The method of hormonal contraception

 

The invention relates to medicine, in particular to the gynecologist, and for hormonal contraception. The method includes the age and the definition of types of hormonal sensitivity in women: giperandrogenii, hyperestrogenemia and norms, with an additional allocation hypoestrogyny, combination hypoestrogyny with hyperandrogenism and combinations of hyperestrogenemia with hyperandrogenism. Taking into account the identified type of hormone sensitivity and age selection of the drug is performed with regard to the type of contraceptive (monophasic, three-phase), dose estrogenic component, the type and dose gestagenna component. The algorithm takes into account the peculiarities of contraceptives 3rd generation, containing as gestagenna component gestodene, desogestrel, norgestimate. The method provides a differentiated approach to the role of modern hormonal contraceptives 3rd generation women of childbearing age, which improves the tolerability of drugs, to reduce the frequency of complications and side effects of hormonal contraception. table 2.

The invention relates to medicine, in particular to the gynecologist.

According to the health Ministry, 7.3% of women of childbearing age (2.8 million people) use the this is due to a violation of the estrogen-progesterone balance, resulting from the assignment of contraceptives without regard to types of hormonal sensitivity of women (3).

Modern contraceptives 3rd generation are optimized for use with not only contraception, but also lecebnim effect in various pathological conditions associated with disturbances of a hormonal background, but at present there are no differentiated approach to their destination.

In clinical practice, hormonal contraception is prescribed in the absence of contraindications to the use of contraceptives (severe comorbidities), taking into account risk factors and age women. Common empirical method of appointment of contraceptives, namely, that women are prescribed low-dose monophasic preparations and see, and you are experiencing complications change the dose and type of drug (4).

The disadvantage of this method is that its use leads to an increase in the frequency of complications and side effects that are adjusted only after the occurrence of clinical manifestations, not profilactics by proper assignment of contraceptives.

Another method of appointment of hormonal contraception spend an appoint a three-phase low-dose contraceptives (5).

The method adopted by us for the prototype, is that when prescribing hormonal contraceptives include the types of hormonal sensitivity, highlighting the hyperandrogenism, giperandrogenii and norm (1). If giperandrogenii prescribed drugs with low content gestagenna component (for example, anteovin) and drugs with ciproteron acetate (Diane-35), with hyperestrogenemia prescribed drugs with a predominance of progestogen (for example, rigevidon, ovidon), and when determining norms prescribe any contraceptive.

Stipulate that the types of hormonal sensitivity when prescribing hormonal contraception is only necessary for the preparations of the 2nd generation, and contraceptives 3rd generation is considered acceptable for women of all types.

The described method of hormonal contraception has the following disadvantages: 1) the absence of a differentiated approach to the use of contraceptives 3rd generation; 2) the lack of a comprehensive accounting of the types of hormonal sensitivity and age women; 3) the absence of selection hypoestrogenic types and combinations of types (hypoestrogyny with hyperandrogenism, giperandrogenii with hyperestrogenic), under which the appointment of contraceptives requires a special approach; 4) h is Vanneste tactics assignment of hormonal contraception.

The objectives of our proposal are to reduce the number of complications and side effects, as well as providing maximum therapeutic effect of hormonal contraception by using a new, convenient for clinical application, the assignment algorithm of hormonal contraceptives on the basis of a prediction of their actions.

We offer the method of hormonal contraception, the essence of which is the appointment of contraceptives with regard to the age and types of hormonal sensitivity in women: giperandrogenii, hyperestrogenemia and regulations, characterized in that it further allocate hypoestrogenia, the combination hypoestrogyny with hyperandrogenism and the combination of hyperestrogenemia with hyperandrogenism. When determining giperandrogenii prescribed drugs with antiandrogenna action, the definition of hyperestrogenemia prescribed volume is decreased contraceptives with minimal amount of estrogen or clean progestins, when determining the norms prescribed low-dose and volume is decreased contraceptives 3rd generation, when determining hypoestrogyny prescribe low-dose contraceptives with minimal antiestrogenic action, when determining the combination of hypoestrogen antiestrogenic action when determining the combination of giperandrogenii with hyperestrogenic prescribed volume is decreased contraceptives with antiandrogenic action.

