How do Yaz and Ovocept-LD compare in treating simple ovarian cysts. What are the key differences in effectiveness and side effects between these birth control pills. Which contraceptive shows better results for ovarian cyst management.

Understanding Simple Ovarian Cysts: Types and Prevalence

Functional ovarian cysts are common benign masses that occur in women of reproductive age. They include follicular, corpus luteum, and theca lutein cysts. These cysts typically cause no symptoms and often resolve on their own without surgical intervention.

Follicular cysts are the most prevalent type, rarely exceeding 8 cm in diameter. They form when a follicle fails to rupture or shrink after releasing an egg. Corpus luteum cysts develop after ovulation if the corpus luteum fills with fluid instead of breaking down. Theca lutein cysts are the rarest form, usually occurring in association with pregnancy-related conditions.

Prevalence and Age Distribution

• Approximately 2/3 of ovarian masses occur in women aged 27-40
• 80-85% of these masses are benign
• Functional cysts account for the majority of benign ovarian masses in reproductive-age women

Clinical Presentation and Diagnosis of Ovarian Cysts

While many ovarian cysts are asymptomatic, some may present with various symptoms. Common clinical manifestations include menstrual irregularities, abdominal pain, and in rare cases, complications such as cyst rupture or ovarian torsion.

Symptoms of Ovarian Cysts

• Menstrual cycle lengthening
• Intermenstrual bleeding or spotting
• Abdominal pain and tenderness
• Pelvic pain during intercourse

Diagnosis of ovarian cysts primarily relies on ultrasound imaging. This non-invasive technique allows healthcare providers to assess the size, location, and characteristics of the cyst, guiding treatment decisions.

Treatment Approaches for Simple Ovarian Cysts

The management of simple ovarian cysts depends on various factors, including cyst size, symptoms, and the patient’s overall health. Treatment options range from watchful waiting to medical management with hormonal contraceptives or surgical intervention in severe cases.

Conservative Management

For small, asymptomatic cysts, a wait-and-see approach may be recommended. Many functional cysts resolve spontaneously within a few menstrual cycles without intervention.

Medical Management

Hormonal contraceptives, particularly combined oral contraceptive pills (OCPs), are often prescribed to manage simple ovarian cysts. These medications work by suppressing ovulation and potentially shrinking existing cysts.

Surgical Intervention

Large cysts (typically >6 cm) or those causing severe symptoms may require surgical removal. This is usually performed via laparoscopy, a minimally invasive procedure.

Comparative Study: Yaz vs Ovocept-LD for Ovarian Cyst Treatment

A clinical study conducted at Iran-Isfahan Shariati Hospital compared the efficacy of two low-dose combined oral contraceptives, Yaz and Ovocept-LD, in treating simple ovarian cysts. The study involved 84 patients divided into two groups, with one group receiving Yaz and the other Ovocept-LD.

Study Design and Methodology

• Group A: 42 patients received Yaz once daily for 28 days
• Group B: 42 patients received Ovocept-LD once daily for 21 days
• Cyst evaluation was performed using ultrasound before and after treatment
• Statistical analysis was conducted using SPSS software

Key Findings

The study revealed that both Yaz and Ovocept-LD demonstrated effectiveness in treating simple ovarian cysts. However, statistical analysis showed that Yaz had a significantly greater impact on cyst resolution compared to Ovocept-LD.

Yaz: Composition and Unique Properties

Yaz is a low-dose combined oral contraceptive containing 20 μg ethinyl estradiol and 3 mg drospirenone. Its unique composition offers several advantages in the treatment of ovarian cysts and related conditions.

Pharmacological Actions of Yaz

• Contraceptive effect
• Anti-mineralocorticoid properties
• Anti-androgenic effects

The anti-mineralocorticoid action of drospirenone may help reduce fluid retention and bloating, while its anti-androgenic properties can benefit patients with androgen-related symptoms such as acne or hirsutism.

Ovocept-LD: Composition and Characteristics

Ovocept-LD is another low-dose combined oral contraceptive containing 30 μg ethinyl estradiol and 3 mg norgestrel. While effective in contraception and cyst management, it may have a different side effect profile compared to Yaz.

Common Side Effects of Ovocept-LD

• Weight gain
• Spotting
• Breast tenderness
• Nausea
• Headache

These side effects, while generally mild, may impact patient compliance and overall satisfaction with the treatment.

Comparing Efficacy and Tolerability: Yaz vs Ovocept-LD

The comparative study highlighted several key differences between Yaz and Ovocept-LD in the treatment of simple ovarian cysts. These findings can guide healthcare providers in selecting the most appropriate contraceptive for patients with ovarian cysts.

Efficacy in Cyst Resolution

Yaz demonstrated superior efficacy in resolving simple ovarian cysts compared to Ovocept-LD. This faster and more effective cyst reduction may be attributed to the unique pharmacological properties of drospirenone.

Tolerability and Side Effect Profile

The study suggests that Yaz may have a more favorable side effect profile compared to Ovocept-LD. Patients treated with Yaz reported fewer adverse effects, potentially leading to better compliance and treatment outcomes.

Clinical Implications and Recommendations

Based on the findings of this comparative study, healthcare providers may consider Yaz as a preferred option for managing simple ovarian cysts in suitable patients. The combination of higher efficacy and better tolerability makes Yaz an attractive choice for both contraception and ovarian cyst management.

Factors to Consider When Choosing Treatment

• Patient’s medical history and contraindications
• Presence of androgen-related symptoms
• Risk of fluid retention or bloating
• Patient preferences and lifestyle factors

While Yaz shows promising results, it’s essential to tailor treatment decisions to individual patient needs and characteristics. Regular follow-up and monitoring are crucial to ensure optimal outcomes and address any concerns promptly.

Future Directions in Ovarian Cyst Management

The comparative study of Yaz and Ovocept-LD opens up new avenues for research in the management of simple ovarian cysts. Future studies may explore long-term outcomes, impact on fertility, and potential benefits in specific patient populations.

