne still appeared. Suspicion of breast fibroadenoma.

What happened after the cancellation?

After discontinuation, I returned to taking Diana-35.

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Some kind of vicious circle. I drank Diana-35 for another 1.5 years (in total I drank OK more

5 years). And what was the need? I still don't understand. In the contraceptive action of these

I didn’t need pills; a few pimples could be gotten rid of with cosmetics

means, but I could seriously undermine my health. I really wanted to quit drinking OK, but

I was afraid that there would be hot flashes, terrible skin, oily sparse hair, and women’s diseases would begin

parts. After all, I already had a negative withdrawal experience, I lived like hell for six months, and all the doctors denied

from me as best they could. I understood that I was about to want to get pregnant and that I needed to solve the problems of withdrawal.

OK already here and now. I was left alone with my problems. I am my own rescuer

circle. About a year ago I found and read the book from cover to cover "Killer Hormones" and realized that

Even a hundredth part of a mg of the hormone is destructive for some, but life-saving for others. In differentdosages

any substance can be both a healer and an executioner. Hunting for you to swallow another pill

to be an executioner to yourself, and most importantly to your women's health? And I continued to fight with my

organism, also studying it from cover to cover. The book says that according to science, hormone replacement

natural (synthetic) are called hormone antagonists, contraceptives are also related to them

relate. But I have their own hormones , I have health, then what, what and why do I replace it?

Ethinyl estradiol, contained in the tablets I took, is a female sex steroid

hormone, belongs to estogens, and it replaced hormones in my body that ideally should

be able to produce my ovaries. Drospirenone is also an antagonist hormone that “knows how” to suppress

male sex hormones (androgens) in the female body.

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I’ll say right away that reducing the dose when taking OCs will not help your body “get out of the habit” of taking pills. This

like a drug, without receiving a certain exact dose, the body can rebel. And those who

advises this, and there are many such advisers on the Internet, they are not responsible for the fact that if the dose is inaccurate

Side effects may begin that we can only guess about. I recommend it like this

great advisors to remove information from their blogs (and there is little such information) so that people

harm. Tear off the hands of such literate people, turn off the Internet and take away the keyboard. So drink

It's not worth taking half a pill, you could harm yourself. But who could have thought that it was me

Is a dosage of 35 mcg and 2 mg, respectively, and no more or less? It feels like

ordinary gynecologists are not familiar with the basics of endocrinology. Therefore, it’s better to ask questions

Just contact a gynecologist-endocrinologist, there are such specialists, although there are very few of them.

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Vitamins, hormone replacement therapy in the form of "Remens", herbs and drugs for those who are

menopause do not work in this case. I would definitely refuse to drink the latter, so as not to harm

to your women's health. Phytoestrogens are also very doubtful for me personally, this is the same

The best thing to do is take away a child’s candy and give him a carrot instead. Of course you can if you really

bad, get distracted by sports, come up with a hobby, but it’s not particularly distracting if it gets too intense

physically ill. Regarding phytoestrogens, I once saw articles about how girls “raised” themselves

breast with a decoction of hop cones. I can’t believe that supporters of this method had no side effects.

phenomena. About the book about killer hormones, then I believe that similar medical literature

hormones (and which ones exactly) can build muscle mass, give a woman’s body feminine

forms, prolong youth, increase libido, but at the same time there is a clear description of hormones and is given

explanation that all hormones are highly toxic and toys with hormones are fraught with death

no outcome. I don’t need such games of life and death, this was another argument in favor

that it’s time to end my friendship with OK forever. Also not very pleasant facts from the book I

I learned about how some hormones are obtained (this is truly shocking information) and

how all hormones are tested directly on people by trial and error. This is inhumane, wake up!!!

Believe me, after learning some facts about hormones, you will even want to forget about what they are.

this, not to mention voluntarily putting another pill in your mouth.

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I think that feeling unwell after stopping OK is a banal psychosomatics.

Psychosomatics is a direction in medicine (psychosomatic medicine) and psychology that studies the influence of psychological factors on the occurrence and course of somatic (physical) diseases.

There is a popular opinion (including in alternative medicine) that all human diseases arise due to psychological inconsistencies and disorders that arise in the soul, in the subconscious, in the thoughts of a person.

All the problems are due to the fact that we are afraid of getting pregnant after stopping OK, we are afraid of illnesses due to

female part, we are afraid of terrible painful acne and greasy greasy hair, we are afraid that

in the first days of the cycle we will experience terrible pain during menstruation. That is, we are afraid of losing

all those “charms” of life that give us OK.

Excerpt from the book: With the help of the release and action of various hormones, the endocrine system, along with the nervous system, ensures the existence of the body through fine and precise regulation and coordination of the work of internal organs and tissues, as well as all types of metabolism.

And if the nerves are shaken, there is stress, phobias, then what about the proper functioning of hormones?

speech? You need to be in harmony with yourself and all body systems, including the endocrine system, will also be

fine. The book also provides one technique that allows you to concentrate on your

endocrine system mentally, due to which certain glands begin to work as

hours, hormonal levels improve, but read about this in the book. I won't tell you this secret,

But I can say for sure that the technique works. Emotions affect hormones first of all!!!

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First of all, you need to adjust yourself to the fact that nothing bad will happen, read less about other people’s

reviews about OK and in general, even theoretically, do not know what happens after cancellation. Your body

individual, and delving into the problems that someone has experienced can be unconsciously transferred to

yourself and after stopping OK, get the whole “bouquet” of diseases and problems. If you can’t do it yourself, then

talk about it with someone you trust, you can contact a psychologist, or you can tell

And me. By the way, regarding PMS, thanks to reading the book, I came to the conclusion that it Not

hormonal levels during PMS affect mood, it is the emotional background that affects the course

PMSand for hormones. I also send special greetings to fans of protein diets and those who love

experiment with taking natural oils internally: don’t be afraid to harm your hormones

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So I managed to get in the mood and one fine “red day” I didn’t buy a calendar and didn’t

opened another package, didn’t take another cute little pill, and now

I've been free for 10 months. I decided that I’d stop being addicted to pills, stop wasting money on them.

money and poison your body with this crap. I decided that I would rather spend the same 100 hryvnia

on acne cosmetics than on anti-pregnancy drugs. And everything worked out for me. I started to live

a full life without pills, headaches, hot flashes and even endured the first two

months after withdrawal, a few acne. By the way, I held up well, despite depression and breakdowns

I didn’t either, serotonin was produced well. By the way, thanks to the book I found out,

(I repeat once again) that it is not the hormone of happiness that is produced due to good lighting and gives

good mood, and a good mood allows this hormone to be produced in sufficient quantities

quantity. This once again proves that everything is in our hands and everything depends on ourselves. Even

health. Or rather, health comes first, and everything else will follow!

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Pros of canceling OK:

1. You begin to get to know and love yourself again, you want to pamper yourself more and feel sorry for yourself less.
2. You re-learn the properties of your skin, study new cosmetics, and pay more attention to yourself.
3. You begin to feel fertile, feminine, as if you are being born again.
4. I want to open up more horizons for myself.
5. You begin to love children even more!!!

