Estroprogestative combinations - Use
Combined oral contraception is the most used method. Its efficacy, expressed as a percentage of pregnancies occurring in one year, is approximately 0.1% compared with 85% in absence of contraception.
They can moreover be prescribed in particular therapeutic uses: dysmenorrhea, micropolycystic ovaries, endometriosis for which there are more effective products such as danazol, acne where a contraceptive pill with anti-androgenic effect is more suitable.
The progestative contraception by oral route, is addressed to the women presenting a contraindication for the use of an estroprogestative combination.
Adverse effects
The adverse effects of combination oral contraceptives are mainly vascular accidents.
The increase in the risk of vascular events is linked to anomalies induced by or revealed by the combined contraception: arterial hypertension, disorders of hemostasis, venous thromboembolic risk (phlebites, thrombophlebites) and arterial (thromboses, sometimes myocardial infarction). This risk is raised in women who smoke, those who are older than thirty five years and those who present a hyperlipidemia or a deficiency in anticoagulant factors.
Certain recent progestins like gestodene and desogestrel were suspected to increase the venous thromboembolic risk. This could result from a prescription bias: their initially supposed good tolerance caused them to be prescribed to women at higher thromboembolic risk. Biological data, however, indicates that these progestins decrease the efficacy of anticoagulant factors.
A certain number of incidents can be observed during contraceptive treatment: menstruation disturbances, digestive disorders, weight gain, mammary tension, headache, modifications of mood. Jaundices by retention were reported.
The intake of estrogens alone increases the risk of endometrial and breast cancers, but when they are combined with progestins, this risk disappears and moreover the risk of cancer of the ovary decreases.
Contra-indications
There are absolute and relative contraindications to the use of hormonal contraception.
- Absolute: pregnancy, previous thromboembolic and cardiovascular events, (coronary, valvular damages…), breast and uterine cancers, hepatic disorders.
- Relative: diabetes, hyperlipidemia, tobacco; age. For these women, if a pill is prescribed, it is better to choose a low-dose one
Precautions of employment
A general medical and gynaecological examination is necessary before the onset of a contraceptive treatment. The risk factors previously enumerated must be taken into account.
Before a scheduled surgical operation or a long immobilization with a risk of thrombosis, it is necessary to stop the contraceptive treatment.
The intake of enzymatic inductive drugs such as rifampin, phenobarbital, some other anticonvulsants, can accelerate the degradation of the contraceptive products and make them ineffective.
Notice
In addition to the hormonal contraception there are:
- barrier methods, male and female devices with or without spermicides, condoms, diaphragms, cervical caps. Condoms must be used to reduce the risk of sexually transmitted diseases, in particular HIV
- intra-uterine devices, made of copper or impregnated with progesterone or levonorgestrel.
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