For many of us, the term “hormonal medications” sounds ominous. In the minds of most people who are not involved in medicine and pharmaceuticals, hormones are monstrous pills that bring a lot of equally monstrous side effects.

What are these fears based on? And if hormones are so harmful, why are they used so widely? Let's try to figure out together what hormonal pills actually are.

Classification

Hormonal medications contain hormones or substances that have properties similar to hormones (hormonoids). Hormones are produced in the human endocrine glands and spread through the bloodstream to various organs and systems, regulating the vital functions of the body.

Hormonal drugs can be divided into hormone preparations:

• pituitary gland
  These include human chorionic gonadotropin and oxytocin, known probably to every woman;

• thyroid gland.
  These drugs are used to treat insufficient production of one's own hormones (for example, hypothyroidism) and the opposite condition - excess production of hormones;

• pancreas.
  The most famous drugs in this group are insulin preparations;

• parathyroid glands;

• adrenal cortex.
  This group includes glucocorticosteroids, which are widely used in many branches of medicine as anti-inflammatory, antiallergic and analgesic agents;

• sex hormones: estrogens, gestagens, androgens;

• anabolic agents.

What is treated with hormonal pills?

Despite the very wary attitude towards hormonal drugs on the part of patients, we can safely say that these drugs are extremely necessary and important. Often only hormonal drugs can provide a chronically ill person with a decent quality of life, and sometimes save life itself.

Therapy with hormonal pills is necessary for:

- oral contraception;

- hormone replacement therapy in postmenopausal women and elderly men suffering from testosterone deficiency;

— treatment of inflammatory and allergic diseases;

- treatment of hormonal deficiency.
These pathologies include hypothyroidism, type 1 diabetes mellitus, Addison's disease and other diseases;

- treatment of many oncological diseases.

Oral contraception. Achievements of modern medicine

The first studies that laid the foundation for the development of hormonal contraceptives were carried out back in 1921. Ten years later, scientists had already precisely clarified the structure of steroid hormones and discovered that high doses of sex hormones inhibit, that is, block ovulation.

The first combined hormonal contraceptive was released in 1960 by American pharmacists. It contained really high doses of hormones, and therefore had not only contraception, but also a lot of side effects.

Over time, the situation has changed dramatically. In the 90s of the last century, hormonoids were synthesized, which, along with high activity, have excellent tolerability. Therefore, modern women do not have to worry about the extra pounds gained as a result of taking hormonal birth control pills. This side effect is a thing of the past along with the loading doses of active ingredients contained in the first contraceptives.

The effectiveness of all contraceptives is assessed using the Pearl index, which determines the probability of pregnancy within one year with constant use of the drugs. On average, the Pearl index of hormonal contraceptives ranges from 0.3% to 2-3%. The maximum value of this indicator reaches 8%.

If a woman has average fertility and does not become pregnant from her husband's toothbrushes, the chance of pregnancy rarely exceeds 1%. Of course, subject to daily use of the tablets.

However, let's return to classifications. Modern hormonal contraceptives can be:

1. combined;

2. non-combined (mini-pill);

3. emergency contraceptive pills.

Let's try to figure out how these groups differ.

1. Combined hormonal contraceptives: COCs

Behind the funny abbreviation COCs are hidden very serious medications, which are the most popular modern contraceptives. All COCs include two active ingredients - estrogen and gestagen. Ethinyl estradiol is used as estrogen, and levonorgestrel, norgestrel, desogestrel and other synthetic hormones can act as a gestagen.

The dose of ethinyl estradiol in modern COCs is much lower than in the first “killer” tablets. Because of this, side effects of estrogen such as weight gain, breast tenderness, and nausea are rare when taking new medications.

Monophasic COCs have a constant dose of estrogen and progestin in each tablet. Despite the fact that during the menstrual cycle the concentration of hormones in a woman’s body is not constant, monophasic contraceptives are a strictly defined dose taken daily.

Biphasic contraceptives contain two types of pills in one package. The main difference between the second type of tablets is the increased content of gestogen, which is also characteristic of the physiological cycle.

However, three-phase COCs are traditionally considered the most adapted to the menstrual cycle. They include three groups of tablets. The concentration of active substances in each group approaches the content of estrogens and gestagens in a certain phase of the menstrual cycle. The first group of tablets imitates the follicular phase, which lasts 5 days, the second - the periovulatory phase, which lasts 6 days, and the last - the luteal phase, the longest 10-day phase. At the same time, the concentration of estrogen in three-phase COCs, as well as in the menstrual cycle, is maximum, and the level of gestagen increases from the first phase to the third.

Pharmacology: how do hormonal birth control pills work?

The contraceptive effect of all hormonal birth control pills, regardless of composition and dosage, is based on blocking the release of hormones responsible for ovulation and implantation. The ovaries practically “fall asleep”, decreasing in size. Ultimately, hormonal pills:

• suppress ovulation;
• change the properties of cervical mucus. As a result of this effect, the cervical canal becomes a real barrier for nimble sperm;
• change the state of the endometrium, as a result of which the “lining” of the inner surface of the uterus does not allow the egg to implant if fertilization does occur.

How to take hormonal birth control pills?

The answer to the question of how to take hormonal pills that protect against pregnancy can be expressed in one single word: regularly. Depending on the period for which the course is designed - 21 or 28 days - the tablets should be taken once a day throughout the entire treatment period, preferably at the same time.

An important question that concerns most women taking COCs is what to do if the patient forgot to take the pill on time. First of all, don't panic. The situation is solvable and, in general, very banal.

It is impossible to do without hormonal tablets containing HA in the treatment of allergic diseases, including bronchial asthma. Glucocorticoids are able to reduce the inflammatory response and counteract the activity of immune cells that are involved in the pathological process. Most often, HA is administered by inhalation, but in some severe cases, hormonal drugs in tablets and ampoules are used.

Glucocorticoids are certainly included in the treatment regimen for oncological diseases. Their main purpose is to reduce the side effects of chemotherapy. In addition, hormonal tablets can help destroy cancer cells in lymphoblastic leukemia, Hodgkin's lymphoma, non-Hodgkin's lymphoma and multiple myeloma.

Glucocorticoids in tablets

Most often, several tableted glucocorticoids are used.

The drug effectively reduces inflammation by suppressing the function of leukocytes. Interestingly, the anti-inflammatory effect of Dexamethasone is 30 times greater than the activity of another GC - hydrocortisone.