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Pros of reading the book:

1. Now doctors will definitely not fool me by prescribing this or that unnecessary test or unnecessary treatment.
2. I always get along with myself first.
3. Slight rejuvenating effect. Yes, yes, even that.
4. I don't have PMS, I've become less irritable and more friendly.
5. Sound sleep and good nutrition are my faithful companions.
6. Additional medical knowledge, and even knowledge of metaphysics and psychosomatics.
7. A fascinating pastime, the book is read in one breath.
8. Cancellation of OK and improvement of health is the most important thing for me!!!

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“My body and mind interact perfectly. I control my thoughts."

I was inspired to write this review by the empty packaging of Diane-35,

which I accidentally found during spring cleaning!!!

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In fact, I haven’t read anything more exciting than this book for a long time. Thanks to the authors for

The book is written in an accessible manner, with humor and a pleasant style. All terms are “chewed” and understandable to

reader of any age. There are no stupid and annoying pictures, there are few pictures and they are also humorous.

If your attending physician is as dumb as a Siberian felt boot, you can feel free to give him this book -

Here's another plus sign! A book is the best gift, and such an educational book, of course

same treasure. My only regret is that I did not read this book earlier, because it is very useful. Is it true-

I have not come across hormones, although I have been interested in this topic for a long time.

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Regarding OK, while healing the reproductive system, you can easily disrupt the endocrine system, even

to disability, lack of fertility and death. The choice is yours!

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I hope I didn't bore you! Be healthy and do not self-medicate!

And now, half a century later, the importance of the hormonal method is difficult to overestimate. 200 of the world's leading historians agreed that neither the theory of relativity, nor the nuclear bomb, nor even the Internet had such an impact on twentieth-century society as the contraceptive pill.

Today, 24 types of combined oral contraceptives are registered in Russia. Let's figure out the principle by which all these drugs are distinguished.

Combined oral contraceptives (COCs) are so called because these pills contain two hormones (or rather, their analogues) - estrogen and gestagen. (There are also mini-pills containing one hormone, but we are not talking about them now.) Estrogen and gestagen enter the body in different combinations. During the period when the body does not receive hormones, a woman begins to experience “withdrawal bleeding,” or, in simple terms, menstruation.

There are three generally accepted classifications of COCs: according to the estrogenic component, according to the gestagen component and according to their dosage regimen during one cycle.

Estrogen component

According to this principle, all available types of COCs are divided into two types: ethinylestradiol-containing and preparations based on estradiol valerate, they are also NOC (natural oral contraceptives).

Until recently, it was used exclusively as an estrogenic component ethinylestradiol(EE), a reliable but rather harsh synthetic hormone. Among EE-containing drugs, the following types are distinguished:

Highly dosed(“Non-ovlon”, “Anteovin”) - contain 50 mcg ethinyl estradiol (EE). They have not been used for a long time due to the high risk of side effects.

Low dosage– contain 30–35 µg EE. There are many such drugs, including Yarina, Zhanin, Marvelon, Diane-35, etc. A feature of low-dose drugs is good cycle control with high contraceptive reliability.

Microdosed– containing 15–20 µg EE. These are the well-known “Jess”, “Logest”, “Mersilon”. Despite the negligible hormone content, microdosing preparations are quite reliable. During the adaptation period, spotting and spotting is possible, but contraceptive protection is effective regardless of the presence of discharge.

In 2009, the first and so far the only drug containing estradiol valerate as an estrogenic component is “Qlaira”. Estradiol valerate is chemically identical to the hormone produced by the female body. Its effect is milder than that of EE, hence the name “natural oral contraceptive”.

Attempts to create a contraceptive drug based on estradiol valerate have been going on for a long time, but the mildness of its effect was fraught with possible intermenstrual bleeding. To solve this problem, Klaira uses dienogest, which reliably regulates the growth of the endometrium, and.

Progestin component

So, estrogen is designed to stabilize the menstrual cycle, and gestagen prevents pregnancy. Initially, they were used as a gestagenic component testosterone derivatives. Along with a high progestogenic effect, they to one degree or another had residual androgenic activity. This is how COCs containing levonorgestrel and other hormones were created - desogestrel, gestodene, which appeared in the 70–80s.

Further evolution of gestagens was aimed at eliminating androgenic activity. As a result, gestagens with antiandrogenic effects were created: cyproterone acetate, dienogest, drospirenone. Drospirenone among other things, it prevents the retention of excess fluid in the body, which is observed in some cases against the background of testosterone derivatives in combination with EE.

Dosage regimen

The additional non-contraceptive properties of the drugs depend on the doses and in what combination the two hormonal components are used.

If all tablets in a package contain the same amount of estrogens and gestagens, the drug is called monophasic. Such drugs provide good control of the cycle, with their help it is easy to postpone menstruation or switch to prolonged use (4-5 menstruation per year).

Was created in the 70s two-phase drug "Anteovin". Now it is no longer used.

At the end of the 70s, a new dosage regimen was created - three-phase. Now three different dosages create a semblance of natural hormonal fluctuations. The drug "Triquilar" is very popular today.

As a result of many years of research, a unique dynamic dosing regimen, maximally repeating the natural female cycle. The package 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 regimen contributes to a more stable bleeding profile and good tolerability, while having high contraceptive reliability. In the class of dynamic dosing regimen, only Qlaira is currently represented. Let's hope that its appearance opens a new era - natural and even safer contraception.

Oral contraceptives (OCs or birth control pills) are available by prescription and contain combinations of estrogen and progestin, or progestin alone.

Most women use a combination of hormonal pills. Women who experience severe headaches or high blood pressure from estrogen in combination pills can take progestin pills.

Birth control pills are the most popular method of contraception and are used by millions of women.
Birth control pills work like this:

Prevents ovulation. Ovulation is the release of an egg from the ovary. If the egg is not released, fertilization by sperm cannot occur;
- Prevents sperm from entering the uterus by keeping cervical mucus thick and sticky.

When a woman stops taking the pill, she usually regains fertility within 3-6 months.

Hormones used in birth control pills

Most pills contain a combination of estrogen and progesterone in a synthetic form (progestin). The estrogen compound used in most oral contraceptive (OC) combinations is estradiol. There are many different progestins, but common types include: levonorgestrol, drospirenone, norgestrol, norethindrone, and desogestrel.

These hormones may cause side effects, especially during the first 2-3 months of starting to use them. Common side effects of oral contraceptives include:

Bleeding during the first few months;
- nausea and vomiting;
- headaches (in women with a history of migraine);
- soreness and tightness of the breast;
- irregular bleeding or bleeding between periods;
- weight gain (this is not related to oral contraceptives).

Low-dose monophasic oral (oral) contraceptives

Combined oral contraceptives are aimed at blocking ovulation. These OCs contain a combination of estradiol and a progestin, levonorgestrel. They are divided into monophasic (the level of hormonal substances in the tablets remains unchanged throughout the entire intake) or triphasic (the tablets contain three combinations of hormones that change during the menstrual cycle).

