medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2018-12-146-151medsovet-2579Research ArticleГИНЕКОЛОГИЯGYNECOLOGYКомбинированная оральная контрацепция. Есть ли ресурс для расширения использования?Combined oral contraception: is there a resource for increased use?КузнецоваИ. В.KuznetsovaI. V.

д.м.н., профессор

MD, Prof.

ЕвсюковаЛ. В.EvsyukovaL. V.

к.м.н.

PhD in medicine

КоноваловВ. А.KonovalovV. A.

к.м.н.

PhD in medicine

ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский университет)РоссияI.M.Sechenov First Moscow State Medical University, Federal State Autonomous Educational Institution for Higher Education of the Ministry of Health of Russia (Sechenov University)Russian FederationФГБОУ ВО «Рязанский государственный медицинский университет им. академика И.П. Павлова» Минздрава РоссииРоссияI.P.Pavlov Ryazan State Medical University, Federal State Autonomous Educational Institution for Higher Education of the Ministry of Health of RussiaRussian Federation201825072018012146151Copyright © Кузнецова И.В., Евсюкова Л.В., Коновалов В.А., 20182018Кузнецова И.В., Евсюкова Л.В., Коновалов В.А.Kuznetsova I.V., Evsyukova L.V., Konovalov V.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/2579

Комбинированные оральные контрацептивы (КОК) являются высокоэффективным методом предохранения от нежеланной беременности, но, к сожалению, ресурс их противозачаточного и терапевтического потенциала используется недостаточно, и около 40% беременностей во всем мире наступают незапланированно. Причинами отсутствия должного распространения КОК являются недостаточная осведомленность о полезных свойствах контрацепции наряду с преувеличенными опасениями негативных последствий приема гормонов как среди женщин, так и среди врачей. Преодолеть эту проблему можно только с помощью предоставления адекватной информации медицинским работникам относительно накопленных данных и доведения этой информации до потенциальных пользователей. В обзоре рассматриваются риски вероятных осложнений, а также профилактические и лечебные преимущества некоторых КОК. Группа КОК представлена препаратами, свойства которых могут существенно отличаться из-за различной дозы эстрогенного компонента и качественной характеристики прогестинов. Несмотря на появление новых комбинаций, заслуживают внимания КОК, данные об эффективности и безопасности которых подтверждает длительная практика применения.

Combined oral contraceptives (COCs) are a highly effective method for preventing unintended pregnancy, but unfortunately, the resource of their contraceptive and therapeutic potential is not used enough, and global unintended pregnancies account for about 40%. The reasons for the lack of proper distribution of COCs are insufficient awareness of the beneficial properties of contraception, along with exaggerated fears of the adverse effects of hormone intake both among women and among doctors. This problem can only be overcome by providing adequate information to health professionals regarding the accumulated data and bringing this information to potential users. The review examines the risks of possible complications, as well as the preventive and therapeutic benefits of some COCs. The COC group is represented by preparations, which properties may differ significantly due to the different dose of the estrogen component and the qualitative characteristics of the progestins. Despite the launch of new combination drugs, COCs deserve high attention. Their efficacy and safety is confirmed by the long practical administration.

 