Potential Areas for Further Research

• Long-term effects of continuous use of Yaz for cyst management
• Comparative studies with other contraceptive formulations
• Impact of hormonal treatments on ovarian reserve and future fertility
• Personalized treatment approaches based on genetic or hormonal profiles

As our understanding of ovarian cyst pathophysiology and hormonal influences continues to grow, we may see more targeted and effective treatment strategies emerge in the coming years.

Patient Education and Shared Decision-Making

Effective management of simple ovarian cysts extends beyond medication choice. Patient education and involvement in the decision-making process are crucial for ensuring treatment success and satisfaction.

Key Points for Patient Education

• Nature and typical course of simple ovarian cysts
• Treatment options and their respective benefits and risks
• Importance of adherence to prescribed medication regimens
• Signs and symptoms that warrant immediate medical attention
• Impact of treatment on fertility and contraception

Healthcare providers should engage patients in discussions about their treatment preferences, concerns, and lifestyle factors that may influence medication choice. This collaborative approach can lead to better treatment outcomes and patient satisfaction.

Monitoring and Follow-up Strategies

Regular monitoring and follow-up are essential components of ovarian cyst management. This allows healthcare providers to assess treatment efficacy, detect any complications, and adjust the treatment plan as needed.

Recommended Follow-up Protocol

1. Initial follow-up ultrasound after 1-2 months of treatment
2. Regular clinical assessments to evaluate symptoms and side effects
3. Periodic ultrasound examinations to monitor cyst size and characteristics
4. Adjustment of treatment duration based on individual response
5. Long-term follow-up to assess recurrence risk and overall reproductive health

By implementing a comprehensive monitoring strategy, healthcare providers can optimize treatment outcomes and ensure the long-term well-being of patients with simple ovarian cysts.

Integrating Ovarian Cyst Management with Overall Women’s Health

The management of simple ovarian cysts should be viewed within the broader context of women’s reproductive health. Hormonal treatments like Yaz and Ovocept-LD can offer benefits beyond cyst resolution, including contraception, menstrual cycle regulation, and management of other gynecological conditions.

Comprehensive Approach to Women’s Health

• Screening for other gynecological conditions
• Addressing fertility concerns and family planning
• Managing associated symptoms such as menstrual pain or irregularities
• Promoting overall reproductive health and well-being

By taking a holistic approach to patient care, healthcare providers can maximize the benefits of hormonal treatments while addressing the diverse health needs of women with ovarian cysts.

As research in this field continues to evolve, we can expect more refined treatment strategies and a deeper understanding of the complex interplay between hormonal contraceptives and ovarian cyst management. The comparative study of Yaz and Ovocept-LD represents an important step forward in optimizing care for women with simple ovarian cysts, paving the way for more personalized and effective treatment approaches in the future.

The comparative study of Yaz and Ovocept-ld on patients with simple ovarian cysts referring to Iran-Isfahan Shariati Hospital

Adv Biomed Res. 2014; 3: 205.

Published online 2014 Oct 7. doi: 10.4103/2277-9175.142315

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Author information Article notes Copyright and License information Disclaimer

Background:

Functional ovarian cysts include follicular, corpus luteum, and theca lutein cysts are the most common adnexal masses (about 50%) in women of reproductive age. Treatment with the combined monophasic oral contraceptives reduces functional ovarian cysts. Yaz (drospirenone/ethinyl estradiol) is a low-dose combined oral contraceptive pill containing 20 μg ethinyl estradiol and 3 mg drospirenone. In addition to contraceptive effects, Yaz has anti-mineralocorticoid and anti-adrenergic effects. Ovocept- low-dose LD is also a low-dose combined oral contraceptive drug containing 30 μg ethinyl estradiol and 3 mg norgestrol. Ovocept-LD has some side-effects such as weight gain, spotting, breast tenderness, nausea, and headache.

Materials and Methods:

Being a clinical study, the present research was carried out on 42 patients with the simple ovarian cysts from 2010 to 2012. 84 Patients were assigned to A and B groups. Group A received Yaz once a day for a period of 28 days and group B received Ovocept-LD once a day for a period of 21 days. After treating by Yaz and Ovocept-LD, Cysts were evaluated by ultrasound. Results were analyzed by the SPSS software. A P < 0.05 was considered the significance threshold.

Results:

Obtained results indicated that both Yaz and Ovocept-LD had an effect on the simple ovarian cysts. Statistical tests, however, has shown that the effect of Yaz has been significantly more than that of Ovocept-LD.

Conclusion:

Given the faster and better recovery effect, and the lesser side effects of Yaz as compared to Ovocept-LD, it is recommended to use Yaz for the simple ovarian cysts.

Keywords: Ovocept-LD, simple ovarian cyst, Yaz

Functional ovarian masses consist of follicular, corpus luteum and theca lutein cysts. Being benign, these cysts usually cause no symptoms and require no surgery.[1] Follicular cysts are the most common functional cysts and rarely grow more than 8 cm. If the follicle is larger than 3 cm in diameter, then it may be termed a follicular cyst.[2] Around 2/3^rd of ovarian masses occur in reproductive age (27-40) of which 80-85% are benign. These ovarian masses are mostly functional ovarian cysts. Functional cysts are masses with thin wall, containing fluid or semisolid material, which can be caused by hormonal or functional disorders. Naturally, they are not malignant.[3] If the follicle, at any follicular-phase, reaches a size larger than 3 cm (it rarely grows to a size of 10 cm), it will be recognized a follicular cyst. This is caused by abnormalities in gonadotropin secretion, which is commonly asymptomatic; however, sometimes has one of the following symptoms: menstrual cycle lengthening, bleeding between menstrual periods, or spotting. [4] Sometimes, it is ruptured spontaneously and results in abdominal pain and tenderness which is revealed mostly within 1-2 days, and occasionally causes ovarian torsion (in cysts larger than 4-6 cm). Ultrasound is of help in its diagnosis.[5] Small cysts are screened or treated with contraceptive pills while laparotomies are performed on the large ones. Luteum cysts are less common. Normally 2-4 days after ovulation, corpus luteum bleeding and subsequently, the blood absorption take place, then the serous fluid is collected and corpus luteum cyst, being 5-10 cm in diameter and containing serous, occur if bleeding or corpus luteum activity continues.[6,7] Its clinical characteristics range from no symptom to peritoneal hemorrhage caused by the cyst rupture. In a quarter of cases, the cyst is ruptured that may be due to coitus, trauma to the abdomen, or abdominal examination. This is usually very painful and lasts for less than 24 h. At times, due to intra-abdominal bleeding, one goes into shock. There are symptoms of unilateral pain, spotting, and tender adnexal mass if the cyst remains intact.[8] Progetine or contraceptives are employed to small cysts (smaller than 6 cm), where laparotomies are used for the large cysts.[9]

