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Everything you need to know about hormonal contraception

IT IS , of course, already difficult to surprise someone with the USE OF HORMONAL CONTRACEPTION , but it is easy to get lost in the myths that surround this topic. In the USA, up to 45% of women aged 15–44 prefer hormonal contraception , while in Russia only 9.5% of women have ever used it. With the help of gynecologist-endocrinologist Valentina Yavnuk, we figured out how she works, what medicinal properties she has, whether she is a danger to a woman’s health and what does feminism have to do with it. 

What is hormonal contraception

A distinctive feature of the modern world is a large-scale movement to free the individual from various cultural, religious and social stereotypes. An essential part of this process is associated with the acquisition of reproductive freedom by women. This means that the woman regains the right to control her own body: to live a sex life that suits her, and to make her own decisions about whether she is ready to become pregnant or to terminate an unwanted pregnancy. In many ways, it was the emergence and development of hormonal contraception that allowed women to take control of their bodies.

Hormonal contraception is a method of preventing unwanted pregnancy that a woman can completely regulate herself. Moreover, its effectiveness is higher than all other options for protection – subject to the rules of use, of course. So, a possible pregnancy becomes something that partners can consciously choose. True, such contraceptives do not protect against genital infections – here the only way to protect yourself is a condom.     

All hormonal contraceptives generally work according to the same principle: they suppress ovulation and / or prevent the egg from fixing on the surface of the uterine lining. This is due to the fact that a small amount of synthetic sex hormones constantly enters the body. Ovulation suppression puts the ovaries in an artificially induced controlled “sleep”: they decrease in size and the follicles stop emitting eggs for nothing.

How hormones work

Hormones are substances that actively affect all functions of the human body. Yes, in most cases they help to improve the quality of skin and hair, stabilize weight and have many non-contraceptive benefits. Nevertheless, in no case should you take hormones on your own, without consulting your doctor. In addition, these drugs should not be prescribed by a cosmetologist or gynecologist without referral to a consultation with a gynecologist-endocrinologist.  

Sex hormones are biologically active substances in our body that are responsible for the development of male or female sex characteristics. We have two types of them: estrogens are produced by the ovaries and from the beginning of puberty form the female characteristics of the body, are responsible for libido and menstruation. Gestagens are produced by the corpus luteum of the ovaries and the adrenal cortex and provide the possibility of conception and continuation of pregnancy, which is why they are called “pregnancy hormones”.    

It is these two types of hormones that provide our monthly cycle, during which the egg matures in the ovary, ovulation occurs (when the egg leaves the ovary) and the uterus is prepared for gestation. If fertilization does not occur, then after ovulation the egg dies, and the endometrium, that is, the mucous membrane of the uterus, begins to be rejected, which leads to the onset of menstruation. Despite the opinion that menstruation is a “ruptured egg”, in fact, it is the rejection of the mucous membrane that causes bleeding. An unfertilized egg does come out with it, but it is too small to see it. 

The main estrogen in the female body is the hormone estradiol, which is produced in the ovaries. A high concentration of estradiol in the blood in the middle of the cycle leads to the fact that the pituitary gland is actively “turned on” in the brain. The pituitary gland triggers ovulation and the production of the main progestogen – progesterone – in case of pregnancy. Hormonal contraceptives work like this: they suppress the ovulatory activity of the pituitary gland, which controls all this complex process “from above”, and maintain a stable level of the pregnancy hormone progesterone. Thus, the pituitary gland rests from reproductive concerns, and the female body experiences a state of so-called false pregnancy: there is no monthly fluctuation of hormones, the eggs quietly “sleep” in the ovary, so fertilization becomes impossible.     

There are also other types of hormonal drugs. The gestagens in their composition change the quantity and quality of vaginal mucus, increasing its viscosity. So it becomes more difficult for sperm to get into the uterus, and the changed thickness and quality of its coating excludes the implantation of the egg and reduces the mobility of the fallopian tubes.

How to start using hormonal contraceptives

You can take hormonal contraceptives from late puberty, when the monthly cycle is established (on average, from 16-18 years), and until the end of menstruation and the onset of menopause. In the absence of complaints and with regular preventive diagnostics, women are advised to take a break from taking hormones only if necessary to become pregnant, during pregnancy and lactation. If there are no contraindications, hormonal contraception can be taken the rest of the time.

Remember that the gynecologist-endocrinologist must carefully collect information about the state of your body in order to effectively select the drug and avoid unnecessary risks. This information includes a history – collection of information about thromboembolic diseases, diabetes, hyperandrogenism and other diseases in your family – and examination. The examination should include a general gynecological examination, an examination of the mammary glands, measuring blood pressure, taking a smear from the cervix, donating blood for coagulation and sugar, and assessing risk factors based on the results.

What are the types of hormonal contraception?