комбинированные оральные контрацептивыосложнения КОКлечебные эффекты КОКпрофилактические эффекты КОКпрогестиныдезогестрелcombined oral contraceptivescomplications of COCtherapeutic effects of COCspreventive effects of COCsprogestinsdesogoestrelumReferencesAlkema L, Kantorova V, Menozzi C, Biddlecom A. National, regional and global rates and trends in contraceptive prevalence and unmet need for family planning between 1990 and 2015: a systematic and comprehensive analysis. Lancet, 2013, 381(9878): 1642-1652.Alkema L, Kantorova V, Menozzi C, Biddlecom A. National, regional and global rates and trends in contraceptive prevalence and unmet need for family planning between 1990 and 2015: a systematic and comprehensive analysis. Lancet, 2013, 381(9878): 1642-1652.Daniels K, Daugherty J, Jones J. Current contraceptive status among women aged 15–44: United States, 2011–2013. NCHS Data Brief 2014, 173: 1-8.Daniels K, Daugherty J, Jones J. Current contraceptive status among women aged 15–44: United States, 2011–2013. NCHS Data Brief 2014, 173: 1-8.Hannaford PC, Iversen L, Macfariane TV, et al. Mortality among contraceptive pill users: cohort evidence from Royal College of General Practitioners’ Oral Contraception Study. BMJ, 2010, 340: 927.Hannaford PC, Iversen L, Macfariane TV, et al. Mortality among contraceptive pill users: cohort evidence from Royal College of General Practitioners’ Oral Contraception Study. BMJ, 2010, 340: 927.Sedgh G, Singh S, Hussain R. Intended and unintended pregnancies worldwide in 2012 and recent trends. Stud Fam Plann, 2014, 45(3): 301–314.Sedgh G, Singh S, Hussain R. Intended and unintended pregnancies worldwide in 2012 and recent trends. Stud Fam Plann, 2014, 45(3): 301–314.Bank J, Yun SC, Kim YM, Khang YH. Impact of unintended pregnancy on maternal mental health: a causal analysis using follow up data of the Panel Study on Korean Children (PSKC). BMC Pregnancy Childbirth, 2015, 15: 85.Bank J, Yun SC, Kim YM, Khang YH. Impact of unintended pregnancy on maternal mental health: a causal analysis using follow up data of the Panel Study on Korean Children (PSKC). BMC Pregnancy Childbirth, 2015, 15: 85.Tsui Amy O, McDonald-Mosley R, Burke AE. Family planning and the burden on unintended pregnancies. Epidemiol Rev, 2010, 32(1): 152-174.Tsui Amy O, McDonald-Mosley R, Burke AE. Family planning and the burden on unintended pregnancies. Epidemiol Rev, 2010, 32(1): 152-174.De La Rocherbrochard E, Joshi H. Children born after unplanned pregnancies and cognitive development at 3 years: social differentials in the United Kingdom Millenium Cohort. Am J Epidemiol, 2013, 178(6): 910–920.De La Rocherbrochard E, Joshi H. Children born after unplanned pregnancies and cognitive development at 3 years: social differentials in the United Kingdom Millenium Cohort. Am J Epidemiol, 2013, 178(6): 910–920.Kadir R, James AH. Reproductive health in women with bleeding disorders. Canada: World Federation of Hemophilia, 2009, 15 p.Kadir R, James AH. Reproductive health in women with bleeding disorders. Canada: World Federation of Hemophilia, 2009, 15 p.Национальные медицинские критерии приемлемости методов контрацепции. М., 2012, 16 с.National medical eligibility criteria for contraceptive methods. M., 2012, 16 pLidegaard O, Lokkegaard E, Svendsen AL, Agger C. Hormonal contraception and risk of venous thromboembolism: national follow-up study. BMJ, 2009, 339: b2890.Lidegaard O, Lokkegaard E, Svendsen AL, Agger C. Hormonal contraception and risk of venous thromboembolism: national follow-up study. BMJ, 2009, 339: b2890.Previtali E, Bucciarelli P, Passamonti SM, Martinelli I. Risk factors for venous and arterial thrombosis. Blood Transfus, 2011, 9: 120–138.Previtali E, Bucciarelli P, Passamonti SM, Martinelli I. Risk factors for venous and arterial thrombosis. Blood Transfus, 2011, 9: 120–138.Curtis S, Evens E, Sambisa W. Contraceptive discontinuation and unintended pregnancy: an imperfect relationship. Int Perspect Sex Reprod Health, 2011, 37(2): 58–66.Curtis S, Evens E, Sambisa W. Contraceptive discontinuation and unintended pregnancy: an imperfect relationship. Int Perspect Sex Reprod Health, 2011, 37(2): 58–66.Trussell J. Contraceptive failure in the Unated States. Contraception, 2011, 83(5): 397–404.Trussell J. Contraceptive failure in the Unated States. Contraception, 2011, 83(5): 397–404.