Режимы контрацепции: повышение приверженности женщин современным комбинированным оральным контрацептивам с максимально коротким безгормональным интервалом
Режимы контрацепции: повышение приверженности женщин современным комбинированным оральным контрацептивам с максимально коротким безгормональным интервалом
Андреева Е.Н., Шереметьева Е.В. Режимы контрацепции: повышение приверженности женщин современным комбинированным оральным контрацептивам с максимально коротким безгормональным интервалом. Гинекология. 2020; 22 (2): 46–50. DOI: 10.26442/20795696.2020.2.200128
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Andreeva E.N., Sheremetyeva E.V. Contraception modes: increasing women's commitment to modern combined oral contraceptives with the shortest possible hormone-free interval. Gynecology. 2020; 22 (2): 46–50.
DOI: 10.26442/20795696.2020.2.200128
Режимы контрацепции: повышение приверженности женщин современным комбинированным оральным контрацептивам с максимально коротким безгормональным интервалом
Андреева Е.Н., Шереметьева Е.В. Режимы контрацепции: повышение приверженности женщин современным комбинированным оральным контрацептивам с максимально коротким безгормональным интервалом. Гинекология. 2020; 22 (2): 46–50. DOI: 10.26442/20795696.2020.2.200128
________________________________________________
Andreeva E.N., Sheremetyeva E.V. Contraception modes: increasing women's commitment to modern combined oral contraceptives with the shortest possible hormone-free interval. Gynecology. 2020; 22 (2): 46–50.
DOI: 10.26442/20795696.2020.2.200128
Согласно определению, контрацепция – это предотвращение беременности и заражения от болезней механическими, химическими и другими противозачаточными средствами и способами. По статистике Всемирной организации здравоохранения (ВОЗ) до 40% женщин репродуктивного возраста по-прежнему считают, что их потребности в услугах планирования семьи не удовлетворяются во время консультирования. Рекомендуя контрацепцию, важно учитывать: характеристики потенциального потребителя, базовый риск заболевания, возможные нежелательные лекарственные реакции различных препаратов, стоимость, доступность и предпочтения самой женщины. Женщины часто вынуждены отказаться от использования того или иного метода контрацепции в связи с нежелательными явлениями, например, при использовании комбинированных оральных контрацептивов (КОК) возможно ухудшение самочувствия (головные боли, лабильность настроения, увеличение массы тела, отечность, снижение либидо) в безгормональный интервал, особенно при режиме приема 21/7. Отсутствие контрацепции может привести к увеличению риска наступления нежелательной беременности. Согласно статистике, в Российской Федерации в 2018 г. абсолютное число абортов составило 567 183, что, согласно классификации Организации Объединенных Наций, соответствует среднему уровню (уровень частоты абортов на 1 тыс. женщин фертильного возраста). По данным клинической практики имеется зависимость между ухудшением самочувствия и длительностью безгормонального интервала при приеме КОК. В настоящий момент в нашей стране есть единственный КОК, у которого безгормональный интервал 2 дня, содержащий эстроген, идентичный натуральному – эстрадиола валерат и диеногест. Согласно данным Кокрейновской библиотеки КОК с коротким безгормональным интервалом максимально эффективны в отношении клинических проявлений синдрома «эстрогеновой абстиненции». ВОЗ призывает врачей-клиницистов повышать информированность женщин в отношении современных методов контрацепции.
Ключевые слова: комбинированный оральный контрацептив, безгормональный интервал, мигрень, дисменорея, беременность, эстрадиола валерат, качество жизни, психологический статус
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By definition, contraception is the prevention of pregnancy and infection from diseases by mechanical, chemical and other contraceptives and methods. According to World Health Organization (WHO) statistics, up to 40% of women of reproductive age still believe that their needs for family planning services are not met during counseling. When recommending contraception, it is important to consider: the characteristics of the potential consumer, the underlying risk of the disease, possible undesirable drug reactions of various drugs, the cost, availability and preferences of the woman herself. Women are often forced to abandon the use of a contraceptive method in connection with adverse events, for example, when using combined oral contraceptives (COCs), they may feel worse (headaches, mood lability, weight gain, swelling, decreased libido) in a hormone-free interval, especially with the reception mode 21/7. Lack of contraception can lead to an increased risk of an unwanted pregnancy. According to statistics in the Russian Federation in 2018, the absolute number of abortions amounted to 567 183, which, according to the UN classification, corresponds to the average level (level of abortion rate per 1000 women of childbearing age). According to clinical practice, there is a relationship between deterioration of well-being and the duration of the hormone-free interval. At the moment, in our country there is the only COC, which has a hormone-free interval of 2 days, containing bioidentical estrogen – estradiol valerate and dienogest. According to the Cochrane Library, COCs with a short hormone-free interval are most effective in relation to the clinical manifestations of the “estrogen withdrawal” syndrome. WHO calls on clinicians to raise women's awareness of modern methods of contraception.
