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Combined oral contraceptives

In harmony with hormones. Combined oral contraceptives

In previous issues, we told you about the physiological and barrier methods of preventing unwanted pregnancy and intrauterine devices (IUDs). Now we are talking about the most numerous group of modern contraceptives – hormonal contraceptives, or rather, their variety – combined oral preparations.

Gynecologist-endocrinologist, Cand. honey. Sciences, Tyumen

Hormonal contraception is not only one of the most common, reliable and effective means of preventing unwanted pregnancies, but, as has been proved by scientists of different countries, has a beneficial effect on the woman’s organism and its reproductive health. In order to understand the mechanism of action of hormonal contraceptives, let us turn to the origins – the physiology of the female body.

All the changes occurring in it are cyclical, i.e. repeat after a certain time. A cycle is usually called the period from the first day of menstrual bleeding until the next.

The average cycle is 28 days, but can be reduced to 21 days or increased to 35, which is also the norm. In the middle of the menstrual cycle (approximately on day 14 with a 28-day cycle) ovulation occurs the exit of a mature egg from the ovary, and if she is at that moment meets with the spermatozoon, then pregnancy occurs.

The whole complex process is regulated by female sex hormones – estrogen and progesterone, the ratio of which varies three times for each cycle. Combined oral contraceptives (COCs) are tablets that consist of from synthetic analogs estrogen and progesterone. COCs differ in the ratio of active substances in the preparation and are divided into the following types: single-phase, two-phase and three-phase.

The ratio of hormones in three-phase COCs is most similar to the physiological fluctuations of estrogen and progesterone in the female body. In two-phase COC, the ratio of hormones changes two times, which is somewhat different from natural processes.

Most of all, single-phase contraception means do not correspond to the course of internal female hormonal processes. However, the mechanism of action of all COCs is the same and does not depend on the dosage of the components.

And does not mean that three-phase contraceptives better. Individual tolerance and effectiveness of the drug depends on a variety of characteristics, and often there are cases when single-phase agents are well tolerated by the body, and three-phase ones, on the contrary, cause negative symptoms (nausea, headache, etc.).

Use of COCs is possible from the moment of the onset of sexual activity to the period of menopause. For menopausal women after menopause, the use of oral contraceptives is indicated as hormone replacement therapy, in order to prevent changes in bone and cartilage tissue associated with calcium leaching.

Contraceptive effect when using COC is achieved in several ways. At first, combined contraceptives suppress ovulation and, consequently, make it impossible for the maturation itself and the release of the egg into the fallopian tube. Secondly, they change the composition of the secretion of the cervix, which normally should promote the promotion of spermatozoons inside the uterus.


If the doctor has prescribed a drug for you, the plate of which contains 21 tablets, they are taken from the first day of the cycle, one tablet a day, after which they make a seven-day break, and then start a new plate. During this week, the contraceptive effect of hormones remains the same, and additional methods of protection are not required. In addition, during this period there is a menstrual reaction.

If the oral contraceptive contains 28 tablets, they are taken without any interruptions (a menstrual-like reaction will occur between 21 and 28 in the afternoon). After a year of continuous COC, a three-month break is necessary to restore the function of the ovaries.

During this period other methods of protection from pregnancy are preferable.

For the correct choice of hormonal contraceptives, a consultation of a gynecologist is necessary, which, according to the diagnostic data, will prescribe the drug most suitable for you. When choosing a hormonal contraceptive, the following studies are needed:

  1. Gynecological examination, taking swabs from the vagina and cervix to determine the microbial flora and eliminate cancer (on the structure of cells in the smear);
  2. Ultrasound examination (ultrasound) of pelvic organs 2 times per cycle - after menstruation and before the next menstruation. The growth and maturation of the mucous membrane of the uterine cavity, the presence of ovulation, etc. are assessed. Possible diseases of the pelvic organs are excluded.
  3. Consultation mammologist (doctor involved in the treatment of diseases of the mammary glands), ultrasound of the mammary glands.
  4. Determination of the level of hormones in the blood - according to the prescription of the attending physician, if necessary.


We have already said that it is necessary to take COCs daily for effective contraception. A missed tablet increases the risk of pregnancy, but in any case, do not panic. If you forgot to take one pill, then drink it right away, as soon as you remember it, regardless of time, and the next - as usual.

In this case, the risk is minimal, but if it happened during the proposed ovulation, it is better to use an additional contraceptive (condom, etc.) before the next menstruation. In general, the peculiarities of the action of modern COCs are such that the admission of taking the tablet for less than 12 hours does not affect the contraceptive effect of the drug in any way. However, if in doubt, it is better to consult a gynecologist who prescribes the drug.

If you forgot to take two tablets, an additional method of prevention is extremely desirable. To restore the effect of COC, it is necessary to take two forgotten tablets immediately, and two more - the next day, for example, in the morning and in the evening.

In this case, COCs are used in emergency contraception regardless of the days of the week on the package. In this case, the occurrence of bloody discharge from the vagina associated with a large concentration of hormones, but this symptom lasts no more than two or three days. If this phenomenon continues for a longer time, consult a gynecologist.


Although I know that this is not very reliable. Oval never heard about Patentex, but it wentogle.

You will definitely have to try.

April 11, 2014 02:22

I have since adolescence had problems with thyroid gland and, accordingly, hormonal failures. Weight then picked up for no reason, then abruptly dumped. Therefore, there was no question of taking hormonal medications or patches.

Now only Patentex Oval or, if they ended abruptly and did not have time to buy, then condoms. But candles like more, because from the condom sometimes itch.

10 april 2014 22:35

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