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Контрацепция после аборта: как сделать правильный выбор?
DOI: 10.26442/20795696.2021.2.200833
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Dobrokhotova YuE, Narimanova MR, Khlynova SA, Saprykina LV, Il’ina IIu. Post-abortion contraception: how to make the right choice? 2021; 23 (2): 205–209. DOI: 10.26442/20795696.2021.2.200833
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Ключевые слова: аборт, постабортная контрацепция, комбинированные оральные контрацептивы, Метафолин, фолаты, этинилэстрадиол, дроспиренон
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More than 600 thousands abortions are performed annually in Russia. Women presenting for abortion care are often motivated by the pregnancy to use effective contraception; they are also at high risk for repeat unintended pregnancy. Contraceptive counseling and the supply of contraceptive methods are part of post-abortion care and positively influence the subsequent use of contraceptive methods. Oral contraceptives (OCs) following induced abortion offer a reliable method to avoid repeated abortion. Immediate administration of combined OCs after abortion may reduce vaginal bleeding time and amount, shorten the menstruation recovery period, and reduce the risk of complications and unintended pregnancies. Сombination of ethinylestradiol 30 µg + drospirenone 3 mg demonstrates the advantages of a low estrogen dose with the antimineralocorticoid activity of drospirenone that is responsible for the drug’s significant antiandrogenic and antimineralocorticoid effects, reflected clinically in lower rates of adverse events including less fluid retention. Сombination of ethinylestradiol 30 µg + drospirenone 3 mg and Metafolin has similar contraceptive efficacy, side effect, safety and benefits profile to other drospirenone-containing contraceptives. The article presents the results of the latest studies about using of combined OCs (ethinylestradiol 30 µg + drosperinone 3 mg and Metafolin) after abortion.
Keywords: abortion, post-abortion contraception, combined oral contraceptives, Metafolin, folate, ethinylestradiol, drosperinone
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1. Doklad «Demografiia – 2024. Kak obespechit’ ustoichivyi estestvennyi prirost naseleniia Rossii». Available at:
https://www.oprf.ru/about/structure/structurenews/newsitem/51897. Accessed: 06.04.2020 (in Russian)
2. Reiting regionov RF po demografii – 2019. Available at:
https://riarating.ru/infografika/20190423/630123908.html. Accessed: 03.04.2020 (in Russian)
3. Bloomberg otsenil poteri mirovoi ekonomiki ot koronavirusa v $5 trln. Available at: https://meatinfo.ru/news/bloomberg-otsenil-poteri-mirovoy-ekonomiki-ot-koronavirusav-5-trln-406827?u.... Accessed: 10.04.2020 (in Russian)
4. Guttmacher Institute. Adding it up: Investing in Contraception and Maternal and Newborn Health 2017. Available at: https://www.guttmacher.org/fact-sheet/adding-it-up-contraception-mnh-2017. Accessed: 15.09.2019.
5. Sedgh G, Singh S, Hussain R. Intended and unintended pregnancies worldwide in 2012 and recent trends. Stud Fam Plann. 2014; 45 (3): 301–14.
DOI: 10.1111/j.1728-4465.2014.00393.x
6. Available at: https://www.mkchita.ru/social/2020/07/17/chislo-abortov-pri-pervoy-beremennosti-vyroslo-v-rossii.htm.... Accessed: 10.02.2021
7. Elektronnyi resurs TASS. Available at: https://tass.ru/ (in Russian)
8. Costescu D. Levonorgestrel-releasing intrauterine systems for long-acting contraception: current perspectives, safety, and patient counseling. Int J Womens Health. 2016; 8: 589–98.
9. Gambera A, Corda F, Papa R, et al. Observational, prospective, multi-centre study to evaluate the effects of counselling on the choice of com-bined hormonal contraceptives in Italy – the ECOS (Educational CO-unselling effectS) study. BMC Womens Health. 2015; 15: 69. DOI: 10.1186/s12905-015-0226-x
10. Dikke GB. Potrebnosti, ozhidaniia i somneniia u pol’zovatelei gormonal’nymi kontratseptivami. Gynecology. 2020; 22 (1): 33–7 (in Russian) DOI: 10.26442/20795696.2020.1.200044
11. Dikke GB. Medical abortion in outpatient practice. Moscow: GEOTAR-Media, 2018 (in Russian)
12. Balan VE. Postabortnaia reabilitatsiia – zalog uspekha povtornoi beremennosti. Effektivnaia farmakoterapiia. 2011; 1: 78–81 (in Russian)
13. Van Look PF, Cottingham J. The World Health Organization’s safe abortion guidance document. Am J Public Health. 2013; 103 (4): 593–6. DOI: 10.2105/AJPH.2012.301204
14. Rossijskie klinicheskie rekomendatsii po medikamentoznomu preryvaniyu beremennosti. Moscow, 2015. Available at: www.ru486.ru/docs/fed.pdf. Accessed: 20.07.2020 (in Russian)
15. Che Y, Liu X, Zhang B, Cheng L. Oral contraception following abortion: A systematic review and meta-analysis. Medicine (Baltimore). 2016; 95 (27): e3825. DOI: 10.1097/MD.0000000000003825
17. Serov VN. Gormonal’naia kontratseptsiia kak metod reabilitatsii posle abortov. Gynecology. 2007; 9 (6): 25–8 (in Russian)
18. Fan GS, Bian ML, Cheng LN, et al. Efficacy and safety of drospirenone-ethinylestradiol on contraception in healthy Chinese women: a multicenter randomized controlled trial. Zhonghua Fu Chan Ke Za Zhi. 2009; 44 (1): 38–44 (In Chinese).