Dexamethasone tablets are indicated for the hormonal treatment of Addison's disease, hypothyroidism, bronchial asthma, rheumatoid arthritis, ulcerative colitis, eczema, and malignant tumors in advanced stages.

The dosage of Dexamethasone is selected individually.

The drug is an analogue of hydrocortisone. Prednisolone is able to influence all stages of the inflammatory process and have a pronounced anti-inflammatory effect.

There are indeed many indications for the use of Prednisolone tablets - hormonal treatment is prescribed for systemic lupus erythematosus, multiple sclerosis, joint diseases, bronchial asthma, cancer, adrenal insufficiency, allergies, autoimmune pathologies and many others.

The drug produced by the Polish plant Polfa contains triamcinolone GC in a dose of 4 mg. The main indications for Polcortolone include joint diseases, allergic pathologies that are difficult to treat, rheumatic, dermatological, hematological, oncological and other diseases.

Side effects of glucocorticoids

HAs have truly unique qualities. Therefore, glucocorticoids could be called healing drugs, if not for the side effects. Due to the large number of adverse events due to treatment, long-term use of these drugs may even be dangerous.

We list the most common side effects of hormonal tablets of the glucocorticoid group:

• decreased immunity;
• increased blood sugar levels. With long-term treatment with GC, the development of diabetes mellitus is possible;
• decreased calcium absorption, which can lead to osteoporosis, a dangerous bone disease;
• muscle atrophy;
• increased levels of cholesterol and triglycerides in the blood;
• mood changes, depression, memory impairment, in severe cases - psychosis;
• gastritis and peptic ulcer;
• menstrual irregularities, decreased libido;
• slow wound healing;
• weight gain.

Another extremely unpleasant side of corticosteroids is withdrawal syndrome: after stopping long-term use of hormonal pills, there is a possibility of severe side effects. To avoid such a development of events, medications should be discontinued gradually, gradually reducing the dose over a certain period of time.

Hormonal deficiency: when can you not do without pills?

The most common pathologies that require constant use of hormonal medications are diseases of the thyroid gland.

Thyroid insufficiency - hypothyroidism - is a common disease in which the production of hormones is reduced. Treatment is based primarily on compensating for the lack of hormones. For this purpose, hormonal tablets are prescribed, which include sodium levothyroxine.

Levothyroxine sodium is a levorotatory isomer of thyroxine. It is a synthetic analogue of thyroid hormone. Thyroxine is the first-line medicine for hypothyroidism, euthyroid goiter, and also after removal or resection of the thyroid gland.

Despite the fact that thyroxine is a hormonal medicine, when the correct dosage is prescribed according to indications, there are practically no side effects.

Hormones in oncology: when drugs save lives

Hormone therapy in oncology, along with chemotherapy, is one of the main drug treatments for cancer. Hormone treatment is used for several types of hormone-sensitive tumors, including breast, prostate, endometrial (uterine cancer), and adrenal cortex.

Most drugs used to treat hormone-dependent tumors inhibit, that is, block the release of hormones. These drugs include one of the most well-known drugs for the treatment of breast cancer - Tamoxifen.

Many drugs can reduce the production of other hormones, which are responsible for the growth of malignant tumors. Often, hormonal treatment is almost the only opportunity to fight the tumor and prolong the patient’s life.

Hormonal pills are a whole pharmaceutical world, in which there is a place for effectiveness, uniqueness, and side effects. And only doctors can untie this tangled tangle of complex concepts, indications and contraindications. Then the correctly prescribed remedy turns out to be the right path to a fulfilling life.

Female hormones play an important role and affect the functioning of the entire body. More and more women are faced with the problem of hormonal imbalance. One of the most pressing issues is adjusting hormone concentrations. Female sex hormones in tablets or female hormonal preparations should be taken only under the strict supervision of a doctor; self-medication may have irreversible processes.

Classification of hormonal drugs

Female hormone pills are prescribed to solve a wide variety of health problems. Female sex hormones in tablets (both synthetic and natural) are divided into 4 broad groups:

1. estrogens (steroid);
2. estrogens (non-steroidal);
3. progesterones, gestagens, as well as analogues;
4. combined hormones.

Female hormonal pills taken by the patient uncontrollably can cause serious complications in the body. As a result, these consequences will become irreversible.

Estrogen drugs

Ovarian follicles produce estrogens, natural sex hormones. These substances contribute to the normal functioning and development of the female body. Estrogens affect systems and organs, therefore, after using estrogen-based drugs, the following processes can occur in the body:

• Endometrial proliferation;
• Development and growth of the uterus;
• Active formation of sexual characteristics of the secondary type;
• Stabilization of the general condition of the body, help to cope with disorders that arise due to functional failure of the ovaries during menopause or radical surgical intervention in women’s health;
• Participate in the formation and maintenance of bone strength.

Interestingly, osteoporosis (bone fragility) occurs most often during menopause or during surgical intervention in the functioning of the ovaries. As a result, the likelihood of pathological fractures significantly increases.

If we take into account the effects of estrogen use, the tablets can be taken for the following conditions:

1. Menstrual irregularities (for example, amenorrhea) in women of childbearing age.
2. Underdeveloped genitals.
3. Weakly expressed secondary sexual characteristics or their complete absence.
4. Disorder after surgery to remove the ovaries and during menopause.
5. Infertility.
6. Problems with labor.
7. Post-term pregnancy (over 42 weeks).
8. For the prevention and treatment of osteoporosis during menopause.

Synthetic female hormonal drugs are increasingly being used. Medicines of natural origin (conjugated estrogens) also do not lose their popularity. Female sex hormones in tablets are presented on the pharmacological market in the following drugs:

• Estroferm;
• Premarin;
• Climacterin;
• Szigetin;
• Sinestrol.

When using estrogen drugs, a woman must be under the constant supervision of her doctor. Long-term use of such drugs can cause uterine bleeding of varying intensity, tumor formation, and endometrial growth. Estrogen medications are prescribed for the following situations:

1. the appearance of neoplasms in people under 60 years of age;
2. pathological conditions of the mammary glands (various forms of mastopathy);
3. inflammatory processes in the endometrium;
4. menopause period.

Premarin

Refers to products that are based on conjugated estrogen. Premarin is popular among women, but it should be taken with extreme caution. Contraindications to taking Premarin include diabetes mellitus, epilepsy, hypertension, central nervous system pathologies, and hereditary metabolic pathologies. An absolute contraindication to taking Premarin is pregnancy and breastfeeding.