Low-dose monophasic OCs are such as: Seasonal, Sizonic, Librel, Yarina.

Mini-pills are birth control pills that contain the hormone progestogen, similar to the natural hormone progesterone produced by a woman's ovaries. Progestogen-only pills contain only one ingredient and are different from the more common combination birth control pills, which contain progestogen and estrogen.

Below is a list of contraceptives taking into account age, whether the woman has given birth or not, and whether she suffers from any hormonal or other disorders of the body.

Microdosed birth control pills.They are suitable for young, nulliparous women who have regular sex life. Drugs in this group are easily tolerated and have minimal side effects. Great for those who have never used hormonal contraceptives. As well as contraception for mature women over 35 years of age (up to the onset of menopause).

Name		Note
Zoely	Nomegestrol acetate 2.50 mg; Estradiol hemihydrate 1.55 mg.	A new monophasic drug containing hormones similar to natural ones.
Claira	Estradiol valerate 2 mg; Dienogest 3 mg.	New three-phase drug. Best suits the natural hormonal background of a woman.
Jess	Ethinyl estradiol 20 mcg; drospirenone 3 mg.
Jess Plus	Ethinyl estradiol 20 mcg; drospirenone 3 mg; calcium levomefolate 451 mcg.	New monophasic drug + vitamins (folates). Has an anti-androgenic (cosmetic) effect.
Dimia	Ethinyl estradiol 20 mcg; drospirenone 3 mg.	Monophasic drug. Similar to Jess.
Miniziston 20 fem	Ethinyl estradiol 20 mcg; levonorgestrel 100 mcg.	New monophasic drug.
Lindinet-20	Ethinyl estradiol 20 mcg; gestodene 75 mcg.	Monophasic drug.
Logest	Ethinyl estradiol 20 mcg; gestodene 75 mcg.	Monophasic drug.
Novinet	Ethinyl estradiol 20 mcg; desogestrel 150 mg.	Monophasic drug.
Mercilon	Ethinyl estradiol 20 mcg; desogestrel 150 mcg.	Monophasic drug.

Low-dose birth control pills. Recommended for young, nulliparous women who have regular sex life (in the event that microdosed drugs are not suitable - the presence of bleeding on the days of taking active tablets after the end of the period of adaptation to the drug). As well as contraception for women who have given birth, or women of late reproductive age.

Name		Note
Yarina	Ethinyl estradiol 30 mcg; drospirenone 3 mg.	Monophasic drug of the latest generation. Has an anti-androgenic (cosmetic) effect.
Yarina Plus	Ethinyl estradiol 30 mcg; drospirenone 3 mg; calcium levomefolate - 451 mcg.	A monophasic drug of the latest generation containing vitamins (folates). Has an anti-androgenic (cosmetic) effect.
Midiana	Ethinyl estradiol 30 mcg; drospirenone 3 mg.	New monophasic drug. Analogous to Yarina.
Tri-Mercy	Ethinyl estradiol 30 mcg; desogestrel 125 mcg.	Three-phase drug of the latest generation.
Lindinet-30	Ethinyl estradiol 30 mcg; gestodene 75 mcg.	Monophasic drug.
Femoden	Ethinyl estradiol 30 mcg; gestodene 75 mcg.	Monophasic drug.
Silest	Ethinyl estradiol 30 mcg; norgestimate 250 mcg.	Monophasic drug.
Janine	Ethinyl estradiol 30 mcg; dienogest 2 mg.	Monophasic drug. Has an anti-androgenic (cosmetic) effect.
Silhouette	Ethinyl estradiol 30 mcg; dienogest 2 mg.
Jeanetten	Ethinyl estradiol 30 mcg; dienogest 2 mg.	New monophasic drug. Analogous to Janine.
Miniziston	Ethinyl estradiol 30 mcg; levonorgestrel 125 mcg.	Monophasic drug.
Regulon	Ethinyl estradiol 30 mcg; desogestrel 150 mcg.	Monophasic drug.
Marvelon	Ethinyl estradiol 30 mcg; desogestrel 150 mcg.	Monophasic drug.
Microgynon	Ethinyl estradiol 30 mcg; levonorgestrel 150 mcg.	Monophasic drug.
Rigevidon	Ethinyl estradiol 30 mcg; levonorgestrel 150 mcg.	Monophasic drug.
Belara	Ethinyl estradiol 30 mcg; chlormadinone acetate 2 mg.	New monophasic drug. Has an anti-androgenic (cosmetic) effect.
Diana-35	Ethinyl estradiol 35 mcg; cyproterone acetate 2 mg.	Monophasic drug with anti-androgenic (cosmetic) effect.
Chloe	Ethinyl estradiol 35 mcg; cyproterone acetate 2 mg.	Monophasic drug. Analogous to Diana-35.
Bellune-35	Ethinyl estradiol 35 mcg; cyproterone acetate 2 mg.	New monophasic drug. Analogous to Diana-35.
Desmoulins	Ethinyl estradiol 35 mcg; ethynodiol diacetate 1 mg.	Monophasic drug.

High-dose oral contraceptives. These drugs are used only as prescribed by a doctor for the treatment of various hormonal diseases, as well as for contraception during the treatment of hormonal disorders.

Name		Note
Tri-regol	Ethinyl estradiol 40 mcg; levonorgestrel 75 mcg.	Therapeutic three-phase drug. The package contains tablets for three menstrual cycles.
Triquilar	Ethinyl estradiol 40 mcg; levonorgestrel 75 mcg.	Therapeutic three-phase drug.
Trisiston	Ethinyl estradiol 40 mcg; levonorgestrel 75 mcg.	Therapeutic three-phase drug.
Ovidon	Ethinyl estradiol 50 mcg; levonorgestrel 250 mcg.	Therapeutic monophasic drug.
Non-Ovlon	Estradiol 50 mcg; norethisterone acetate 1 mg.	Therapeutic monophasic drug

- “Mini-pill” or progestin contraceptives. Recommended for women during breastfeeding, as well as for women who have given birth or women of late reproductive age who have regular sex life, in case of contraindications to the use of estrogens.

Name		Note
Lactinet	Desogestrel 75 mcg.	Monophasic drug of the latest generation. Especially for nursing mothers.
Charosetta	Desogestrel 75 mcg.	New monophasic drug.
Exluton	Linestrenol 500 mcg.	Monophasic drug of the latest generation.
Microlute	Levonorgestrel 30 mcg.	Monophasic drug.

Advantages and disadvantages of birth control pills

Benefits of oral contraceptives. In addition to preventing pregnancy, oral contraceptives may also have the following benefits:

Managing heavy menstrual bleeding and cramps, which are often symptoms of uterine fibroids and endometriosis (Natasia);
- prevention of iron deficiency anemia caused by severe bleeding;
- reduction of pelvic pain caused by endometriosis;
- protection against ovarian and endometrial cancer with long-term use (more than 3 years);
- reduction of symptoms of premenstrual dysphoric disorder.

