Женское сексуальное здоровье является залогом профилактики гинекологических заболеваний и определяющим компонентом качества жизни. В гармонии сексуальных отношений важное место занимает выбор метода контрацепции, обеспечивающей отсутствие боязни незапланированной беременности, высокую степень свободы при половых отношениях и формирование интимного комфорта.
Ключевые слова: оральные контрацептивы, хлормадинона ацетат, Белара, сексуальность, сексуальное здоровье, либидо, качество жизни.
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Female sexual health is the guarantee of the gynecological illnesses prophylaxis and a key component defining quality of life. Choice of contraception method providing the absence of any unexpected pregnancy risks and fears, as well as high level of freedom in sex and intimate comfort formation holds an important place in harmonization of sexual relations. Key words: oral contraceptives, chlormadinone acetate, Belara, sexuality, sexual health, libido, quality of life.
1. Abraham S, Luscombe G et al. Oral contraception and cyclic changesin premenstrual andmenstrual experiences. J Psychosom Obstet Gynaecol 2003; 24 (3): 185–93.
2. Azamar-Arizmendi CG et al. A five-day gradual reduction regimen of chlormadinone reduces premenstrual anxiety and depression: a pilotstudy. Arch Med Res 2006; 37 (7): 907–13.
3. Azar-Ramos R. Incidence of side effects with contraceptive placebo. Am J Obstet Gynecol 1969; 105: 1144–9.
4. Bancroft J, Davidson D, Warner P, Tyrer G. Androgens and sexual behaviour in women using oral contraceptives. Clin Endocrinol (Oxf) 1980; 12: 327–40.
5. Borsini F, Mancinelli A, D’Arkano V et al. Pharmacol Biochem Behav 1988; 29 (9): 275–9.
6. Buster JE. Managing female sexual dysfunction. Filters activated: Review. Clear all Fertil Steril 2013; 100 (4): 905–15; doi: 10.1016/j.fertnstert. 2013.08.026
7. Caruso S, Agnello C, Intelisano G et al. Sexual behavior of women taking low-dose oral contraceptive containing 15 microg ethinyl estradiol/60 microg gestodene. Contraception 2004; 69: 237–40.
8. Contreras C, Azamar-Arizmendi G et al. A five-day gradual reduction regimen of chlormadinone reduces premenstrual anxiety and depression: a pilotstudy. Arch Med Res 2006; 37 (7): 907–13.
9. Cour F, Bonierbale M. Sexual desire disorders in women. Prog Urol 2013; 23 (9): 562–74; doi: 10.1016/j.purol.2012.09.019. Epub 2012.
10. Dennerstein L, Spencer-Gardner C et al. Progesterone and the premenstrual syndrome: a double blind crossover trial. Br Med J (Clin Res Ed) 1985; 290 (6482): 1617–21.
11. Dougherty D, Bjork J et al. The influence of menstrual-cycle phase on the relationship between testosterone and aggression. Physiol Behav 1997;
62 (2): 431–5.
12. Emrich HM, Zervessen DV, Kissling W et al. Arch Psych Nervenkr 1980; 229: 1–16.
13. Epperson C, Wisner K et al. Gonadalsteroidsin the treatment of mood disorders. Psychosom Med 1999; 61 (5): 676–97.
14. Genazzani A, Stomati M et al. Progesterone, progestagens and the central nervoussystem. Hum Reprod 2000; 15 (Suppl. 1): 14–27.
15. Graham C, Sherwin B. The relationship between mood and sexuality in women using an oral contraceptive as a treatment for premenstrualsymptoms. Psychoneuroendocrinology 1993; 18: 273–81.
16. Hancke K, Zahradnik HP. Die therapie des prämenstruellen syndroms. Gyn Praxis 2007; 31: 55–65.
17. Heinemann LA, Thiel C, Assmann A, Möhner S. Frequency and reasons for switching/stopping use of oral contraceptives. Results of the German Cohort Study on Women Health Zentralbl Gynakol 2001; 123 (10): 568–77.
18. Honma S, Iwamura S, Iizuka K et al. Identification and anti-androgenic activity of the metabolites of 17alpha-acetoxy-6-chloropregna-4,6-diene-3,20-dione (chlormadinone acetate) in the rat, rabbit, dog and man. Chem Pharm Bull (Tokyo) 1977; 25: 2019–31.
19. Jung-Hoffmann C, Kuhl H. Divergent effects oftwo low-dose oral contraceptives on sex hormone-binding globulin and free testosterone. Am J Obstet Gynecol 1987; 156: 199–203.
20. Lloyd KG, Zibkovic B, Skatton B et al. Prog Neuropsychopharmacol Biol Psych 1989; 13 (3–4): 341–51.
21. Majewska M. Steroids and brain activity. Essential dialogue between body and mind. Biochem Pharmacol 1987; 36 (22): 3781–8.