19. Barnett C, Dinger J, Minh TD, Heinemann K. Unintended pregnancy rates differ according to combined oral contraceptive – results from the INAS-SCORE study. Eur J Contracept Reprod Health Care. 2019; 24 (4): 247–50. DOI: 10.1080/13625187.2019.1629412
19. Mansour D, Verhoeven C, Sommer W, et al. Efficacy and tolerability of a monophasic combined oral contraceptive containing nomegestrol acetate and 17β-oestradiol in a 24/4 regimen, in comparison to an oral contraceptive containing ethinylestradiol and drospirenone in a 21/7 regimen. Eur J Contracept Reprod Health Care. 2011; 16 (6): 430–43. DOI: 10.3109/13625187.2011.614029
20. Schultz-Zehden B, Boschitsch E. User experience with an oral contraceptive containing ethinylestradiol 30 mug and drospirenone 3 mg (yasmin((r))) in clinical practice. Treat Endocrinol. 2006; 5 (4): 251–6. DOI: 10.2165/00024677-200605040-00006
21. Foster RH, Wilde MI. Dienogest. Drugs. 1998; 56 (5): 825–33. DOI: 10.2165/00003495-199856050-00007
22. Sitruk-Ware R. Pharmacology of different progestogens: the special case of drospirenone. Climacteric. 2005; 8 (Suppl. 3): 4–12. DOI: 10.1080/13697130500330382
23. En’kova EV. Vliianie novogo peroral’nogo kontratseptiva na metabolizm i sostoianie serdechno-sosudistoi sistemy. Meditsinskii sovet. 2015; 20: 10–3 (in Russian)
24. Unanian AL, Arakelov SE, Polonskaia LS, et al. Postabortnaia reabilitatsiia: teoreticheskie i prakticheskie aspekty. Meditsinskii sovet. 2014; 9: 26–8 (in Russian)
25. Obeid R, Schön C, Wilhelm M, et al. Dietary and lifestyle predictors of folate insufficiency in non-supplemented German women. Int J Food Sci Nutr. 2019; 70 (3): 367–76. DOI: 10.1080/09637486.2018.1511686
26. Pedersen W. Abortion and depression: a population-based longitudinal study of young women. Scand J Public Health. 2008; 36 (4): 424–8. DOI: 10.1177/1403494807088449
27. Reardon DC. Physical Health of Women After Seeking Abortion Services. Ann Intern Med. 2020; 172 (2): 163–4. DOI: 10.7326/L19-0623. PMID: 31958828
28. Filatova S, Gyllenberg D, Sillanmäki L, et al. The Finnish psychiatric birth cohort consortium (PSYCOHORTS) – content, plans and perspectives. Nord J Psychiatry. 2019; 73 (6): 357–64. DOI: 10.1080/08039488.2019.1636135
29. Kasimova LN, Zhiliaeva TV. Rol’ folatov v etiologii, patogeneze i lechenii depressivnykh rasstroistv. Prakticheskaia meditsina. 2012; 2: 13–8 (in Russian)
30. Sakevich VI. Ot aborta k kontratseptsii. Demoskop Weekly. 2016; 687–688. Available at: http://demoscope.ru/weekly/2016/0687/demoscope687.pdf (in Russian)
31. George L, Mills JL, Johansson AL, et al. Plasma folate levels and risk of spontaneous abortion. JAMA. 2002; 288 (15): 1867–73. DOI: 10.1001/jama.288.15.1867
32. Mao YY, Yang L, Li M, et al. Periconceptional Folic Acid Supplementation and the Risk of Spontaneous Abortion among Women Who Prepared to Conceive: Impact of Supplementation Initiation Timing. Nutrients. 2020; 12 (8): 2264. DOI: 10.3390/nu12082264
33. Bukowski R, Malone FD, Porter FT, et al. Preconceptional folate supplementation and the risk of spontaneous preterm birth: a cohort study. PLoS Med. 2009; 6 (5): e1000061. DOI: 10.1371/journal.pmed.1000061
34. Hodgetts VA, Morris RK, Francis A, et al. Effectiveness of folic acid supplementation in pregnancy on reducing the risk of small-for-gestational age neonates: a population study, systematic review and meta-analysis. BJOG. 2015; 122 (4): 478–90. DOI: 10.1111/1471-0528.13202
35. Best K, Green TJ. Adequate maternal pre-conceptional folate status may reduce the risk of gestational diabetes mellitus. Evid Based Nurs. 2020; ebnurs-2019-103157. DOI: 10.1136/ebnurs-2019-103157
36. Li M, Li S, Chavarro JE, et al. Prepregnancy Habitual Intakes of Total, Supplemental, and Food Folate and Risk of Gestational Diabetes Mellitus: A Prospective Cohort Study. Diabetes Care. 2019; 42 (6): 1034–41. DOI: 10.2337/dc18-2198
ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России, Москва, Россия
* pr.dobrohotova@mail.ru
________________________________________________
Yuliya E. Dobrokhotova*, Metanat R. Narimanova, Svetlana A. Khlynova, Liudmila V. Saprykina, Irina Iu. Il’ina
Pirogov Russian National Research Medical University, Moscow, Russia
* pr.dobrohotova@mail.ru