The method is as follows. After a thorough history taking and exclude any contraindications to the prescription of hormonal contraception determine the type of hormone sensitivity in women with the help of laboratory diagnostics, which is used for radioimmunoassay method for the determination of the concentration of sex hormones in the serum.

The obtained data are compared with normatywnymi values that can be different depending on the test systems and laboratory equipment. Standards used by us (data laboratory diagnostic center of CMLTO, Krasnodar), are presented in table. 2.

Based on the excess or decrease compared with normal values identify the type of hormonal sensitivity.

Decreasing the concentration of estradiol, increasing the concentration of follitropin and progesterone define the hypoestrogenia.

By increasing the concentration of testosterone and 17-oksiprogesterona, the predominance of secretion of LH levels have over follitropin determine the hyperandrogenism.

is retrogenia.

In the absence of deviations of the data from the normative values hormones determine the norm.

At lower concentrations of estradiol, along with increasing levels of testosterone and 17-oksiprogesterona, the predominance of synthesis of LH levels have over follitropin determine the combination hypoestrogyny with hyperandrogenism.

When increasing concentrations of testosterone, 17-oksiprogesterona and estradiol, decreased levels of progesterone and follitropin determine the combination of giperandrogenii with hyperestrogenic.

Taking into account the identified type of hormone sensitivity and patient age (under 25, 25 - 35 years over 35 years) prescribe hormonal contraception. Selection of the drug is performed with regard to the type of contraceptive (monophasic, three-phase), dose estrogenic component, the type and dose gestagenna component. The algorithm takes into account the peculiarities of contraceptives 3rd generation, containing as gestagenna component gestodene, desogestrel, norgestimate (see tab.1).

When hypoestrogyny prescribe low-dose contraceptives with minimal antiestrogenic action: the age of 35 three - phase desogestrelthinyl contraceptives after 35 years - monophasic desogestrelthinyl con is esogithbradodedryj contraceptives 3rd generation and ciproteron-acetazolamide drugs in 25-35 years - low-dose monophasic contraceptives 3rd generation and ciproteron-acetazolamide drugs, after 35 years as volume is decreased contraceptives 3rd generation.

If hyperestrogenemia prescribed volume is decreased contraceptives with minimal amount of estrogen or clean progestins: up to 25 years - monophasic low-dose contraceptives, 25-35 years - monophasic volume is decreased contraceptives after 35 years gestagenna contraceptives (net progestins).

When determining the norms prescribed low-dose and volume is decreased contraceptives: up to 25 years - three-phase contraceptives 3rd generation, 25-35 years - monophasic low-dose and three-phase contraceptives 3rd generation, after 35 years as volume is decreased contraceptives 3rd generation.

When combined hypoestrogyny with hyperandrogenism prescribe low-dose contraceptives with antiandrogenna effect and minimum antiestrogenic action (desogestrelthinyl): up to 25 years - three-phase, 25-35 years - monophasic low-dose, after 35 years as volume is decreased.

The combination of giperandrogenii with hyperestrogenic prescribed volume is decreased contraceptives with antiandrogenicity clean progestins.

The method is tested by us in a clinical setting in 90 patients. The purpose of our hormonal contraceptives with regard to the age and types of hormonal sensitivity of women helped to reduce the frequency of adverse reactions and complications of hormonal contraception with 30% (1) up to 6%, as well as to correct hormonal imbalances and to achieve a therapeutic effect in 87% of patients with initial violations.

Clinical examples.