The effect of the drug is significantly reduced when taken simultaneously with rifampicin, butadione, and barbiturates. The medicine is prescribed to patients for the following conditions:

• Disturbances in the functioning of the ovaries.
• Decreased bone strength (osteoporosis) during menopause;
• Unstable menstrual cycle, absence of menstruation;
• Menopausal disorders;
• Neoplasms in the prostate.

Female hormonal pills (estrogen, progesterone) can bring both benefit and harm. Much in this case depends on the correct application.

Estroferm

The lack of natural estrogens can be compensated with the help of the drug Estroferm, which stabilizes the functioning of the ovaries and also reduces the severity of adverse symptoms during menopause. The drug is not a contraceptive, so it cannot protect against unplanned pregnancy.

If taking the drug has not been able to normalize the menstrual cycle, and the discharge continues to be irregular, additional studies should be performed to determine the exact cause of the hormone imbalance in the body.

With long-term treatment with the use of the drug Estroferm, there is a need to undergo regular preventive examinations. The medication should be stopped if:

1. the functioning of the cardiovascular system worsens (blood clots appear, stagnation of blood circulation occurs, blood pressure rises);
2. yellowness of the sclera and skin is observed;
3. vision deteriorates;
4. surgery is planned.

Progesterone, gestagens and their analogues

Progesterone is a hormonal substance of the corpus luteum. It stimulates the appearance of changes in the uterine mucosa, which are characteristic of the secretory phase of the monthly cycle. During pregnancy, it changes the mucous membrane to create optimal conditions for the development of a fertilized egg. Progesterone also significantly affects the reduction in contraction and excitability of smooth muscle fibers of the fallopian tubes and uterus, and has a stimulating effect on the excretory ducts of the mammary glands during lactation.

Progesterone of synthetic origin has a similar effect. In most cases, the drug is tolerated without side effects, but sometimes there is an increase in blood pressure, as well as swelling of the legs.

If we talk about female hormonal pills that contain progesterone, we can name the following medications:

• Norkolut;
• Turinal;
• Pregnin;
• Postinor.

Progesterone and hormone analogues are used for the development of pathological processes in the liver, the appearance of tumors in the mammary glands and reproductive organs, and when there is a risk of blood clots.

Pregnin

Pregnin is a hormonal agent. This drug is made on the basis of progesterone of synthetic origin. The therapeutic and biological effect of this medicine is almost identical to that of the natural hormone produced by the corpus luteum. But there is confirmation that Pregnin has low activity compared to the natural hormone (at least 5 times).

The main feature of the product is that it retains its therapeutic effect and activity when taken orally at a high level. Pregnin is not recommended for use if there is a threat of miscarriage or an incipient miscarriage. Pregnin can be prescribed for the following conditions:

1. Low functional activity of the corpus luteum;
2. The occurrence of uterine bleeding due to disturbances in the functioning of the ovaries;
3. Lack of menstruation;
4. Scanty menstruation, short periods;
5. Painful sensations during menstruation;
6. Infertility therapy with a combination of progesterone and estrogens.

The Pregnin tablet must be placed sublingually (under the tongue) and wait until the product dissolves. The product should be absorbed in the oral cavity. This allows for a high therapeutic effect compared to swallowing and absorption through the gastrointestinal mucosa.

Some hormonal medications for women can be purchased without a prescription. At the same time, you should not use such drugs without prior consultation with a specialist.

Norkolut

Norkolut is a gestagenic drug. It is based on norestyrsterone and has high activity when taken orally. The dosage of the drug is selected individually for each patient. This makes the treatment highly effective and also avoids side effects. So, when should you use Norkolut:

• Premenstrual disorders;
• Irregular menstrual cycle, during which a reduction in the secretory phase is observed;
• Pain in the mammary glands;
• Endometriosis (overgrowth of the uterine lining);
• Irregular and heavy periods;
• Menopausal bleeding from the internal genital organs;
• Benign formations in the uterus.

As for side effects, the following conditions may be observed when using the product: headache, rash, nausea, weight gain, itching, increased fatigue, and swelling of the mammary glands.

Before starting treatment with Norkolut, you should undergo an examination. This is important to completely exclude malignant tumors in the genitals or breasts.

Postinor

Postinor, which is created on the basis of progesterone of synthetic origin, is rightfully recognized as one of the most popular contraceptives today. Clinical studies of Postinor made it possible to establish that the drug protects against unplanned pregnancy by 85%.

Postinor should be taken according to the instructions. Its effectiveness depends on how quickly the drug is taken after intimacy.

If Postinor is taken within a few hours after sexual intercourse, then protection against pregnancy is 95%, which indicates a high level of effectiveness of the drug. When taking Postinor after 2-3 days, the effectiveness is reduced to 60%. If you take the drug according to the instructions, then it will not have any negative effect on blood clotting and metabolism in the body. Taking Postinor is contraindicated:

1. Children under 16 years old.
2. For those who have pathological processes in the liver, there is a pronounced lack of functioning of the organ.
3. Hereditary severe diseases (lactose intolerance).
4. High sensitivity to the main component of the drug.

Postinor has an effect before implantation (introduction) of the fertilized egg into the uterus, but after this the drug loses its effectiveness.

Combined hormonal drugs

Scientists have been able to use progestins and estrogens (as well as agents with a similar spectrum of action) to create hormonal combination drugs that are used to eliminate disorders during menopause and, if necessary, to treat cancer. Basically, such hormonal drugs for women are used not only for therapeutic purposes, but also for preventive measures. But it is worth remembering that hormonal drugs have side effects on the body.

The use of hormonal drugs (contraceptives are also included in this list) should only be under the supervision of a doctor. In pharmacies you can purchase the following combined hormonal pills for women, created on the basis of progesterone, estrogen and analogues of these substances:

• Ovidon;
• Rigevidon;
• Lindiol;
• Divina;
• Pregestrol;
• Desmoulins.

Ovidon

Belongs to the group of combined hormonal contraceptives that provide protection against unwanted pregnancy. Ovidone is available without a prescription, but the opinion of a gynecologist should still be taken into account. The specialist will give advice on the correct use and dosage of hormonal pills.

Ovidone is used not only as a contraceptive, but also to eliminate menstrual irregularities and relieve painful symptoms.

