akusherstvoObstetrics, Gynecology and ReproductionАкушерство, Гинекология и Репродукция2313-73472500-3194IRBIS LLC10.17749/2313-7347/ob.gyn.rep.2021.329akusherstvo-1349Research ArticleОRIGINAL ARTICLESОРИГИНАЛЬНЫЕ СТАТЬИControl of side effects in strategy for increasing adherence to combined oral contraceptives. The role for a three-phase desogestrel-containing drugМенеджмент побочных эффектов в стратегии повышения приверженности к комбинированным оральным контрацептивам. Роль трехфазного препарата, содержащего дезогестрелhttps://orcid.org/0000-0001-9524-8962ДиккеГ. Б.DikkeG. B.

Дикке Галина Борисовна – доктор медицинских наук, профессор кафедры акушерства и гинекологии с курсом репродуктивной медицины. 

190013 Санкт-Петербург, Московский проспект, д. 22, лит. М

Galina B. Dikke – MD, Dr Sci Med, Professor, Department of Obstetrics and Gynecology with a Course of Reproductive Medicine 

22 Lit. M, Moskovskiy Avenue, Saint Petersburg 190013

galadikke@yandex.ruЧОУ ДПО «Академия медицинского образования имени Ф.И. Иноземцева»РоссияInozemtsev Academy of Medical EducationRussian Federation202227062022163244254Copyright © Dikke G.B., 20222022Дикке Г.Б.Dikke G.B.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gynecology.su/jour/article/view/1349Introduction

Introduction. The frequency of side effects when taking combined oral contraceptives (COCs) is still high, which is the reason for refusal to take COCs by women worldwide with a frequency of 30 to 81 %. Management of side effects will help increase the user's adherence to the chosen method of contraception.

Aim

Aim: to identify approaches to prevent users from refusing to take COCs due to side effects and increase adherence to their use.

Materials and Мethods

Materials and Мethods. The search for foreign literary sources in English was carried out in the international bases PubMed/MEDLINE, Google Scholar, Cochrane Library, in Russian in еLibrary database, by keywords: «hormonal contraception», «combined oral contraceptives», «side effects», «adherence». Search depth was 30 years (1992–2022). 437 and 74 articles were identified, respectively, of which the review included 44 manuscripts that satisfied the criteria for inclusion on the topic studied: full-text manuscripts with the results of original studies, systematic reviews and meta-analyses.

Results

Results. In the literature, there is a lower incidence of side effects of COCs containing 30–35 µg of ethinylestradiol (tri- and monophasic) compared with 20 micrograms of ethinylestradiol. It was found that the risk of intermenstrual bleeding is 30 % lower when using COCs containing thirdgeneration progestogens compared with second-generation progestogens (relative risk (RR) = 0.71; 95 % confidence interval (CI) = 0.55–0.91) using monophasic combinations as an example. The use of a three-phase COC containing desogestrel (DSG) was characterized by a low incidence of irregular bleeding (3.3 % in the first cycle and a decrease to 2.3 % by the 12th cycle), no effect on physiological parameters, a decrease in blood androgens content and a positive effect on seborrhea and acne, excellent tolerance (2.6% failures due to adverse events). Three-phase COCs are characterized by a lower frequency of intermenstrual bleeding (by 2 times) and amenorrhea (by 3 times) compared with other COCs. A positive effect on reducing the frequency of irregular spotting and breakthrough bleeding was shown when switching from a COC of another composition to a three-phase one containing DSG, and continuing to use it.

Conclusion

Conclusion. A three-phase COC containing DSG continues to be a topical hormonal contraceptive for women both for the first time and when switching from another COC due to side effects, including those associated with menstrual irregularities.

Введение

Введение. Побочные эффекты при приеме комбинированных оральных контрацептивов (КОК) являются причиной отказов от приема КОК женщинами во всем мире с частотой от 30 до 81 %. Управление побочными эффектами будет способствовать повышению приверженности пользователей к выбранному методу контрацепции.

Цель

Цель: определить подходы для предотвращения отказа пользователей от приема КОК по причине побочных эффектов и повышения приверженности к их использованию.

Материалы и методы

Материалы и методы. Поиск зарубежных литературных источников на английском языке проводился в международных базах PubMed/MEDLINE, Google Scholar, Cochrane Library, на русском языке – в базе eLibrary по ключевым словам: «гормональная контрацепция», «комбинированные оральные контрацептивы», «побочные эффекты», «приверженность», «hormonal contraception», «combined oral contraceptives», «side effects», «adherence». Глубина поиска составила 30 лет (1992–2022 гг.). Идентифицировано 437 и 74 статей соответственно, из которых в обзор были включены 44 источника, удовлетворявшие критериям включения по изучаемой теме: полнотекстовые источники с результатами оригинальных исследований, систематические обзоры и метаанализы.

Результаты

Результаты. В литературе отмечается более низкая частота побочных эффектов КОК, содержащих 30–35 мкг этинилэстрадиола (трех- и монофазных) по сравнению с 20 мкг этинилэстрадиола. Установлено, что риск межменструальных кровотечений на 30 % ниже при использовании КОК, содержащих прогестагены третьего по сравнению с прогестагенами второго поколения (относительный риск (ОР) = 0,71; 95 % доверительный интервал (ДИ) = 0,55–0,91) на примере монофазных комбинаций. Использование трехфазного КОК, содержащего дезогестрел (ДЗГ), характеризуется низкой частотой нерегулярных кровотечений (3,3 % в первом цикле и снижением до 2,3 % к 12-му циклу), отсутствием влияния на физиологические показатели, уменьшением содержания андрогенов в крови и положительным влиянием на себорею и акне, отличной приемлемостью (частота отказов – 2,6 % по причине нежелательных явлений). При приеме трехфазных КОК отмечается меньшая частота межменструальных кровотечений (в 2 раза) и аменореи (в 3 раза) по сравнению с иными КОК. Показано положительное влияние на снижение частоты нерегулярных кровянистых выделений и прорывных кровотечений при переключении с КОК с другим составом на трехфазный, содержащий ДЗГ, и продолжение его использования.

Заключение

Заключение. Трехфазный КОК, содержащий ДЗГ, продолжает оставаться актуальным средством гормональной контрацепции для женщин как впервые начинающих прием КОК, так и при переключении с другого КОК в связи с побочными эффектами, в том числе связанными с нарушением менструального цикла.

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