There are several types of hormonal contraception: they differ in the way they are taken, regularity, composition and dosage of hormones. Oral contraceptives are one of the most popular. For example, in the United States, it accounts for about 23% of all methods of contraception. These are pills that are taken every day with a break, depending on the properties of a particular drug. Tablets are of two types in composition: mini-pills contain only synthetic progestogen (they can be used by nursing mothers), and combined oral contraceptives (COCs) contain synthetic estrogen and one of the types of synthetic progestogens – depending on the indications and state of the body, you may need certain substances.     

Oral contraceptives have the lowest hormone dosages and are highly effective in protecting against unwanted pregnancies. Recently, a natural analogue of estrogen was found – estradiol valerate. The drug based on it has the lowest concentration of the hormone to date, while maintaining the contraceptive effect. The only drawback of the pills is the need to take them every day at the same time. If this condition seems difficult, then it is worth choosing a method that requires less care, since violation of the rules of admission leads to an increased risk of pregnancy and possible complications.

The lifestyle of a modern woman often not only does not imply permanent pregnancy, but also requires her to withstand a large social load.

Mechanical contraceptives are placed on or under the skin and inside the vagina or uterus. They constantly release a small concentration of hormones and need to be changed periodically. The patch is fixed on any part of the body and is changed once a week. The ring is made of elastic transparent material and is inserted into the vagina for a month, almost like a tampon. There is also a hormonal intrauterine system or a spiral, which is inserted only by a doctor – but it lasts up to five years. Hormonal implants are installed under the skin – and can also work for almost five years.

There are also hormonal injections, which are also injected for a long time, but in Russia they are practically not used: they are mainly popular in poor countries where women do not have access to other methods – injections are highly effective and not too expensive. The disadvantage of this method is that it cannot be canceled: the plaster can be removed, the ring can be removed, the spiral removed, and the pills can be stopped drinking – but it is impossible to stop the action of the injection. At the same time, implants and spirals are also inferior to rings, tablets and plasters in mobility, since they can only be removed with the help of a doctor. 

What is treated with hormonal contraceptives

It is due to the fact that hormonal contraceptives help stabilize the hormonal background of the female body that they have not only contraceptive, but also therapeutic, that is, non- contraceptive effect. Gynecologists and endocrinologists believe that modern women suffer from ecological and social reproductive dissonance – in other words, from the dramatic difference between how we live and how our ancient biological mechanism works. The lifestyle of a modern woman often not only does not imply constant pregnancy, but also requires her to withstand a large social load. Since the introduction of contraception, the number of a woman’s monthly cycles per life has increased significantly. Monthly hormonal changes are associated not only with the monthly risk of symptoms of premenstrual syndrome or dysphoric disorder, but also deplete the strength of the body as a whole. A woman has the right to spend these energy resources at her discretion on any other type of constructive activity – and hormonal contraceptives help in this.   

Due to the action described above, hormonal contraceptives treat the symptoms of premenstrual syndrome and are even able to cope with the manifestation of its more severe form – premenstrual dysphoric disorder. And due to the combined estrogen-gestagenic contraceptives, endocrinologists correct hyperandrogenism – an excess of male hormones in a woman’s body. This excess can lead to a violation of the cycle, infertility, heavy menstruation and their absence, obesity, psycho-emotional problems and other serious conditions. Due to hyperandrogenism, we may be bothered by other problems: hirsutism (increased male hair growth), acne (inflammation of the sebaceous glands, acne) and many cases of alopecia (hair loss). The effectiveness of COCs in the treatment of these diseases is quite high.      

After consulting a doctor, some pills can be taken in such a mode that even withdrawal bleeding will not occur.  

Hormonal contraceptives treat abnormal uterine bleeding – this is a general term for any abnormalities in the menstrual cycle: change in frequency, irregularity, bleeding too much or too long, and so on. The reasons for such failures and the severity of the condition may be different, but hormonal contraceptives are often prescribed as part of a comprehensive treatment. In the absence of contraindications, they will most likely choose a spiral: it daily releases progestogen into the uterine cavity, which effectively causes changes in the lining of the uterus, due to which it corrects heavy menstrual bleeding. The risk of developing ovarian cancer and cancer of the lining of the uterus with the use of hormonal contraceptives decreases, as the ovaries decrease in size and “rest”, as during pregnancy. Moreover, the longer the admission lasts, the lower the risk.     

Hormonal drugs are mainly designed to mimic a monthly cycle, so there is monthly withdrawal bleeding – “menstruation” with a few days off between drug cycles. Good news for those who hate periods: after consulting with your doctor, some pills can be taken in such a way that there will be no bleeding.   

Who shouldn’t take hormonal contraceptives

According to the WHO, there is an impressive list of contraindications that cannot be ignored. Combined contraceptives should not be taken by pregnant women, non-lactating mothers earlier than three weeks after childbirth and lactating women – earlier than six months after childbirth, smokers after thirty-five years, hypertensive patients who have thromboembolic diseases or their risk, diabetics with vascular disorders or experience more than twenty years, and also in case of breast cancer, gallbladder diseases, coronary heart disease or complications with the valve apparatus, with hepatitis, liver tumors. 