Being a very rare functional ovarian cysts, theca lutein cysts are usually bilateral and occur in association with a pregnancy (including molar pregnancy).[10] These types of cysts may be associated with the multiple pregnancies, molar pregnancies, choriocarcinoma, diabetes, sensitivity to Rhesus isoimmunisation RH, taking clomiphene citrate, ovulation induction with the human menopausal gonadotropin, human chorionic gonadotropin, and a gonadotropin releasing hormone1 analogues. Although, theca lutein cysts might have several holes and be quite large (>30 cm), they regress spontaneously.[11] Treatment with combined monophasic oral contraceptives reduces the risk of functional ovarian cysts dramatically.[11]

Since, the estrogen existing in combined monophasic oral contraceptives causes several complications such as spotting, nausea, vomiting, headaches, and weight gain, in this research we decided to compare the level of estrogen existing in Ovocept- LD with that of Yaz (which is one of the modern contraceptives) according to their effect on the recovery speed of simple ovarian cysts and the extent to which they cause complications.

Yaz is one of combined monophasic oral contraceptives containing 20 μg ethinyl estradiol and 3 mg drospirenone. It is taken in a 24 day active treatment period, followed by a 4 hormone-free day period (24/4). In addition to contraceptive properties; Yaz has anti-androgenic and anti-mineralocorticoid properties. Ovocep-LD is a low-dose combined oral contraceptive containing ethinyl estradiol and norgestrel, which is prescribed to be taken in a 21-day active treatment period, followed by a 7-day non-treatment period (21/7).[12,13] The 24/4 dosage regimen of Yaz provides a shorter hormone-free period as compared to the 21/7 dosage regimen of Ovocept-LD.[14] The present study is aimed to compare the effect of Yaz and Ovocept-LD on the simple ovarian cysts of patients referring to Shariati Hospital between 2010 and 2011.

The present research is based on a clinical study carried out on women referring to the women’s clinics of Shariati Hospital complaining of menstrual disorders and (or) abdominal pain or under abdominal pain who was diagnosed to have simple ovarian cysts by gynecologists (paraclinical) (look at the Consort 2010 flow diagram at the end of the text) []. Ovarian ultrasound was requested for patients, from whom 84 qualified people were selected. The patients were divided into A and B groups through randomization while they had the chance to select one of these two pills to be treated with. The group A underwent treatment with Yaz once a day and for a period of 28 days. The treatment with Ovocept-LD was carried out on group B once a day for a period of 21 days. After finishing the first period of treatment, the 2^nd ovarian ultrasound was carried out and in case of no improvement for the cyst, the treatment with Yaz and Ovocept-LD was carried out on patients for the 2^nd time (as the former period). Having finished the 2^nd period, the treatments were compared. A check-list was prepared for samples and the cysts’ diameter seen, prior and after treatment, through ultrasound was mentioned in it and the check-list was completed for both groups. The sampling was simple and the size of the sample was obtained from the following formula. Inclusion criteria included the observation of simple ovarian cyst in the ultrasound and with 3-8 cm in size and tendency of the patient to participate in the study. Exclusion criteria of study included the existence of relative and absolute cases of taking contraceptive pills and existence of acute abdominal symptoms such as the symptoms of peritoneal and sensitivity of uterine. Tools of collecting data were the questionnaire, interview, and method of analyzing data with SPSS software and t-test and Chi-square statistical methods. P < 0.05 was considered as significant.

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Consort 2010 flow diagram

The results obtained from the present study showed there was no meaningful and considerable difference between both groups regarding the number of pregnancies, the number of deliveries resulting in a live birth, the menstrual pattern before the treatment and a history of cysts. In Yaz group (A), cysts of 33 patients were eliminated after one period of treatment; cysts of 7 patients were eliminated after two periods of treatment; cysts of two patients decreased in size after two periods of treatment. The consequence of treatment in Ovocept-LD group (B), the cysts of 5 patients were eliminated after one period of treatment; 27 patients’ cysts were eliminated after two periods of treatment; 10 patients’ cysts decreased in size after two periods of treatment. Based on the statistical tests, after the 1^st period of treatment, the rate of response to treatment in Yaz group had been significantly more than Ovocept-LD group P ≤ 0.01 (P = 001). In Ovocept-LD group after two periods of taking pills, cysts of 32 patients were eliminated and cysts of 10 patients decreased in size. In Yaz group, in total, cysts of 40 patients were eliminated after two periods of taking pills and cysts of two patients decreased in size after same periods. The rate of response to the treatment in two periods in Yaz group had been significantly more than Ovocept-LD group (P = 0.026 0 026). The mean of cyst’s diameter in both groups of Yaz and Ovocept-LD had been 47/3 mm and 49/5 mm before the treatment, and after the 1^st period of treatment 35/3 mm and 10/6 mm, and after the 2^nd period of treatment 4/7 mm and 2/2 mm respectively. Based on the test of repeated measure, both types of pills are effective on the decrease of cysts; however, Yaz is significantly more effective (all data were stated in Tables –).

