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The questions about contraception seem to be endless, and the most effective method, hormonal , is still a source of distrust for many. While some are afraid to start taking hormones, others do not know how to give them up without feeling a lot of undesirable effects like the return of PMS or acne. How can you avoid this situation? In what cases do you have to cancel seemingly suitable COCs? Is it true that they are prescribed a short course before a planned pregnancy and what tests need to be done before starting the appointment? We asked these questions to an expert.
gynecologist- reproductologist , head of the reproduction department of the clinic “Dad, Mom and Baby”, Nizhny Novgorod
Combined oral contraceptives are designed to prevent unwanted pregnancies. This is their main and only task – and this is one of the few groups of drugs that are used in absolutely healthy people, and for a long time. If old OCs were feared because they could provoke weight gain or exacerbate depression, then with new ones, on the contrary, health often improves and patients are afraid to stop taking them. In fact, if we are talking about the cancellation of modern COCs after a long period (a year or longer), then a healthy woman should not have any withdrawal syndrome. Another thing is the presence of problems with weight, skin or manifestations of PMS even before the appointment of a contraceptive.
The latest generations of COCs have additional effects – they prevent fluid retention and regulate the sensitivity of the receptors located in the skin to testosterone (this helps to reduce rashes). Of course, when taking such drugs, if these conditions existed, they will improve, and after the abolition of the contraceptive, PMS and skin and weight problems can naturally return. The solution is to correct these conditions regardless of the use of the contraceptive. As for acne – indeed, some types of contraceptives are registered as drugs for the treatment of acne, and they can be prescribed not only by a gynecologist, but also by a dermatocosmetologist .
Sometimes, after stopping the pills, women complain of hair loss – this is due to hormonal changes: when taking COCs, the life cycle of the hair changes, so that they can grow for a long time and not fall out. After discontinuation of the drug, a return to normal occurs, which creates the appearance of “excess” hair loss, although in fact, the hair does not become smaller than before. Since there are no pronounced hormonal fluctuations against the background of COCs, the mood is also smoothed out – and its changes when returning to the natural cycle can be an unpleasant surprise.
Of course, you need to stop taking it after finishing the already started packaging, without throwing it in the middle of the cycle. By and large, the cancellation should also take place under the supervision of a doctor: you should understand what lies ahead, the transition to another method of contraception or the planned pregnancy.
After the abolition of COCs, the concentration of pituitary hormones becomes “correct” for the next couple of cycles, which effectively stimulates ovulation
There are not so many contraindications to taking COCs. First of all, these are acute thrombosis of large vessels, strokes and heart attacks in history. However, no ” varicose veins ” and “blood thickening” have anything to do with limiting the use of COCs. Oral contraceptives are categorically contraindicated for women over thirty-five years of age who smoke more than fifteen cigarettes a day. It happens that while taking COCs there is a migraine – then a complex algorithm is used. If a migraine with aura, then COCs are contraindicated, but it is possible to use drugs only with progestins (that is, not combined, but with one hormonal component). True, you need to carefully weigh the possible risks, look at other risk factors for a particular woman. For migraine without aura, the use of a contraceptive depends on age and is not recommended after 35 years.
There is a very detailed guideline – National Medical Acceptance Criteria for Contraceptive Methods. It is he who should be used by a gynecologist when choosing a contraceptive and conducting consultations for his patients. To prescribe a contraceptive, it is enough for the patient to use it and consult a gynecologist, taking into account these acceptance criteria. Tests for ” coagulogram “, “all hormones” and the like are not required.
In case of menstrual irregularities, if pregnancy is planned, COCs are sometimes prescribed in a short course. This is done so that the so-called rebound effect occurs – full ovulation (and the rapid onset of pregnancy) after the drug is discontinued. The bottom line is that a three-month course of COCs causes a temporary decrease in the levels of pituitary hormones; after discontinuation of the drug, the concentration of these hormones becomes “correct” and rhythmic for the next couple of cycles, and this effectively stimulates ovulation. Of course, only a gynecologist can prescribe a contraceptive for this purpose and only if there is evidence. In patients with normal ovulation and a regular cycle, the appointment of COCs “to increase the chance” of pregnancy does not make sense.
When preparing for pregnancy, folic acid should be taken three to five months before the planned conception – this is the only vitamin that is really necessary for a healthy pregnancy and prevents serious disturbances in the fetus. For the convenience of patients who do not want to take two drugs – COC and folic acid – contraceptives with its addition have been invented. However, after the contraceptive is canceled and until the end of the first trimester of pregnancy, you will still have to take folate .