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6. Egarter C, Frey Tirri B, Bitzer J et al. Women's perceptions and reasons for choosing the pill, patch, or ring in the CHOICE study: a cross-sectional survey of contraceptive method selection after counseling. BMC Womens Health 2013; 13: 9. DOI: 10.1186/1472-6874-13-9
7. Alkema L, Kantorova V, Menozzi C, Biddlecom A. National, regional, and global rates and trends in contraceptive prevalence and unmet need for family planning between 1990 and 2015: a systematic and comprehensive analysis. Lancet 2013; 381: 1642-52. DOI: 10.1016/S0140-6736(12)62204-1
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[Prikaz Ministerstva zdravookhraneniia RF ot 1 noiabria 2012 g. №572n "Ob utverzhdenii Poriadka okazaniia meditsinskoi pomoshchi po profiliu “akusherstvo i ginekologiia (za iskliucheniem ispol'zovaniia vspomogatel'nykh reproduktivnykh tekhnologii)” (in Russian).]
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[Dikke G.B., Erofeeva L.V. Kontratseptsiia v sovremennoi Rossii: primenenie i informirovannost'. Populiatsionnoe issledovanie. Akusherstvo i ginekologiia. 2016; 2: 108–13. http://dx.doi.org/10.18565/aig.2016.2.108-113 (in Russian).]
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DOI: 10.1136/bmjsrh-2017-200036
14. Dinger J. Comparative effectiveness of combined oral contraceptives in adolescents. J Fam Plann Reprod Health Care 2011; 37: 118. DOI: 10.1136/jfprhc.2011.0092
15. Smith SK, Kirkman RJ, Arce BB et al. The effect of deliberate omission of Trinordiol or Microgynon on the hypothalamo-pituitary-ovarian axis. Contraception 1986; 34: 513–22. DOI: 10.1016/0010-7824(86)90060-0
16. Zapata LB, Steenland MW, Brahmi D et al. Effect of missed combined hormonal contraceptives on contraceptive effectiveness: a systematic review. Contraception 2013; 87: 685–700. DOI: 10.1016/j.contraception.2012.08.035
17. Baerwald A, Olatunbosun O, Pierson R. Ovarian follicular development is initiated during the hormone-free interval of oral contraceptive use. Contraception 2004; 70: 371–7. DOI: 10.1016/j.contraception.2004.05.006
18. Dusterberg B, Nishino Y. Pharmacokinetic and pharmacological features of oestradiol valerate. Maturitas 1982; 4: 315–24. 3.
19. Smith JD, Oakley D. Why do women miss oral contraceptive pills? An analysis of women’s self-described reasons for missed pills. J Midwifery Women’s Health 2005; 50: 380–5. DOI: 10.1016/j.jmwh.2005.01.011
20. Sulak PJ, Scow RD, Preece C et al. Hormone withdrawal symptoms in oral contraceptive users. Obstet Gynecol 2000; 95: 261–6. DOI: 10.1016/s0029-7844(99)00524-4
21. Archer DF. Menstrual-cycle-related symptoms: a review of the rationale for continuous use of oral contraceptives. Contraception 2006; 74: 359–66. DOI: 10.1016/j.contraception.2006.06.003
22. Nappi RE, Lobo Abascal P, Hsieh J, Micheletti MC. Cycle control with an extended-regimen oral contraceptive combining levonorgestrel and ethinyl estradiol that includes continuous low-dose ethinyl estradiol instead of the traditional hormone-free interval. Int J Womens Health 2017; 9: 739–47. DOI: 10.2147/IJWH.S142078
23. Bitzer J. Hormone withdrawal-associated symptoms: overlooked and under-explored. Gynecol Endocrinol 2013; 29 (6): 530–5. DOI: 10.3109/09513590.2012.760194
24. Baerwald AR, Pierson RA. Ovarian follicular development during the use of oral contraception: a review. J Obstet Gynaecol Can 2004; 26: 19–24.
25. Sullivan H, Furniss H, Spona J et al. Effect of 21-day and 24-day oral contraceptive regimens containing gestodene (60 microg) and ethinyl estradiol (15 microg) on ovarian activity. Fertil Steril 1999; 72:115–20.
26. Klipping C, Duijkers I, Trummer D et al. Suppression of ovarian activity with a drospirenone-containing oral contraceptive in a 24/4 regimen. Contraception 2008; 78: 16–25.
27. Spona J, Elstein M, Feichtinger W et al. Shorter pill-free interval in combined oral contraceptives decreases follicular development. Contraception 1996; 54: 71–7.
28. Legro RS, Pauli JG, Kunselman AR et al. Effects of continuous versus cyclical oral contraception: a randomized controlled trial. J Clin Endocrinol Metab 2008;93: 420–9.