1. Patient M., 21 years. Complaints of weakness, fatigue, brittle nails, dryness and itching of the vagina, decreased libido, painful menstruation. In the history of the reception volume is decreased estadisticas drug (LOGEST), against which all of the above symptoms persisted. Objective: infantile type physique, poor hair growth and axillary area, dry skin and hair. Gynecological examination: poor vaginal secretion, hyperemic mucosa, conical cervix, the reduced size of the uterus in hyperinteractive.

Data from laboratory studies: estradiol 1 phase of the cycle - 64,9 pmol/l (norm 75,7-314.4 M. pmol/l), follitropin - 14,5 mIU/ml (normal 3-14 mIU/ml), progesterone in the 2nd phase of the cycle - 23.3 ng/ml (normal range of 0.95-21 ng/ml), testosterone is 0.55 ng/ml (normal 0,04-to 0.66 ng/ml), e. it was found a decrease of estradiol and increased levels of follitropin and progesterone. On the basis of laboratory data and clinical examination was determined hypoestrogenic type of hormonal sensitivity.

When hypoestrogyny undesirable destination volume is decreased contraceptives, as well as estadisticas drugs (LOGEST) because they have a pronounced gestagenna action and mild anti-estrogenic effect. Considering the age (25 years) the patient was assigned to low-dose desogestrelthinyl the contraceptive pill (marvelon), the intake of which she was normalized condition of the skin, hair, decreased brittle nails, there was an increase of libido, loss of dryness and itching in the vagina, painless menstruation.

2. Patient K., 25 years. Worried about acne, scanty and irregular menstruation with a tendency to delay. A history of reception tri-regola with the purpose of contraception, against which reported increased acne, scanty menstruation and weight gain of 4 kg During examination: tall (174 cm), athletic body type, oily skin and hair, severe acne, hypoplasia of the mammary glands.

Data from laboratory studies: testost is - of 8.3 mIU/ml (normal up to 14.7 mIU/ml) estradiol in the 1st phase of the cycle 95,4 pmol/l (norm 75,7-314.4 M. pmol/l), follitropin - 8,7 mIU/ml (normal 3-14 mIU/ml), progesterone in the 2nd phase of the cycle - 4,37 ng/ml (normal range of 0.95-21 ng/ml), i.e., revealed elevated levels of testosterone and 17-oksiprogesterona, the predominance of secretion of LH levels have over follitropin. On the basis of clinical and laboratory examination was identified hyperandrogenic type of hormonal sensitivity.

If giperandrogenii the appointment of hormonal contraceptives containing levonorgestrel (tri-regol) is undesirable, because this gestagen possesses androgenic and anabolic effects. With regard to age (25 years), the patient was assigned to a three-phase desogestrelthinyl hormonal contraceptive (three-Mersey), with antiandrogenna action, and on the 1st month of taking it noted the reduction of oily skin, 2-month - reducing the fat content of hair and acne, normalization of the volume of menstrual blood loss. Body weight against a background of 6 months of taking the drug has not changed. The menstrual cycle has become regular on a background of reception of contraceptives and was not broken after its cancellation.

3. Patient C. , 30 years. Complaints abundant long menstruation with clots, bloating, disease is containing contraceptives (three-Mersey), against which said leg cramps, nausea, bloating, pain in the heart, pain and engorgement, a weight gain of 3 kg Objective: overweight (BMI= 27,4) with preferential deposition of fatty tissue on the buttocks and thighs, normal skin and hair, varicose veins in the legs.

Data from laboratory studies: estradiol 1 phase of the cycle - 346,9 pmol/l (norm 75,7-314.4 M. pmol/l), follitropin - 2,47 mIU/ml (normal 3-14 mIU/ml), progesterone in the 2nd phase of the cycle - 038 ng/ml (normal range of 0.95-21 ng/ml), testosterone is 0.55 ng/ml (normal 0,04-to 0.66 ng/ml), 17-oksiprogesterona in the 1st phase of the cycle - 0,87 (normal to 0.73 1.09 ng/ml), lutropin in the 2nd phase of the cycle to 10.7 mIU/ml (normal up to 14.7 mIU/ml), i.e., was identified elevated levels of estrogen, reducing the concentration of follitropin and progesterone. On the basis of clinical and laboratory examination has giperestrogennoy type of hormonal sensitivity.

