Hormonal methods

| There are two types of oral contraceptives or birth control pills, those that combine two hormones (combined), and those that have only one (minipill)

There are two types of oral contraceptives or birth control pills, those that combine two hormones (combined), and those that have only one (minipill). The combined contain two hormones (estrogens and progesterone) with a great similarity to those produced in the female body. Its way of acting is basically by inhibiting ovulation, so that without producing the ovum there could be no fertilization. They also make the cervical mucus thicker and therefore hinder the passage of sperm into the uterine cavity and modify the endometrium in such a way that the implantation of a possible embryo is very difficult.

When to use hormonal methods for family planning

Treatment should always be started after a visit with a specialist doctor since there are some contraindications, absolute or relative, when taking oral contraceptives, among which are smokers over 35 years of age, patients with a history of deep vein thrombosis, with coagulation disorders, history of stroke or heart attack, uncontrolled hypertension, liver disease, migraines with aura at any age or without aura in those over 35 years of age, obesity, history of breast cancer, genital bleeding of unknown origin, epilepsy, diabetes mellitus, breastfeeding and evidently suspicion of pregnancy.

The pills currently used have a very low dose of the drug so that the side effects are mild and infrequent, but nausea, gastrointestinal discomfort, some fluid retention leading to slight weight gain, breast tension, headache or irregular bleeding may appear.

They have certain non-contraceptive advantages to take into account, such as regularization of cycles, decrease in the amount of menstrual flow and menstrual pain, improvement in acne and hirsutism, decrease in benign breast disease, pelvic inflammatory disease and ectopic gestation, in addition to reduce the risk of ovarian and endometrial cancer.

Some drugs decrease their effectiveness and therefore require additional contraceptive methods if both treatments are combined, such as antibiotics derived from penicillin, griseofulvin, rifampicin and tetracyclines. antiepileptic treatments These include topiramate, also used for pathologies other than epilepsy, and sedative hypnotics.

The taking of the first box must start the first day of menstruation and continue a daily pill for 21, 22 or 28 days depending on the presentation. Those of 28 days do not require rest between one box and another, but the white placebo tablets correspond to rest. Those of 21 or 22 days require 7 or 6 days of rest respectively to complete the 28-day cycles.

The rule will appear during the break or while taking white pills. If there is a forgetfulness in the white pills it is not a problem since they do not contain medication. In case of forgetting a pill with medication, it should be taken before 12 hours of the usual time or skip the dose if more than 12 hours have passed and use additional contraceptive methods until the end of the cycle. If vomiting or diarrhea occurs in the first 4 hours after taking it, it should be repeated. In case of bleeding during the cycle or lack of menstruation at the end, you should contact the gynecologist.

Types

• The vaginal ring is another form of combination contraceptive that is administered vaginally. The ring is kept in the vagina for 3 weeks and is removed for a week, which is equivalent to the rest week in pill presentations. The hormones it contains are the same as the combined pills and therefore with an equivalent mechanism of action and effects. The main advantage is the reduction of forgetfulness through an administration route that does not require daily reminders.
• The contraceptive patch is also a combined hormonal contraception method but with a transdermal route of administration. A patch is applied every week for 3 weeks and rests for the fourth week.
• Combined hormonal contraceptives are also in injectable form that require a monthly injection and with the same effects as pills.
• The progesterone-only oral contraceptive, the minipill, can also inhibit ovulation, but above all it works by hindering the progression of sperm and preventing implantation. One tablet should be taken daily without a break, and has the advantages of being able to be administered to women who have a contraindication to taking estrogens, such as women who are breastfeeding. The most important disadvantage is that they can cause irregular periods or intermenstrual losses.

It is also in intramuscular injectable presentation with a duration of 3 months and in a subdermal implant, which lasts for 3 years and is placed under the skin of the arm.

The emergency contraception is a contraceptive method indicated as an exceptional method in case of failure of the usual method. Its effectiveness is approximately 85%, greater if it is taken before 12 hours after sexual intercourse and it is not effective after 72 hours after intercourse. It is not an abortive treatment but its mechanism of action is usually due to the delay in ovulation or due to the difficulty in implantation. In case of failure it is not harmful to the fetus.