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Purely gestagen tableted contraceptives (mini-pili)

 

Oral contraceptives minipili contain only microdoses of progestogens (300-500 μg), which is 15-30% of the dose of progestogen in combined estrogen-progestogen preparations.

The mechanism of mini-saw action includes the following factors.

  • The factor of the neck: under the influence of mini-pills, the amount of cervical mucus decreases, its viscosity increases, which reduces the penetrating ability of spermatozoa in the period of the period.
  • Uterine factor: the use of mini-pili leads to changes in the endometrium, preventing implantation (premature secretory transformation, and with prolonged use - atrophy of the endometrium).
  • Pipe factor: mini-pills cause the migration of the egg to slow down the fallopian tube due to a decrease in the contractile activity of the fallopian tubes.
  • The central factor: in 25-30% of patients, mini-pills suppress ovulation.

The contraceptive effectiveness of mini-pili is 0.3-9.6 pregnancies per 100 women / years. Mini-pili are a reliable method of contraception only in lactating women. In other situations, you should use them only if you can not use more reliable methods, such as COCs.

The basic preparations of a class of a mini- saw

  • The microlus is the most low-dose preparation of this group of contraceptives. Each pellet contains 30 μg of levonorgestrel. In the package, 35 dragees (5 weeks reception).
  • Exluton is one of the first drugs of this group. Each pellet contains a relatively high dose of the hormone - 500 mcg linestrenol, due to the fact that lynestrol requires metabolic activation in the liver, in which the dose loss occurs. The package contains 28 dragees (4 weeks of intake).
  • Charozetta is a low-dose drug. One dragee contains 75 micrograms of desogestrel. In this regard, it is necessary to carefully comply with the regimen, since desogestrel is metabolized during primary passage through the liver. This may lead to a decrease in the contraceptive reliability of the drug in some women. The package contains 28 dragees (4 weeks of intake).

Mini-saw reception mode

The drug is taken in continuous mode at the same time of the day starting from the 1st day of the menstrual cycle. Since, in most cases, ovulation in women persists, contraception can only be relied upon with careful adherence to the mini-saw regimen (a deviation in the intake time of not more than 2 hours). After giving birth, if a woman is breastfeeding, the drug is started 6-8 weeks after the birth of the child; if she does not breast-feed - right after delivery.

Indications

  • Lactation period (after 6 weeks after delivery) - mini-pills do not affect the duration of lactation, the quantity and quality of milk.
  • Presence of contraindications to the appointment of estrogens (a number of extragenital diseases) or estrogen-dependent complications in the anamnesis.
  • Reproductive age, including late, premenopause.
  • Obesity.

Contraindications

  • High risk for the health of women in the event of an unwanted pregnancy.
  • Pregnancy.
  • Malignant tumors of mammary glands.
  • Simultaneous reception of rifampicin, griseofulvin or anticonvulsants.
  • Bleeding from the genital tract of an unknown etiology.
  • Presence in the anamnesis of idiopathic jaundice during pregnancy.
  • Dysfunction of the liver, cirrhosis of the liver in severe form, syndromes Dubin-Johnson, Rotor.
  • Viral hepatitis in the active stage.
  • Malignant and benign liver tumors.
  • Severe headache, including migraine, with manifestation of focal neurological disorders.
  • Thromboembolic diseases.
  • The defeat of the vessels of the brain and heart.

Side effects

  • Violations of the menstrual cycle.
  • Nausea, vomiting.
  • Depression.
  • Weight gain.
  • Decreased libido.
  • Headache, dizziness.
  • Breast engorgement.

Method Restrictions

  • Smaller contraceptive efficacy compared with COCs.
  • The need for strict adherence to the regimen of taking the drug (taking at the same time).
  • Increased risk of developing functional ovarian cysts.
  • The increased risk of ectopic pregnancy (its frequency is 2 per 100 women / years, but according to WHO eligibility criteria, an ectopic pregnancy in a history is classified as a second class of acceptability, ie the benefit of using the method exceeds the theoretical and proven risk) .
  • Violations of the menstrual cycle:
    • the appearance of acyclic uterine bleeding;
    • shortening of the menstrual cycle to 25 days or less;
    • the appearance of uterine bleeding "breakthrough".