At the beginning of taking the drug, you may experience nausea, headaches, vomiting, weight fluctuations, increased fatigue, skin rashes, and bleeding from the genitals. Stop taking the pills if pregnancy occurs, venous thrombosis occurs, blood circulation deteriorates, vision decreases, or any exacerbations of chronic diseases. Women over 35 years of age should take the drug with caution.

Pregestrol

This drug is also included in the group of combined drugs. Pregestrol consists of two active ingredients - ethinyl estradiol and pregnyl. The same substances are included in the foreign analogues of the drug - Lutestrol and Klimovan.

The drug is also used to eliminate anovulation (when, in the second phase of the cycle, a mature egg does not leave the ovary). Treatment should be prescribed by a doctor after studying the individual picture of the disease. The number and duration of therapeutic measures depend on the woman’s health condition and the effectiveness of previous courses of treatment.

Adverse reactions when taking this hormonal drug may include increased fatigue and mood swings. Long-term treatment with Pregestrol may cause the development of male secondary sexual characteristics (androgenic activity).

If you observe unusual conditions, side symptoms and signs, you should consult a doctor. Pregestrol is not used after gynecological operations to eliminate tumors.

Summing up

Hormonal pills for women are potent medications. The pharmacological industry today has been able to synthesize all the substances that are produced by the endocrine glands. Hormonal drugs for women have found their use in obstetrics and gynecology. These drugs are used for pregnancy planning, treatment, and preventive measures. The regimen according to which patients take these medications is drawn up by the doctor. He selects the most effective drug, determines its dosage and course duration.

Your doctor will prescribe how to take hormonal pills, but self-medication can lead to disastrous consequences.

Preparations containing female sex hormones estrogens have different indications for use. They are used for contraception, treatment of diseases of the female genital area, as well as correction of disorders that develop during the menopausal period.

Each group of medications containing estrogens has its own characteristics, so the selection of therapy using female sex hormones should be carried out by a qualified specialist. Self-medication can lead to worsening disorders or the development of serious diseases.

Show all

What drugs contain estrogens?

Analogs of the female sex hormone estrogen are included in the following pharmaceutical preparations:

Characteristic




Medicines containing female hormones in tablets may have different compositions and features of use.




Before using them, you should consult a specialist and also study the instructions for use.






Analogues of Flucostat and Diflucan - a list of cheap and effective drugs

Anteovin

Anteovin is a combined contraceptive drug. The active ingredients are levonorgestrel and ethinyl estradiol.

Release form:

• white tablets contain 0.05 mg levonorgestrel and 0.05 mg ethinyl estradiol;
• The pink tablets contain 0.125 mg levonorgestrel and 0.05 mg ethinyl estradiol.




Pharmacodynamics

The drug Anteovin belongs to the pharmacotherapeutic group of estrogen-progestogen drugs with contraceptive action. The effect is achieved due to the ability of the combination of active ingredients to inhibit follicle maturation and ovulation.

Pharmacokinetics

When taken orally, both active ingredients are intensively and completely absorbed from the gastrointestinal tract. Metabolism is carried out slowly by liver cells. Elimination of metabolites occurs through the kidneys and intestines.

The active substances of the drug can pass into breast milk.

Indications

The use of this tool is carried out:

• for the purpose of contraception;
• for the treatment of functional disorders of the menstrual cycle (dysmenorrhea, algodysmenorrhea).

Contraindications

Contraindications for use are:

• severe kidney pathology;
• cardiovascular diseases, including cerebrovascular pathology (both currently existing ailments and indications of them in the anamnesis are taken into account);
• hypertension;
• diabetes mellitus;
• porphyria;
• disorder of the hemostatic system;
• lipid metabolism disorders;
• tumor changes in the liver;
• tumor lesion of the breast or uterus;
• uterine bleeding of unknown etiology;
• otosclerosis;
• a history of itchy skin during pregnancy;
• periods of pregnancy and breastfeeding;
• idiopathic jaundice.

Many of the pathological conditions, depending on the degree of severity, can be considered either relative or absolute contraindications.

The decision on the possibility of using Anteovin for the above diseases should be made by a specialist.

Side effects

When using this product, there is a possibility of:

• dyspeptic manifestations;
• fluctuations in body weight, both upward and downward (however, the drug is not prescribed as a means of losing weight);
• changes and increased sensitivity of the mammary glands;
• headaches;
• symptoms characteristic of asthenic syndrome;
• cramps in the leg muscles;
• bloody vaginal discharge.

Caution should be exercised when combining Anteovin with rifampicin, phenobarbital, sulfa drugs, and broad-spectrum antibiotics, as these substances can reduce the effectiveness of the combined contraceptive drug. In this case, it is advisable to consult a specialist about the need to use additional methods of contraception.

It must be taken into account that a reliable contraceptive effect develops no earlier than the second cycle of taking pills. When planning pregnancy, it is recommended to stop using Anteovin 3 months before the expected conception.

Trigestrel

The drug is a combination of levonorgestrel and ethinyl estradiol and is used for oral contraception.




Contraindications

The use of Trigestrel is excluded if the patient has the following conditions:

• any thrombosis and thromboembolism and predisposition to them;
• disorders of the cerebrovascular system, including in history;
• conditions preceding thrombosis;
• migraine, accompanied by focal neurological symptoms, as well as a history of attacks of the disease;
• diabetes mellitus accompanied by vascular complications;
• pancreatitis, characterized by severe hypertriglyceridemia;
• liver dysfunction;
• liver tumors;
• hormone-dependent malignant tumors, including their history and suspicion of them;
• vaginal hemorrhages of unknown origin;
• pregnancy or suspicion of it;
• breast-feeding;
• hypersensitivity to the components of the product;
• fructose intolerance.

Side effects

The most common adverse reactions are:

• weight gain;
• headaches;
• decreased emotional background, mood swings;
• soreness of the mammary glands;
• nausea.

Serious adverse reactions requiring discontinuation of the hormonal drug include arterial and venous thromboembolism.

The list of adverse events, the connection of which with the use of combined contraceptives has not been confirmed, but has not been refuted:

• poor tolerance of contact lenses due to increased sensitivity of the cornea;
• dyspeptic symptoms;
• hypersensitivity reactions;
• fluid retention in the body with the formation of edema syndrome;
• headaches;
• development of migraine;
• mood swings;
• decreased libido;
• soreness and hypertrophy of the mammary glands;
• discharge from the mammary glands and genital tract;
• skin rashes, urticaria, erythema nodosum;
• venous and arterial thromboembolic complications, including occlusion of peripheral deep veins and pulmonary vessels; thrombosis and embolism, myocardial infarction, cerebral stroke, not classified as hemorrhagic.

