Contraception, reproductive health and family planning
Doctors disagreed about the harm and benefits of hormonal contraception
Irina Vlasova, GZT.ru
On Wednesday, April 20, a meeting of doctors with the media devoted to the problems of women's reproductive health was held in Moscow.
Some doctors advocated a broader practice of using female hormonal contraceptives, citing the example of EU countries where they are used by up to 80% of women of childbearing age. Some experts in the field of medicine did not support the initiative of doctors, urging them to be careful with this type of contraception.
The main achievement of the XX centuryNatalia Tapilskaya, Professor of the Department of Oncology at the St. Petersburg State Pediatric Medical Academy, advocated the expansion of the practice of using hormonal contraception.
"If in the EU countries they are used by up to 80% of women of childbearing age, then in Russia – 3-4%," she said. This is facilitated by a number of myths, such as the fact that such contraceptives are "unnatural and affect health," and also cause weight gain. Modern contraceptives contain low doses of synthetic female sex hormones, similar to those formed in a woman's body. "The hormone content in them has been minimized over the years after many years of research, while the number of side effects has also decreased, while maintaining the effect of preventing pregnancy," said Professor Tapilskaya. "Third–generation drugs contain low (30-35 mcg) or minimal (20 mcg) doses of estrogens along with a high content of progestogens."
Who will protect the woman
Professor Tapilskaya said that women's reproductive health can and should be protected with contraception.
"I am an operating obstetrician–gynecologist - oncologist," Tapilskaya said, "for 25 years of practice, I see that women from the same family come to the department for surgery, since ovarian cancer has a pronounced heredity. If women were advised to use hormonal contraception, then their influence is such that daughters in this family could be saved from cancer problems."
The professor gave examples of reducing the risk of ovarian, uterine, lung cancer, as well as benign fibroids and ovarian cysts when using hormonal contraception. In addition, hormonal contraception solves a number of cosmetic women's problems: normalizes the condition of the skin and hair, relieves puffiness, treats acne.
There are risksWhen asked about the risks of using hormonal contraception, Professor Tapilskaya answered GZT.
It is known that there is a risk of venous, coronary and cerebral thrombosis in some women. Therefore, diseases such as stroke, heart attack, type 2 diabetes, tumors of the reproductive system and liver, venous thrombosis, neurological migraines, smoking over the age of 45 are contraindications to the appointment of hormonal contraceptives.
It is also impossible to use them when prescribing drugs of "competitive absorption" – sleeping pills or antibiotics.
According to other researchers, risk factors for the use of contraceptives with estrogens will also be age over 45, smoking, hypertension, obesity and gallstone disease. Obstetricians and gynecologists do not recommend using them for a month after oral surgery, during pregnancy and lactation.
In general, the researchers attribute to the positive properties of hormonal contraceptives their high efficiency with almost immediate contraceptive effect, low frequency of side effects and good control of the effectiveness of such therapy. In addition, there is evidence of a reduction in the risk of benign breast diseases, ovarian cancer, endometrial cancer and uterine fibroids, as well as a reduction in the risk of ectopic pregnancy. Contraception is especially important to prevent teenage pregnancies.
Disputed dataNevertheless, experts in the field of medicine agree that this type of contraception has not yet proven to be absolutely harmless.
"I treat hormonal contraception cautiously,– GZT said.EN expert of the Formulary Committee of the Russian Academy of Medical Sciences, specialist of the Center of Obstetrics and Gynecology named after Academician V.I.Kulakov (FSU NCAGiP) Professor Alexander Gus. – Science still has controversial data, decades of research are needed. If everything was so simple and it was possible to really reduce the number of cases of ovarian cancer with the help of hormonal contraceptives, it would not occur in such numbers."
Professor Gus noticed that there is evidence of an increase in breast cancer cases associated with taking hormonal drugs, other undesirable effects, because he advocates prescribing such contraception only as prescribed.
He is supported by Professor, head of the maternity department of the Federal State University NCAGiP. Kulakova, chief obstetrician-gynecologist of the Moscow Department of Health Oleg Baev: "If such contraception is prescribed according to indications, it gives a good effect. There are groups of women with a predisposition to certain diseases, in particular having problems with the endometrium, etc., it is good for them. In terms of effectiveness, if a couple wants to avoid pregnancy, hormonal contraceptives are now leading, but they have their own problems with side reactions."
Interviewed by GZT.EN doctors generally treat hormonal contraceptives with caution and do not exclude possible facts of lobbying by manufacturers of their products.
However, there are conditions in women when these hormonal pills are very useful, doctors say. This is, first of all, the state of health after childbirth or abortion. They are shown to women who have undergone ectopic pregnancy, iron deficiency anemia, endometriosis, severe premenstrual syndrome and dysmenorrhea.
The main disadvantages of the method are the need for daily use, when mistakes are not excluded when taking pills. Also, such contraception does not save from sexually transmitted infections. Everyone agrees that the method has adverse reactions, there is a decrease in the effectiveness of hormonal contraception while taking some other medications. In addition, many research data require further elaboration and cannot be interpreted unambiguously.
Clear policy The best information about the benefits and risks of using drugs is given to us by systematic reviews of all the studies conducted," explains Vasily Vlasov, Professor at the Higher School of Economics, President of the Society of Evidence–based Medicine Specialists.
Unlike the old contraceptive drugs, which caused a lot of unpleasant side effects, modern contraceptive drugs are relatively safe, says Professor Vlasov.
"As for their protective effect against the development of tumors, the information about this, although obtained in many studies, cannot be considered quite unambiguous. The fact is that hormones introduced into a woman's body act somewhat differently in youth, in middle age and at an older age. Thus, the use of hormonal contraceptives is accompanied by a decrease in the risk of ovarian cancer, and hormone replacement therapy with the same drugs increases the risk of ovarian cancer. An equally complex picture is revealed when studying the effect of hormonal contraceptives on the risk of breast cancer. In general, such drugs increase the risk of breast cancer and cervical cancer. From other cancers, a certain reduction in the risk of colon cancer and endometrial cancer (the inner lining of the uterus) has been established," he believes.
In addition to a small change in the risk of some tumors, which is not completely unambiguous, taking hormonal contraceptives repeatedly increases the risk of venous thromboembolism, Vasily Vlasov confirmed. And using such contraception in the hope of reducing the risk of getting cancer is frivolity.
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