If hyperestrogenemia it is undesirable to prescribe hormonal contraceptives containing more than 20 micrograms of ethinyl estradiol. Preferably the appointment of a monophasic combined volume is decreased contraceptives or clean gestagennah drugs. Considering the age of the patient was recommended microdo spotting, what is regarded by us as an adaptive response. Body weight during the first three months of admission decreased by 3 kg, menstruation became less obalnimi and long, no bloating and pain in the breast, the indices of coagulation after 3 and 6 months of admission remained within normal limits.

4. Patient C., 36 years. No complaints. History of receiving low-dose monophasic contraceptive, which was well tolerated. Somatic diseases no, don't smoke.

Data from laboratory studies: estradiol 1 phase of the cycle - 192,8 pmol/l (norm 75,7-314.4 M. pmol/l), follitropin - 6,7 mIU/ml (normal 3-14 mIU/ml), progesterone in the 2nd phase of the cycle and 8.1 ng/ml (normal range of 0.95-21 ng/ml), testosterone - 0.25 ng/ml (normal 0,04-to 0.66 ng/ml), 17-oksiprogesterona in the 1st phase of the cycle - 0,76 (normal to 0.73 1.09 ng/ml), lutropin in the 2nd phase of the cycle and 8.6 mIU/ml (normal up to 14.7 mIU/ml), i.e., all results are within normal limits. Set the type of normal hormonal sensitivity.

With regard to age (over 35 years) was appointed as the volume is decreased contraceptive (mersilon). While taking the drug had no complaints.

5. Patient N., 27 years. Complaints of weakness, fatigue, poor painful menstruation, acne. In the history of the reception phase levonorgestrelthinyl body type, high growth, hirsutism, oily skin and hair, acne on the forehead, cheeks, chin. Gynecological examination: poor vaginal secretion, reduced the size of the uterus in retroflexion.

Data from laboratory studies: estradiol 1 phase of the cycle - 54,2 pmol/l (norm 75,7-314.4 M. pmol/l), testosterone - of 0.95 ng/ml (normal 0,04-to 0.66 ng/ml), 17-oksiprogesterona in the 1st phase of the cycle of 1.27 ng/ml (normal to 0.73 1.09 ng/ml), follitropin - 11,7 mIU/ml (normal 3-14 mIU/ml), progesterone in the 2nd phase of the cycle - to 16.9 ng/ml (normal range of 0.95-21 ng/ml), lutropin in the 2nd phase of the cycle - 27,6 mIU/ml (normal up to 14.7 mIU/ml), i.e., has revealed reduction of estradiol, increasing the levels of testosterone, 17-oksiprogesterona and the predominance of synthesis of LH levels have over follitropin. On the basis of laboratory data and clinical examination, it was determined combination hypoestrogyny with hyperandrogenism.

When combined hypoestrogyny with hyperandrogenism undesirable assignment levonorgestrelbuy contraceptives, because they have strong androgenic and antiestrogenic effects. With regard to age (27 years) the patient was assigned to low-dose desogestrelthinyl the contraceptive pill (marvelon), the intake of which she was normalized overall condition, decreased acne e menses with clots, acne, excess hair growth. In the history of the reception monophasic levonorgestrellevonorgestrel contraceptive (rigevidon), which reported increased acne, leg cramps, nausea, bloating, pain in the heart, pain and engorgement, a weight gain of 5 kg Objective: overweight (BMI=30,2) with preferential deposition of adipose tissue in the abdomen, oily skin and hair, severe acne, hirsutism.