Table 1

Frequency distribution of the pill complications in both groups

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Table 5

Frequency distribution of treatment result in both groups

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Table 2

Frequency distribution of cysts in both groups

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Table 3

Frequency distribution of treatment consequence in both groups in terms of the treatment period

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Table 4

A comparison in the cyst’s diameter in both groups after and prior treatment

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Many studies show that the Yaz has mineralocorticoid feature that can decrease bloating and fluid retention and has great effectiveness in preventing the pregnancy in 99% of cases. Furthermore, many studies show that the hormonal fluctuations of this pill decrease in comparison to the oral contraceptive pills. [15] A study on women suffering from polycystic ovary by Kebapcilar et al. showed that three periods of treatment with Yaz decreased ovarian cysts considerably.[16] In addition, a study carried out by Kriplani et al. on women suffering from polycystic ovary indicated that the group which had received Yaz, after 6 months, had much lower hirsutism and ovarian cysts in comparison with the control group.[17] The results of these two studies are similar to the present research. A study under the name of “hormone therapy effects on functional ovarian cysts” was carried out on 93 women. They ranged in age from 17 to 55 with one-sided and two-sided cysts with sizes of 3.1-6.1 cm. The patients were divided into two groups. The patients in group 1 were assigned the oral contraceptive pills containing 35 μg ethinyl estradiol and 1 mg norethindrone. The patients in group 2 received the oral contraceptive pills containing 50 μg ethinyl estradiol and 1 mg norethindrone. After 6 weeks, patients were appraised by transvaginal ultrasound. In group 1, during this time, the cysts of 16 (54%) patients were eradicated. Within the same time, the cysts of 19 (62%) patients from group 2 were fully eliminated. This difference statistically was meaningful.[18] A study was conducted on 239 patients whose cysts were removed. These patients were randomly assigned to 3 groups. The group 1 was left untackled after the treatment through surgery. The group 2 took the oral contraceptive pills periodically after the surgical operation. The group 3 took those pills permanently. The result of the study revealed that the recurrence of cysts was reduced considerably in those patients taking pills permanently.[19] Furthermore in Palep-Singh study has been shown that Yaz could provide good cycle control for women with PCOS.[20,21] Overall, it could be concluded because of the faster and better recovery effect, and the less important side effects of Yaz as compared to Ovocept-LD, it is recommended to use Yaz for the simple ovarian cysts.

SR carried out the plan and coordinated the study. AF participated in most of the experiments and prepared the manuscript. LD organized, finalized, and participated in manuscript preparation. All authors have read and approved the content of the manuscript.

Source of Support: Nil

Conflict of Interest: None declared.

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Oral Contraceptives Are Not an Effective Treatment for Ovarian Cysts

DEAN A. SEEHUSEN, MD, MPH, AND J. SCOTT EARWOOD, MD, Eisenhower Army Medical Center, Fort Gordon, Georgia

Am Fam Physician. 2014;90(9):623

Clinical Question

Are oral contraceptives an effective therapy for ovarian cysts?

Evidence-Based Answer

Oral contraceptives are not an effective treatment for ovarian cysts, whether the cysts are spontaneous or associated with medically induced ovulation. Most cysts resolve without intervention within two to three months. Those that do not resolve in this time frame are more likely to be pathologic in nature and should prompt referral for a surgical evaluation. (Strength of Recommendation: B, based on inconsistent or limited-quality patient-oriented evidence.)

Practice Pointers

Oral contraceptives have long been known to be highly effective at suppressing the development of ovarian cysts. In one study, the relative risk of developing ovarian cysts was 0.22 (95% confidence interval, 0.13 to 0.39) for women taking an oral contraceptive compared with those not taking an oral contraceptive.¹ Although oral contraceptives are commonly used to treat ovarian cysts, the authors sought to clarify whether this is appropriate. Eight randomized controlled trials were included in this review. Although the studies were too heterogeneous to conduct meta-analyses for most questions, results from these studies were consistent enough to draw several conclusions.

Five trials looked at spontaneously occurring ovarian cysts, representing a combined total of 398 women. The largest study included 141 women, and four of the studies were conducted in Turkey. The oral contraceptives used in these studies contained ethinyl estradiol combined with desogestrel or levonorgestrel. Individually, none of the five trials found a statistically significant benefit of oral contraceptive use vs. expectant management in expediting resolution of cysts.

Three trials with a total of 288 participants evaluated the effectiveness of oral contraceptives for treating ovarian cysts in women whose ovulation was medically induced. In these studies, ovulation was induced with clomiphene (Clomid), human menopausal gonadotropin, human chorionic gonadotropin, or a combination of these medications. Eligibility criteria for these studies included the presence of an adnexal cyst that was at least 1.5 to 2 cm in diameter. Participants were randomized to monophasic oral contraceptives or expectant management. Problems with randomization, blinding, and sample size estimation were common to all three studies. No benefit of oral contraceptives over expectant management was observed in any trial.

A common finding in the studies included in this review was that ovarian cysts that were not resolving within two to three cycles were often pathologic in nature. For example, in a 2003 study of 62 women randomized to oral contraceptives or expectant management, 19 women had persistent cysts and subsequently underwent laparoscopy. ² Six of the cysts were serous cystadenomas, four were endometriomas, two were mucinous cystadenomas, and one was a mucinous cystadenofibroma. The remaining six were follicular cysts. This reflects the general consensus that functional cysts typically resolve in eight to 12 weeks.³ These findings are also consistent with current guideline recommendations that ovarian cysts smaller than 50 mm be managed expectantly for up to three cycles and that oral contraceptives not be used for treatment.⁴

SOURCE:

These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, assistant medical editor.

A collection of Cochrane for Clinicians published in AFP is available at https://www.aafp.org/afp/cochrane.

how to choose and take, how they work, cost

Kirill Zhukov

knows everything about sex hormones

Author’s profile

I work as an endocrinologist and nutritionist, I often encounter side effects from combined oral contraceptives.