Disadvantages and serious risks of oral contraceptives

Combinations of birth control pills may increase the risk of developing or worsening some serious medical conditions. The risks depend partly on the woman's medical history. Some of the main risks associated with the combination of birth control pills are deep vein thrombosis, heart attack and stroke.

Smoker for more than 35 years;
- have uncontrolled high blood pressure, diabetes or polycystic ovary syndrome (PCOS);
- have a history of heart disease, stroke, thrombosis, or risk factors for heart disease (unhealthy cholesterol levels, obesity);
- have migraines with aura.

Serious risks of birth control pills may include:

- venous thromboembolism (VTE)

All combinations of estrogen and progestin - birth control products - carry a risk of blood clots in the veins (venous thromboembolism), which can lead to blood clots in the arteries of the legs (deep vein thrombosis) or lungs (pulmonary embolism). Birth control pills containing drospirenone (Yazev and Beyaz) may increase the risk of blood clots much more than other types of birth control. Because of the risk of VTE, the Centers for Disease Control and Prevention recommends that women not use combined hormonal contraceptives for 21 to 42 days after giving birth;

- Hormones and pregnancy.

Hormonal imbalances often lead to complications, the first of which is cycle failure. Due to this phenomenon, women who want to have children may encounter difficulties conceiving and more severe complications once pregnancy occurs. Planning a pregnancy with an unstable ovulatory phase and hormone imbalance should be carefully monitored, it is necessary to lead a healthy lifestyle, eat right and monitor the level of sex hormones. The Time Factor complex helps maintain the natural ratio of progesterone and estrogen in the body. Biologically active substances in the complex will help not only alleviate the symptoms of premenstrual syndrome, but also normalize the cycle, and, accordingly, make it possible to identify days suitable for conception.

- heart and blood circulation.

Combination birth control pills contain estrogen, which may increase the risk of stroke, heart attack, and blood clots in some women;

- risks of developing cancer.

Several studies have found an association between an increased risk of cervical cancer and long-term (more than 5 years) use of oral contraception. Recent studies show that OCs slightly increase the risk of breast cancer;

- liver problems.

In rare cases, oral contraceptives have been associated with liver tumors, gallstones, or hepatitis (jaundice) in studies. Women with a history of any liver disease should consider other methods of contraception;

- interactions with other medications.

Some types of medications may interact with each other, reducing the effectiveness of oral contraceptives. These drugs include anticonvulsants, antibiotics, antifungals, and antiretrovirals. The herbal remedy St. John's wort may interfere with the effectiveness of birth control pills. The patient should ensure that their doctor knows all medications, vitamins or herbal supplements he or she is taking;

- HIV and STDs.

Birth control pills do not protect against all sexually transmitted diseases (STDs), including HIV. Unless a woman is in a monogamous relationship with a completely uninfected partner, she should ensure that a condom is used during intercourse - regardless of whether she is taking oral contraceptives.

Genetic disorders when taking oral contraceptives

“Genetic disorders” refer to any physical or mental pathology that can be inherited from parents. There are congenital diseases. Some genetic disorders do not appear at birth, but develop as a person grows and signs and symptoms appear. The pathology may remain unrecognized until a person reaches puberty or adulthood.

A comprehensive genetic analysis of the genes for blood coagulation factors II and V to identify the risk of thromboembolic complications while taking hormonal oral contraceptives (OCs) will make it possible to make the right decision about safer methods of contraception and family planning.

The most serious complication when taking OCs of a hormonal nature is their effect on the hemostatic system. The estrogenic component of combined OCs activates the blood coagulation system, which increases the likelihood of thrombosis - first of all, coronary and cerebral, then thromboembolism.

In women using combined OCs, the risk of venous thromboembolic complications is low, but it is higher than in those who do not use these OCs. Age, excess body weight, surgery, and thrombophilia increase the risk.

In most cases, genetic risk factors for the development of thromboembolic complications are mutations in the genes of blood coagulation factors II and V. The likelihood of developing thrombosis associated with a genetic predisposition seriously increases when they are combined with other genetic defects.

The mutation of factor V and the use of hormonal contraceptives mutually affect the blood coagulation system, and this, when combined, significantly increases the risk of venous thrombosis. This risk when taking OCs in women who are carriers of the Leiden mutation is 6-9 times higher than in women with normal factor V, and more than 30 times higher compared to those who do not take OCs.

With a mutation in the prothrombin gene (F2), its level increases and can be 1.5-2 times higher than normal, which leads to increased blood clotting. A pathologically altered genotype is an indicator of the risk of developing thrombosis and myocardial infarction. When mutations in the F2 and F5 genes are combined, the risk of developing thromboembolic complications while taking hormonal contraceptives increases significantly. In this regard, a number of experts consider screening for the presence of the Leiden mutation and prothrombin gene mutation necessary for all women who take hormonal contraceptives (or those who are planning to take them).

Many women are afraid to take birth control pills for fear of side effects. Innovative technologies make it possible to produce contraceptive drugs that contain a minimal amount of hormones and only affect the process of conception.

pharmachologic effect

New generation birth control pills contain a complex of progestogens and estrogens. These sex hormones inhibit the synthesis of gonadotropins (follicle-stimulating and luteinizing hormone) in the pituitary gland of the brain. As a result, the process of egg maturation and follicle rupture is blocked, so pregnancy cannot occur.

Oral contraceptives help thicken the cervical mucus, which makes it difficult for sperm to move and penetrate into the uterus. After taking birth control pills, a secretory transformation of the endometrial layer occurs; even if spontaneous ovulation occurs, fertilization of the egg occurs, the embryo cannot be implanted into the uterine wall.

Third-generation progestogens have a high affinity for the hormonal receptors of progesterone, so they can bind to them and have a contraceptive effect, blocking ovulation and the release of FSH and LH. At the same time, progestogens have a low affinity for androgen receptors, which reduces the risk of side effects such as male-pattern hair growth, acne, excess weight, hair loss, irritability, etc.

The contraceptive effect of the pills is mainly provided by progestogens; estrogens support the proliferation of the inner layer of the uterus, control the course of the menstrual cycle, and replace the lack of estradiol, the synthesis of which is blocked along with ovulation. Thanks to synthetic estrogens, intermenstrual bleeding does not occur while taking modern birth control pills.

Depending on the composition of the active ingredients, COCs are distinguished - combined oral contraceptives containing progestogens + estrogens, and purely progestogen contraceptive pills (mini-pills).

Taking into account the daily dosage of synthetic estrogens, COCs are classified:

• High-dose ones contain up to 50 mcg/day. ethinyl estradiol.
• Low-dose contraceptives include no more than 35 mcg/day. estrogenic component.
• Microdosed tablets are characterized by the smallest amount, not exceeding 20 mcg/day.

High-dose hormonal contraceptives are used only for medicinal purposes and for emergency protection after unprotected sexual intercourse. Currently, preference is given to low and micro-dose contraceptives for the prevention of unwanted pregnancy.

Depending on the combination of progestogens and estrogens, COCs are divided into:

• Monophasic tablets are characterized by a constant daily dose of both sex hormones.
• Multiphasic contraceptives are characterized by variable dosages of estrogen. This creates an imitation of fluctuations in hormonal balance in a woman’s body during different phases of the menstrual cycle.