29. Zeun S et al. Pharmacokinetics of an oral contraceptive containing oestradiol valerate and dienogest. Eur J Contracept Reprod Health Care 2009; 14: 221–32.
30. Fruzzetti F et al. An overview of the development of combined oral contraceptives containing estradiol: focus on estradiol valerate/dienogest. Gynecol Endocrinol 2012; 28: 400–8.
31. Endrikat J, Blode H, Gerlinger C et al. A pharmacokinetic study with a low-dose oral contraceptive containing 20 microg ethinylestradiol plus 100 microg levonorgestrel. Eur J Contracept Reprod Health Care 2002; 7: 79–90.
32. MacGregor EA, Guillebaud J. The 7-day contraceptive hormone-free interval should be consigned to history. BMJ Sexual & Reproductive Health 2018.
DOI: 10.1136/bmjsrh-2017-200036
33. Machado RB, Pereira AP, Coelho GP et al. Epidemiological and clinical aspects of migraine in users of combined oral contraceptives. Contraception 2010; 81 (3): 202–8. DOI: 10.1016/j.contraception.2009.09.006
34. Merki-Feld GS et al. Temporal relations in hormone-withdrawal migraines and impact on prevention- a diary-based pilot study in combined hormonal contraceptive users. J Headache Pain 2017; 18 (1): 91. DOI: 10.1186/s10194-017-0801-7
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1. Selected practice recommendations for contraceptive use. 2nd ed., World Health Organization, 2005. (in Russian).
2. Pekinskaia rabochaia programma, 1995 g., p. 95. (in Russian).
3. Denisov B.P., Sakevich V.I. Primenenie kontratseptsii v Rossii: po materialam vyborochnogo obsledovaniia. Dokazatel'naia meditsina i klinicheskaia epidemiologiia. 2009; 1. (in Russian).
4. Aleksandrova G.A., Golubev N.A., Tiurina E.M., et al. Osnovnye pokazateli zdorov'ia materi i rebenka, deiatel'nost' sluzhby okhrany detstva i rodovspomozheniia v Rossiiskoi Federatsii. Sbornik. M., 2019. (in Russian).
5. Tokova Z.Z., Prilepskaya V.N., Gata A.S., Kuzemin A.A. Special statistics of the modern methods of contraception in the federal districs of Russian Federation. Gynecology. 2016; 18 (4): 68–71. (in Russian).
6. Egarter C, Frey Tirri B, Bitzer J et al. Women's perceptions and reasons for choosing the pill, patch, or ring in the CHOICE study: a cross-sectional survey of contraceptive method selection after counseling. BMC Womens Health 2013; 13: 9. DOI: 10.1186/1472-6874-13-9
7. Alkema L, Kantorova V, Menozzi C, Biddlecom A. National, regional, and global rates and trends in contraceptive prevalence and unmet need for family planning between 1990 and 2015: a systematic and comprehensive analysis. Lancet 2013; 381: 1642-52. DOI: 10.1016/S0140-6736(12)62204-1
8. https://www.gazeta.ru/science/2013/03/15_a_5057773.shtml
9. Medical eligibility criteria for contraceptive use. 5th ed. Geneva: World Health Organization; 2015 (in Russian).
10. Prikaz Ministerstva zdravookhraneniia RF ot 1 noiabria 2012 g. №572n "Ob utverzhdenii Poriadka okazaniia meditsinskoi pomoshchi po profiliu “akusherstvo i ginekologiia (za iskliucheniem ispol'zovaniia vspomogatel'nykh reproduktivnykh tekhnologii)” (in Russian).
11. Dikke G.B., Erofeeva L.V. Kontratseptsiia v sovremennoi Rossii: primenenie i informirovannost'. Populiatsionnoe issledovanie. Akusherstvo i ginekologiia. 2016; 2: 108–13. http://dx.doi.org/10.18565/aig.2016.2.108-113 (in Russian).
12. Prilepskaia V.N. Rukovodstvo po kontratseptsii. 4-izd., dop. M.: MEDpress-inform, 2017 (in Russian).
13. MacGregor EA, Guillebaud J. The 7-day contraceptive hormone-free interval should be consigned to history. BMJ Sexual & Reproductive Health 2018.