For example, women may complain of breast tenderness and headaches, mood swings, irregular bleeding. However, with the correct selection of drugs, such effects do not appear or quickly disappear.

While there is a misconception that combined oral contraceptives cause serious health problems, in most cases this is not the case. Unfounded fears make patients avoid a reliable method of protection against unwanted pregnancy and refuse the possible benefits of such contraception for women’s health.

I will tell you about combined oral contraceptives, or COCs: how they work and what they are, when they can and cannot be taken, what to look for when choosing to minimize the risks of side effects.

See a doctor

Our articles are written with love for evidence-based medicine. We refer to authoritative sources and go to doctors with a good reputation for comments. But remember: the responsibility for your health lies with you and your doctor. We don’t write prescriptions, we give recommendations. Relying on our point of view or not is up to you.

What are COCs and how do they work? That is, hormones that control everything related to the function of childbearing.

Combination Contraceptives – Mayo Clinic Blog

To understand how COCs work, you need to remember how the menstrual cycle works. It lasts an average of 28 days – the norm will be from 21 to 40 days.

At the same time, there are several phases in the menstrual cycle. In the first, which begins during menstruation, one of the follicles matures – these are the structural units of the female ovaries. Inside each follicle is an egg.

Phases of the menstrual cycle – NHS website

Approximately 14 days after the onset of menstruation, when the follicle is fully mature, the egg is released – this process is called ovulation. Then she will have to go down the fallopian tubes. In the period from the onset of menstruation to ovulation, a large amount of female sex hormones, estrogens, are released to help the maturation process.

After the release of the egg, the follicle turns into the so-called corpus luteum and begins to secrete not only estrogen, but also progesterone, a hormone that prepares the body for pregnancy. Because of it, the endometrium – the surface layer of the uterus – becomes thicker. If conception does not occur, then the corpus luteum will eventually stop releasing hormones and menstruation will begin. And if the egg meets the sperm, conception will occur – and the fertilized egg will easily fix itself in the thickened endometrium.

An egg is released from a mature follicle approximately in the middle of the menstrual cycle Days of the menstrual cycle: in the process, the egg is released, the endometrium thickens, and then is rejected

Combined oral contraceptives contain synthetic analogues of estrogen and progesterone – the latter are called progestins – in a certain dosage.

The choice of combined oral contraceptives – an international guide for doctors Uptodate

Pills change the process of the menstrual cycle: they inhibit the development of the follicle, as a result, the egg does not come out – we can say that the menstrual cycle “freezes”, the female body begins to work as if the cycle did not have. COCs also make the mucus in the cervix thicker and more viscous so that spermatozoa do not get into the organ cavity, and disrupt the growth of the endometrium. All this is enough to avoid pregnancy with a high probability.

COC packaging usually contains active tablets and dummy tablets, the latter may not be available. One package of combined oral contraceptives can contain 21, 24 or more, for example 63 or 84, active tablets and 4-7 pacifiers. At the time when a woman takes inactive pills, she begins to bleed a little – a kind of imitation of menstruation, it is called withdrawal bleeding. It occurs due to a sharp cessation of the intake of hormones with pills, which provokes the rejection of the endometrium and its release as during normal menstruation – only real menstruation is preceded by ovulation, but here it is not.

Due to the suppression of ovulation, certain changes occur, in particular, the production of prostaglandins, hormone-like compounds that cause uterine contractions, is reduced, and there is also no such cyclical fluctuation in the level of sex hormones as in a normal menstrual cycle. Therefore, while taking contraceptives, the problems associated with menstruation disappear or significantly decrease: pain, cramps, nausea, manifestations of premenstrual syndrome.

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Pacifiers are taken at the end of a 28-day pill cycle. Source: cristi180884 / Shutterstock

What are combined oral contraceptives?

These three types are not much different, except for the concentration of hormones and the number of pacifiers – they all work well and contain the lowest possible doses of active substances.

Three-phase COCs are more modern: they are considered to be more physiological, as close as possible to the normal cycle, but still do not allow ovulation. The important thing here is that new does not mean better. All drugs are selected individually, and only a doctor should do this: it may happen that a three-phase, more modern drug is not suitable, and a monophasic one will be the best option. In addition, monophasic COCs are more convenient to take due to the fact that you do not need to strictly adhere to a certain sequence of taking pills.

The three-phase preparation will contain three types of tablets with different concentrations of active ingredients. Source: Vidal

How effective are combined oral contraceptives compared to other methods of contraception? The effectiveness of each method is determined by the Pearl Index. It is equal to the average number of pregnancies per year for 100 women.

Contraceptive effectiveness – NHS website

Contraceptive Efficacy – Drugs.com

For combined oral contraceptives, the Pearl Index is less than one. That is, with the ideal use of COCs, more than 99% of women will not experience pregnancy. And even with errors in the use of pills, they are protected quite reliably: according to various sources, 91-93% of women will be protected, only 7-9 out of 100 will become pregnant.

For comparison: with the ideal use of condoms, two women out of 100 will become pregnant, with errors in their use – 13-18. That is, condoms are half as effective as COCs.

The division of the effectiveness of contraceptives into ideal and with errors, or theoretical and practical, is due to the fact that almost any method of contraception can fail, because its reliability depends on many factors. The condom may break or slip, COCs may be of poor quality, or the woman may forget to take the pill. The most reliable in this regard are contraceptive implants, intrauterine devices and surgical sterilization, since their use practically does not depend on external factors or the actions of a woman.

In any case, KOC has a high degree of theoretical and practical effectiveness. They are inferior to contraceptive implants, intrauterine devices, contraceptive injections and surgical sterilization, but still quite reliable.

