Гормональная контрацепция, ввиду многочисленных полезных эффектов, всегда использовалась не только для предохранения от нежеланной беременности, но и с целью лечения разнообразных гинекологических заболеваний. Увлечение лечебными аспектами гормональных противозачаточных средств привело к смещению акцентов на терапевтическую практику и недостаточному использованию профилактического потенциала контрацептивных гормонов. Это особенно относится к ведению женщин старшей репродуктивной группы, находящихся в возрасте пременопаузы и перименопаузы. У этой группы женщин ведущее значение имеют вопросы лечения нарушений, ассоциированных с угасанием овариальной функции, в том числе аномальных маточных кровотечений и замещения эстрогенного дефицита, в то время как проблема предохранения от беременности отодвигается на второй план. Снижение фертильности в данном возрастном периоде не должно являться аргументом для отказа от контрацепции, тем более что своевременное назначение контрацептивного средства позволит не лечить, а предотвратить развитие тех самых нарушений, которые впоследствии становятся показанием для лечебного назначения контрацептивных гормонов. Двойная профилактика, включающая предохранение от нежеланной беременности и предотвращение гинекологических заболеваний, ассоциированных со старением репродуктивной системы, – основание для своевременного подбора эффективной и безопасной контрацепции с дополнительными лечебными свойствами женщинам, вступающим в физиологический период пременопаузы.
Hormonal contraception, because of the numerous beneficial effects is always used not only for protection against unwanted pregnancy, but also as means of treating a variety of gynecological diseases. Enthusiasm for curative aspects of hormonal contraceptives has led to a shift in emphasis on therapeutic practice and underuse of preventive potential of contraceptive hormones. This particularly refers to the management of women of seniorreproductive group repositories in premenopausal and perimenopausal age. In this group the leading role is left to the questions of treating disorders associated with the extinction of ovarian functions including abnormal uterine bleeding, and substitution of estrogen deficiency, while the problem of birth control tends to be overshadowed. Reduced fertility in this age period should not be an argument for abandoning contraception, especially taking into consideration the fact that timely administration of contraceptive will not heal, but prevent the development of similar violations, which subsequently become an indication for therapeutic purpose of contraceptive hormones. Dual prevention, including the prevention of unwanted pregnancies and prevention of gynecological diseases associated with aging of the reproductive system is the basis for the selection of effective, timely and safe contraception with additional healing properties for women entering into physiological premenopausal period.
1. World Contraceptive Use 2003 United Nations Department of Economic and Social Affairs Population Division.
2. Прилепская В.Н. Руководство по контрацепции. М: МЕДпресс-информ, 2006.
3. Jensen JT, Parke S, Mellinger U et al. Effective treatment of heavy menstrual bleeding with estradiol valerate and dienogest: a randomizedcontrolled trial. Obstet Gynecol 2011; 117: 777–87.
4. Marjoribanks J, Farquhar C, Roberts H, Lethaby A. Long term hormone therapy for perimenopausal and postmenopausal women. Cochrane Database of Systematic Reviews Meta-Analysis 2012; 7: CD004143.
5. Freeman EW, Halbreich U, Grubb GS et al. An overview of four studies of a continuous oral contraceptive (levonorgestrel 90 mcg/ ethinyl estradiol 20 mcg) on premenstrual dysphoric disorder and premenstrual syndrome. Contraception 2012; 85: 437–45.
6. Sulak P, Willis S, Kuehl T et al. Headaches and oral contraceptives: impact of eliminating the standard 7-day placebo interval. Headache 2007; 47: 27–37.
7. Edelman AB, Gallo MF, Jensen JT et al. Continuousor extended cycle vs. cyclic use of combined oral contraceptives for contraception. Cochrane Database of Systematic Reviews 2005; 3: CD004695.
8. Speroff L, Darney PD. A clinical guide for contraception. 5th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2011.
9. Alexander NJ, Baker E, Kaptein M et al. Why consider vaginal drug administration? Fertil Steril 2004; 82: 1–12.
10. Медицинские критерии приемлемости методов контрацепции РФ. 2012: 242.
11. Curtis KM, Jamieson DJ, Peterson HB, Marchbanks PA. Adaptation of the World Health Organization’s medical eligibility criteria for contraceptive use for use in the United States. Contraception 2010; 82: 3–9.