Tablets with a low content of hormones provide reliable protection against unplanned pregnancy (99%), are well tolerated, and allow you to control the menstrual cycle. After stopping taking COCs, reproductive function is restored within 1–12 months.

In addition to the contraceptive effect, oral contraceptives are prescribed for the treatment of dysmenorrhea, reducing the volume of blood loss during menstruation, ovulatory pain, and reducing the frequency of relapses of inflammatory diseases of the genitourinary system. COCs reduce the risk of developing endometrial cancer of the uterus, ovaries, rectum, anemia, and ectopic pregnancy.

Pros and cons of taking COCs

The main benefits of taking combined birth control pills include:

• high level of reliability – 99%;
• additional therapeutic effect;
• prevention of chronic diseases, cancer;
• rapid contraceptive effect of pills;
• protection against ectopic pregnancy;
• accidental use of COCs in early pregnancy is not dangerous;
• prevent the occurrence of intermenstrual, dysfunctional uterine bleeding;
• contraceptives are suitable for long-term contraception;
• the ability to stop taking the pill if you want to get pregnant;
• the condition of the skin improves.

After short-term use of combined oral contraceptives (3 months), the sensitivity of hormonal receptors in the ovaries increases, therefore, after discontinuation of COCs, increased stimulation of ovulation and the release of gonadotropins occurs - a rebound effect. This method of therapy helps women suffering from anovulation to become pregnant.

The disadvantages of taking birth control pills include high cost and possible side effects. Undesirable manifestations are rare (10–30%), mainly in the first few months. Later, the women's condition returns to normal. The simultaneous use of COCs and anticonvulsants, antituberculosis drugs, tetracyclines, antidepressants reduces the therapeutic effect of contraceptives.

Common side effects include:

• irritability, aggressiveness, tendency to depression;
• migraine;
• swelling of the mammary glands;
• impaired glucose tolerance;
• weight gain;
• chloasma - the appearance of age spots on the skin;
• acne, seborrhea;
• breakthrough bleeding;
• intermenstrual bleeding;
• thrombophlebitis;
• decreased libido;
• amenorrhea due to endometrial atrophy;
• increased blood pressure.

If side effects do not go away after 3 months of taking contraceptives, the pills are discontinued or replaced with other drugs. A complication such as thromboembolism is extremely rare.

Indications and contraindications for taking COCs

Combined oral contraceptives are suitable for women who have regular sex life, suffer from painful, heavy menstruation, endometriosis, and benign tumors of the mammary glands. It is possible to prescribe birth control pills in the postpartum period if the mother does not breastfeed.

Contraindications:

• thrombophlebitis;
• diseases of the cardiovascular system;
• diabetes;
• pregnancy or suspicion of possible conception;
• pancreatitis;
• inflammatory diseases, liver tumors;
• renal failure;
• lactation;
• uterine bleeding of unknown etiology;
• migraine;
• individual intolerance to the active ingredients.

If pregnancy occurs, birth control pills should be stopped immediately. But if a woman takes the medicine after conception, there is no significant risk to the intrauterine development of the child.

COC dosage regimens

Contraceptives are selected individually for each woman. This takes into account the presence of gynecological diseases, concomitant systemic ailments, and possible contraindications.

The doctor advises the patient about the rules for taking COCs and monitors them for 3–4 months. During this period, the tolerability of the pills is assessed, and a decision may be made to cancel or replace the contraceptive. Dispensary records are maintained throughout the entire period of contraceptive use.

First-line drugs include monophasic COCs containing estrogen no more than 35 mcg/day. and gestagens with weak androgenic effects. Three-phase tablets are prescribed for primary or secondary estrogen deficiency, decreased libido, dry vaginal mucous membranes, and menstrual irregularities.

After starting to take birth control pills, side effects may occur in the form of spotting, intermenstrual bleeding, breakthrough uterine bleeding caused by changes in hormonal levels. After 3 months, all symptoms should go away. If the discomfort persists, the drug is replaced taking into account the problems that have arisen.

Birth control pills are taken at the same time every day. For convenience, serial numbers are indicated on the blister. COCs are started on the first day of the menstrual cycle and continued for 21 days. Then they take a break for 1 week, during this period withdrawal bleeding is observed, which ends after the start of a new package.

If you miss taking another contraceptive pill, you should take it no later than 12 hours later. If more time has passed, the contraceptive effect of the drug will be lower. Therefore, over the next 7 days it is necessary to use additional barrier agents against unwanted pregnancy (condom, suppositories). You cannot stop taking COCs.

Dosage regimens

Schemes for prolonged use of combined oral contraceptives for menstrual irregularities:

• Short dosing of birth control pills allows you to increase the interval between periods by 1-4 weeks. Such regimens are used to delay spontaneous menstruation, prevent bleeding, and cancel after a course of oral contraceptives.
• Long-term dosing is prescribed to delay menstruation from 7 weeks to several months. Treatment with birth control pills is prescribed for anemia, endometriosis, premenstrual syndrome, hyperpolymenorrhea.

Some women prefer cyclic use of COCs with a seven-day break due to fear of pregnancy and infertility. Some patients believe that menstruation is a physiological process.

Popular combined oral contraceptives

Low Hormone Microdose Pills:

• Median is a monophasic estrogen-progestogen COC. The drug contains drospirenone, which has an antimineralkorticoid effect, prevents excess body weight gain, the appearance of edema, acne, oily skin, and seborrhea.
• contains ethinyl estradiol 20 mcg, dospirinone 3 mg. The contraceptive drug is prescribed for contraception purposes, for the treatment of severe acne, painful menstruation.
• Lindinet 20 tablets include ethinyl estradiol 20 mcg, gestodene - 75 mcg. Indicated for use in painful menstruation, irregular cycles, and for contraception.
• Zoely. Active ingredients: estradiol hemihydrate – 1.55 mg, nomegestrol acetate – 2.5 mg. Nomegestrol acetate is a highly selective progestogen with a similar structure to progesterone. The active component has mild androgenic activity and does not have mineralocorticoid, estrogenic or glucocorticoid effects.

Mini-pill

Popular contraceptive pills with minimal hormone content - mini-pills - are an alternative means of contraception for women who are contraindicated in taking COCs. The drugs contain microdoses of progestin, an analogue of progesterone. One capsule contains 300–500 mcg/day. The action of mini-pills is inferior to COCs, but they have a milder effect; they are recommended for women who experience side effects after taking combined contraceptive pills.

Representatives of the fairer sex can take low-dose progestin preparations during lactation; the active substance does not affect the taste of breast milk and does not reduce its volume. Unlike COCs, mini-pills do not cause blood thickening, do not contribute to thrombus formation, or increase blood pressure, therefore they are approved for use in cardiovascular pathologies and thrombophlebitis.

Progestin-only birth control pills do not affect ovulation; they thicken cervical mucus, preventing sperm from entering the uterine cavity and ovaries. In addition, the peristalsis of the fallopian tubes slows down, proliferative changes in the endometrium occur, which does not allow the embryo to implant in the event of fertilization of the egg. When taking gestagen drugs, the menstrual cycle and regular bleeding are maintained.