22. McEwen B, Alves S. Estrogen actionsin the central nervoussystem. Endocr Rev 1999; 20 (3): 279–307.
23. Mok W, Krieger N. Evidence that 5 alpha-pregnan-3 alpha-ol-20-one isthemetabolite responsible for progesterone anesthesia. Brain Res 1990; 533 (1): 42–5.
24. Nappi RE, Domoney C. Pharmacogenomics and sexuality: a vision. Climacteric 2013; 16 (Suppl. 1): 25–30; doi: 10.3109/13697137.2013. 806402. Epub 2013.
25. Nyunt A, Stephen G, Gibbin J et al. Androgen status in healthy premenopausal women with loss of libido. J Sex Marital Ther 2005; 31: 73–80.
26. Olsen R, Tobin A. Molecular biology of GABAA receptors. Faseb J 1990;
4 (5): 1469–80.
27. Paige K. Effects of oral contraceptives on affective fluctuations associated with the menstrual cycle. Psychosom Med 1971; 33 (6): 515–37.
28. Pariser S. Women and mood disorders. Menarche to menopause. Ann Clin Psychiatry 1993; 5 (4): 249–54.
29. Perrouin-Verbe B, Courtois F, Charvier K, Giuliano F. Sexuality of women with neurologic disorders. Prog Urol 2013; 23 (9): 594–600; doi: 10.1016/j.purol.2013.01.004. Epub 2013.
30. Pluchino N, Cubeddu A, Giannini A et al. Progestogens and brain: An update. Maturitas 2009; 62 (4): 349–55.
31. Pluchino N, Genazzani A. Selective effect of chlormadinone acetate on brain allopregnanolone and opioids content. Contraception 2009.
32. Rapkin A. A review of treatment of premenstrual syndrome and premenstrual dysphoric disorder. Psychoneuroendocrinology 2003; 28 (Suppl. 3): 39–53.
33. Rapkin A, Morgan M et al. Progesterone metabolite allopregnanolone in women with premenstrual syndrome. Obstet Gynecol 1997; 90 (5): 709–14.
34. Raudrant D, Rabe T. Progestogens with antiandrogenic properties. Drugs 2003; 63: 463–92.
35. Sanders SA, Graham CA, Bass JL, Bancroft J. A prospective study of the effects of oral contraceptives on sexuality and wellbeing and their relationship to discontinuation. Contraception 2001; 64 (1): 51–8.
36. Schramm G, Steffens D. A 12-month evaluation ofthe CMA-containing oral contraceptive Belara: efficacy, tolerability and anti-androgenic properties. Contraception 2003; 67 (4): 305–12.
37. Schramm G, Steffens D. Contraceptive efficacy and tolerability of chlormadinone acetate 2mg/ethinyl estradiol 0.03mg (Belara®). Results of a post-marketing surveillance study. Clin Drug Invest 2002; 22: 221–31.
38. Shiah IS, Yatham LN, Gau YC, Baker GB. Prog Neuropsychopharmacol Biol Psych 1998; 27: 419–23.
39. Smith S. Female sex steroid hormones: from receptors to networks to performance – actions on the sensorimotor system. Prog Neurobiol 1994; 44 (1): 55–86.
40. Smith SS. Withdrawal properties of a neuroactive steroid: implications for GABA(A) receptor gene regulation inthe brain and anxiety behavior. Steroids 2002; 67 (6): 519–28.
41. Sutker P, Libet J et al. Alcohol use, negative mood states, and menstrual cycle phases. Alcohol Clin Exp Res 1983; 7 (3): 327–31.
42. Walker A, Bancroft J. Relationship between premenstrual symptoms and oral contraceptive use: a controlled study. Psychosom Med 1990; 52 (1): 86–96.
43. Winkler UH, Sudik R. The effects of two monophasic oral contraceptives containing 30 mcg of ethinyl estradiol and either 2 mg of chlormadinone acetate or 0,15mg of desogestrel on lipid, hormone andmetabolic parameters. Contraception 2009; 79: 15–23.
44. Zahradnik H, Goldberg J, Andreas J. Efficacy and safety ofthe newantiandrogenic oral contraceptive Belara. Contraception 1998; 57 (2): 103–9.
45. Zahradnik HP, Hanjalic-Beck A. Efficacy, safety and sustainability of treatment continuation and results of an oral contraceptive containing 30 mg ethinyl estradiol and 2 mg chlormadinone acetate, in long-term usage (up to 45 cycles) – an open-label, prospective, non-controlled, office-based Phase III study. Contraception 2008; 77 (5): 337–43.