12. Jensen JT. Evaluation of a new estradiol oral contraceptive: estradiol valer-ate and dienogest. Exp Opin Pharm 2010; 11:1147–57.
13. Finer LB, Zolna MR. Unintended pregnancy in the United States: incidence and disparities, 2006. Contraception 2011; 84: 478–85.
14. Pazol K, Creanga AA, Zane SB et al. Abortion surveillance – United States, 2009. MMWR Surveillance Summaries 2012; 61 (8): 1–44.
15. Pal L, Santoro N. Age-related decline in fertility. Endocrin Metab Clin NA 2003; 32 (3): 669–88.
16. Callaghan WM. Overview of maternal mortality in the United States. Sem Perinatol 2012; 36 (1): 2–6.
17. Jacobsson B, Ladfors L, Milsom I. Advanced maternal age and adverse perinatal outcome. Obstet Gynecol 2004; 104 (4): 727–33.
18. Sivin I. Utility and drawbacks of continuous use of a copper T IUD for 20 years. Contraception 2007; 75 (Suppl. 6): S70–75.
19. Sherman CA, Harvey SM, Noell J. Are they still having sex? STI’s and unintended pregnancy among midlife women. J Women Aging 2005; 17 (3): 41–55.
20. Endrikat J, Gerlinger C, Richard S et al. Ovulation inhibition doses of progestins: a systematic review of the available literature and of marketed preparations worldwide. Contraception 2011; 84 (6): 549–57.
21. Shoupe D. Contraception. Chichester, West Sussex: Wiley–Blackwell; 2011.
22. Isley MM, Kaunitz AM. Update on hormonal contraception and bone den-sity. Rev Endocr Metab Dis 2011; 12 (2): 93–106.
23. Xu H, Wade JA, Peipert JF et al. Contraceptive failurerates of etonogestrel subdermal implants in overweight and obese women. Obstet Gynecol 2012; 120 (1): 21–6.
24. Grant L. Treatment of perimenopausal menorrhagia with Implanon. J Fam Plan Reprod Health Care 2008; 34 (4): 274.
25. Peipert JF, Zhao Q, Allsworth JE et al. Continuation and satisfaction of reversible contraception. Obstet Gynecol 2011; 117 (5): 1105–13.
26. Lethaby AE, Cooke I, Rees M. Progesterone or progestogen-releasing intrauterine systems for heavy menstrual bleeding. Cochrane Database of Systematic Reviews 2005; 4: CD002126.
27. Milsom I. The levonorgestrel-releasing intrauterine system as an alternative to hysterectomy in perimenopausal women. Contraception 2007; 75 (Suppl. 6): S152–154.
28. Sitruk-Ware R. The levonorgestrel intrauterine system for use in peri- and postmenopausal women. Contraception 2007; 75 (Suppl. 6): S155–160.
29. A new low-dose levonorgestrel-releasing IUD (Skyla). Med Lett Drugs Ther 2013; 55 (1412): 21–2.
30. Somboonporn W, Panna S, Temtanakitpaisan T et al. Effects of the levonorgestrel-releasing intrauterine system plus estrogen therapy in perimenopausal and postmenopausal women: systematic review and meta-analysis. Menopause 2011; 18 (10): 1060–6.
________________________________________________
1. World Contraceptive Use 2003 United Nations Department of Economic and Social Affairs Population Division.
2. Прилепская В.Н. Руководство по контрацепции. М: МЕДпресс-информ, 2006.
3. Jensen JT, Parke S, Mellinger U et al. Effective treatment of heavy menstrual bleeding with estradiol valerate and dienogest: a randomizedcontrolled trial. Obstet Gynecol 2011; 117: 777–87.
4. Marjoribanks J, Farquhar C, Roberts H, Lethaby A. Long term hormone therapy for perimenopausal and postmenopausal women. Cochrane Database of Systematic Reviews Meta-Analysis 2012; 7: CD004143.
5. Freeman EW, Halbreich U, Grubb GS et al. An overview of four studies of a continuous oral contraceptive (levonorgestrel 90 mcg/ ethinyl estradiol 20 mcg) on premenstrual dysphoric disorder and premenstrual syndrome. Contraception 2012; 85: 437–45.