Дикке Г.Б., Ерофеева Л.В. Контрацепция в современной России: применение и информированность (популяционное исследование). Акушерство и гинекология, 2016, 2: 105–110.Dicke GB, Erofeeva LV. Contraception in modern Russia: application and awareness (population research). Akusherstvo i Ginekologiya, 2016, 2: 105-110.Денисов Б.П. Применение контрацепции в России (по материалам выборочного обследования). Доказательная медицина и клиническая эпидемиология, 2009, 1: 34–39.Denisov BP. The use of contraception in Russia (based on a sample survey). Dokazatelnaya Meditsina i Klinicheskaya Epidemiologiya, 2009, 1: 34-39.Lindh I, Blohm F, Andersson-Ellströ m E, et al. Contraceptive use and pregnancy outcome in three generations of Swedish female teenagers from the same urban population. Contraception, 2009, 80: 163–169.Lindh I, Blohm F, Andersson-Ellströ m E, et al. Contraceptive use and pregnancy outcome in three generations of Swedish female teenagers from the same urban population. Contraception, 2009, 80: 163–169.Lawrie TA, Helmerhorst FM, Maitra NK, et al. Types of progestogens in combined oral contraception: effectiveness and side-effects. Cochrane Database Syst Rev, 2011, 11: CD004861.Lawrie TA, Helmerhorst FM, Maitra NK, et al. Types of progestogens in combined oral contraception: effectiveness and side-effects. Cochrane Database Syst Rev, 2011, 11: CD004861.Dinger JC, Bardenheuer K, Assmann A. International Active Surveillance Study of Women Taking Oral Contraceptives (INAS-OC Study). BMC Med Res Methodol, 2009, 9: 77.Dinger JC, Bardenheuer K, Assmann A. International Active Surveillance Study of Women Taking Oral Contraceptives (INAS-OC Study). BMC Med Res Methodol, 2009, 9: 77.Veljković M, Veljković S. The risk of breast, cervical, endometrial and ovarian cancer in oral contraceptive users. Med Pregl, 2010, 63(9–10): 657– 661.Veljković M, Veljković S. The risk of breast, cervical, endometrial and ovarian cancer in oral contraceptive users. Med Pregl, 2010, 63(9–10): 657– 661.Dossus L, Allen N, Kaaks R, et al. Reproductive risk factors and endometrial cancer: the European Prospective Investigation into Cancer and Nutrition. Int J Cancer, 2010, 127(2): 442–451.Dossus L, Allen N, Kaaks R, et al. Reproductive risk factors and endometrial cancer: the European Prospective Investigation into Cancer and Nutrition. Int J Cancer, 2010, 127(2): 442–451.Vessey M, Yeates D, Flynn S. Factors affecting mortality in a large cohort study with special reference to oral contraceptive use. Contraception, 2010, 82(3): 221–229.Vessey M, Yeates D, Flynn S. Factors affecting mortality in a large cohort study with special reference to oral contraceptive use. Contraception, 2010, 82(3): 221–229.Moorman PG, Havrilesky LJ, Gierisch JM, et al. Oral contraceptives and risk of ovarian cancer and breast cancer among high-risk women: a systematic review and meta-analysis. J Clin Oncol, 2013, 31: 4188–4198.Moorman PG, Havrilesky LJ, Gierisch JM, et al. Oral contraceptives and risk of ovarian cancer and breast cancer among high-risk women: a systematic review and meta-analysis. J Clin Oncol, 2013, 31: 4188–4198.Havrilesky LJ, Gierisch JM, Moorman PG, et al. Oral contraceptive use for the primary prevention of ovarian cancer. Evid Rep Technol Assess (Full Rep), 2013, 212: 514.Havrilesky LJ, Gierisch