DOI: 10.1136/bmjsrh-2017-200036
14. Dinger J. Comparative effectiveness of combined oral contraceptives in adolescents. J Fam Plann Reprod Health Care 2011; 37: 118. DOI: 10.1136/jfprhc.2011.0092
15. Smith SK, Kirkman RJ, Arce BB et al. The effect of deliberate omission of Trinordiol or Microgynon on the hypothalamo-pituitary-ovarian axis. Contraception 1986; 34: 513–22. DOI: 10.1016/0010-7824(86)90060-0
16. Zapata LB, Steenland MW, Brahmi D et al. Effect of missed combined hormonal contraceptives on contraceptive effectiveness: a systematic review. Contraception 2013; 87: 685–700. DOI: 10.1016/j.contraception.2012.08.035
17. Baerwald A, Olatunbosun O, Pierson R. Ovarian follicular development is initiated during the hormone-free interval of oral contraceptive use. Contraception 2004; 70: 371–7. DOI: 10.1016/j.contraception.2004.05.006
18. Dusterberg B, Nishino Y. Pharmacokinetic and pharmacological features of oestradiol valerate. Maturitas 1982; 4: 315–24. 3.
19. Smith JD, Oakley D. Why do women miss oral contraceptive pills? An analysis of women’s self-described reasons for missed pills. J Midwifery Women’s Health 2005; 50: 380–5. DOI: 10.1016/j.jmwh.2005.01.011
20. Sulak PJ, Scow RD, Preece C et al. Hormone withdrawal symptoms in oral contraceptive users. Obstet Gynecol 2000; 95: 261–6. DOI: 10.1016/s0029-7844(99)00524-4
21. Archer DF. Menstrual-cycle-related symptoms: a review of the rationale for continuous use of oral contraceptives. Contraception 2006; 74: 359–66. DOI: 10.1016/j.contraception.2006.06.003
22. Nappi RE, Lobo Abascal P, Hsieh J, Micheletti MC. Cycle control with an extended-regimen oral contraceptive combining levonorgestrel and ethinyl estradiol that includes continuous low-dose ethinyl estradiol instead of the traditional hormone-free interval. Int J Womens Health 2017; 9: 739–47. DOI: 10.2147/IJWH.S142078
23. Bitzer J. Hormone withdrawal-associated symptoms: overlooked and under-explored. Gynecol Endocrinol 2013; 29 (6): 530–5. DOI: 10.3109/09513590.2012.760194
24. Baerwald AR, Pierson RA. Ovarian follicular development during the use of oral contraception: a review. J Obstet Gynaecol Can 2004; 26: 19–24.
25. Sullivan H, Furniss H, Spona J et al. Effect of 21-day and 24-day oral contraceptive regimens containing gestodene (60 microg) and ethinyl estradiol (15 microg) on ovarian activity. Fertil Steril 1999; 72:115–20.
26. Klipping C, Duijkers I, Trummer D et al. Suppression of ovarian activity with a drospirenone-containing oral contraceptive in a 24/4 regimen. Contraception 2008; 78: 16–25.
27. Spona J, Elstein M, Feichtinger W et al. Shorter pill-free interval in combined oral contraceptives decreases follicular development. Contraception 1996; 54: 71–7.
28. Legro RS, Pauli JG, Kunselman AR et al. Effects of continuous versus cyclical oral contraception: a randomized controlled trial. J Clin Endocrinol Metab 2008;93: 420–9.
29. Zeun S et al. Pharmacokinetics of an oral contraceptive containing oestradiol valerate and dienogest. Eur J Contracept Reprod Health Care 2009; 14: 221–32.
30. Fruzzetti F et al. An overview of the development of combined oral contraceptives containing estradiol: focus on estradiol valerate/dienogest. Gynecol Endocrinol 2012; 28: 400–8.
31. Endrikat J, Blode H, Gerlinger C et al. A pharmacokinetic study with a low-dose oral contraceptive containing 20 microg ethinylestradiol plus 100 microg levonorgestrel. Eur J Contracept Reprod Health Care 2002; 7: 79–90.
32. MacGregor EA, Guillebaud J. The 7-day contraceptive hormone-free interval should be consigned to history. BMJ Sexual & Reproductive Health 2018.
DOI: 10.1136/bmjsrh-2017-200036
33. Machado RB, Pereira AP, Coelho GP et al. Epidemiological and clinical aspects of migraine in users of combined oral contraceptives. Contraception 2010; 81 (3): 202–8. DOI: 10.1016/j.contraception.2009.09.006
34. Merki-Feld GS et al. Temporal relations in hormone-withdrawal migraines and impact on prevention- a diary-based pilot study in combined hormonal contraceptive users. J Headache Pain 2017; 18 (1): 91. DOI: 10.1186/s10194-017-0801-7
35. Cupini LM, Matteis M, Troisi E et al. Sex-hormone-related events in migrainous females.
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Авторы
Е.Н. Андреева1,2, Е.В. Шереметьева*1
1 ФГБУ «Национальный медицинский исследовательский центр эндокринологии» Минздрава России, Москва, Россия;
2 ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова» Минздрава России, Москва, Россия
*s1981k@yandex.ru
________________________________________________
Elena N. Andreeva1,2, Ekaterina V. Sheremetyeva*1
1 Endocrinology Research Centre, Moscow, Russia;
2 Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
*s1981k@yandex.ru