Complications at reception the COOK
Complications at reception the COOK — the undesirable or dangerous side effects arising at the use of hormonal contraceptives. Are shown by emotional lability, headaches, a mastodiniya, leykorey, gastrointestinalny frustration, an itch in genitals, a hyperpegmentation, virilization signs, an aggravation of a number of chronic diseases. Uses of tool methods are diagnosed by means of a research of a condition of a hemostasis, pigmentary exchange, fermental systems (ultrasonography, KT, MPT, a X-ray analysis, endoscopy). At treatment waiting tactics is applied, correction of appointments, cancellation of medicines, therapy of medical emergencies is carried out.
Complications at reception the COOK
COC (the combined oral contraceptives) — effective and safe medicines for prevention of undesirable pregnancy. Their protecting effect is based on oppression of secretion of gonadotrophins, the termination of an ovulation, increase in viscosity of cervical slime, endometrium regression, decrease in sokratitelny activity of fallopian pipes. Frequency of side effects when using estrogen-gestagennykh of means in the first months of their reception makes 10-40%, in the subsequent — no more than 5-10%. According to observations, the threat for health of the women accepting the COOK is 10 times lower, than at pregnancy, childbirth, abortions. In spite of the fact that the risk of unplanned pregnancy because of insufficient efficiency of hormonal contraceptives does not exceed 0,1%, in Russia this method of protection because of fear of complications is applied by no more than 25% of women, and in recent years this indicator tends to reduction.
The reasons of complications at reception the COOK
Side effects of the combined oral contraceptives have a polietiologichesky basis. Their emergence and degree of expressiveness in many respects depend on specific features of the woman — constitutional predisposition, age, the state of health. According to experts in the sphere of obstetrics and gynecology, are the main reasons for complications at hormonal contraception:
- Mechanism of action of the COOKS components. Receptors to the estrogen and progestins which are a part of oral contraceptives are not only in reproductive organs and gipotalamo-hypophysial area. They are revealed in different fabrics which functioning changes at hormonal stimulation. Therefore at an imbalance of hormones tranzitorny or permanent polyorgan violations, temporary or constant functional insufficiency of various bodies and systems can be noted.
- Existence of the obvious and latent pathology. There is a number of relative and absolute contraindications for appointment the COOK. Reception of contraceptives can show a congenital trombofiliya, not diagnosed liver pathology, to provoke complications and to worsen the forecast at IBS, arterial hypertension, angiopatiya, the complicated diseases of the valvate device of heart, malignant new growths, thromboses of deep veins, diabetes with complications, diseases of a liver and kidneys.
- Individual sensitivity. The inherited and acquired features immune and fermental systems, addictions are capable to raise a susceptibility of an organism of the woman to action of the COOKS main components, and also to cause the atypical answer. On any substance which is a part of contraceptives there can be an allergic reaction. The risk of intolerance of medicines increases at obesity of the III-IV degree, smoking more than 15 cigarettes a day, the use of some medicines.
The mechanism of development of complications at reception the COOK is connected with hormonal effects of estrogen and progestagen, and also with violation balance estrogen-gestagennogo at the specific patient. On observations of obstetricians-gynecologists, the majority of undesirable manifestations is caused in the women accepting oral contraceptives by influence of the estrogen entered into structure the COOK for control over menstrual function. Etinilestradiol has prokoagulyantny effect (increases coagulability of blood), promotes development of an aldosteron under the influence of whom in an organism sodium and water are late that HELL, increase in weight is followed by reversible increase. The stimulating effect of estrogen on mammary glands often is shown by a mastodiniya, on mucous vaginas — strengthening of vaginal allocations, on skin — stimulation of melanotsit and emergence of a hyperpegmentation.
In pathogenesis of complications of hormonal contraception progestins also play a role. They render the weakening effect on gladkomyshechny muscles that leads to emergence of locks, an abdominal distension, bile outflow violation. Androgenic activity of the derivatives of a 19-nortesteron entering in the COOK of the 1st generation is shown by stimulation of anabolic processes, emergence of signs of a virilization. Competitive interaction of progestins with glucocorticoid receptors leads to insulin resistance development, strengthening of synthesis of triglycerides and bilious acids that increases probability of obesity. At the expense of inhibition the caused estrogen of proliferation and a karnifikation of a vaginal epithelium violation of a vaginal biocenosis and colonization of a mucous kandidama is possible. In atypical cases oppression of secretion of gonadotrophins of a gestagenama and an anovulyation can be resistant, remain after medicine cancellation.