Regulon

The components of the combination of active ingredients are ethinyl estradiol and desogestrel. The drug is available in tablet form. Each tablet is coated, white or off-white, and is marked “P8” on one side and “RG” on the reverse.



As auxiliary ingredients, the product contains:

• vitamin E;
• magnesium stearate;
• silicon dioxide;
• stearic acid;
• povidone;
• potato starch;
• milk sugar.

The drug is available at the pharmacy with a prescription.

Regulon belongs to the pharmacotherapeutic group of contraceptive drugs containing estrogen and progesterone.

Pharmacodynamics

The contraceptive effect is due to the ability of the combination of active ingredients to inhibit the production of gonadotropins and suppress ovulation. In addition, an additional factor is the increase in the viscosity of mucus in the cervical canal, which impedes the movement of sperm. The drug also affects the condition of the endometrium - the changes it causes prevent the implantation of a fertilized egg.

The combination of Regulon's active ingredients has a beneficial effect on lipid metabolism, increasing the content of high-density lipoproteins in the blood without changing the concentration of low-density lipoproteins.

Under the influence of the medication, blood loss during menstruation is reduced, the cyclicity of menstruation is normalized, and an improvement in the condition of the skin is observed, which is especially pronounced in cases of acne.

Pharmacokinetics

Desogestrel is quickly and completely absorbed from the gastrointestinal tract and metabolized in the liver. Elimination from the body occurs through the kidneys and intestines. The half-life is about 30 hours. A stable concentration of the substance is restored after the middle of the cycle.

Ethinyl estradiol is completely absorbed and metabolized by hepatocytes. It is excreted from the body by the kidneys and intestines. The half-life is about a day.

Indications and method of use

Regulon is used when contraception is necessary. The drug is intended for oral administration, 1 tablet per day. It is strongly recommended that you take the medicine at approximately the same time of day.

Use of the product should begin on the first day of the menstrual cycle.




After taking the last tablet from the blister pack, that is, after 21 days, a week-long break is taken, during which menstrual-like bleeding begins. At the end of the seven-day break, use of the drug should be resumed (exactly 4 weeks after the start of the previous package, on the same day of the week). You need to start taking the medicineeven if your periods have not stopped.

According to this regimen, the drug should be taken as long as there is a need for contraception. In the absence of violations of the pill-taking regimen, the contraceptive effect continues during the week-long break.

It is allowed to start taking Regulon from the 2nd to the 5th day of the menstrual cycle. However, it is necessary to use additional methods of contraception in the first 7 days of using the medicine. If more than 5 days have passed since the start of menstruation, contraception should be used from the beginning of the next cycle.

Features of the use of the drug in different groups of patients:

• Non-breastfeeding women It is prescribed to start taking Regulon no earlier than 3 weeks after birth (after preliminary consultation with a specialist). There is no need to use other methods of contraception. If sexual intercourse has already taken place after childbirth, the start of contraceptive use should be postponed until the first menstruation.
• After termination of pregnancy provided there are no contraindications, the medication should be started on the 1st day. There is no need for additional methods of contraception.
• Switching from another 21- or 28-day medicinal product This is done as follows: the first Regulon tablet must be taken the day after the completion of the 28-day cycle. If the previous contraceptive was 21 days, then you need to start taking the new hormone after a 7-day break (without additional methods of contraception).

Contraindications

• pregnancy and breastfeeding;
• the presence of risk factors for thrombosis (arterial and venous), including arterial hypertension;
• the presence of precursors of thrombosis, including a history of: angina pectoris, pulmonary embolism;
• migraine, especially accompanied by focal neurological symptoms, including a history of such attacks;
• the patient has venous and arterial thrombosis or thromboembolism, including in the deep veins of the leg, pulmonary embolism, myocardial infarction, acute cerebrovascular accident currently or in history;
• the presence of venous thromboembolism in close relatives of the patient;
• diabetes mellitus accompanied by angiopathy;
• inflammation of the pancreas, including a history of inflammation, with severe hypertriglyceridemia;
• dyslipidemia;
• cholestatic jaundice, hepatitis B, including a history (for hepatitis, the drug should not be prescribed until the parameters are normalized and for 3 months after);
• history of jaundice caused by steroid use;
• Gilbert, Dubin-Johnson, Rotor syndrome;
• liver tumors;
• severe itching during pregnancy or when taking steroids;
• otosclerosis or its progression during a previous pregnancy;
• hormone-dependent malignant neoplasms or suspicion of their presence;
• vaginal bleeding of unknown origin;
• smoking in combination with age over 35 years (from 15 cigarettes per day);
• individual hypersensitivity to the components of the drug.

The following conditions that increase the risk are not absolute contraindications, but require special caution when using Regulon: thrombosis or thromboembolism:

• age from 35 years;
• smoking;
• family history;
• obesity (with an index of 30 kg/m2);
• dyslipoproteinemia;
• arterial hypertension;
• epilepsy;
• heart valve defects;
• atrial fibrillation;
• prolonged immobilization;
• surgical interventions, especially in the lower extremities;
• severe injuries;
• superficial thrombophlebitis;
• varicose veins;
• operation;
• period after childbirth;
• severe depression, including a history of depression;
• diabetes mellitus not complicated by vascular disorders;
• systemic lupus erythematosus;
• Crohn's disease;
• ulcerative colitis;
• sickle cell anemia;
• liver diseases (acute and chronic).

Side effects

Of the side effects, the most dangerous, requiring immediate cessation of taking the drug, are:

• arterial hypertension;
• hemolytic-uremic syndrome;
• porphyria;
• hearing loss due to otosclerosis.

Some of the more rare ones include:

• arterial and venous thromboembolism, including myocardial infarction, stroke, deep vein thrombosis of the lower extremities and pulmonary artery;
• exacerbation of systemic lupus erythematosus;
• thromboembolism of the hepatic and mesenteric vessels, retinal vessels.

Side effects with less severe consequences:

• acyclic bleeding, amenorrhea;
• development or exacerbation of inflammatory processes of the vagina, galactorrhea;
• soreness of the mammary glands;
• dyspeptic syndrome;
• ulcerative colitis;
• jaundice;
• itching associated with cholestasis;
• cholelithiasis;
• skin rash;
• exudative erythema;
• headaches;
• migraine;
• mood swings;
• depression;
• fluid retention in the body;
• increased sensitivity of the cornea;
• allergic reactions.

