Classification by phase
The logic behind creating multiphasic agents is based on the natural hormonal fluctuations in the female body:
- Monophasic — the dosage of components remains unchanged throughout the course (examples: Diane-35, Jeanine, Yarina, Logest, Femoden, Minisiston).
- Biphasic — the amount of estrogen is stable, while the progestin level increases in the second half of the cycle (currently practically unused; a representative is Anteovin).
- Triphasic — the progestin dose increases stepwise in two stages (representatives are Trikvilar, Tri-Merci).
Additional therapeutic effects
In addition to preventing unwanted pregnancy, these medications affect various body systems due to the properties of specific progestins:
- Antiandrogenic effect: mediated by cyproterone and dienogest. Helps reduce hirsutism, acne, oily seborrhea, and hair loss. Medications Diane-35 and Jeanine are effective for hyperandrogenism, and Jeanine is also used in the treatment of endometriosis.
- Antimineralocorticoid effect: drospirenone in the preparation Yarina blocks fluid retention, preventing edema, breast tenderness, and weight gain.
- Cycle regulation and oncoprotection: menstrual blood loss is reduced, lowering the risk of anemia and dysmenorrhea. The progestin component protects the endometrium and ovaries by neutralizing the mitogenic effects of estrogens.
Adverse effects and impact on hemostasis
COC intake may be accompanied by adverse reactions from various organs:
- Gastrointestinal tract and CNS: nausea, rare vomiting, migraine-like headaches.
- Reproductive system: breakthrough bleeding, amenorrhea, breast tenderness.
- Cardiovascular system: edema and elevated blood pressure.
The main risk factor is associated with the estrogen component (ethinyl estradiol), which stimulates the synthesis of blood clotting factors and increases the risk of thrombosis. In healthy women, this risk is compensated by the simultaneous activation of the fibrinolysis system. However, in smoking patients, compensatory mechanisms are suppressed, making smoking an absolute contraindication.
Briefly: answers to topical questions
What generations of progestins exist in COCs?
The provided materials describe 3rd-generation progestins in detail and mention "older" progestins.
- 3rd-generation progestins — highly selective progestins, which include norgestimate, desogestrel, gestodene, dienogest, and drospirenone. They have a documented antiandrogenic effect; modern selective progestins do not adversely affect lipid metabolism. Drospirenone additionally possesses an antimineralocorticoid effect.
- "Older" progestins — progestins with a pronounced androgenic effect, the use of which may cause acne, seborrhea, and hirsutism.
A specific classification of all progestin generations is not presented in the provided materials.
The 21/7 rule: twenty-one days of taking strictly by the clock, seven days of rest — keeping the cycle under control.
Class and exam questions
How to properly take a standard 21-tablet pack of COCs?
Intake begins on the first day of the menstrual cycle and continues daily at the same time for 21 days. After that, a 7-day break is taken, during which withdrawal bleeding occurs.
Why is smoking a contraindication for taking COCs?
Ethinyl estradiol stimulates blood clotting, and in smoking women, the compensatory activation of fibrinolysis is impaired. This sharply increases the risk of venous and arterial thrombosis.
What causes the antimineralocorticoid effect of Yarina?
This property is provided by the progestin component drospirenone. It prevents the retention of sodium ions and water normally stimulated by estrogens, protecting against edema and weight gain.
What else to study on this topic
- Detailed pathogenesis of thrombophilia associated with estrogen intake
- Comparison of pharmacokinetics of various progestins (drospirenone, dienogest, cyproterone)
- Clinical manifestations and management of amenorrhea and breakthrough bleeding
- Mechanisms of the oncoprotective action of progestins on uterine and ovarian tissues
- Drug interactions of COCs
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