Hormonal contraceptives

Introduction

Among the safest and most effective methods of contraception, hormonal contraceptives play a prestigious role. Hormonal contraceptives, in fact, are very popular drugs and, for many sexually active women with a fixed partner, they are the first choice method of contraception.

Advantages and disadvantages

In addition to guaranteeing a "very high protection from unwanted and unexpected pregnancies, hormonal contraceptives (used constantly and correctly) prove to be prodigious allies of female health for several reasons:

• Maintain perfect menstrual regularity, reducing amenorrhea episodes, irregular cycles and intermenstrual bleeding
• Relieve menstrual pains
• They ease the symptoms of PMS
• (Some) ensure a low menstrual flow
• They help relieve some aesthetic ailments, such as acne
• They decrease the incidence of ovarian and endometrial cancer, and do not cause cervical cancer
• Some women use hormonal contraceptive methods to cope with more or less important pathological disorders, such as endometriosis, fibroids and hormonal imbalances

However, it should be stressed that the use of hormonal contraceptive methods does NOT protect in any way from sexually transmitted diseases. For this reason, hormonal contraceptives are not suitable for occasional sexual intercourse or with multiple partners.

Which ones are they?

Hormonal contraceptive methods can be taken by mouth, applied to the skin or inserted directly into the uterus (by a gynecologist) or into the vagina (by the woman herself). Some contraceptive drugs can even be injected into the deltoid muscle or buttock, or implanted under the skin of the arm.
Among these, we mention:

• Estrogen-progestogen contraceptive pill
• Minipill (composed exclusively of progestins)
• Vaginal ring
• Transdermal patch
• Injection of progestin
• Implantable hormonal contraceptive methods: IUDs and sticks
• Post-coital contraception: which should NOT be considered a usual method of contraception.

Key points

The general characteristics, advantages and disadvantages of each hormonal contraceptive method are described in the table. Furthermore, a percentage value is reported which expresses the theoretical protection guaranteed by the contraceptive against unwanted pregnancies.

Estroprogestinic contraceptive pill

General characteristics Benefits Disadvantages Protection from unwanted pregnancy

• The combined contraceptive pill consists of estrogens (e.g. ethinylestradiol) and progestogens (e.g. norethisterone levonorgestrel, ethinodiol, desogestrel or gestodene)
• It should generally be taken for 21 consecutive days, followed by a 7-day suspension (during which the "fake" menstruation occurs)
• It works by inhibiting ovulation and making the cervical mucus less suitable for the passage of spermatozoa
• The combination of hormones (estrogen + progestin) disfavors fertilization and the "implantation of the egg"

• Effective and safe method of contraception
• Reduces the risk of amenorrhea
• Reduces the symptoms of PMS
• It reduces the incidence of fibroids and ovarian cysts
• Reduces the risk of thyroid disease
• Reduces the risk of iron deficiency anemia
• Reduces the risk of ovarian cancer
• Contraceptive method indicated for monogamous relationships
• Reduces the risk of pelvic inflammatory disease, endometritis and metritis

• It does not protect against STDs
• Possible weight gain
• Possible increase in blood pressure
• It tends to slow down the metabolism (due to the inhibitory effect of the hormones contained in the pill on thyroid hormones)
• Breast turgor
• Chloasma
• Cutaneous xerosis
• Spotting (during the first months of taking)
• Increased body hair
• Nausea, hot flashes, dizziness, irritability
• Possible vaginal dryness
• Slightly increased risk of cardiovascular disease
• Slightly increased risk of breast cancer
• Hypertensive women should not use this method of contraception
• Requires a prescription

• Extremely High: 93-99.9%
• Contraceptive efficacy may be impaired after episodes of vomiting or severe diarrhea (within 5 hours after administration)
• The effectiveness is compromised by the concomitant intake of some drugs (antiepileptics, antibiotics, antivials) or natural substances (eg St. John's wort)

Minipill (progestin)

General characteristics Benefits Disadvantages Protection from unwanted pregnancy

• The minipill consists exclusively of progesterone (norethisterone, levonorgestrel or ethinodiol).
• It must be taken daily, without interruption
• It acts mainly in the mucus of the uterine cervix (made inhospitable for the sperm)
• Prevents implantation of the fertilized egg in the uterus

• It does not interfere with blood pressure, blood clotting, lipid metabolism, cholesterol
• It does not alter the vaginal pH
• It does not cause dryness of the eyelids
• It does not generate breast turgor
• It does not cause cellulite
• It does not interfere with libido
• Does not interfere with lactation (can be taken immediately after delivery)

• It does not protect against STDs
• For optimal contraceptive coverage, the minipill must ALWAYS be taken AT THE SAME TIME (with a maximum tolerance of half an hour)
• It can cause the gradual disappearance of menstruation (during the period of taking the minipill)
• Contraceptive safety noticeably lower than the combined pill
• Contraceptive efficacy may be impaired after episodes of vomiting or severe diarrhea (within 5 hours after administration)
• Requires a prescription

