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Principles for the selection of oral contraceptives

The purpose of oral contraceptives should be differentiated, taking into account the peculiarities of somatic and gynecological status, sexual activity, initial hormonal levels, history data, and the possibility of adverse reactions. When selecting drugs, preference should be given to low-dose contraceptives containing third-generation progestogens.



The main provisions of the management system of patients applying OK:

1. strict accounting of contraindications to the appointment of OK;

2. annual detailed gynecological examination, including extended colposcopy, cytological examination of ecto-and endocervix (in the literature an increase in the incidence of cervical dysplasia by 1.5-2 times, as well as endocervical hyperplasia with prolonged use of OC; however, the frequency of invasive cervical cancer does not exceed that in the population);

3. transvaginal ultrasound scan of the uterus and its appendages annually and / or with menstrual dysfunction (intermenstrual bleeding 3 months after starting the drug; pseudo-amenorrhea);

4. inspection of the mammary glands every 1 / 2-1 year (special attention is paid to patients in the history of which there were benign breast tumors and / or in the presence of breast cancer in the family);

5. blood pressure measurement; with a steady increase in diastolic pressure up to 90 mm Hg. Art. and more - stop receiving OK;

6. clinical and laboratory testing of patients with burdened heredity, mild hepatic and renal dysfunction;

7. clinical evaluation of possible complaints and adverse reactions:

o weight gain - recommend taking low-dose OK. containing third-generation progestogens, diet and exercise; with cyclic weight gain - OK with a low content of hormones or termination of their reception,

o visual impairment (pain in the eyes, weakness of sharpness, fuzziness - observed when wearing contact lenses); stop taking OK, temporary refusal to wear lenses, consultation of an ophthalmologist and a neurologist is required,

o development of depression; stop taking OK, prescribe vitamins B (20 mg / day);

o the appearance of scant bloody discharge from the genital tract in the first three cycles (observed in 25% of women); OK should be continued, as this symptom does not require treatment; with persistent bleeding over three cycles, you must adhere to the following recommendations:

a. in the first phase or in the middle of the cycle, take an extra pill of the drug from a spare package (for multiphase preparations, take a pill of the same day) and resume normal intake after stopping bleeding; In the next cycle, select a drug containing a large dose of estrogen.

b. in the second phase, the recommendations are identical to those described above, however, in the next cycle, a drug containing a high dose of progestogen is needed,

c. with continued bleeding to eliminate the error in receiving OK. as well as organic pathology (uterine fibroids, endometriosis, endometrial hyperplastic processes, cervical polyps, cervical or uterine carcinoma, ectopic pregnancy, threatened abortion, inflammatory diseases),

o delayed menstrual-like reaction - "post-table amenorrhea": pregnancy should be excluded (especially if there are errors in taking the drug):

a. recommend the measurement of basal temperature for at least three days (an increase in temperature to 37 ° C and above indirectly favors pregnancy),

b. determine the titer of trophoblastic hormone or P-subunit of chorionic gonadotropin in serum: conduct a transvaginal ultrasound scan,

c. if pregnancy is excluded, the most likely cause of pseudo-amenorrhea is considered to be the individual hypersensitivity of the hypothalamic-pituitary system to exogenous hormones in patients with an unfavorable premorbid background; if "post-table amenorrhea" first appeared - to recommend a drug with a lower hormone content, with the re-development of "post-table amenorrhea" - another method of contraception: after the abolition of OK, the menstrual cycle. usually restored without additional therapy; the duration of "pseudo-amenorrhea" over 6 months requires appropriate examination and treatment;



8. the duration of the continuous reception of OK to the present time remains the subject of discussion; However, according to numerous studies (both domestic and foreign), healthy young women can take OK for many years.

Recommendations for patients applying OK:

• strictly observe the regimen of administration of the drug - do not skip the pill, strictly adhere to the 7 day interval;

• take a pill of the drug at the same time (in the morning or in the evening), drinking milk (to prevent nausea) or water;

• if one tablet is missed, it should be taken as soon as possible (no later than the 12-hour interval), another one - at the usual time; contraception within 7 days after the “forgotten” pill cannot be considered reliable, so an additional method of birth control should be used; if the period after an erroneously missed pill is more than 12 hours and less than 7 pills are left in the package - do not take a 7 day break and use an additional method of contraception;

• in the absence of a mental-reaction, continue taking it in the usual manner and consult a doctor (pregnancy or “post-cell amenorrhea” is possible);

• simultaneous use of broad-spectrum antibiotics, antihistamines, anticonvulsants, painkillers, nitrofurans, barbiturates leads to a decrease in the contraceptive effect of OC (due to the activation of the metabolic function of the liver), which is clinically manifested by intermenstrual bleeding; in such a situation, it is necessary to use an additional method of contraception (for example, barrier + spermicides) before the next menstrual-like reaction;

• after discontinuation of the drug, pregnancy may occur in the first cycle ("rebound" effect), therefore, if you are not interested in conception, you should use other methods of contraception;

• suspend receipt of QA 6 weeks before the upcoming scheduled operation; in case of emergency surgery, the drug can be continued, warning the surgeon about it;

• stop using OK 3 months prior to the planned pregnancy; for the purpose of contraception to use another method (preferably mechanical); take vitamins of group B, folic acid, the content of which decreases while taking OK;

• the transition to the use of the drug with the same or a high content of hormones requires compliance with the standard 7 day interval; the transition to a low-dose OK is started the next day after taking the last pill of the “old” drug; during the transition from monophasic to multiphase preparations, a more abundant menstrual-like reaction may appear;

• if vomiting occurs (within 3 hours after taking the drug), you must additionally take another pill; diarrhea that lasts several days requires the use of an additional method of contraception until the next menstrual-like reaction;

• any complaints that arose against the background of the OK application should be discussed with the doctor; with a sudden, localized, severe headache, migraine attack, chest pain, acute visual impairment, difficulty breathing, jaundice, high blood pressure above 160/100 mm Hg.
Art. - Immediately stop taking the drug;

• when scant intermenstrual bleeding occurs in the first months of taking the drug, it is necessary to take an extra pill from a spare package (for multiphase drugs, take a pill of the same day); if the discharge has ceased - to continue the usual mode of administration, with continued bleeding (or bleeding at a later date) - consult a doctor.

OK can be used as an "emergency" contraception in the case of the so-called "naked" sexual intercourse (condom rupture, rape, etc.). The postcoital preparations (“Postinor”) previously used for these purposes are currently not recommended for use by WHO. To ensure emergency contraception, a special scheme has been developed (Yuzpe method), which is distinguished by high contraceptive effectiveness: during the first 72 hours after uncovered intercourse, 3 tablets of monophasic OK are taken; after 12 hours, the drug is repeated in the same dose. As a rule, in two days after using the scheme of "emergency" contraception, bleeding from the genital tract appears. Despite the high contraceptive reliability of the “emergency” method, it should be borne in mind that this scheme is intended only for emergency situations and cannot be used regularly.
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