46. Zahradnik HP, Wetzka B et al. Zyklusabhängige Befindlichkeitsstörungen der Frau. Gynäkologe 2000; 33: 225–38.
47. Zinder O, Dar D. Neuroactive steroids: their mechanism of action and their function in the stress response. Acta Physiol Scand 1999; 167 (3): 181–8.
________________________________________________
1. Abraham S, Luscombe G et al. Oral contraception and cyclic changesin premenstrual andmenstrual experiences. J Psychosom Obstet Gynaecol 2003; 24 (3): 185–93.
2. Azamar-Arizmendi CG et al. A five-day gradual reduction regimen of chlormadinone reduces premenstrual anxiety and depression: a pilotstudy. Arch Med Res 2006; 37 (7): 907–13.
3. Azar-Ramos R. Incidence of side effects with contraceptive placebo. Am J Obstet Gynecol 1969; 105: 1144–9.
4. Bancroft J, Davidson D, Warner P, Tyrer G. Androgens and sexual behaviour in women using oral contraceptives. Clin Endocrinol (Oxf) 1980; 12: 327–40.
5. Borsini F, Mancinelli A, D’Arkano V et al. Pharmacol Biochem Behav 1988; 29 (9): 275–9.
6. Buster JE. Managing female sexual dysfunction. Filters activated: Review. Clear all Fertil Steril 2013; 100 (4): 905–15; doi: 10.1016/j.fertnstert. 2013.08.026
7. Caruso S, Agnello C, Intelisano G et al. Sexual behavior of women taking low-dose oral contraceptive containing 15 microg ethinyl estradiol/60 microg gestodene. Contraception 2004; 69: 237–40.
8. Contreras C, Azamar-Arizmendi G et al. A five-day gradual reduction regimen of chlormadinone reduces premenstrual anxiety and depression: a pilotstudy. Arch Med Res 2006; 37 (7): 907–13.
9. Cour F, Bonierbale M. Sexual desire disorders in women. Prog Urol 2013; 23 (9): 562–74; doi: 10.1016/j.purol.2012.09.019. Epub 2012.
10. Dennerstein L, Spencer-Gardner C et al. Progesterone and the premenstrual syndrome: a double blind crossover trial. Br Med J (Clin Res Ed) 1985; 290 (6482): 1617–21.
11. Dougherty D, Bjork J et al. The influence of menstrual-cycle phase on the relationship between testosterone and aggression. Physiol Behav 1997;
62 (2): 431–5.
12. Emrich HM, Zervessen DV, Kissling W et al. Arch Psych Nervenkr 1980; 229: 1–16.
13. Epperson C, Wisner K et al. Gonadalsteroidsin the treatment of mood disorders. Psychosom Med 1999; 61 (5): 676–97.
14. Genazzani A, Stomati M et al. Progesterone, progestagens and the central nervoussystem. Hum Reprod 2000; 15 (Suppl. 1): 14–27.
15. Graham C, Sherwin B. The relationship between mood and sexuality in women using an oral contraceptive as a treatment for premenstrualsymptoms. Psychoneuroendocrinology 1993; 18: 273–81.
16. Hancke K, Zahradnik HP. Die therapie des prämenstruellen syndroms. Gyn Praxis 2007; 31: 55–65.
17. Heinemann LA, Thiel C, Assmann A, Möhner S. Frequency and reasons for switching/stopping use of oral contraceptives. Results of the German Cohort Study on Women Health Zentralbl Gynakol 2001; 123 (10): 568–77.
18. Honma S, Iwamura S, Iizuka K et al. Identification and anti-androgenic activity of the metabolites of 17alpha-acetoxy-6-chloropregna-4,6-diene-3,20-dione (chlormadinone acetate) in the rat, rabbit, dog and man. Chem Pharm Bull (Tokyo) 1977; 25: 2019–31.
19. Jung-Hoffmann C, Kuhl H. Divergent effects oftwo low-dose oral contraceptives on sex hormone-binding globulin and free testosterone. Am J Obstet Gynecol 1987; 156: 199–203.
20. Lloyd KG, Zibkovic B, Skatton B et al. Prog Neuropsychopharmacol Biol Psych 1989; 13 (3–4): 341–51.
21. Majewska M. Steroids and brain activity. Essential dialogue between body and mind. Biochem Pharmacol 1987; 36 (22): 3781–8.
22. McEwen B, Alves S. Estrogen actionsin the central nervoussystem. Endocr Rev 1999; 20 (3): 279–307.
23. Mok W, Krieger N. Evidence that 5 alpha-pregnan-3 alpha-ol-20-one isthemetabolite responsible for progesterone anesthesia. Brain Res 1990; 533 (1): 42–5.