A number of complications the COOK are caused by insufficient effect of hormones because of a low dosage at the wrong selection of medicine, the admission of reception of tablets, deterioration in absorption at vomiting and diarrhea, an inactivation owing to interactions with some antibacterial, anticonvulsive, adrenoblokiruyushchy means. In such cases endometrium maturing is broken, there are smearing or breakthrough bleedings, the strengthened menstrualnopodobny reaction more often. The pathological processes happening in target organs usually aggravate expressiveness of side effects of contraceptive hormonal therapy. The COOKS components are also capable to strengthen proliferation of gormonochuvstvitelny cancer cells.
For systematization of complications when using oral contraceptives use criteria of time of emergence of side effects, the mechanism of development, firmness and the nature of violations. The frustration arising within the first 3 months of reception the COOK are called early. Usually they are tranzitorny, have adaptive character. The late complications connected with organic changes are found on 3-6 months of contraception. The consequences of use of hormonal contraceptive medicines remaining later their cancellations are considered remote. Taking into account the mechanism of development distinguish estrogen - dependent and gestagen-dependent complications. For the choice of optimum medical tactics the COOK it is expedient to classify undesirable consequences of reception on the following groups:
- General clinical violations. Are presented by functional and organic frustration which turn out to be consequence of system estrogenic and progestinovy effects. Include a wide range of complications, from easy vegetative and emotional violations to a heavy decompensation of associated diseases.
- Disorders of menstrual function. Are usually caused by the insufficient or raised dose of the COOKS hormonal components or atypical reaction to a contraceptive. Are shown by the intermenstrual smearing allocations or "breakthrough" bleedings, the strengthened menstrualnopodobny reaction, amenorey.
Symptoms of complications at reception the COOK
In the first three months of the use of hormonal contraceptives the woman can show complaints to a headache, dizzinesses, the increased irritability, bad mood, morbidity and a nagrubaniye of mammary glands, hypostases, developing of intermenstrual bleedings, nausea, vomiting, an abdominal distension, a chair delay, a hyperpegmentation of skin (hloazma), an itch in a vagina, bleach which in most cases pass independently. Reception the COOK 2 generations often is followed by androgenic effects — increase in greasiness of skin, emergence of acne rash, a girsutizm, increase in weight by 4,5 kg and more.
The permanent violations of work of a gastrointestinal tract, skin manifestations, emotional frustration, adynamy, decrease in sexual desire remaining more than 3 months a delay or lack of menstrualnopodobny reaction are usually noted at mistakes in selection of a dosage, the increased individual sensitivity and existence of associated diseases. At 2% of the women applying estrogen-gestagennye the medicines, an anovulyation and leading to infertility remain after the contraception termination. Some clinical symptoms testify to a decompensation of somatic pathology. At the stagnation of bile provoked by oral contraceptives, the patient tests a persistent itch, emergence of ekskoriation, yellownesses of skin is possible.
The most terrible consequences of application the COOK are the sharp tromboembolichesky violations demanding emergency medical service. Sudden developing of short wind, a blood spitting is characteristic of a thrombembolia of a pulmonary artery. At obstruction of vessels of an abdominal cavity the woman feels intensive long abdominal pains. Damage of arteries of a retina is followed by sudden violation or loss of sight. Violation of passability of arteries and veins of extremities is shown by unilateral pain in a groin, a gastrocnemius muscle, a sleep, muscular weakness. Sharp forms of defeat of kardialny and brain vessels are the myocardial infarction and a stroke with the corresponding clinical symptomatology.
At suspicion on development of complications in the woman who accepts the COOK assessment of nature of organ violations, an exception of diseases reckon with similar clinical symptomatology as the main objectives of a diagnostic stage. By drawing up the scheme of inspection consider the nature of clinical manifestations demonstrating the general reaction to introduction of hormones or defeat of concrete body. The recommended screening methods of diagnostics are:
- Ultrasonography of a small pelvis. It is shown at disorder of menstrual function, complaints to vaginal allocations. Allows to estimate a condition of reproductive organs, to reveal pregnancy, some diseases (submukozny myoma, endometrial cancer, polyps of a mucous uterus, etc.). If necessary the sonografiya is supplemented with KT, MPT, a kolposkopiya, a tservikoskopiya, hysteroscopy, a diagnostic laparoscopy, crops of dab on flora, other tool and laboratory gynecologic researches.