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Effectiveness of different methods of contraception

Contraceptive implant

Theoretical efficacy, Pearl index

0. 1

Practical efficacy, Pearl index

0.1

Surgical sterilization of women

Theoretical efficacy, Pearl index

0.5

Practical efficacy, Pearl index 9 0003

0.5

Hormonal IUDs

Theoretical efficacy, Pearl index

0.5

Practical efficacy, Pearl index

0.7

Copper IUDs

Theoretical efficacy, Pearl index

0.6

Practical efficacy, Pearl index

0.8

Contraceptive injections

Theore Practical efficiency, Pearl index

0.05

Practical efficiency, Pearl index

3-6

Theoretical efficiency, Pearl index

0.3

Practical efficiency, Pearl index

7-9

Contraceptive patch

Theoretical efficacy, Pearl index

0.3

Practical efficacy, Pearl index

7-9

Male condoms 9016 8

Theoretical efficiency, Pearl index

2

Practical efficiency, index Perlya

13-18

How to take COCs and what to do if you miss taking a pill

Theoretically, you can start taking pills on any day of the menstrual cycle, as long as pregnancy is excluded. However, it is best to start taking them from the first to the fifth day of the cycle – it is counted from the beginning of menstruation. If the pills are not started during menstruation, then for the first week it is better to use additional methods of contraception, such as condoms, since the effect of COCs does not occur immediately.

It is advisable to take the tablets at the same time of the day – to maintain a constant concentration of hormones in the blood and, accordingly, the best effectiveness of the drug. You can’t take a break between packages with pacifiers – you need to start the next one as soon as the previous one has ended. If there are only active tablets in the package – 21, 63 or 84 pieces, it is sometimes advised to take a break between them of 4-7 days for the onset of withdrawal bleeding about once every 1-3 months, but this is not necessary.

12,000 R

this is the average cost of taking COCs for a year contraception will cost 12,000 R annually. At the same time, you can save money by buying large packs designed for three months at once: in terms of a tablet, they are cheaper.

The average cost of a package of COCs is 700-1000 R. Source: Eapteka

You should try not to skip active pills – take them in order and every day. An omission may result in a decrease in the effectiveness of COCs. However, with everyone there are situations when one or more pills for some reason were not drunk. What to do in this case depends on the number of missed pills.

If one tablet is missed, then the next day you can take two tablets at once: the missed one and the one that follows it. Then you can continue taking COCs as usual.

If two or more tablets are missed, then the next day you can take the last one missed and the one that follows it. At the same time, such a pass reduces the effectiveness of protection against pregnancy, so for the next seven days you need to additionally use a condom. If the missed pills were closer to the end of the package and there were less than seven tablets left, then the dummy pills are skipped – you should immediately start the next package so that the contraceptive effect does not decrease.

Code of Practice for Contraceptive Use – World Health OrganizationPDF, 1.58 MB

What to Do When You Miss a COC – NHS

Intermittent use of COCs, when more than one tablet is missed, can lead to extra-cycle bleeding. In this case, it is better to consult a doctor. For those who regularly miss pills, it is recommended to choose another method of contraception.

Usually, bleeding that mimics menstruation occurs only when a woman takes dummy pills or takes a break between active pills at the end of her cycle. The absence of bleeding during this period does not yet indicate pregnancy – if the pills are taken correctly, the risk is very low. However, if you take breaks and there is no withdrawal bleeding for two or more months, you missed taking active pills, there was nausea or vomiting, or there are other reasons to suspect pregnancy, you should take a test and visit a gynecologist.

Guide to Combined Oral Contraceptives – UK NHSPDF, 284KB

If withdrawal bleeding needs to be tolerated, you can skip the pacifiers and start a new pack of COCs right away. Now it is believed that only active tablets can be taken for as long as you like – this is safe. Still, continuous use of COCs may be recommended for the treatment of dysmenorrhea, endometriosis, and some other conditions. If you want to stop taking dummy pills, you should consult a gynecologist.

Hormonal contraception to suppress menstruation – an international guide for doctors Uptodate

Bloody discharge that occurs outside of periods of taking dummy pills is the so-called breakthrough uterine bleeding. They are a kind of adaptation of the body to the hormones taken. Periodic bleeding or spotting is the norm in the first 3-4 months of taking the pills. They can also occur due to non-compliance with the regimen of taking drugs.

COCs: side effects and health problems – an international guide for doctors Uptodate

If a woman is taking COCs correctly, and breakthrough bleeding continues for a long time, this may indicate that the drug is not chosen correctly or is not suitable. Then you should contact a gynecologist to adjust the dose of COCs or change the drug. In some women, they also occur when switching to a continuous regimen of taking COCs without pacifiers, usually such manifestations stop within a year.

Guidelines for the management of women with breakthrough bleeding who are taking birth control – Royal Australian College of General Practitioners

Who should use combined oral contraceptives

Combined oral contraceptives are just one method of contraception. In general, they can be recommended to all healthy non-smokers before menopause, but the final decision should be made by the doctor.

Hormonal contraception – an international reference book for doctors Uptodate

COCs can be recommended for women with heavy blood loss during menstruation and anemia that develops as a result, including uterine myoma – a benign tumor of the muscle tissue of the organ. They will also improve well-being with endometriosis – pathological growth of the endometrium – and severe pain during menstruation. Taking such pills allows you to eliminate or mitigate the listed problems due to the fact that real menstruation does not occur.

COCs can also help with polycystic ovary syndrome. With this disease, the production of male sex hormones is increased, which can lead to excess weight, body hair growth, and an irregular menstrual cycle. COCs reduce the production of male hormones, due to this they can mitigate the manifestations of the disease.

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For which diseases you can not use combined oral contraceptives

Thrombosis. For example, if a woman or her immediate family had a deep vein thrombosis, pulmonary embolism, stroke or heart attack before age 50. The risk of thrombosis when taking COCs is slightly increased, so a tendency to them will be a contraindication to prescribing such contraception.

Combined hormonal methods of contraception – American College of Obstetrics and Gynecology

Cardiovascular disease or risk. When there is coronary heart disease, hypertension, the level of cholesterol in the blood is increased. These are all risk factors for thrombosis. Thus, among women with hypertension who take COCs, the risk of stroke and myocardial infarction is higher than among those who did not take COCs. Stopping the pill in women with hypertension may help control blood pressure better.

