Pros and cons of using oral contraceptives. The main advantages of oral contraceptives:
- Dysmenorrhea – painful menstruation. All oral contraceptives have an effect on dysmenorrhea because they inhibit proliferation (growth) and hypervascularization (increased formation of endometrial vessels) of the endometrium due to the ovulation-blocking effect. In anovulatory cycles (not preceding ovulation) in women who do not use hormonal contraceptives, menstruation itself is slightly painful.
- Polymenorrhea – copious menstruation. Hormonal contraceptives keep the mucous membrane at a low level, which leads to scant genital bleeding. They are suitable for young girls in the first years after the onset of menarche (first menstruation). In them, due to the immaturity of the hypothalamic-pituitary-ovarian axis, the first and subsequent periods are often very severe and can lead to anemia. Treatment lasts from three to six months, and, if necessary, longer.
- Periovulatory (during ovulation) and postmenstrual uterine bleeding. They are observed in women aged about 35 years and may be due to a deficiency of estrogens, insufficiency of the corpus luteum formed at the site of the burst follicle and producing progesterone, as well as the presence of anovulatory cycles – menstruation (pseudo menstruation) without prior ovulation. When taking combined oral contraceptives, a balanced amount of estrogens and progestogens is received, which leads to a cure for the condition. The result of hormonal contraceptives in this case is achieved in the second month of admission.
- Sterility. When the hypothalamic-pituitary-ovarian axis is suppressed for at least three months by taking hormonal pills after their termination, a “violent” reaction is observed with the maturation of sometimes more than one Graaf follicle and the possibility of multiple pregnancies. This shows that hormonal contraceptives are also suitable for the treatment of some forms of infertility.
- Premenstrual syndrome. Most complaints are related to fluid retention in the body, headaches, swelling, mastodynia (chest pain), and depressive states. Some contraceptives contain derivatives of 17 alpha-spironolactone, which, in addition to the action close to the action of natural progestogens, also have a diuretic effect.
- Polycystic ovaries. Women with polycystic ovaries have fewer than eight true menstrual cycles per year because their ovaries do not ovulate due to the presence of polycystic ovary syndrome. In addition, the disease is often combined with acne, seborrhea, hypertrichosis (an increase in lanugo – mossy body hair), and the use of oral hormonal agents leads to a decrease in these symptoms accompanying the disease, due to the existing gestagenic component in them. After stopping taking pills, the blocking effect on the synthesis of endogenous hormones of a woman stops, which leads to a violent reaction of hormone synthesis, ovulation, and the desired pregnancy occur.
- Endometriosis. Oral contraceptives are used in cases where the focus of endometriosis is small, or a combination of medication and surgical treatment for a larger focus. Treatment with oral contraceptives alone is not enough in these cases, but, of course, significantly reduces the existing endometrial focus. There is also an accumulation effect, that is, the longer hormonal contraceptives are used, the better the effect on endometriosis.
- Functional ovarian cysts. In women who have a tendency not to “burst” the follicle, but to preserve it in the form of a functional (follicular) cyst, it is very advisable to use hormonal contraceptives, by suppressing the growth of follicles and blocking ovulation. .
- Ectopic pregnancy. This is a pregnancy that develops outside the uterus. When using an intrauterine pessary as a method of contraception, the risk of ectopic pregnancy does not decrease, while when using hormonal contraceptives, cases of ectopic pregnancy are rather medical exotics.
- Endometrial carcinoma . There are numerous studies that prove that women who use or have used hormonal contraceptives are less likely to get endometrial cancer. This is due to a decrease in the number of mitoses, especially in the proliferative phase of the endometrium, and this leads to the prevention of atypical endometrial hyperplasia underlying endometrial cancer.
- Ovarian cancer. The absence of ovulation has a preventive effect on the ovaries in relation to the development of ovarian cancer. It turned out that the “weak” place of the ovary and the place from which the malignant process can develop is exactly where the follicle bursts. Reducing the number of ovulations in a woman’s fertile years reduces this risk. The risk of ovarian cancer is lower in women who have given birth and are breastfeeding and is based on the same principle – the absence of ovulation.
- Benign breast diseases. Elevated estrogen levels in women with anovulatory cycles — for example, with polycystic ovaries — create a prerequisite for ductal hyperplasia of the breast. Taking combined oral contraceptives provides a balanced amount of hormones in the female body, which is certain prevention of these diseases.
One of the most serious disadvantages of combined oral contraceptives is that they increase the risk of vascular thrombosis by reducing the amount of blood clotting inhibitor – antithrombin 3. For this reason, they are not prescribed to women after 35 years. , or they are prescribed, but under stricter control compared to younger patients. The risk of blood clots is reduced to that before taking the pills about a month after they stop.
Using only hormone therapy with estrogen increases the risk of endometrial cancer, as well as breast cancer. For this reason, in women who entered menopause early – up to 40 years old, as well as with post-castration syndrome (disease or surgical removal of the genital glands – ovaries), it is recommended to take combined hormonal drugs with the presence of estrogens. and progestogens that have a protective effect. The choice and dosage of hormonal contraceptives are individual for each patient. If side effects occur, which is relatively rare in new hormonal contraceptives, you can change the drug or switch to another method of contraception, but only after consulting with a gynecologist.