The advisability of using the drug when these reactions occur is determined individually by the attending physician.

Analogs




Complete analogues of the oral contraceptive Regulon in composition are:

• Novinet.
• Marvelon.
• Tri-Mercy.
• Benidetta.


Ovestin

Each tablet of the drug contains 2 mg of estriol. One blister contains 30 tablets.

Taking the drug helps restore the vaginal epithelium, normalize the pH of the environment and vaginal microflora, and increases its resistance to infectious inflammatory diseases.




Indications

The use of Ovestin is indicated for the following conditions caused by estrogen deficiency:

• cases of atrophy of the mucous membrane of the lower parts of the genitourinary tract;
• dryness and itching in the vagina;
• pain during sexual intercourse;
• frequent painful urination;
• chronic cystitis and urinary incontinence when there is urge;
• pre- and postoperative therapy in postmenopausal women, especially during surgical interventions with access through the vagina;
• unclear results of a cytological examination of the cervix (if a tumor process is suspected).

Contraindications

This drug should not be prescribed:

• in case of hypersensitivity to it;
• for estrogenic tumors (including suspected cases);
• with vaginal bleeding of unknown origin;
• with thrombosis, including in history;
• during pregnancy.

Side effects

Side effects of the drug Ovestin are expressed in tension or soreness of the mammary glands. Nausea, focal pigmentation, and hypersecretion of cervical mucus may occur.

Less common effects include:

• headaches;
• arterial hypertension;
• cramps in the calf muscles;
• visual disturbances.

Estrimaks

The drug is available in the form of film-coated tablets containing estradiol in a dose of 2 mg as the active substance.

The action of the product is aimed at optimizing the trophism of the genitourinary system and preventing the development of osteoporosis. The result of the drug’s action is the elimination of vegetative-vascular and psycho-emotional disorders, which is achieved by influencing the hypothalamic-pituitary system.

The medication should be taken orally, without chewing, with a small amount of water. It is recommended to do this at approximately the same time of day, without interruptions. The recommended duration of treatment is six months. After this period, a medical examination is necessary to assess the effect of the drug and decide whether to continue therapy.

In women who are in menopause or have had their uterus removed, the medication can be started on any day. If you have menstruation, the first tablet should be taken on the 5th day of the cycle.

• pregnancy or suspicion of its presence;
• breastfeeding period;
• the presence of a mammary tumor, suspicion of it or indication in the anamnesis;
• estrogen-dependent tumors, including genital organs;
• liver diseases;
• thrombophlebitis;
• irregular vaginal bleeding of unknown origin;
• severe kidney and heart disease;
• hypersensitivity to any of the ingredients of the drug;
• cerebrovascular accident;
• retinopathy;
• dyslipidemia;
• severe itching or cholestatic jaundice during pregnancy or while taking steroid drugs;
• otosclerosis, including its exacerbation during pregnancy;
• stage of hyperestrogenism during menopause;
• pituitary tumors;
• diffuse connective tissue diseases.

Relative contraindications:

• bronchial asthma;
• diabetes mellitus;
• migraines;
• epilepsy;
• arterial hypertension;
• heart failure, ischemic heart disease;
• renal and hepatic dysfunction;
• edema syndrome;
• endometriosis;
• fibrocystic mastopathy;
• porphyria.

Side effects

The use of the drug Estrimax causes the following side effects described in the table:

Organs and systems	Side effects
Genitourinary	Changes in the nature of vaginal discharge, bleeding; development of premenstrual syndrome; an increase in the size of fibroids; endometrial hyperplasia; symptoms of cystitis without a bacterial process; change in sexual desire
Endocrine	Tension and enlargement of the mammary glands, secretion
	Symptoms of dyspepsia; spasms in the epigastric region; bloating; cholestatic jaundice, cholelithiasis
Cardiovascular	Arterial hypertension; thromboembolism
Skin	Melasma; melanoma; erythema multiforme; hemorrhagic rashes; alopecia; hirsutism
Organs of vision	Discomfort when wearing lenses associated with increased sensitivity of the cornea; visual disturbances due to changes in corneal curvature
	Headaches; dizziness; migraine; chorea-like disorders; depression
General reactions	Long-term use of the drug leads to disruption of the metabolism of sodium, calcium and water with the formation of peripheral edematous syndrome; decreased tolerance to carbohydrates; spasms in the calf muscles

When prescribing a medication, it is necessary to take into account its ability to interact with barbiturates, tranquilizers, narcotic analgesics, anesthesia compounds and some anticonvulsant biological drugs. These drugs activate the metabolism of Estrimax, reducing its effectiveness.

The effect of Estrimax is enhanced in the presence of folic acid and thyroid medications. The effectiveness of lipid-lowering agents increases in the presence of a hormonal medication. Since the medicine tends to reduce glucose tolerance, in case of diabetes mellitus it may be necessary to adjust the dose of glucose-lowering compounds.

The course of some diseases may worsen during replacement therapy with Estrimax. In this regard, regular detailed medical examinations are necessary for patients with otosclerosis, multiple sclerosis, systemic lupus erythematosus, melanoma, epilepsy, migraines, and bronchial asthma. Women with arterial hypertension receiving hormone replacement therapy require systematic monitoring of blood pressure. To avoid an increased risk of blood clots, you should stop taking the drug one to one and a half months before the planned surgery. It is necessary to suspend the use of Estrimax during a period of prolonged immobilization.

Cases requiring immediate cessation of use:

• deep vein thrombosis;
• thromboembolic diseases;
• significant increase in blood pressure;
• the appearance of jaundice;
• the occurrence of migraine-like headaches;
• unexpected visual impairment.

The drug does not affect the ability to drive a car or use other machinery. Not suitable for children and men.

Analogues in composition are Estrofem and Proginova.



Both drugs contain 2 mg of active ingredient in each tablet and have properties similar to Estrimaks. However, you should not replace one medication with another on your own. If necessary, you should first consult with a specialist.

Sex hormones for women play a very important role in their bodies. But recently, hormonal disorders have become quite common, which can be associated with poor ecology, constant stress and other negative factors. To bring the content of these elements back to normal, special preparations were developed - female hormones in tablets. They not only help a woman be healthy and beautiful, but also protect her from unwanted pregnancy.