The contraceptive effect is achieved 3–4 hours after taking the tablet and lasts for 24 hours. Mini-pills provide 95% protection against unplanned pregnancy.

Rules for using the mini-pill

Before starting to use contraceptives, women must be examined by a gynecologist to rule out pregnancy and chronic diseases of the reproductive system. To get the desired result, you must strictly follow the rules for using the mini-pill:

• Taking pills starts from the first day and continues until the 28th day of the menstrual cycle, drinking them continuously at the same time. Missing the next dose of contraceptives for more than 3 hours completely eliminates the contraceptive effect.
• Nausea may occur during the first few weeks, but this symptom usually goes away gradually. To reduce discomfort, it is recommended to take the tablet with food.
• If you vomit after taking the mini-pill, you should take the pill again as soon as you feel normal. This recommendation also applies to diarrhea. In the next 7 days, you must use additional contraception (condom) to protect against unwanted pregnancy.
• When switching from COCs, you should take mini-pills immediately after finishing the package of combined contraceptives.
• Pregnancy can occur in the first month after stopping progestogen pills. Ovulation occurs 7–30 days (average 17) after the end of the 56-day course.
• Women who are prone to the appearance of age spots (chloasma) after exposure to the sun should avoid prolonged exposure to ultraviolet radiation.
• When taking mini-pills and barbiturates, activated carbon, laxatives, anticonvulsants, and Rifampicin at the same time, the effectiveness of contraceptives becomes less.
• In the postpartum period, progestin contraceptives are prescribed on the first day of menstruation, but not earlier than 6 months after the birth of the child.
• After an abortion, you start taking pills immediately after the operation; no additional contraception is required.
• The contraceptive effect of the mini-pill is weakened if the gap between taking the next contraceptive pill is more than 27 hours. If a woman forgets to take the medicine, it is necessary to do so as soon as possible and then strictly follow the treatment regimen. Over the next week, it is necessary to use additional means of protection against pregnancy.

Contraindications

It is contraindicated to take oral contraceptives with a low dose of hormones during pregnancy, with uterine bleeding of unknown etiology, liver disease, taking steroids, exacerbation of herpes, liver failure. You should not take the pills if you have previously had an ectopic pregnancy, or if you have detected or suspected malignant tumors of the mammary glands. Contraindications include lactose intolerance and glucose-galactose malabsorption.

A decrease in the effectiveness of contraceptives can be observed if the rules of administration are violated, the use of laxatives, barbiturates, anticonvulsants, after vomiting, diarrhea. Irregular menstruation may occur against the background of gestagen pills. In such cases, it is necessary to stop taking the mini-pill, rule out possible pregnancy (including ectopic) and only then resume the course.

Side effects of birth control pills

Mini-pills have fewer side effects than COCs. The negative consequences of taking birth control pills include:

• vaginal candidiasis (thrush);
• nausea, vomiting;
• intermenstrual bleeding;
• intolerance to contact lenses;
• swelling of the mammary glands, discharge from the nipples;

• contraceptives cause weight gain;
• the appearance of chloasma;
• urticaria, erythema nodosum;
• headache;
• acne;
• breakthrough bleeding while taking drugs that affect liver function;
• decreased libido;
• follicular ovarian cyst;
• amenorrhea, dysmenorrhea.

Minipills may increase insulin requirements in patients with diabetes. Therefore, before taking birth control pills, it is necessary to consult with an endocrinologist and, if necessary, adjust the dosage of hypoglycemic agents. Women should constantly monitor their blood sugar levels during the first month of taking the mini-pill.

In rare cases, the use of progestin drugs can provoke the development of thromboembolism. It should be taken into account that in women over 40 years of age, the risk of developing breast cancer increases during treatment with hormonal drugs. If serious side effects occur, the mini-pill should be discontinued.

If, after pregnancy, there is an accidental use of contraceptives, there is no risk to the fetus, but the further course of pills should be discontinued. At high dosages of progestogens, masculinization of the female embryo can be observed. During lactation, some of the active substances of the drug penetrate into breast milk, but its taste does not change.

Popular mini-pills

• Femulen (ethinodiol).
• Exluton (linestrenol 0.5 mg).
• Charosetta. The active substance is desogestrel in a dosage of 75 mcg. The tablets do not cause significant disturbances in carbohydrate, lipid metabolism, or hemostasis.
• Microlut (levonorgestrel 0.03 mg).
• Continuin (ethinodiol acetate 0.5 mg).

The disadvantages of using progestin contraceptive pills include the possible formation of follicular ovarian cysts, menstrual irregularities, edema, weight gain, and irritability. The contraceptive effect of the mini-pill is lower than that of COCs, 90–97%.

Modern contraceptive drugs contain small doses of hormones, provoke the development of side effects to a lesser extent, and provide reliable protection against unplanned pregnancy. The pills are prescribed by the attending physician, taking into account the woman’s individual indications. The patient must be registered at the dispensary for the entire period of use of the COC or mini-pill. Particularly careful monitoring is carried out during the first 3–4 months from the start of using oral contraceptives.

Registration Certificate Holder:
GEDEON RICHTER, Plc. (Hungary)
Representation:
GEDEON RICHTER JSC
Active substances:
ethinylestradiol + gestodene
ATX code:
Genitourinary system and sex hormones (G) > Sex hormones and modulators of the reproductive system (G03) > Hormonal contraceptives for systemic use (G03A) > Progestogens and estrogens (fixed combinations) (G03AA) > Gestodene and estrogen (G03AA10)
Clinical and pharmacological group:
Monophasic oral contraceptive
Release form, composition and packaging
The drug is dispensed with a prescription, tablets, coating. coated, 20 mcg+75 mcg: 21 or 63 pcs.
Reg. No.: RK-LS-5-No. 014072 dated 06/03/2014 - Valid
Light yellow film-coated tablets, round, biconvex.

1 tab.
ethinylestradiol 20 mcg
gestodene 75 mcg
Excipients: sodium calcium edetate, magnesium stearate, colloidal anhydrous silicon dioxide, povidone, corn starch, lactose monohydrate.

Shell composition: quinoline yellow (E104), povidone, titanium dioxide (E171), macrogol 6000, purified talc, calcium carbonate, sucrose.

21 pcs. — cellular contour packages (1) — cardboard packs.
21 pcs. — cellular contour packages (3) — cardboard packs.

The description of the drug LINDINET 20 is based on the officially approved instructions for use of the drug and was 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 cervical mucus, making it difficult for sperm to penetrate into the uterine cavity, causes changes in the endometrium, making implantation difficult, i.e. prevents conception.

In addition to the contraceptive effect, it has a number of other positive effects.

Effect on the menstrual cycle

Regulates the menstrual cycle, reduces blood and iron loss during menstruation, and reduces the incidence of dysmenorrhea.

Actions associated with inhibition of ovulation

Reduces the incidence of functional ovarian cysts and ectopic pregnancy.