Risks of taking COCs for various conditions and diseases – recommendations from the US Centers for Disease Control and Prevention

Pregnancy and the period immediately after childbirth. There are no data on the effect of taking hormonal contraceptives on the development of the child. However, according to existing recommendations, they should be stopped as soon as a woman finds out about pregnancy or even at the planning stage. After childbirth, COCs should be abandoned:

1. if the woman is not breastfeeding, then for the first 3-4 weeks, since during this period the risk of thrombosis increases;
2. If a woman is breastfeeding, it is best to wait 5-6 weeks for breastfeeding to improve, as estrogen can reduce milk production.

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Smoking, especially over 35 years of age. It also increases the risk of thrombosis when taking COCs and the risk of cardiovascular disease, especially myocardial infarction. At the same time, studies have shown that the likelihood of myocardial infarction when taking COCs increases with an increase in the number of cigarettes smoked per day.

Prolonged immobility. If an operation is expected in the future, after which it will be impossible to move, or the woman is already limited in mobility, for example, due to an injury or some kind of disease. It also increases the risk of developing blood clots.

Migraine with aura. There is evidence that taking COCs for such migraine increases the risk of stroke by about three times. It is especially high if there are other risk factors, such as smoking.

Migraine and contraceptive pills – British Migraine Foundation

Severe liver disease: acute and chronic, liver failure, and liver tumors in the past or now. Taking COCs can aggravate their course.

Breast cancer. Breast cancer can be hormone-dependent, in which case taking COCs increases the likelihood of recurrence and worsens the prognosis.

Unexplained uterine bleeding. An examination is needed here to establish the cause – it could be pregnancy or a tumor.

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Obesity. Obese women who take COCs are more likely to have thrombosis than obese women who use other methods of contraception.

When pregnancy can be planned while taking COCs

Pregnancy can occur at any time after the withdrawal of combined oral contraceptives. Even if you missed one tablet, this already reduces the contraceptive effect of COCs. At the same time, according to modern data, the accidental use of contraceptives during pregnancy is safe: if it occurs during the use of pills, they simply stop taking them.

After the withdrawal of combined oral contraceptives, it may take some time to restore the menstrual cycle, usually 3-4 months. However, according to available data, COCs do not reduce a woman’s ability to conceive, on the contrary, their use may increase the likelihood of pregnancy in the first 12 months after withdrawal.

There is no reliable evidence that you need to take a break between stopping COCs and conceiving a child. However, preparation for pregnancy, such as preventive folic acid intake and screening, is best to start at least three months before it.

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Are combined oral contraceptives safe for those who have no contraindications

Side effects may occur when taking COCs. The most common are nausea, pain in the mammary glands, irregular uterine bleeding, headaches, high blood pressure, and bloating. These phenomena usually disappear within the first 2-4 months of taking the tablets.

Hormonal methods of contraception – an international guide for doctors Uptodate

Systematic review of the risk of venous thrombosis in women taking COCs – Royal Australian College of General Practitioners

Review of COCs – European Medicines Agency

Women’s main concern about taking COCs is that they increase the risk of thrombosis. However, in healthy non-smoking women without contraindications, it is minimal and much lower than the risk of developing thrombosis during pregnancy and childbirth.

Risk of venous thrombosis in women, according to various data

Group

Thrombosis cases per 10,000 women per year

Pre-menopausal women not using COCs

2-4

Women using COCs

5-12

Women during pregnancy and after childbirth

20-30 9000 3

According to some studies, women taking COCs have a slightly higher risk of developing breast or cervical cancer. However, this probability is low, especially at a young age: for example, for cervical cancer, the initial risk doubles when taking pills for more than 10 years. That is, if a woman had an initial risk of getting cancer of 0.5%, then in 10 years it will rise to 1%. With breast cancer, the baseline risk increases by 27% – for example, if it was 1%, then it will become 1.27%.

Gale model for breast cancer risk calculation – you can calculate your own

Oral contraceptives and cancer risk – National Cancer Institute, USA benign breast diseases – according to various sources, by 20-50% of the initial risk.

It is best to consult a doctor for the selection of COCs. He will help you choose the drug that suits you, and then side effects can be avoided.

How to choose combined oral contraceptives

Combined oral contraceptives are prescribed only by a gynecologist. The attending physician measures blood pressure and weight, examines the medical history, including medications that the woman takes, chronic diseases and risk factors: cases of thrombosis, the presence of migraine with aura, breast cancer in the past, and others.

No special examination is needed before prescribing COCs, if the woman is healthy and there are no contraindications to taking COCs. However, if a woman has not visited a gynecologist regularly and has not been examined for a long time, the doctor can perform an examination on a gynecological chair, examine the mammary glands and make several appointments to exclude hidden diseases:

1. cervical cancer screening – a Pap test where a smear is taken from the cervix and stained in a special way to see the changed cells;
2. laboratory tests – for example, a complete blood count or determination of hemoglobin in the blood;
3. screening for sexually transmitted infections.

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If a woman has complaints, for example, irregular periods, then this list can be expanded taking into account the history of the disease and examination.

Remember

1. Combined oral contraceptives are contraceptive pills containing synthetic analogues of female sex hormones: estrogen and progesterone.
2. COCs have the highest degree of effectiveness after surgical sterilization – both theoretical and practical. That is, they best protect against pregnancy.
3. Tablets are best taken from the first to the fifth day of the cycle – it is counted from the first day of menstruation.
4. COCs can be recommended to all healthy non-smokers before menopause, but the final decision should be made by the doctor, as drugs have contraindications.
5. Before an appointment, the attending physician measures blood pressure and weight, reviews the medical history, including medications the woman takes, chronic diseases and risk factors: history of thrombosis, migraine with aura, history of breast cancer, and others.

Endometriosis tablets | Non-hormonal drugs

Treatment of endometriosis is a long and painstaking process, unfortunately not always successful. Modern protocols involve an integrated approach, consisting of surgery and drug therapy. Drugs for the treatment of endometriosis are used independently in cases where the operation is not possible. Mostly hormones or their synthetic analogues are used.