Main sex hormones

The most significant hormones in women are progesterone and estrogen. The ovaries produce estrogen, which affects the health and puberty of the fair sex. In addition, this hormone affects the formation of a woman’s figure and the gentleness of her character. If the body suffers from a lack of estrogen, then it begins to age quickly, but too much of it can lead to various disorders and diseases, such as excess weight or, worse, benign tumors. Progesterone is also important for women’s health, because the distribution of adipose tissue, the formation of mammary glands, genital organs, and the development of the embryo depend on it. The production of this hormone occurs in the corpus luteum of the ovaries and the placenta.

Use of hormonal drugs

To eliminate hormonal imbalances in a girl’s body, it is used in tablets. This is necessary, since an unstable one can provoke serious consequences, such as sudden changes in blood pressure, menstrual irregularities, chronic fatigue, digestive system disorders, and headaches. Everything will be reflected in your appearance: acne, acne may appear, your hair becomes greasy, your skin begins to peel. They are also often used as contraceptives, which helps avoid unwanted pregnancy. It is thanks to this that female hormones in tablets are widely used.

Types of hormonal drugs

Hormonal drugs produced in tablet form can be divided into two types:

It should be noted that it is necessary to take drugs of this kind only if they have been prescribed by an endocrinologist or gynecologist. After all, improper use of hormonal drugs can cause serious harm to a woman’s body.

Most people, due to a lack of knowledge in the field of medicine, consider hormonal drugs to be something terrible that bring a huge amount (from weight gain to significant hair growth). Such fears are unfounded. An example is hormonal pills for women. These drugs are widespread and effective in their use. What hormones are, why they are taken, and which of them are the best is discussed in the article.

Hormonal medications include synthetic hormones or hormonoids (substances that have similar properties). Hormones are produced by glands of the endocrine system. Entering the blood, they spread throughout the body and reach target cells, on which they have a direct effect. Specific reactions occur there that control the vital functions of the body.

All hormonal medications can be divided into the following types:

• pituitary gland preparations - representatives are and, which is known to every woman;
• – used in the treatment of insufficient or excessive synthesis of hormonally active substances;
• pancreatic agents (based on);
• parathyroid preparations;
• hormones of the adrenal cortex - glucocorticosteroids, which are used in most areas of medicine to relieve insufficiency, inflammatory and allergic processes;
• preparations of sex hormones (progestins, androgens);
• anabolic steroids

What are hormonal drugs used for?

Hormonal drugs are used to treat and prevent a number of pathological conditions, namely:

• as contraception;
• for replacement treatment during menopause and menopause, this also includes men with androgen deficiency;
• treatment of inflammatory and allergic diseases;
• replacement therapy for deficiency of certain hormones;
• as part of the complex treatment of tumor processes.

Female hormonal drugs are used for the following purposes:

• menstrual irregularities;
• prevention and treatment of anemia;
• period after ectopic pregnancy;
• postpartum contraception (3 weeks after the end of lactation);
• therapy of gynecological pathologies;
• condition after abortion.

Features of oral contraception

The history of contraception goes back to ancient times. Everything was not used until the structure of steroidal hormonally active substances was studied and the suppressive effect of high doses of sex hormones on ovulation was discovered. This included interrupted sexual intercourse, various cases soaked in infusions and decoctions of herbs, fish bladders, and prolonged breastfeeding.

The use of hormones began in 1921, when the Austrian professor Haberlandt confirmed the possibility of inhibiting the ovulation process by introducing an extract from the ovaries themselves. It was first synthesized in the USA in 1942, and used in 1954. The negative point was that the hormones in the tablets contained at that time a significant dose of the active substance (tens of times higher than what a woman now takes), and therefore caused weight loss. side effects.

Modern agents that are well tolerated were synthesized in the 90s of the 20th century. How effective a drug is is assessed by the Pearl Index. This indicator clarifies the possibility of pregnancy within 12 months of regular use of the drug. The index of modern hormonal drugs ranges from 0.3% to 3%.

Hormone-based contraceptives:

• combined;
• mini-pills (non-combined);
• drugs for urgent contraception.

Combined hormonal agents

COCs are a group of the most popular modern contraceptives. They contain estrogen (ethinyl estradiol) and gestagen (norgestrel, levonorgestrel, desogestrel) - hormonoids similar in their action to female sex hormones.

Depending on the dosage, as well as the ratio of gestagens and estrogens, several groups of hormonal tablets are distinguished:

1. Monophasic - have the same dosage of active substances in each tablet of the package.
2. Biphasic - the amount of estrogen is constant, and the dose of gestagen varies depending on the phase of the cycle.
3. Three-phase - variable content of hormones in the composition.

The last group is considered the most physiological. It contains three types of tablets. The amount of hormones in each type depends on the phase of the menstrual cycle. The first 5 tablets correspond to the follicular phase, the next 6 tablets imitate the periovulatory phase, the remaining 10 - the luteal phase. The amount of estrogen in each of the tablets is maximum, and the level of progestogen gradually increases, reaching its highest levels by the third phase of the cycle.

Mechanism of action

All hormone-based contraceptives are aimed at preventing the production and release of active substances, the action of which is associated with ovulation and implantation of the fertilized egg into the uterine cavity. The gonads decrease in size, as if “falling asleep.”

The drugs have the property of making cervical mucus thicker, which prevents a significant number of sperm from penetrating into the uterus. In addition, there is a change in the functional state of the endometrium, it becomes thinner, and its ability to attach the fertilized egg to itself decreases, if conception does occur.

Reviews from women who use products from this group confirm the effectiveness of use under the age of 35. The package contains 21 tablets of the same color. There may be a strict usage pattern, but it is of little value since all tablets have the same composition. The following is a list of the most popular and effective remedies.

The drug contains 30 mcg and 2 mg of dienogest. Regular intake has the following features:

• Pearl index does not exceed 1%;
• has androgenic activity - taken by women with elevated levels of male hormones;
• normalizes blood cholesterol levels.

A good product made in Germany. Gestagen is represented by gestodene (75 mcg). Available in the form of dragees. It is not advisable to use with other medications, as the risk of uterine bleeding increases.

The product is the most popular representative of the group. Drospirenone acts as a gestagen. Properties are similar to the drug Janine. In addition to lowering cholesterol and anti-adrogenic effects, Yarina has a positive effect on the condition of the skin. This explains why dermatologists prescribe tablets in the treatment of acne and acne.

