Non-contraceptive and therapeutic effects
In addition to their primary function of limiting reproductive capacity, these medications offer a wide range of additional benefits. The most important of these is the prevention of retention ovarian formations (cysts)—the risk of their development decreases by up to 90% during use. By significantly reducing blood loss during menstruation-like bleeding, the medications effectively prevent the development of iron-deficiency anemia.
Clinically significant is the relief or substantial alleviation of symptoms of premenstrual syndrome (PMS) and dysmenorrhea. The medications exert a pronounced therapeutic effect in a number of pathologies, with the choice depending on the type of agent:
- Third-generation COCs are used to treat acne, seborrhea, and hirsutism.
- Triphasic COCs are indicated for uncomplicated cervical ectropion.
- In certain forms of infertility associated with ovulatory dysfunction, the rebound effect (drug withdrawal effect) is utilized.
A positive therapeutic effect on the course of rheumatoid arthritis and an increase in the acceptability of intrauterine contraceptive (IUC) use are also noted.
Pharmacodynamic feature: the protective effect starts after one year of continuous use, its potency dose-dependently increases in proportion to the duration of use, and persists for 10–15 years after complete discontinuation.
Indications for prescription (WHO criteria)
According to international WHO criteria, this method is recommended for women of any age wishing to limit their reproductive function. Special attention is paid to specific clinical situations where prescribing hormonal therapy yields maximum benefit.
The medications are indicated in the post-abortion period, as well as postpartum (strictly 3 weeks later and exclusively in the absence of breastfeeding). In the patient's history, strong indications include a prior ectopic pregnancy and pelvic inflammatory disease (PID).
Targeted prescription depending on composition:
- Monophasic COCs are the drugs of choice for endometriosis, fibrocystic breast disease, and the presence of retention ovarian cysts.
- COCs with third-generation progestogens are optimal for hyperandrogenic conditions (acne, seborrhea, hirsutism).
Additional indications include menorrhagia, confirmed iron-deficiency anemia, severe PMS, dysmenorrhea, and ovulation syndrome.
Absolute contraindications
Patient safety requires the strict exclusion of absolute contraindications before starting therapy. Prescription is strictly prohibited in confirmed pregnancy, as well as in the presence of hormone-dependent malignancies (tumors of the breast, reproductive organs) and any liver tumors.
Cardiovascular contraindications preclude use in:
- Severe cardiovascular pathologies and cerebrovascular diseases.
- Severe arterial hypertension (AH) if blood pressure values exceed 180/110 mm Hg.
- Acute deep vein thrombosis and thromboembolism.
- Migraines accompanied by focal neurological symptoms (aura).
Other strict limitations include marked renal and hepatic impairment, as well as genital bleeding of unclear etiology.
Surgical risk: due to the high risk of thrombotic complications, administration must be stopped 4 weeks before planned major abdominal surgeries. Resumption is possible no earlier than 2 weeks after surgery. Prolonged immobilization is also an absolute contraindication.
Disadvantages and vulnerabilities of the method
Despite high contraceptive and therapeutic efficacy, the method has a number of significant drawbacks that must be discussed with the patient during counseling.
First, unlike barrier contraception, hormonal medications are characterized by a complete lack of protection against sexually transmitted infections (STIs).
Second, the method requires the highest level of discipline: strict daily pill-taking is necessary. This creates a high risk of user errors leading to unwanted pregnancy.
Third, contraceptive reliability can be critically reduced when co-administered with a number of other medications, which requires a thorough pharmacological history.
Briefly: answers to topical questions
Which drug groups reduce the contraceptive reliability of COCs when co-administered?
The contraceptive efficacy of COCs may decrease when co-administered with certain medications. Sources indicate drug interactions when taking:
- antibiotics;
- anticonvulsants;
- beta-blockers, etc.
What types of barrier contraceptives are used in gynecology?
Gynecology utilizes mechanical and chemical barrier methods of contraception.
Mechanical methods include:
- male condoms;
- female condoms;
- vaginal diaphragm.
Chemical methods include:
- spermicides—chemical substances lethal to spermatozoa; dosage forms include vaginal tablets, suppositories, pastes, gels, creams, films, and foams.
Spermicidal sponges are described separately: they create a mechanical barrier and release a spermicide.
What side effects and complications may occur during the adaptation period of COC use?
In the first months of COC use, one of the most frequent side effects is uterine bleeding—ranging from spotting to breakthrough bleeding. In most cases, they resolve spontaneously within the first 3 months of use and do not require discontinuation of the contraceptive.
Possible causes of bleeding:
- estrogen deficiency—bleeding in the 1st half of the cycle;
- progestogen deficiency—bleeding in the 2nd half of the cycle;
- absorption impairment during vomiting or diarrhea;
- missed pills;
- drug interactions during co-administration with antibiotics, anticonvulsants, beta-blockers, etc.
Allergic reactions to any component of the medication are also possible.
To remember the timing of perioperative discontinuation, use the "4-2" rule: discontinue medications 4 weeks BEFORE major abdominal surgery, resume them 2 weeks AFTER (for the prevention of thrombosis).
Class and exam questions
Can COCs be prescribed immediately after childbirth?
No, prescription is possible strictly 3 weeks after childbirth, and only provided that the woman is not breastfeeding the child.
Do oral contraceptives protect against STIs?
No, the method offers absolutely no protection against sexually transmitted infections. For protection against STIs, exclusively barrier contraception must be used.
Which drugs should be chosen for endometriosis and ovarian cysts?
In endometriosis, fibrocystic mastopathy, and ovarian retention cysts, monophasic COCs are indicated.
How long does the therapeutic effect persist after discontinuing the drugs?
The protective effect increases in a dose-dependent manner with the duration of use (starting from 1 year of use) and persists for 10–15 years after complete discontinuation.
What else to study on this topic
- Mechanism of the rebound effect in the treatment of endocrine infertility.
- Classification of COCs: monophasic, triphasic, and progestogen generations.
- Pathogenesis of thrombotic complications associated with hormonal preparations.
- Drug interactions that reduce contraceptive efficacy.
- Complete list of WHO criteria for prescribing various contraceptive methods.
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