Other actions

Reduces the incidence of fibroadenomas and fibrous cysts of the mammary glands, pelvic infections, endometrial cancer, and improves the condition of the skin with acne.

Pharmacokinetics
Gestodene

Suction

After oral administration, it is quickly and completely absorbed from the gastrointestinal tract. After a single dose, Cmax is reached after 1 hour and is 2-4 ng/ml. Bioavailability is about 99%.

Distribution

Gestodene binds to albumin and sex hormone binding globulin (SHBG). 1-2% is found in plasma in free form, 50-75% specifically binds to SHBG. An increase in the level of SHBG in the blood caused by ethinyl estradiol affects the level of gestodene: the fraction associated with SHBG increases and the fraction associated with albumin decreases. Apparent Vd - 0.7-1.4 l/kg. The pharmacokinetics of gestodene depends on the level of SHBG. The concentration of SHBG in blood plasma under the influence of estradiol increases 3 times. When taken daily, the concentration of gestodene in the blood plasma increases 3-4 times and in the second half of the cycle reaches a state of saturation.

Metabolism and excretion

Gestodene is completely metabolized through known pathways of steroid hormone metabolism. The average plasma clearance is 0.8-1 ml/min/kg. The concentration of gestodene in the blood serum decreases in two phases. T1/2 in the terminal phase is 12-20 hours. Gestodene is excreted in urine and bile only in the form of metabolites, in a ratio of 6:4. T1/2 of metabolites - about 1 day.

Ethinyl estradiol

Suction

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

Distribution

Completely (about 98.5%), but nonspecifically binds to albumin and induces an increase in the level of SHBG in the blood serum. Apparent Vd - 5-18 l/kg.

Css is established by the 3-4th day of taking the drug, and it is 20% higher than after a single dose.

Metabolism

It undergoes aromatic hydroxylation to form hydroxylated and methylated 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.

Removal

Serum concentration decreases in two phases. T1/2 in the terminal phase is about 16-24 hours. Ethinyl estradiol is excreted only in the form of metabolites, in a 2:3 ratio with urine and bile. T1/2 of metabolites - about 1 day.

Indications for use
- oral contraception.
Dosage regimen
Prescribe 1 tablet/day for 21 days, if possible at the same time of day. Taking tablets from the next package should begin after a 7-day break, during which withdrawal bleeding should begin. Bleeding usually starts 2 or 3 days after taking the last pill and may not stop until you start taking the next pack of pills.

Taking Lindinet 20 for the first time

The first tablet of 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-hormonal contraceptive measures during the first 7 days of taking the pills during the first cycle.

Switching from a combined oral contraceptive

The first tablet of 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 taking regular tablets (or taking placebo tablets) from the previous package.

Switching from progestogen-containing drugs (mini-pills, injections, implant, IUD)

The transition from the mini-pill 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 - on the day when the next injection is necessary. In this case, in the first 7 days of taking Lindinet 20, it is necessary to use an additional method of contraception.

After an abortion in the first trimester of pregnancy

You can start taking contraceptives immediately after an abortion, and there is no need to use an additional method of contraception.

After childbirth or after an abortion in the second trimester of pregnancy

Women who are not breastfeeding can start taking the drug on days 21-28. If you start taking the drug later, in the first 7 days it is additionally necessary to use a barrier method of contraception. If sexual contact took place before starting contraception, pregnancy should be ruled out before starting the drug or the start of use should be delayed until the first menstruation.

Missed pills

If you miss a pill, take the missed pill as quickly as possible. If the interval in taking the pills is less than 12 hours, then the contraceptive effect of the drug is not reduced, and in this case there is no need to use an additional method of contraception. The remaining tablets should be taken at the usual time.

If the interval is more than 12 hours, the contraceptive effect of the drug may be reduced. In such cases, the woman should take the missed tablet as soon as she remembers, even if she has to take 2 tablets at the same time. Then you should take the pills at the usual time. In the next 7 days, it is necessary to use an additional method of contraception. If at the same time there are less than 7 tablets left in the package, then take the tablets from the next package without taking a break. In such cases, withdrawal bleeding occurs only after the completion of the second pack, but spotting or breakthrough bleeding is possible.

If, upon completion of taking the tablets from the second package, withdrawal bleeding does not occur, then pregnancy should be ruled out before continuing to take the contraceptive.

Measures to be taken in case of vomiting

If vomiting occurs in the first 3-4 hours after taking another tablet, the tablet is not completely absorbed. In such cases, you should act in accordance with the instructions described in the section “Missed tablets”.

If the patient does not want to deviate from her usual contraceptive regimen, the missed pills should be taken from another package.

Changing the start date of menstruation

To ensure that menstrual bleeding begins earlier than usual when taking the pill, it is recommended to reduce the interval between pills by the desired number of days. The shorter the break in taking the drug, the more likely it is that menstrual-like bleeding will not occur, and breakthrough or spotting bleeding will appear while taking the drug from the next package.

To delay menstruation, the drug should be continued from a new package without a 7-day break in taking the drug. Menstruation can be delayed, if necessary, for as long as required until the tablets from the second package are exhausted. When taking tablets from the second package, breakthrough bleeding or spotting may occur. Regular use of 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;

- heart valve disease;

- atrial fibrillation;

- long-term immobilization (since the risk of thromboembolism is increased in the postoperative period, it is recommended to stop taking oral contraceptives at least 4 weeks before the planned operation and return to taking them no earlier than 2 weeks after returning to normal physical activity).

Because the period immediately after childbirth is associated with an increased risk of thromboembolism, the use of Lindinet 20 should be started no earlier than the 28th day after childbirth or abortion in the second trimester of pregnancy.

Arterial thrombosis and thromboembolism

Lindinet 20 increases the risk of developing arterial thrombotic and thromboembolic complications. Described complications 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.

Lindinet should be prescribed with caution to women who have 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 thrombophilias;

- arterial hypertension;

- hyperlipidemia;

- obesity;

- age.

Women who have migraines and take combined oral contraceptives have an increased risk of stroke.

The use of the drug should be stopped immediately if symptoms indicating the development of thrombosis appear: severe chest pain that may radiate to the left arm, unusual pain in the leg, swelling of the leg, sharp pain when breathing or coughing, the appearance of bloody sputum.

Biochemical parameters indicating the presence of hereditary or acquired predisposition to venous or arterial thrombosis include the following: activated protein C resistance (APC), hyperhomocysteinemia, antithrombin III deficiency, protein C deficiency, protein S deficiency, antiphospholipid antibodies (anticardiolipin antibodies, lupus anticoagulant).

Tumors

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

A meta-analysis of 54 pharmaco-epidemiological studies showed that the relative risk of developing breast cancer is slightly higher in women taking combined oral contraceptives (RR = 1.24). This increased risk gradually decreases over 10 years after stopping combined oral contraceptives. However, these studies did not confirm the presence of a cause-and-effect relationship between the disease and taking the drug. Women who take oral contraceptives are diagnosed with breast cancer at an earlier stage than those who do not use them.