It is an analogue of Logest. Significant differences are the country of manufacture, the color of the tablet shell and the slightly higher estrogen content in the composition.

The name of this representative is also constantly heard. Contains ethinyl estradiol and cyproterone acetate. The product is the drug of choice for those women who have an increased level of hair growth, since the gestagen included in the composition has a powerful antiandrogenic effect.

One of the well-tolerated drugs, eliminating the formation of edema, weight gain, and increased appetite. Drospirenone, which is part of the composition, has the following features:

• softens the effect of estrogen;
• relieves manifestations of premenstrual syndrome;
• reduces blood cholesterol levels.

Monophasic drugs do not end with this list. There are also a significant number of representatives:

• Miniziston;
• Mercilon;
• Silest;
• Regividon;
• Dimia;
• Midiana.

Two-phase and three-phase agents

Experts prefer monophasic drugs to representatives of these groups due to fewer side effects. Biphasic ones are rarely used, which is why among them there are tablets whose names are not familiar even to pharmacists: Femoston, Anteovin, Binovum, Neo-Eunomin, Nuvelle.

Three-phase drugs, due to their physiological composition, are more popular, however, side effects and complications when taking them are no less pronounced. The representative of the group will be called as follows: the name begins with the prefix “three”. For example, Tri-regol, Tri-mercy, Trister, Triziston.

The tablets are colored differently depending on the phase of administration. Such drugs must be taken strictly according to the regimen that comes with the package.

Advantages and Disadvantages

Modern contraceptives have a lot of positive qualities, which makes them widely used:

• fast effect and high reliability;
• the ability of the woman herself to control the state of her fertility;
• knowledge of the means;
• low incidence of side effects;
• ease of use;
• lack of influence on the partner;
• reducing the possibility of developing an ectopic pregnancy;
• positive effect in the presence of benign tumor processes of the mammary gland;
• prevention of tumor processes of the female reproductive system;
• relief of manifestations of dysmenorrhea;
• positive effect on the condition of the skin, gastrointestinal tract, and musculoskeletal system.

The negative aspects of COCs include the need for regular use according to a specific regimen, as well as the possibility of delaying subsequent ovulation cycles after discontinuation of the drug.

Contraindications

Absolute contraindications for prescribing COCs are the presence of pregnancy, malignant tumors of the reproductive system and mammary glands, pathology of the liver, heart and blood vessels, acute thrombosis or thrombophlebitis, as well as uterine bleeding of unknown etiology.

Pathological conditions that create problems during the use of drugs include:

• arterial hypertension;
• epileptic condition;
• migraine;
• depression, psychosis;
• diabetes mellitus of any type;
• chronic liver pathologies;
• bronchial asthma;
• tuberculosis;
• porphyrin disease is a pathology of pigment metabolism, accompanied by a high level of porphyrins in the blood and their massive excretion in urine and feces;
• benign tumors of the uterus;
• upcoming immobilization or surgery.

There are a number of factors that reduce the effectiveness of the products used. These include dyspeptic symptoms in the form of vomiting and diarrhea, taking laxatives, antibiotics, and anticonvulsants. If vomiting and diarrhea occur within 3 hours of taking the last tablet, you need to take an additional one.

What are progestin oral contraceptives?

These are alternative drugs (mini-pills) that contain exclusively gestagens. Hormones from this group are needed in the following cases:

• older women;
• during lactation;
• those who smoke;
• those for whom COCs are contraindicated;
• patients with hypertension.

Progestin contraceptives have a higher Pearl index. It can reach 4%, which is a negative point for the contraceptive process. Representatives: Levonorgestrel, Charozetta, Ovret, Micronor.

Reception scheme

The tablets must be taken once a day at the same time. If a woman misses a dose, then she should take hormones as soon as she remembers, even if she has to take two tablets at the same time.

If a woman remembers the pill no later than 12 hours from the time of need to take it, the contraceptive effect remains, but after 12 hours, additional methods of protection should be used.

Urgent means

Emergency contraception is represented by drugs used in times of emergency. These drugs contain significant doses of hormones that prevent the ovulation process or change the functional state of the endometrium of the uterus. The most famous are Postinor, Escapelle, Ginepriston. Cases when there is a need to take such drugs should be as rare as possible, since they cause a huge hormonal surge in the body.

How to choose an oral contraceptive

The specialist assesses the hormonal balance of the patient’s body and determines what minimum dose of the drug will be able to show the desired effect. The dose of estrogen should not be higher than 35 mg, and the dose of gestagen (in terms of levonorgestrel) - 150 mcg. The doctor also pays attention to the woman’s constitutional type. There are three main types:

• with a predominance of estrogen;
• balance;
• with a predominance of gestagens.

Representatives of the first type are suitable for those products that have an increased dose of gestagens, the third - with an increased level of the estrogen component. If a woman has signs of an increased amount of male sex hormones, the ideal option would be to use drugs with an enhanced antiandrogenic effect.

The gynecologist also evaluates the condition of the patient’s reproductive organs. Heavy menstruation over a long period, increased size of the uterus are factors in increased estrogen levels in the body. Scanty menstruation in combination with uterine hypoplasia indicates high levels of gestagen.

Currently, the most used are combined mono- and triphasic oral contraceptives, which have a low dose of hormonally active substances included in the composition. These products have the same effectiveness and safety if you follow the rules for their use. The choice between specific representatives is made on the basis of each individual clinical case. Confirmation that the contraceptive has been chosen correctly is the absence of uterine bleeding or bloody discharge between menstruation.

References

1. Obstetrics: course of lectures. UMO stamp for medical education. Strizhakov A.N., Davydov A.I., Budanov P.V., Baev O.R. 2009 Publisher: Geotar-Media.
2. Obstetrics. National leadership. UMO stamp for medical education. Ailamazyan E.K., Radzinsky V.E., Kulakov V.I., Savelyeva G.M. 2009 Publisher: Geotar-Media.
3. Preeclampsia: theory and practice. Ailamazyan E.K., Mozgovaya E.V. 2008 Publisher: MEDpress-inform.
4. Intrauterine infection: Management of pregnancy, childbirth and the postpartum period. UMO stamp for medical education. Sidorova I.S., Makarov I.O., Matvienko N.A. 2008 Publisher: MEDpress.
5. Clinical recommendations. Obstetrics and gynecology. Savelyeva G.M., Serov V.N., Sukhikh G.T. 2009 Publisher: Geotar-Media.