- Assessment of system of a hemostasis. It is carried out at detection of signs of possible tromboembolichesky complications. Links of the curtailing system react to reception the COOK both vascular , and coagulative, at the same time aggregation activity often increases from a cycle to a cycle of use of medicine. Existence of the menacing violations is demonstrated by reduction of activity of anti-thrombin-III to 50-60% and below, increase in aggregation of platelets up to 50%, increase in concentration of the fibrin degradation products (FDP) in plasma till 8-10 MSC/ml and more.
- Research of exchange of pigments and enzymes. Changes of biochemical indicators are characteristic of a decompensation of the hepatic pathology (a holestaz, chronic persistiruyushchy hepatitis, dyskinesia of biliary tract) provoked by reception the COOK. Level of bilious acids, direct bilirubin increases in blood. Increase in activity of alkaline phosphatase, is possible (ALT, NUCLEAR HEATING PLANT). Laboratory analyses can be supplemented with ultrasonography of a liver and a gall bladder, a holedokhoskopiya, endosonografiy bilious ways.
- Survey mammography. It is carried out at persistent complaints to a mastodiniya which does not pass independently 3 months later after the beginning of reception the COOK. The radiological research of mammary glands provides timely detection of breast cancer which can progress at contraception estrogen-gestagennymi means. When determining signs of neoplastic processes in addition appoint aim mammography, a duktografiya, a biopsy of a mammary gland, the analysis on an onkomarker CA 15-3 and other researches.
Side effects of oral contraceptives differentiate with inflammatory and tumoral diseases of female genitals, secondary amenorey other origin, pathology of a liver, biliary tract, arterial and venous tromboembolichesky frustration, a hypertension, migraine, other pathological states with similar symptomatology. The endocrinologist, the gastroenterologist, the hepatologist, the phlebologist, the neuropathologist, the mammologist, the ophthalmologist, the pulmonologist, the oncologist, the vascular surgeon can be involved in survey of the woman.
Treatment of complications at reception the COOK
The pathological effects caused by reception of the combined oral contraceptives at most of patients pass independently against the background of further use or cancellation of medicine. Sometimes correction of violations requires purpose of medicamentous therapy and even rendering the surgical help. When maintaining patients with complications of hormonal contraception use the following therapeutic approaches:
- Waiting tactics. Usually for 3 months the woman's organism completely adapts to reception the COOK. If expressiveness of early nonspecific frustration significantly worsens quality of life of the patient, symptomatic means — vegetable sedative medicines, soft laxatives, bile-expelling and diuretic phytocollecting can be applied to their correction.
- Medicine replacement. Revision of appointments is justified at violations of menstrual function. Similar complications are usually observed at insufficient or excess influence of hormonal components of an oral contraceptive. Use of medicine of other generation becomes the optimal solution. Similar approach is recommended at identification of androgenic complications.
- Cancellation COOK. Existence of resistant late complications, obvious glucocorticoid effect, a decompensation of somatic diseases, development of oncological pathology forms the basis for the termination of reception of oral contraceptives and selection of an alternative method of contraception. In these cases involve profile experts in treatment of the arisen complications.
- Fight against medical emergencies. Emergence of the serious somatic frustration which are mainly connected with tromboembolichesky violations demands immediate purpose of intensive therapy, and in some cases and carrying out surgical interventions (removal of blood clots, stenting of vessels). The choice of the scheme of treatment is defined by a type of sharp pathology.
Forecast and prevention
At the majority early and parts of the late complications of reception the COOK which are not connected with development of medical emergencies, the forecast favorable. Before purpose of hormonal contraception the woman with the preventive purpose is carefully examined for identification of contraindications. On the basis of the obtained data the patient is carried to the corresponding class of safety. To women from the K1 group (the 1st class of safety) oral contraceptives are appointed without restrictions. At the 2nd class of safety (K2) the method is admissible, its advantages outweigh potential risks. To patients from the K3 group (the 3rd class of safety) estrogen-gestagennye of means is recommended only at inaccessibility or unacceptability of other methods of protection. Belonging to the 4th class of safety (K4) serves as a contraindication to use the COOK. For the purpose of reduction of risk of possible complications preference is given micro and to the low-dosed medicines by 2-4 generations.