JM, Moorman PG, et al. Oral contraceptive use for the primary prevention of ovarian cancer. Evid Rep Technol Assess (Full Rep), 2013, 212: 514.Beral V, Doll R, Hermon C, Peto R, Reeves G. Ovarian cancer and oral contraceptives: collaborative reanalysis of data from 45 epidemiological studies including 23,257 women with ovarian cancer and 87,303 controls. Lancet, 2008, 371: 303–314.Beral V, Doll R, Hermon C, Peto R, Reeves G. Ovarian cancer and oral contraceptives: collaborative reanalysis of data from 45 epidemiological studies including 23,257 women with ovarian cancer and 87,303 controls. Lancet, 2008, 371: 303–314.Havrilesky LJ, Moorman PG, Lowery WJ, et al. Oral contraceptive pills as primary prevention for ovarian cancer: a systematic review and meta-analysis. Obstet Gynecol, 2013, 122: 139–147.Havrilesky LJ, Moorman PG, Lowery WJ, et al. Oral contraceptive pills as primary prevention for ovarian cancer: a systematic review and meta-analysis. Obstet Gynecol, 2013, 122: 139–147.Sitruk-Ware R, Nath A, Mishell DR. Contraception technology: past, present and future. Contraception, 2013, 87(3): 319–330.Sitruk-Ware R, Nath A, Mishell DR. Contraception technology: past, present and future. Contraception, 2013, 87(3): 319–330.Bonafede MM, Miller JD, Lukes AS et al. Retrospective database analysis of clinical outcomes and costs for treatment of abnormal uterine bleeding among women enrolled in US Medicaid programs. Clinin Econom Outcom Res, 2014, 6: 423–429.Bonafede MM, Miller JD, Lukes AS et al. Retrospective database analysis of clinical outcomes and costs for treatment of abnormal uterine bleeding among women enrolled in US Medicaid programs. Clinin Econom Outcom Res, 2014, 6: 423–429.ACOG Practice Bulletin No. 136: Management of Abnormal Uterine Bleeding Associated With Ovulatory Dysfunction. Obstet Gynecol, 2013, 122: 176-185.ACOG Practice Bulletin No. 136: Management of Abnormal Uterine Bleeding Associated With Ovulatory Dysfunction. Obstet Gynecol, 2013, 122: 176-185.ACOG. Management of acute abnormal uterine bleeding in non-pregnant women. Committee Opinion № 557. Obstet Gynecol, 2013, 121: 891-896.ACOG. Management of acute abnormal uterine bleeding in non-pregnant women. Committee Opinion № 557. Obstet Gynecol, 2013, 121: 891-896.ACOG Practice Bulletin No. 136: Management of Abnormal Uterine Bleeding Associated With Ovulatory Dysfunction. Obstet Gynecol, 2013, 122: 176-185.ACOG Practice Bulletin No. 136: Management of Abnormal Uterine Bleeding Associated With Ovulatory Dysfunction. Obstet Gynecol, 2013, 122: 176-185.ACOG. Management of acute abnormal uterine bleeding in non-pregnant women. Committee Opinion № 557. Obstet Gynecol, 2013, 121: 891-896.ACOG. Management of acute abnormal uterine bleeding in non-pregnant women. Committee Opinion № 557. Obstet Gynecol, 2013, 121: 891-896.Munro MG, et al, for the FIGO Working Group on Menstrual Disorders. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Intern J Gynecol Obstet, 2011, 113: 3–13.Munro MG, et al, for the FIGO Working Group on Menstrual Disorders. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Intern J Gynecol Obstet, 2011, 113: 3–13.SOGC. Abnormal Uterine Bleeding in Pre-Menopausal Women. J Obstet Gynaecol Can, 2013, 35(5 Suppl 1): 1-28.SOGC. Abnormal Uterine Bleeding in Pre-Menopausal Women. J Obstet Gynaecol Can, 2013, 35(5 Suppl 1): 1-28.Chandra V, Kim JJ, Benbrook DM, Dwivedi A, Rai R. Therapeutic options for management of endome-trial hyperplasia. J Gynecol Oncol, 2016, 27(1): e8.Chandra V, Kim JJ, Benbrook DM, Dwivedi A, Rai R. Therapeutic options for management of endome-trial hyperplasia. J Gynecol Oncol, 2016, 27(1): e8.Berenson AB, van den Berg P, Williams KJ, Rahman M. Effect of injectable and oral contraceptives on glucose and insulin levels. Obstet Gynecol, 2011, 117(1): 41–47.Berenson