The basic principles of monitoring patients receiving mini-pili

  • With the appearance of abdominal pain and / or prolonged bleeding from the genital tract, it is necessary to exclude functional ovarian cysts (rupture, torsion of the cyst's legs), ectopic pregnancy, hyperplastic processes in the endometrium, uterine myoma, endometriosis.
  • If the menstruation is delayed for 45 days or more, the pregnancy should be excluded (if the patient wishes to save the pregnancy, she should stop taking the mini-pills - the low dose of progestogen in the preparations of this group does not increase the risk of congenital malformations of the fetus).
  • Patients with a high risk of pregnancy (the biphasic nature of the basal temperature curve is preserved) is recommended to use an additional method of contraception from the 10th to the 16th day of the cycle (with a regular menstrual cycle) or COC (in the absence of contraindications).
  • With the appearance of intermenstrual bloody discharge in the first months of the use of mini-pills, you should continue the usual reception of the drug (as a rule, after 6-12 months the menstrual cycle is normalized) or go to another method of contraception.

Recommendations for patients receiving mini-pili

  • During the first 7 days of taking the drug, an additional contraceptive method should be used.
  • It is necessary to strictly adhere to the mode of taking the drug If the tablet is delayed for more than 3 hours, an additional method of contraception must be used within 7 days.
  • If you missed 1 tablet, it should be taken as soon as possible, and the next one - at the usual time.
  • If you miss 2 tablets, you should resort to the method of emergency contraception.
  • If menstruation is delayed for more than 45 days, when taking a mini-saw, you should consult a doctor to determine your pregnancy.
  • In the first months of taking a mini-drip, intermenstrual spotting spotting from the genital tract is possible, and when they are strengthened, it is necessary to consult a doctor.
  • When diarrhea is recommended to use additional methods of contraception.
  • When planning a pregnancy, taking a mini-pills is stopped immediately before a possible conception.

Advantages and disadvantages of pure gestagen tablets contraceptives

Benefits

  • Low progestogen content and absence of estrogen component.
  • In comparison with COC, a lower risk of developing cardiovascular diseases and cerebrovascular disorders.
  • Do not affect carbohydrate metabolism and blood clotting system.
  • They have a therapeutic effect for dysmenorrhea, premenstrual syndrome, ovulatory pain, inflammatory diseases of the internal genital organs.
  • Rapid recovery of fertility (within 3 months after discontinuation of the drug).
  • Allowed to use during lactation.
  • Perhaps the use of smoking women over 35 years.
  • Simplicity and bioavailability of the application.

Contraceptive

  • Do not contain estrogen
  • High efficiency, with daily intake at the same time IP = 0.5-5.0
  • Fast effect
  • Lack of communication with sexual intercourse
  • Do not affect breastfeeding
  • Rapid recovery of fertility

Non-contraceptive

  • May reduce menstrual bleeding
  • Can reduce menstrual pain
  • May reduce the severity of anemia
  • Prophylaxis of endometrial cancer
  • Reduce the risk of developing benign breast tumors
  • Protect from ectopic pregnancy
  • Provide some protection against pelvic inflammatory disease
  • Reduce the risk of ectopic pregnancy

Disadvantages

  • Causes changes in the nature of menstrual discharge in almost all women (irregular smearing or moderate spotting)
  • There may be some gain or weight loss
  • The method depends on the user (requires motivation and discipline)
  • Irregular reception increases the risk of pregnancy
  • The effectiveness of the method may decrease with simultaneous use of certain medications
  • The need to replenish the contraceptive reserve
  • Do not protect against STDs, including hepatitis and HIV infection

Rules for the administration of gestagen tablets contraceptives.

Reception gestagenovyh tableted contraceptives should be started from the 1st day of the menstrual cycle, the date of taking the tablets continues without interruption during the time of the necessary contraception. It is necessary to strictly adhere to the interval in taking the tablets 24 ± 2 hours, since an increase in the interval up to 27 hours or more increases the risk of pregnancy and requires the use of additional methods of contraception within 7 days after inaccuracy in admission.

When switching from a COC to a mini-drink, the reception of the latter should begin the day after the last KOC tablet was taken.

Do not use gestagen tablets!

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Medical expert editor

Portnov Alexey Alexandrovich

Education: Kiev National Medical University. A.A. Bogomolets, Specialty - "General Medicine"

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