There are fewer restrictions on the use of progestogen contraceptives. Again, they should not be taken by pregnant women, breastfeeding earlier than six weeks after delivery, with breast cancer, hepatitis, tumors or cirrhosis of the liver. Combining some antibiotics, sleeping pills, anticonvulsants with hormonal contraception may also be undesirable: tell your doctor about taking other drugs.

Are hormonal contraceptives dangerous?

Hormones have an effect not only on the reproductive system, but also on the entire body as a whole: they change some metabolic processes. Therefore, there are contraindications to taking hormones based on possible side effects. Since the time of the first and second generations of high-dose hormonal contraceptives, there have been many horror stories about weight gain, “hair growth”, strokes, chemical addiction and other sad consequences of taking a high concentration of hormones. In new generations of products, the concentration of hormones is reduced tenfold and other substances are often used than before. This allows them to be used even for non-contraceptive medicinal purposes – therefore, it is wrong to transfer stories about the first generations of drugs to them.

The most common side effect of hormonal contraception is increased blood clotting, which can lead to a risk of thromboembolic disease. Women who smoke and women whose relatives have had any thromboembolic complications are at risk. Since smoking in itself increases the risk of blood clots, most doctors will refuse to prescribe hormonal contraceptives for women who smoke after thirty-five years. The risk of thrombosis is usually higher in the first year of admission and in the first six months after hormone withdrawal, which is why, contrary to popular belief, frequent breaks in hormone intake should not be taken: it is not recommended to take them for less than a year and return to them earlier than after a year break, so as not to harm your health. Prevention of thrombosis, in addition to smoking cessation, is an active lifestyle, consumption of sufficient fluids and an annual blood test for homocysteine and coagulogram.    

While taking hormones, other types of intoxication can also have a negative effect: the use of alcohol and various psychoactive substances, including marijuana, psychedelics and amphetamines, can provoke problems with blood pressure, blood vessels of the heart and brain. If you are not going to reduce the use of toxic substances while taking hormonal contraception, you should inform your endocrinologist about your habits to avoid unnecessary risks. 

The risks of cervical cancer while taking contraceptives increase when a woman has human papillomavirus, chlamydia, or a high risk of contracting sexually transmitted infections – that is, neglecting barrier contraception with non-regular partners. The pregnancy hormone progesterone suppresses the body’s immune response, so women who fall into this risk group can take hormonal contraceptives, but they need to undergo a cytological examination more often – if there are no complaints every six months. There is no convincing evidence that modern contraceptives increase the risk of liver cancer, although the first generations of drugs, due to the high dosage, had a bad effect on her health. Many women are afraid that taking drugs will trigger breast cancer. Most studies have failed to establish a reliable link between hormonal contraceptive use and the occurrence of breast cancer. Statistics show that women with a history of breast cancer, late menopause, childbirth after forty, or have not given birth are at risk. In the first year of HA use, these risks increase, but disappear as they are taken.    

There is no evidence that a woman taking hormonal contraceptives has a shrinking egg supply.

There is an opinion that taking hormonal contraceptives can lead to depressive conditions. This can happen if the progestogen included in the combined contraceptive is not suitable for you: with this problem you need to consult a doctor in order to change the combined drug – most likely, this will help. But in general, depression and even observation by a psychiatrist is not a contraindication for taking contraceptives. However, both doctors must be sure to be informed about the drugs that you are using, because some of them can weaken each other’s action.

There is a myth that hormonal contraceptives, due to inhibition of the reproductive system, lead to infertility, subsequent miscarriage and fetal pathologies. This is not true. The so-called ovarian sleep, or hyperinhibition syndrome, is reversible. At this time, the ovaries are resting, and the whole body is in a hormonally even state of “false pregnancy”. There is no evidence to prove that a woman taking hormonal contraceptives has a reduced egg supply. Moreover, hormonal therapy is used to treat infertility, because after drug withdrawal and recovery, the ovaries work more actively. Taking hormonal contraceptives in the past does not affect the course of pregnancy and fetal development. In most cases, the risks and side effects from taking hormonal contraceptives are significantly lower than from terminating an unwanted pregnancy. 

Also, hormonal contraceptives do not cause amenorrhea, pathological cessation of menstruation. After discontinuation of the drug, it often takes at least three months for menstruation to recover (if it has not been for more than six months, then it is better to see a doctor). The syndrome of hormonal contraception withdrawal is a condition that occurs after the termination of hormone intake, when the body returns to constant monthly hormonal changes. In the first six months after the cancellation, the body can storm, and therefore during this period it is better to be observed by an endocrinologist. Without medical necessity, hormone intake cannot be interrupted in the middle of the cycle: sudden interruptions contribute to uterine bleeding and cycle irregularities.

In the endocrinological environment, there is a poetic phraseological unit that characterizes the status of “balanced” women’s health: the harmony of hormones. Modern hormonal contraceptives still have contraindications and side effects, but with proper selection, adherence to the rules of admission and a healthy lifestyle, they can not only eliminate the risk of unwanted pregnancy, but also significantly improve the quality of life of a modern woman – freeing her strength for the desired activity.

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