AB, van den Berg P, Williams KJ, Rahman M. Effect of injectable and oral contraceptives on glucose and insulin levels. Obstet Gynecol, 2011, 117(1): 41–47.Weill A, Dalichampt M, Raguideau F, Ricordeau Ph, et al. Low dose oestrogen combined oral contraception and risk of pulmonary embolism, stroke, and myocardial infarction in five million French women: cohort study. BMJ, 2016, 353: i2002.Weill A, Dalichampt M, Raguideau F, Ricordeau Ph, et al. Low dose oestrogen combined oral contraception and risk of pulmonary embolism, stroke, and myocardial infarction in five million French women: cohort study. BMJ, 2016, 353: i2002.Mayeda ER, Torgal AH, Westhoff CL. Weight and Body Composition Changes During Oral Contraceptive Use in Obese and Normal Weight Women. J Womens Health (Larchmt), 2014, 23(1): 38–43.Mayeda ER, Torgal AH, Westhoff CL. Weight and Body Composition Changes During Oral Contraceptive Use in Obese and Normal Weight Women. J Womens Health (Larchmt), 2014, 23(1): 38–43.Blum RW, Astone NM, Decker MR, et al. A conceptual framework for early adolescence: A platform for research. Int J Adolesc Med Health, 2014, 26: 321e31.Blum RW, Astone NM, Decker MR, et al. A conceptual framework for early adolescence: A platform for research. Int J Adolesc Med Health, 2014, 26: 321e31.Rothman KJ, Wise LA, Sørensen HT, Riis AH, Mikkelsen EM, Hatch EE. Volitional Determinants and Age-related Decline in Fecundability: A General Population Prospective Cohort Study in Denmark. Fertil Steril, 2013, 99(7): 1958–1964.Rothman KJ, Wise LA, Sørensen HT, Riis AH, Mikkelsen EM, Hatch EE. Volitional Determinants and Age-related Decline in Fecundability: A General Population Prospective Cohort Study in Denmark. Fertil Steril, 2013, 99(7): 1958–1964.Holinka CF, Brincat M, Coelingh Bennink HJT. Preventive effect of oral estetrol in a menopausal hot flash model. Climacteric, 2008, 11(Suppl 1): 15–21.Holinka CF, Brincat M, Coelingh Bennink HJT. Preventive effect of oral estetrol in a menopausal hot flash model. Climacteric, 2008, 11(Suppl 1): 15–21.Coelingh Bennink HJT, Heegaard A-M, Visser M, Holinka CF, Christiansen C. Oral bioavailability and bone-sparing effects of estetrol in an osteoporosis model. Climacteric, 2008, 11(Suppl 1): 2–14.Coelingh Bennink HJT, Heegaard A-M, Visser M, Holinka CF, Christiansen C. Oral bioavailability and bone-sparing effects of estetrol in an osteoporosis model. Climacteric, 2008, 11(Suppl 1): 2–14.Kannis JA, Adams J, Borgström F, et al. The cost-effectiveness of alendronate in the management of osteoporosis. Bone, 2008, 42(1): 4–15.Kannis JA, Adams J, Borgström F, et al. The cost-effectiveness of alendronate in the management of osteoporosis. Bone, 2008, 42(1): 4–15.Allali F, Mansouri L, Abourazzak F, et al. The effect of past use of oral contraceptive on bone mineral density, bone biochemical markers and muscle strength in healthy pre and post menopausal women. BMC Women’s Health, 2009, 9: 31.Allali F, Mansouri L, Abourazzak F, et al. The effect of past use of oral contraceptive on bone mineral density, bone biochemical markers and muscle strength in healthy pre and post menopausal women. BMC Women’s Health, 2009, 9: 31.Allen RH, Cwiak CA. Contraception for midlife women. Menopause, 2016, 23(1): 183–191.Allen RH, Cwiak CA. Contraception for midlife women. Menopause, 2016, 23(1): 183–191.Schindler AE. Non-contraceptive benefits of oral hormonal contraceptives. Int J Endocrinol Metab, 2013, 11(1): 41-47.Schindler AE. Non-contraceptive benefits of oral hormonal contraceptives. Int J Endocrinol Metab, 2013, 11(1): 41-47.Кузнецова И.В. Персональный подбор гормональной контрацепции. Гинекология, 2017, 19(2): 36–44.Kuznetsova IV. Personal choosing of hormonal contraceptives. Ginekologiya, 2017, 19 (2): 36-44.

The authors declare that there are no conflicts of interest present.