• The contraceptive method offers a "high coverage from unwanted pregnancies (even if slightly lower than the combined pill): the effectiveness of the method is variable from 97 to 99.5%.
• The efficacy may be compromised by the concomitant intake of certain drugs (antiepileptics, antibiotics, antivials) or natural substances (eg St. John's wort)

Vaginal ring (NuvaRing)

General characteristics Benefits Disadvantages Protection from unwanted pregnancy

• The contraceptive ring is a ring-shaped device, made of ethylene vinyl acetate (soft, non-toxic and anti-allergic plastic), which allows the slow and regular release of hormones: by doing so, ovulation is denied.
• The contraceptive method is placed in the vagina by the woman, and left there for three consecutive weeks. During the fourth week (when menstruation occurs), the ring must be removed

• The contraceptive ring is inserted and removed by the woman (no medical help is needed)
• It works just like the contraceptive pill - what changes is the route of administration
• It does not interfere with the gastrointestinal tract: the effectiveness of the contraceptive method is maintained even after episodes of vomiting or severe diarrhea
• Very high contraceptive safety
• It does not involve the first hepatic passage
• The presence of the ring is imperceptible, even during intercourse
• It ensures an "excellent menstrual regularity

• It does not protect against sexually transmitted diseases
• It can cause side effects such as: genital itching, dizziness, acne, diarrhea, vomiting, asthenia, low back pain, mood alteration, decreased libido, leucorrhea, breast swelling, dysmenorrhea
• It can favor the "establishment of"fungal infections (ex. Candida albicans) and bacterial. In fact, pathogens can lurk near the device and cause damage
• The contraceptive method may spontaneously come out of the vagina during the first months of use (rare)
• Change contraceptive method if symptoms persist beyond the first 2-3 months of use

• Very high (about 97-99.9%)
• The contraceptive efficacy is reduced in case of expulsion of the ring

Transdermal patch (Evra)

General characteristics Benefits Disadvantages Protection from unwanted pregnancy

• Mechanism of action equivalent to that of the contraceptive pill
• It works transdermally by releasing - just below the skin layer - a mix of estrogen and progestin hormones. Once in the bloodstream, the hormones prevent ovulation.
• It increases the thickness of the cervical mucus, hindering the passage of sperm into the uterine cavity
• The patch should be applied directly to clean, dry, hairless skin, free from wounds, irritations or creams
• The patch must be applied only once a week, for 3 consecutive weeks, then leaving a 7-day break (during which menstruation will occur)

• It allows the woman to live a serene sex life, free from anxieties and fears
• Vomiting and diarrhea do not interfere with contraceptive efficacy
• The hormonal level released in the blood by the contraceptive patch is always constant
• Good ally against acne and hypertrichosis
• Immediate recovery of fertility following discontinuation of use of the patch
• The patch does not necessarily have to be removed and replaced by a new one at the same time. The important thing is that the replacement always takes place on the same day of the week
• The contraceptive patch does not affect either weight gain or the formation / increase of cellulite
• Unlike the pill, this contraceptive method does not generate allergic reactions / intolerances caused by lactose-based excipients

• It does not protect against STDs
• Contraindicated in obese or obviously overweight women
• Contraindicated for smokers
• Possible contact dermatitis
• Spotting, metrorrhagia
• Possible oligomenorrhea and amenorrhea after discontinuation of the contraceptive method

• Very High: 97-99.9%
• The effectiveness of the contraceptive method is compromised in case of accidental detachment of the patch
• The effectiveness is compromised by the concomitant intake of some drugs or natural substances (eg. St. John's wort)

Injection of Progestogens (eg Prontogest)

General characteristics Benefits Disadvantages Protection from unwanted pregnancy

• The contraceptive method consists of intramuscular injections of progestin
• Injections should be repeated every three months into the deltoid muscle or gluteus
• The contraceptive method exerts its therapeutic action by preventing ovulation

• Useful for the treatment of gynecological disorders, such as hypermenorrhea, polymenorrhea, metrorrhagia, amenorrhea
• Prevents miscarriages
• Only after three months, the woman can decide whether or not to continue using this contraceptive method
• Possible disappearance of menstruation during the period of taking the drug
• It can help prevent uterine cancer

• It does not protect against sexually transmitted diseases
• The contraceptive method should not be used for more than 2 consecutive years as it can cause a temporary decrease in bone density
• It can cause side effects such as spotting, weight gain, breast turgor, headache, weakness and menstrual irregularities for the first 3-6 months of treatment.
• Need to go to the doctor every three months to have a "further injection of progestogen
• Quite high cost ($ 30-75 per injection)
• It increases the risk of osteoporosis and fractures

• Very high (> 99%)
• The duration of contraceptive efficacy is three months. At the end of this period, the woman - to continue to exploit the contraceptive effect - must undergo a further injection of progestogen again.

The real risk of becoming pregnant without the use of any contraceptive method is estimated at around 85%.

Other articles on "Hormonal Contraceptives"

1. Mechanical Contraceptives - Barrier Methods
2. Contraceptives - Types of Contraceptives
3. Contraceptives D "Urgency - Morning After Pill and Spiral
4. Implantable contraceptives: IUD coil and sticks
5. Chemical Contraceptives or Spermicides
6. Natural Contraception