Hormonal contraceptives

Introduction

Among the safest and most effective contraceptive methods, hormonal contraceptives play a prestigious role. Hormonal contraceptives, in fact, are widespread drugs and, for many sexually active women with a fixed partner, constitute the first-choice contraceptive method.

Advantages and disadvantages

In addition to guaranteeing extremely high protection against 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 episodes of amenorrhea, irregular cycles and intermenstrual bleeding
They relieve menstrual pain
Lighten the symptoms of PMS
(Some) ensure a scarce menstrual flow
They help to alleviate some aesthetic disorders, such as acne
The incidence of ovarian and endometrial cancer decreases, and does 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 is important to emphasize that the use of hormonal contraceptive methods DOES NOT protect in any way from sexually transmitted diseases. For this reason, hormonal contraceptives are not indicated for occasional sexual intercourse or with multiple partners.

What are they?

The 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 or gluteus muscle, or implanted under the skin of the arm.

Among these, we recall:

Estro-progestin contraceptive pill
Minipillola (composed exclusively of progestins)
Vaginal ring
Transdermal patch
Progestin injection
Implantable hormonal contraceptive methods: IUDs and sticks
Post-coital contraception: which should NOT be considered a habitual contraceptive method.

Key points

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

Estroprogestinica contraceptive pill
General characters	Advantages	Disadvantages	Protection from unwanted pregnancies
The combined contraceptive pill is composed of estrogens (eg ethinyl estradiol) and progestogens (eg norethisterone levonorgestrel, etinodiol, desogestrel or gestodene) It should generally be taken for 21 consecutive days, followed by a 7-day suspension (during which the "fictitious" menstruation takes place) It works by inhibiting ovulation and making the cervical mucus less suitable for the passage of spermatozoa The combination of hormones (estrogens + progestogens) discourages fertilization and ovum implantation	Effective and safe contraceptive method Reduces the risk of amenorrhea It reduces the symptoms of premenstrual syndrome Reduces the incidence of ovarian fibroids and 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	Does not protect against MST Possible increase in body weight Possible increase in blood pressure It tends to slow down the metabolism (due to the inhibitory effect of the hormones contained in the thyroid hormone pill) Breast turgor cloasma Skin Xerosis Spotting (during the first months of employment) Increased body hair Nausea, hot flushes, dizziness, irritability Possible vaginal dryness Mild increase in the risk of cardiovascular disease Mild increased risk of breast cancer Hypertensive women should not use this contraceptive method Requires medical prescription	Extremely high: 93-99.9% Contraceptive efficacy could be compromised after episodes of vomiting or severe diarrhea (within 5 hours after administration) Efficacy is compromised by the concomitant intake of some drugs (antiepileptics, antibiotics, antiviali) or natural substances (eg hypericum)

Minipill (progestin)
General characters	Advantages	Disadvantages	Protection from unwanted pregnancies
The mini-pill is composed exclusively of progesterone (norethisterone, levonorgestrel or etinodiolo). It must be taken daily, without interruption Acts mainly in the mucus of the uterine cervix (rendered inhospitable to the sperm) Prevents implantation of the fertilized egg in the uterus	Does not interfere with blood pressure, blood clotting, lipid metabolism, cholesterol Does not alter vaginal pH Does not cause dry eyelids It does not generate breast turgor Does not cause cellulite Does not interfere with libido Does not interfere with lactation (can be taken immediately after giving birth)	Does not protect against MSTs For an optimal contraceptive coverage, the mini-pill must ALWAYS be taken at the same time (with a maximum tolerance of half an hour) May cause the gradual disappearance of menstruation (during the period of taking the mini-pill) Contraceptive safety significantly lower than the combined pill Contraceptive efficacy could be compromised after episodes of vomiting or severe diarrhea (within 5 hours after administration) Requires medical prescription	The contraceptive method offers high coverage against unwanted pregnancies (even if slightly lower than the combined pill): the effectiveness of the method is variable from 97 to 99.5% Efficacy can be compromised by the concomitant intake of some drugs (antiepileptics, antibiotics, antiviali) or natural substances (eg hypericum)

Vaginal ring (NuvaRing)
General characters	Advantages	Disadvantages	Protection from unwanted pregnancies
The contraceptive ring is a ring-shaped device, made of ethylene vinyl acetate (soft plastic, non-toxic and anti-allergic), which allows the slow and regular release of hormones: in this way, ovulation is denied The contraceptive method should be placed in the vagina by the woman, and left there for three consecutive weeks. During the fourth week (when menstruation occurs), the ring should be removed	The contraceptive ring is inserted and removed by the woman (medical aid is not necessary) It acts just like the contraceptive pill: what changes is the route of administration Does not interfere with the gastro-intestinal tract: the effectiveness of the contraceptive method is maintained even after episodes of vomiting or severe diarrhea Very high contraceptive safety It does not include the first hepatic passage The presence of the ring is imperceptible, even during a relationship Ensures excellent menstrual regularity	It does not protect against sexually transmitted diseases May cause side effects such as: genital itching, dizziness, acne, diarrhea, vomiting, asthenia, low back pain, mood alteration, decreased libido, leucorrhoea, breast turgor, dysmenorrhea It can favor the onset of mycotic infections (eg Candida albicans ) and bacterial infections . In fact, pathogens can nest near the device and cause damage The contraceptive method could spontaneously come out of the vagina during the first months of recruitment (rare) Change the contraceptive method if the symptoms persist beyond the first 2-3 months of intake	Very high (around 97-99.9%) The contraceptive efficacy is reduced in case of ring expulsion

Transdermal patch (Evra)
General characters	Advantages	Disadvantages	Protection from unwanted pregnancies
Action mechanism equivalent to that of the contraceptive pill It acts transdermally by releasing - just below the skin layer - a mix of estrogen and progestin hormones. Once in the bloodstream, hormones prevent ovulation. Increases the thickness of the cervical mucus, hindering the passage of spermatozoa into the uterine cavity The patch should be applied directly to clean, dry, glabrous, free of wounds, irritations or creams The patch should only be applied once a week, for 3 consecutive weeks, then leaving 7 days off (during which menstruation will take place)	It allows the woman to live a serene sexual life, separated 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 the suspension 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 neither weight gain nor the formation / increase of cellulite Unlike the pill, this contraceptive method does not generate allergic reactions / intolerances caused by lactose-based excipients	Does not protect against MST Contraindicated in obese or overweight women Contraindicated for smokers Possible contact dermatitis Spotting, metrorrhagia Possible oligomenorrhea and amenorrhea after withdrawal 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 Efficacy is compromised by the concomitant intake of some drugs or natural substances (eg hypericum)

Progestin injection (eg Prontogest)
General characters	Advantages	Disadvantages	Protection from unwanted pregnancies
The contraceptive method consists of intramuscular injections of progestin The injections must be repeated every three months in the deltoid muscle or in the buttock The contraceptive method exercises its therapeutic action by preventing ovulation	Useful for the treatment of gynecological disorders, such as hypermenorrhea, polymenorrhea, metrorrhagia, amenorrhea Prevents spontaneous abortions Only after three months, the woman can decide whether or not to continue using this contraceptive method Possible disappearance of menstruation during the drug intake period It can help prevent cancer of the uterus	Does not protect against sexually transmitted diseases The contraceptive method should not be used for over 2 consecutive years, as it can cause a temporary reduction in bone density May cause side effects such as spotting, increased body weight, 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 undergo a further progestin injection Rather high cost (30-75 dollars per injection) 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 again undergo a further injection of progestogen