A connection has been established between the formation of benign liver tumors and the use of oral contraceptives, although such benign tumors are rare. When these tumors rupture, intraperitoneal bleeding occurs, which can be fatal.

In rare cases, the development of malignant liver tumors has been reported in women taking oral contraceptives for a long time. In patients with a history of cholestatic jaundice or itching during pregnancy, as well as in patients who have previously taken combined oral contraceptives, the risk of developing the described diseases is higher. If such patients take Lindinet 20, careful monitoring of their condition is necessary, and if the pathological condition returns, the use of the drug must be discontinued.

Other states

In rare cases, retinal vascular thrombosis has been reported when taking oral contraceptives. In case of unexplained partial or complete loss of vision, the appearance of exophthalmos or diplopia, papilledema or damage to the retinal vessels, it is necessary to discontinue oral contraceptives and order additional medical examination.

Previous studies have suggested an increased lifetime relative risk of gallbladder disease in women taking oral contraceptives and estrogen-containing medications. However, recent studies have shown that the relative risk of developing gallbladder disease may be minimal in women taking low-dose oral contraceptives.

The appearance of migraine or worsening migraine attacks, as well as the appearance of a new type of headache, recurring, persistent or very severe, requires discontinuation of oral contraceptives.

Lindinet 20 should be discontinued immediately if generalized itching or epileptic seizures occur.

Effect on carbohydrate and lipid metabolism

There are reports of impaired glucose tolerance in women taking oral contraceptives. Therefore, the condition of women with diabetes and taking oral contraceptives should be carefully monitored.

A small number of women experience persistent hypertriglyceridemia while using oral contraceptives. Decreases in HDL concentrations have been reported with the use of some progestogen-containing drugs. Because estrogen increases HDL cholesterol levels, the cumulative effects of oral contraceptives on lipid metabolism depend on the ratio between estrogen and progestogen doses, the type of progestogen, and the absolute amount of progestogen used in the oral contraceptive.

Women with hyperlipidemia should be closely monitored if they decide to take oral contraceptives. There are reports that women with familial hyperlipidemia who take oral contraceptives containing estrogen experience significant increases in plasma triglyceride concentrations, which may lead to pancreatitis.

Menstrual irregularities

When using the drug, especially during the first 3 months, irregular menstruation (spotting or breakthrough bleeding) may occur.

If irregular menstruation persists for a long time or develops after a regular cycle has been established, it should be taken into account that this phenomenon may have a non-hormonal cause. In this case, to exclude the possibility of developing a malignant neoplasm or pregnancy, it is necessary to conduct a gynecological examination. If a pathological condition is excluded, the use of another type of oral contraceptives may be recommended.

In some cases, a 7-day break in contraception is not accompanied by bleeding. In cases where the use of a contraceptive was not carried out as prescribed, or when there is no bleeding after taking all the tablets from the current package, pregnancy should be excluded before continuing to use the contraceptive from the next package.

Medical examination and follow-up

Before starting the use of oral contraceptives, the patient's family and personal history should be collected, a general medical and gynecological examination should be performed, including blood pressure measurement, laboratory tests, examination of the mammary glands and pelvic organs, as well as a cytological analysis of a cervical smear; in the future, these procedures should be repeated periodically.

Patients should be advised that this drug does not protect against HIV infection (AIDS) and other sexually transmitted diseases.

Liver function

In case of acute or chronic liver dysfunction, the drug should be discontinued until liver function tests return to normal. In patients with impaired liver function, the metabolism of steroid hormones may be insufficient.

Affective disorders

Women who develop severe depression while using oral contraceptives should stop taking the drug. Such patients should be advised to use an alternative method of contraception, and an attempt should be made to determine whether these symptoms are due to the use of oral contraceptives. Women who have previously suffered from depression should be closely monitored; If bouts of depression recur, you should stop taking the oral contraceptive.

Serum folate concentrations may decrease due to the use of oral contraceptives. This may be clinically significant if a woman becomes pregnant soon after stopping oral contraceptives.

Chloasma

The appearance of chloasma is especially often observed in women with a history of chloasma in pregnancy. Women predisposed to chloasma should avoid exposure to the sun, as well as ultraviolet radiation while using oral contraceptives.

Other

In addition to the conditions listed above, increased precautions should be taken in the case of otosclerosis, multiple sclerosis, epilepsy, chorea, intermittent porphyria, seizures, renal dysfunction, obesity, systemic lupus erythematosus and uterine fibroids.

Patients with rare hereditary diseases such as fructose intolerance, glucose-galactose malabsorption or sucrase-isomaltase deficiency should not use this drug.

Impact on the ability to drive vehicles and operate machinery

Considering the possibility of developing side effects such as dizziness and blurred vision, care must be taken when driving a vehicle and operating machinery.

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

Treatment: symptomatic therapy.

Drug interactions
Interactions between ethinyl estradiol and concomitantly administered drugs may result in increased or decreased plasma concentrations of ethinyl estradiol.

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

After discontinuation of medications that reduce the concentration of ethinyl estradiol in the blood, it is recommended to use additional non-hormonal methods of contraception for at least 7 days. After discontinuation of medications that can cause the induction of microsomal liver enzymes and lead to a decrease in the concentration of ethinyl estradiol in the blood serum, it is recommended to use additional non-hormonal methods of contraception for a longer period. Sometimes, depending on the dose, duration of treatment, and the rate of elimination of the enzyme-inducing drug, weeks may pass before liver enzyme induction completely stops.

Active substances that may reduce the serum concentration of ethinyl estradiol:

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

- substances that induce liver microsomal enzymes, for example, rifampicin, rifabutin, barbiturates, primidone, phenylbutazone, phenytoin, dexamethasone, griseofulvin, topiramate, some protease inhibitors and modafinil;

- 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 enterohepatic recirculation of estrogen.

Active substances that may increase serum concentrations of ethinyl estradiol:

- atorvastatin;

- drugs that are also subject to sulfation in the wall of the gastrointestinal tract, for example, ascorbic acid (vitamin C) and paracetamol;

Troleandomycin, when used in combination with oral contraceptives, may increase the risk of intrahepatic cholestasis.

Ethinyl estradiol may affect the metabolism of other drugs by inhibiting liver microsomal enzymes or causing drug conjugation in the liver, in particular glucuronidation. Therefore, plasma and tissue concentrations of other drugs may be increased (eg, cyclosporine, theophylline, corticosteroids) or decreased.

When prescribing any drugs, you should take into account information about their combined use in order to establish possible interaction reactions.

Changes in laboratory results

The use of oral contraceptives may affect the results of some laboratory tests, including tests to determine the function of the liver, thyroid gland, adrenal glands, kidneys, lipoproteins and carrier proteins, as well as parameters of carbohydrate metabolism, coagulation and fibrinolysis.

Usually the changes do not go beyond the reference values ​​and remain within normal limits.

Conditions for dispensing from pharmacies
The drug is available with a prescription.
Storage conditions and periods
The drug should be stored in its original packaging, protected from light and moisture, out of the reach of children, at a temperature of 15° to 25°C. Shelf life: 3 years.