Hormonal contraception is one of the most popular ways to protect against unwanted pregnancy. We decided to check several myths that are associated with this protection method.
The idea of protecting by introducing synthetic hormones into the body appeared in the middle of the 20th century. The first hormonal drug was in the form of pills, it It was called Enovid went on sale in 1961. Now pharmaceutical companies Offer Women have a large selection of hormonal contraception means:
- oral contraceptives (OK);
- vaginal rings and intrauterine spirals with hormones;
- hormonal plasters;
- subcutaneous implants and intramuscular injections.
If the drug contains only progestins (synthetic analogues of female sex hormones of progestogens), such a contraceptive is called the progestogen -containing (PSK), and if progestins and estrogen, then combined. Tablets containing both hormones are called combined oral contraceptives (COC).
Progestins and estrogen "Frozen»The natural cycle of a woman in the first phase, prevent the maturation and exit from the egg follicle, as well as thickening of the endometrium, which does not allow the sperm to gain a foothold on the smooth wall of the uterus.
Hormonal contraception is considered extremely reliable - Perl index showing how many women became pregnant, using this method correctly for these drugs It is Only 0.3-0.6. For comparison, Perl index for a male condom equal 2, and for interrupted intercourse - 6.
Is it true that taking hormonal contraceptives increases the risk of cancer?
No less excess weight, as a possible consequence of hormonal contraceptives, women afraid oncological diseases. Questions about probabilities development of such pathologies Due to the use of this method of protection, women are given on resources dedicated to the female health, and specialized forums.
Unsuitable data was obtained relative to several types of cancer and some forms of hormonal contraception. So, taking hormonal drugs does not increase, but, on the contrary, reduces The risk of ovarian cancer is 30-50%, endometrial cancer - 30%, colorectal cancer - by 15–20%. It is interesting that this is a long -term effect of taking drugs, that is, the risk remains reduced to 30 years after the woman stopped taking the pills. The protective effect against ovarian cancer was observed even in patients with mutation in BRCA1 or BRCA2 genes associated with the extremely high probability of developing ovarian and breast cancer.
There is no scientific consensus on the role of hormonal contraception in the development of two other types of cancer: the cervix and mammary gland. 2003 meta -analysis conducted by the International Cancer Research Agency (France), showedthat the risk increases by 10% less than five years of use, by 60%-in five to nine years of use and doubles in ten or more years of use. At the same time, the refusal to use the COC leads to a gradual reduction in risk to medium -foliage values, and ten years after the cancellation of such contraception methods, all unwanted effects disappear.
However, oncologists They are in no hurry To blame the pills for everything - perhaps women who prefer hormonal contraception do not use barrier methods of protection and are faced with higher chances to become infected with the human papillomavirus (HPV), which proven the risk of cervical cancer. The inability to conduct a meta -analysis of the connection between this cancer and the intake of COC, given the potential infection of women HPV, Turned Attention scientists and later. With the growth of the popularity of vaccination against this virus, one can hope that a wide population study of vaccinated in childhood will be able to finally clarify this issue.
As for breast cancer, here the researchers are more likely to agree that there is still some risk increase associated with taking hormonal contraceptives. Back in 1996, scientists from Oxford University introduced its meta -analysis, including data on more than 150,000 women. They noted that those who took oral contraceptives had a 7 percent increase in risk regarding those who never used them. The duration of the reception did not lead to a proportional increase in the risk, but the abolition reduced it so much that in ten years there was no statistical difference between the groups.
Analysis of 2010, carried out on the basis of the Harvard School of Public Health and included information about 116,000 women, discoveredthat an increase in risk was observed mainly in those who used three -phase drugs with the active substance with a levonorgestrel (in Russia, this applies, for example, preparation Under the trade name "Trikvlar").
Joint British-Dat study of 2017 Lone The results of a ten -year observation for 1.8 million divers. It turned out that those who took hormonal contraception during the study or recently stopped using such drugs had a slightly increased risk of developing breast cancer (up to 20%). This was facilitated by both oral intake of hormones and the use of an intrauterine hormonal spiral. Oncologist Lidia Choi from the Oncology Institute. Karmanos (USA) Turns Attention that taking oral contraceptives is only one of the many factors that increase the risk of breast cancer. Among others are family history, age, ethnicity, genetic mutations, early onset of menstruation or late menopause, obesity, hormone replacement therapy during menopause, alcohol and smoking. Given that these factors accumulate and cause cancer usually after 60 years, and the reception of oral contraceptives, as a rule, ceases earlier, a reason for serious anxiety No.
Scientists from the University of Aberdeen (Great Britain) tried evaluate The influence of oral contraception on the general risk of death from all causes. In addition to the listed types of cancer, they took into account, in particular, other oncological diseases, diseases of the circulatory system and coronary disease. It turned out that mortality from all causes among women resorting to oral contraception, even lower.
Is it true that taking hormonal contraceptives leads to infertility?
Some from taking hormonal contraceptives Stops fear that such drugs protect against unwanted pregnancy now, but Provide and long -term effect - in particular, do impossible Conception and bearing the desired child in the future.