24. Nappi RE, Domoney C. Pharmacogenomics and sexuality: a vision. Climacteric 2013; 16 (Suppl. 1): 25–30; doi: 10.3109/13697137.2013. 806402. Epub 2013.
25. Nyunt A, Stephen G, Gibbin J et al. Androgen status in healthy premenopausal women with loss of libido. J Sex Marital Ther 2005; 31: 73–80.
26. Olsen R, Tobin A. Molecular biology of GABAA receptors. Faseb J 1990;
4 (5): 1469–80.
27. Paige K. Effects of oral contraceptives on affective fluctuations associated with the menstrual cycle. Psychosom Med 1971; 33 (6): 515–37.
28. Pariser S. Women and mood disorders. Menarche to menopause. Ann Clin Psychiatry 1993; 5 (4): 249–54.
29. Perrouin-Verbe B, Courtois F, Charvier K, Giuliano F. Sexuality of women with neurologic disorders. Prog Urol 2013; 23 (9): 594–600; doi: 10.1016/j.purol.2013.01.004. Epub 2013.
30. Pluchino N, Cubeddu A, Giannini A et al. Progestogens and brain: An update. Maturitas 2009; 62 (4): 349–55.
31. Pluchino N, Genazzani A. Selective effect of chlormadinone acetate on brain allopregnanolone and opioids content. Contraception 2009.
32. Rapkin A. A review of treatment of premenstrual syndrome and premenstrual dysphoric disorder. Psychoneuroendocrinology 2003; 28 (Suppl. 3): 39–53.
33. Rapkin A, Morgan M et al. Progesterone metabolite allopregnanolone in women with premenstrual syndrome. Obstet Gynecol 1997; 90 (5): 709–14.
34. Raudrant D, Rabe T. Progestogens with antiandrogenic properties. Drugs 2003; 63: 463–92.
35. Sanders SA, Graham CA, Bass JL, Bancroft J. A prospective study of the effects of oral contraceptives on sexuality and wellbeing and their relationship to discontinuation. Contraception 2001; 64 (1): 51–8.
36. Schramm G, Steffens D. A 12-month evaluation ofthe CMA-containing oral contraceptive Belara: efficacy, tolerability and anti-androgenic properties. Contraception 2003; 67 (4): 305–12.
37. Schramm G, Steffens D. Contraceptive efficacy and tolerability of chlormadinone acetate 2mg/ethinyl estradiol 0.03mg (Belara®). Results of a post-marketing surveillance study. Clin Drug Invest 2002; 22: 221–31.
38. Shiah IS, Yatham LN, Gau YC, Baker GB. Prog Neuropsychopharmacol Biol Psych 1998; 27: 419–23.
39. Smith S. Female sex steroid hormones: from receptors to networks to performance – actions on the sensorimotor system. Prog Neurobiol 1994; 44 (1): 55–86.
40. Smith SS. Withdrawal properties of a neuroactive steroid: implications for GABA(A) receptor gene regulation inthe brain and anxiety behavior. Steroids 2002; 67 (6): 519–28.
41. Sutker P, Libet J et al. Alcohol use, negative mood states, and menstrual cycle phases. Alcohol Clin Exp Res 1983; 7 (3): 327–31.
42. Walker A, Bancroft J. Relationship between premenstrual symptoms and oral contraceptive use: a controlled study. Psychosom Med 1990; 52 (1): 86–96.
43. Winkler UH, Sudik R. The effects of two monophasic oral contraceptives containing 30 mcg of ethinyl estradiol and either 2 mg of chlormadinone acetate or 0,15mg of desogestrel on lipid, hormone andmetabolic parameters. Contraception 2009; 79: 15–23.
44. Zahradnik H, Goldberg J, Andreas J. Efficacy and safety ofthe newantiandrogenic oral contraceptive Belara. Contraception 1998; 57 (2): 103–9.
45. Zahradnik HP, Hanjalic-Beck A. Efficacy, safety and sustainability of treatment continuation and results of an oral contraceptive containing 30 mg ethinyl estradiol and 2 mg chlormadinone acetate, in long-term usage (up to 45 cycles) – an open-label, prospective, non-controlled, office-based Phase III study. Contraception 2008; 77 (5): 337–43.
46. Zahradnik HP, Wetzka B et al. Zyklusabhängige Befindlichkeitsstörungen der Frau. Gynäkologe 2000; 33: 225–38.
47. Zinder O, Dar D. Neuroactive steroids: their mechanism of action and their function in the stress response. Acta Physiol Scand 1999; 167 (3): 181–8.
1. ГБОУ ВПО Первый Московский государственный медицинский университет им. И.М.Сеченова Минздрава России;
2. ГБУЗ ГКБ №53, Москва; 3ФГБОУ ВПО Российский университет дружбы народов, Москва