6. Sulak P, Willis S, Kuehl T et al. Headaches and oral contraceptives: impact of eliminating the standard 7-day placebo interval. Headache 2007; 47: 27–37.
7. Edelman AB, Gallo MF, Jensen JT et al. Continuousor extended cycle vs. cyclic use of combined oral contraceptives for contraception. Cochrane Database of Systematic Reviews 2005; 3: CD004695.
8. Speroff L, Darney PD. A clinical guide for contraception. 5th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2011.
9. Alexander NJ, Baker E, Kaptein M et al. Why consider vaginal drug administration? Fertil Steril 2004; 82: 1–12.
10. Медицинские критерии приемлемости методов контрацепции РФ. 2012: 242.
11. Curtis KM, Jamieson DJ, Peterson HB, Marchbanks PA. Adaptation of the World Health Organization’s medical eligibility criteria for contraceptive use for use in the United States. Contraception 2010; 82: 3–9.
12. Jensen JT. Evaluation of a new estradiol oral contraceptive: estradiol valer-ate and dienogest. Exp Opin Pharm 2010; 11:1147–57.
13. Finer LB, Zolna MR. Unintended pregnancy in the United States: incidence and disparities, 2006. Contraception 2011; 84: 478–85.
14. Pazol K, Creanga AA, Zane SB et al. Abortion surveillance – United States, 2009. MMWR Surveillance Summaries 2012; 61 (8): 1–44.
15. Pal L, Santoro N. Age-related decline in fertility. Endocrin Metab Clin NA 2003; 32 (3): 669–88.
16. Callaghan WM. Overview of maternal mortality in the United States. Sem Perinatol 2012; 36 (1): 2–6.
17. Jacobsson B, Ladfors L, Milsom I. Advanced maternal age and adverse perinatal outcome. Obstet Gynecol 2004; 104 (4): 727–33.
18. Sivin I. Utility and drawbacks of continuous use of a copper T IUD for 20 years. Contraception 2007; 75 (Suppl. 6): S70–75.
19. Sherman CA, Harvey SM, Noell J. Are they still having sex? STI’s and unintended pregnancy among midlife women. J Women Aging 2005; 17 (3): 41–55.
20. Endrikat J, Gerlinger C, Richard S et al. Ovulation inhibition doses of progestins: a systematic review of the available literature and of marketed preparations worldwide. Contraception 2011; 84 (6): 549–57.
21. Shoupe D. Contraception. Chichester, West Sussex: Wiley–Blackwell; 2011.
22. Isley MM, Kaunitz AM. Update on hormonal contraception and bone den-sity. Rev Endocr Metab Dis 2011; 12 (2): 93–106.
23. Xu H, Wade JA, Peipert JF et al. Contraceptive failurerates of etonogestrel subdermal implants in overweight and obese women. Obstet Gynecol 2012; 120 (1): 21–6.
24. Grant L. Treatment of perimenopausal menorrhagia with Implanon. J Fam Plan Reprod Health Care 2008; 34 (4): 274.
25. Peipert JF, Zhao Q, Allsworth JE et al. Continuation and satisfaction of reversible contraception. Obstet Gynecol 2011; 117 (5): 1105–13.
26. Lethaby AE, Cooke I, Rees M. Progesterone or progestogen-releasing intrauterine systems for heavy menstrual bleeding. Cochrane Database of Systematic Reviews 2005; 4: CD002126.
27. Milsom I. The levonorgestrel-releasing intrauterine system as an alternative to hysterectomy in perimenopausal women. Contraception 2007; 75 (Suppl. 6): S152–154.
28. Sitruk-Ware R. The levonorgestrel intrauterine system for use in peri- and postmenopausal women. Contraception 2007; 75 (Suppl. 6): S155–160.
29. A new low-dose levonorgestrel-releasing IUD (Skyla). Med Lett Drugs Ther 2013; 55 (1412): 21–2.
30. Somboonporn W, Panna S, Temtanakitpaisan T et al. Effects of the levonorgestrel-releasing intrauterine system plus estrogen therapy in perimenopausal and postmenopausal women: systematic review and meta-analysis. Menopause 2011; 18 (10): 1060–6.
Авторы
И.В.Кузнецова
ГБОУ ВПО Первый МГМУ им. И.М.Сеченова Минздрава России