The variety of hormonal contraception offers different methods of effect of effect. So, the hormonal spiral is usually placed for five years, and without its extraction the chances of getting pregnant during this period are really insignificant (index Perl is from 0.1 to 0.3, which is comparable to sterilization). Injection hormonal contraceptives, for example, the already mentioned “depot-provetra”, Provide Protection is only three months, but all this time it is also almost impossible to get pregnant. Oral contraceptives most often require daily reception at a strictly defined time of day, and passing only one tablet can lead to pregnancy.
Typically, in the instructions, manufacturers indicate for what time after the cancellation of the drug, a woman is able to get pregnant. So, after extracting the hormonal spiral, the probability of conception It is About 20% in the first month, reaches 60% by six months and 90% by the year. In the case of injection drugs, a woman and her partner can successfully conceive a child within 18 months after the last injection. For oral contraceptives, the timing of the possible conception less Total: 56% of women can become pregnant in the first three months, 82% - within six months and up to 95% - within a period of up to a year after cancellations.
For comparison, the average probability of getting pregnant in a human population It is 20% in each cycle, six months later from the beginning of regular attempts to conceive a child, 74% of pairs achieve success, 93% within a year. That is, there is no difference for the woman whether she made oral contraceptives before the decision to conceive the child, whether she used a spiral or used, for example, barrier contraception - with a probability of more than 90% within a year after the termination of contraception, she has a chance to get pregnant.
Moreover, it is oral contraceptives that can lead to Rebound effect (cancellation syndrome)-after two or three months of taking drugs and their subsequent ovary cancellation can Start working more actively, and the probability of conception will increase.
Thus, there are no scientific data indicating that hormonal drugs make women barren. The reproductive cycle is restored quickly, and during the year nine out of ten people can become pregnant regardless of how they used to protect. Moreover, oral contraceptives can lead to a rebound effect, that is, after a short-term technique, the chance to get pregnant will even increase.
Is it true that taking hormonal contraceptives leads to a weight gain?
Widespread fear: hormonal contraceptives Change The general endocrinological background so that even while the woman preserving the diet and physical activity is inevitable will bring To the appearance of extra pounds. This fear is so Popularthat medical Clinics They even release Articles, tellingHow, using this protection method, do not gain excess weight. Survey, carried out by VTsIOM by order of the pharmaceutical company Gideon Richter in 2016, showed that 68% of Russians are afraid of weight gain on the background of hormonal contraceptives.
The hormonal contraceptives of the first generation were significantly different from those that are sold in modern pharmacies. For example, drugs of 1960-1970 Contained 3-5 times more estrogen and 5-20 times more progestins than modern contraceptives. Then the scientists did not yet understand how much hormones needed to prevent pregnancy, and produced tablets with an inflated concentration of these substances. However, the pharmacology has not stopped in development since then, and today's drugs are low -dosed and even microdose.
In 2013, Kokrainovskaya database Published Meta analysis 16 studies on the connection of weight gain and taking hormonal contraceptives. Scientists did not find significant evidence confirming such a pattern. In three out of 16 studies, some women taking progestin drugs have a weight gain. However, firstly, it was insignificant (less than 2 kg for 12 months of reception), and secondly, similar changes recorded in some other women who also participated in the study, but preferred other protection methods. That is, two extra kilograms appeared in an average of a certain number of women, regardless of what contraceptives they use. Meta analysis 2014, which included 49 separate studies, could not at all detect the dependencies between the reception of combined oral contraceptives and the weight gain.
Experts from the clinical efficiency department of the faculty of sexual and reproductive health of the Royal College of Obstetro-Gynecologists (Great Britain) in 2019 found that the use of a certain drug with a certain group of women could indeed lead to the appearance of the latest extra pounds. It was about adolescents under 18 years of age with an index of body weight of more than 30 points (that is, having obesity) using an injection drug called “depot-proveters”. This group gained approximately 3.5 kg in the first two years of use and up to 5.8 kg, if you used the drug for three years. Moreover, its manufacturers and so Not recommended Injections for more than two years, as well as use in adolescence, since the drug can adversely affect the density of bones. Moreover, the “depot-proverse” in many countries, including in Russia, is not registered as a contraceptive-its application limited Therapy of hormone -dependent forms of recurrent breast cancer in menopause, recurrent and/or metastatic cancer of the endometrium or kidney. However, even the experts called the evidence regarding the weight gain when using the “depot-string”, since a person with obesity, if he does not change his lifestyle, usually continues to gain body weight, especially in the teenage period. For other hormonal contraceptives (injection and oral), scientists did not find any pattern compared to both non -hormonal methods of protection, and with a lack of contraception in general.
Thus, the vast majority of modern hormonal contraceptives do not lead to a set of excess weight. The exception is the inheritance from the grandmother's drugs from the last century, which are unlikely to be consumed. Also, one injection drug can lead to weight gain (only in adolescents with obesity), although scientists are not yet fully confident in their conclusions. At the same time, manufacturers of the drug are in good faith in the instructions that its use by minors is undesirable.
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