The most popular drugs for the treatment of endometriosis today are:

• combined oral contraceptives (COCs)
• Gonadotropic releasing hormone agonists
• synthetic analogs of testosterone and progesterone

Birth control pills

Contraceptives were one of the first drugs to treat endometriosis. At first, single-phase progestins containing only gestagens were used. They suppress the processes of proliferation and cyclic changes in the endometrium both in the uterus itself and in endometriosis foci. After some time, sclerosis and regressive development of foci are observed. With prolonged use, these drugs inhibit the synthesis of gonadotropic hormones. As a result, pain and other manifestations of the disease are reduced. The most common side effect of this therapy is irregular bleeding. To date, gestagenic preparations have lost their relevance a little, giving way to estrogen-gestagenic ones.

Among the representatives of this group, the following drugs are currently prescribed:

• Dufaston
• Norkolut
• Premalyut

Over time, in order to reduce side effects and be more effective, COCs containing estrogens and gestagens began to be used. The course implies continuous intake for 3-6 cycles of the following drugs:

• Jeanine
• Yarina
• Diane 35
• Jess
• Claira
• Dimia

The drugs create a specific hormonal background in the woman’s body that mimics a false pregnancy. The result is approximately the same as when taking gestagens, endometrial proliferation decreases, endometriosis foci become sclerotic and decrease in size, new ones do not appear. In approximately 80% of women, regular use of estrogen-gestagen contraceptives relieves spasms and pain.

Male hormone analogues for the treatment of endometriosis

Androgen-methylstestosterone analogues are the first drugs for the treatment of endometriosis, which began to be used in the treatment of this disease approximately forty years ago. The main purpose of their use, as well as contraceptives, is to suppress the menstrual cycle and the associated proliferation of the endometrium. Tablets were prescribed for the treatment of endometriosis at a dose of 5-10 mg for six months. Now from this group, derivatives of 17a-ethynyl-testosterone, for example, danazol, are more common. The drug reduces the level of gonadotropic hormone, blocks progesterone, estrogen and androgen receptors in the ovaries.

Danazol has a lot of side effects, including:

• weight gain
• fatty seborrhea
• edema
• acne
• breast atrophy
• change in sex drive
• menopause symptoms (hot flashes, sleep disturbance, irritability, fatigue, depression, cycle disturbances and bleeding between periods)
• increase in the blood level of low density lipoproteins, thereby increasing the risk of cholesterol plaques in the coronary vessels, angina pectoris, heart attack

Approximately the same side effects occur when taking synthetic progesterone analogues such as Provera.

Also included in this group are drugs such as:

• Duphaston (dydrogesterone)
• Visanne (dienogest)
• Orgametril (linestrenol)

Duration of drug administration 6-8 months. Quite often, after the end of the course, women experience relapses. Now this group of drugs is rarely used, they were replaced by birth control pills for the treatment of endometriosis and more modern drugs.

Gonadotropic releasing hormone agonists as drugs for the treatment of endometriosis

This group of drugs is a synthetic analogue of pituitary releasing hormones, which are responsible for the synthesis of latinizing and follicle stimulating hormone. Their decrease in the blood causes a decrease in the production of progesterone by the corpus luteum of the ovaries in the second half of the cycle. As a result, there is no endometrial proliferation in endometriotic lesions. The level of estrogen also decreases, which leads to a state of artificial reversible menopause. Drugs are administered by injection daily, or once every 28 days under the skin of the abdomen. There are medicines in the form of sprays that are injected into the nose.

The best-known drugs for the treatment of endometriosis from this group are:

• Leuprolide acetate or Lupron
• Nafarelin acetate or Sinarel
• Goserelin acetate or Zoladex.

Although gonadotropic-releasing hormone agonists are currently considered the most suitable drug therapy for endometriosis, their side effects are quite serious. First of all, these are the symptoms of menopause. It includes:

• hot flashes
• irritability
• sleep disorders
• Decreased performance
• mood swings up to depression
• weight set
• leg cramps and signs of osteoporosis due to impaired calcium absorption
• increased risk of angina and heart attack

In rare cases, menopause may be irreversible. Medicines in this group are not recommended to take more than six months in a row.

Non-hormonal drugs

To stop pain, fatigue and heavy discharge, prescribe drugs such as:

• Ibuprofen
• Novigan
• Papaverine

Support immunity, improve general well-being will help:

• Cycloferon
• Retinol
• Ascorbic acid
• Tocopherol
• Thiamine
• Pyridoxine

Preparations of different groups

A synthetic analog of steroid hormones, gestrinone (a derivative of 19-norsteroid), has now begun to be used quite successfully. It was developed in the late 70s, originally planned to be used as a prolonged contraceptive. Gestrinone blocks estrogen and progesterone receptors in endometrial tissue. As a result, the involution of its ectopic foci begins. The high activity of the drug allows you to prescribe it in small doses, which significantly reduces side effects. During the application, gestrinone has shown its effectiveness, it relieves the symptoms of the disease well and in a fairly short time allows you to get rid of small foci of endometriosis.

The drug is contraindicated in women with renal insufficiency and severe liver disease. The main side effects are:

• sweating
• hot flashes
• increased appetite
• irritability
• Decreased performance
• edema
• weight set

These symptoms are less pronounced than when taking pituitary hormone agonists. Take the drug starting from the first day of the cycle, continuously, for six months. In most patients, menstruation disappears at this time, along with pain syndrome.

Mephiston, a drug for the treatment of endometriosis, is currently undergoing clinical trials. It has already been successfully used for medical abortions. But it was found that at a dose of 50 mg per day, it is able to reduce the size of endometriosis lesions and reduce pain. At the same time, side effects are insignificant, manifested by rare hot flashes, loss of appetite, and fatigue.

It should be remembered that tablets for the treatment of endometriosis are not capable of permanently curing the disease.