Data from laboratory studies: testosterone - 1,21 ng/ml (normal 0,04-to 0.66 ng/ml), 17-oksiprogesterona in the 1st phase of the cycle of 1.56 ng/ml (normal to 0.73 1.09 ng/ml), estradiol in the 1st phase of the cycle 320,8 pmol/l (norm 75,7-314.4 M. pmol/l), follitropin - 1,79 mIU/ml (normal 3-14 mIU/ml), progesterone in the 2nd phase of the cycle - 0.27 ng/ml (normal range of 0.95-21 ng/ml), lutropin in the 2nd phase of the cycle at 16.9 mIU/ml (normal up to 14.7 mIU/ml), i.e., revealed elevated levels of testosterone, 17-oksiprogesterona and estradiol at lower concentrations of follitropin and progesterone. On the basis of clinical and laboratory examination revealed a combination of giperandrogenii with hyperestrogenic.

The combination of giperandrogenii with hyperestrogenic it is undesirable to prescribe hormonal contraceptives containing more than 20 g abolishes action (rigevidon). With regard to age (29 years) patient was assigned as volume is decreased desogestrelthinyl hormonal contraceptive (novinet) with antiandrogenna and minimal estrogenic effects. On the background of the drug, the patient reported a reduction of oily skin and hair, reducing the severity of acne. Body weight decreased by 4 kg Menstruation became regular, painless, less abundant and long, did not mention the bloating and pain mammary glands.

Using the proposed method provides a differentiated approach to the role of modern hormonal contraceptives 3rd generation women of childbearing age, which improves the tolerability of drugs, to reduce the frequency of complications and side effects of hormonal contraception, to achieve correction of hormonal and therapeutic effect in patients with baseline abnormalities and is a convenient and simple method to apply in clinical practice.

Literature 1. Serov Century. N. , Spiders S. C. Oral hormonal contraception. - M.: "Triada-X", 1998, 167 S. (pages 109-112).

2. Service of health protection of mother and child in 2000,//Collection of Russian Ministry of health, 2000, pp. 24-29.

3. Manuilova I. A. Modern contrace osobie to provide services in the field of family planning. 1992, 168 S. (pages 51-52) 5. Manukhin I. B., Tumilovich L. G., M. Gevorgyan A. Clinical lectures on gynecological endocrinology. - M: Medical information Agency, 2001, 247 S. (p. 33).

6. Smetnik B. N., Tumilovich L., non-operative gynecology. SPb. SOTHIS, 1995, 224 S. (PP 133-140).

Claims

The method of hormonal contraception, including the appointment of agents, depending on the woman's age and level of sexual hormones in blood serum, characterized in that when giperandrogenii women up to 25 years, to appoint a three-phase desogestrelthinyl contraceptives 3rd generation and ciproteron-acetazolamide drugs, women, 25-35 years old - low-dose monophasic contraceptives 3rd generation and cyproteronacetate drugs, and women after 35 years as volume is decreased contraceptives 3rd generation, with hyperestrogenemia women up to 25 years are prescribed low-dose monophasic contraceptives, women 25-35 years - monophasic volume is decreased contraceptives, and women after 35 years - progestins; at normal rates of hormones in women up to 25 years, to appoint a three-phase contraceptives 3rd generation, women 25-35 years - low-dose monophasic and travatine; when hypoestrogyny women up to 35 years, to appoint a three-phase desogestrelthinyl contraceptives, and after 35 years - monophasic desogestrelthinyl contraceptives; hypoestrogyny, combined with hyperandrogenism, women up to 25 years, to appoint a three-phase desogestrelthinyl contraceptives, women 25-35 years monophasic low-dose desogestrelthinyl contraceptives, and women after 35 years as volume is decreased desogestrelthinyl contraceptives; if giperandrogenii, combined with hyperestrogenic, women under 35 years prescribed volume is decreased contraceptives 3rd generation, after 35 years - only desogestrelthinyl progestins.

 

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