Spermicides

Restrictions on COC use

Prescribing combined oral contraceptives (COCs) requires a thorough medical history, as there are a number of conditions in which their use is strictly restricted. First of all, the drugs are not prescribed to patients over 35 years of age who have a nicotine dependence (smoking). A serious obstacle is the presence of diabetes mellitus, especially if it is accompanied by pronounced vascular complications.

Patients with diagnosed grade III–IV obesity are also in the risk group, which precludes the standard use of these agents. The lactation period deserves special attention: the use of COCs at this time is unacceptable, since active estrogens have the ability to pass into breast milk. It is important to note that the possibility of using oral contraception in the presence of any other comorbid conditions whose course could potentially be affected by hormonal agents is always determined by a physician strictly on an individual basis.

Conditions for immediate withdrawal

In clinical practice, urgent situations arise that require the emergency discontinuation of hormonal contraception (HC). The patient must be informed of the need to immediately discontinue the drug if sudden and very severe headaches appear. Alarming neurological symptoms include sudden visual disturbances, coordination disorders, speech problems, and any loss of sensation in the extremities.

From the cardiovascular and respiratory systems, indications for withdrawal include acute chest pain, the appearance of unexplained shortness of breath, or symptoms of hemoptysis. Acute abdominal pain, especially if it is prolonged, as well as sudden sharp pain in the legs require immediate discontinuation of intake. Other critical conditions include a significant increase in blood pressure (BP), the appearance of skin itching, the development of jaundice, or the occurrence of a skin rash.

Basic rules and administration regimens

To ensure the maximum reliability of the contraceptive effect, it is necessary to strictly follow the rules for taking the drugs.

• Start of therapy: taking the first pill should coincide with the 1st day of the menstrual cycle.
• Dosing regimen: the drug is taken daily, strictly 1 pill at the same time of day.
• Standard protocol: a classic pack contains 21 active pills. After 21 days of continuous intake, a mandatory 7-day break is taken. It is during this period that a menstruation-like reaction occurs. Upon completion of the break, a new treatment cycle begins.
• Multi-phasic agents: when using multi-phasic contraceptives, it is critically important to take the pills in the exact sequence specified by the manufacturer.
• Special situations: after a surgical abortion, starting COCs is permitted on the day of the procedure. After childbirth (in the absence of lactation), the need for contraception arises after 3 weeks.
• Cycle management: if a postponement of menstruation-like bleeding is required, no break in intake is made. The patient continues taking pills from the next pack (for multi-phasic preparations, only the pills of the last phase are used).

Microdosed COCs and extended regimens

Modern pharmacology offers microdosed COCs (e.g., the drug Yaz), which have their own characteristics. A pack of such an agent contains 28 pills.

The administration regimen looks like 24 active pills followed by 4 placebo pills. This ratio has a clear rationale: the action of hormones is extended for another 3 days, and the presence of placebo pills facilitates compliance with the continuous administration regimen.

In addition, an extended regimen for using monophasic COCs is employed. It involves the continuous intake of pills for 3 consecutive cycles, after which a single 7-day break is taken.

Action algorithm for missed pills

Violation of the administration regimen reduces the effectiveness of protection. The critical time is considered to be an interval of more than 36 hours between intakes — in this case, the reliability of the contraceptive effect is not guaranteed.

Class and exam questions

What else to study on this topic

• The mechanism of estrogen penetration into breast milk and their effect during lactation.
• Pathogenesis of vascular complications in diabetes mellitus during COC use.
• Causes of acute pain in the legs and chest (risk of thrombosis) with hormonal contraception.
• Pharmacokinetics of multi-phasic drugs and the importance of strict sequence in their administration.
• Rationale for the three-week interval before starting contraception after childbirth without lactation.

Other topics in the "Gynecology" section

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.