What are contraceptive combination preparations?
Combination preparations contain an estrogen and a progestogen hormone. All combination preparations contain the estrogen ethinylestradiol in an amount of 15 to 50 micrograms. As a progestogen hormone, several substances are used with varying properties. Combination preparations are available in the form of a pill (DE pill), a patch and a vaginal ring.
The hormones in the combination preparations block the release of the natural hormones in the pituitary gland (the brain attachment) that are needed to stimulate the ovaries to produce a mature egg. That means that no more eggs are released and therefore no fertilization can take place. The progestagens are responsible for the blockage of ovulation. The estrogen has been added to make the womb lining stronger so that no intermediate bleeding occurs during the use of these combination preparations and there is a withdrawal bleed during the stopping week that looks like a menstrual period.
Because the ovaries are brought to a resting phase by the combination preparations, these preparations are not only suitable for preventing pregnancy, but also for the treatment of severe and painful bleeding. Moreover, the chance of having uterine lining or ovarian cancer later in life is reduced by approximately 50%. With the pill there are daily varying amounts of the hormones administered in the body. At the patch and the ring, the hormone release is constantly distributed over 24 hours.
How do you use contraceptive combination preparations?
If the pill, patch or ring is started for the first time, there is already immediate protection against pregnancy if it is started on the first or second day of menstruation. If a start is made later in the cycle, additional contraception is required during the first 3-week period. If you change your pill or switch to a patch or ring, you can simply start the new pill, patch or ring at the end of the week. Even then, the method immediately protects against pregnancy.
The pill must be swallowed daily. It is advisable to take the pill at a fixed time, for example in the evening. In this way, the chance of forgetting a pill is the smallest. Therefore, place the pill strip in a fixed place, for example near the toothbrush or on the bedside table. There can be a maximum of 12 hours of play in the time of ingestion. The pill then remains reliable. If the pill is taken more than 36 hours after the previous pill, the rules for forgetting the pill should be followed. See the failed contraceptive brochure .
The Evra® contraceptive patch should be changed weekly. The patch can be stuck anywhere on the skin with the exception of the breasts and the inside of the thighs. It is important to stick the plaster on a clean and dry piece of skin, preferably before a shower or bath. Most shower and bath foams contain cream-like fabrics, making the plaster easier to release. If the patch is glued on beforehand, the risk of releasing is extremely small. The plaster also stays in place when swimming and in the sauna.
The Nuvaring® contraceptive ring is inserted into the vagina once every 3 weeks. Inserting is as easy as inserting a tampon. In sexual intercourse the ring may be removed for a short time, but as a rule this is not necessary. As a reminder to remove the ring after 3 weeks and to put it back in a week later (after the stop week), stickers can be pasted in the agenda. You can also use the free SMS service. A text message is then sent when the ring has to be removed and inserted again. Register for this SMS service on the site of the nuvaring.
A stop week is planned after three weeks for both the pill, plaster and ring. As a rule, bleeding occurs during the stop week, which is less than when no hormones are used. The stopping week is intended to simulate the normal cycle. The stopping week may never last longer than 7 days. From a medical point of view, a stopping week is not necessary. More and more women are choosing to skip the stop week and continue immediately with the next pill strip, patch or ring. Skipping the stopping week has no adverse consequences for health and later fertility. Moreover, skipping the stop week is safer. Forgetting one or more pills usually has no consequences. Skipping the stop week does mean that intermediate bleeding may occur. The advice is to insert a stopping week if the intermediate bleeding becomes a nuisance. A short stopping week of three or four days is then sufficient for the bleeding to continue. After that, you can simply continue to swallow the pill, stick a new patch or insert the ring.
How reliable are the contraceptive combination preparations?
If the combination preparations are used exactly according to the instructions, the chance of becoming pregnant is less than half a percent per year. In practice, the chance of getting pregnant appears to be greater, especially when using the pill. The most common cause is forgetting the pill.
About 80% of pill users in the Netherlands forget to take the pill on time one or more times each year. But also not replacing the ring in time after sexual intercourse or not restarting the pill, ring or patch on time after the stop week is a common reason. Diseases associated with vomiting or prolonged diarrhea can reduce the intake of the pill. Some medicines and homeopathic remedies in which St John’s wort is used also reduce the effectiveness of the pill.
What are the side effects of contraceptive combination preparations?
When a pill, bandage or ring is first started, the body needs time to adjust to the hormones administered. The breasts are then often more sensitive, sometimes some fluid is retained and a nausea may occur. As a rule, these symptoms have disappeared after about three months. With longer use, irregular bleeding may occur during use or the bleeding may disappear completely. Sometimes depressive feelings arise, the desire to make love may decrease, weight may increase slightly, pain may occur in sexual intercourse or there may be more discharge.
Compared with women who do not use hormones, the risk of thrombosis and / or embolism is slightly increased when using combination preparations, especially during the first two years of use. The chance is also increased after switching to a different combination preparation. There is a slightly increased risk of cardiovascular disease, especially in combination with cigarette smoking. There is also a slightly increased chance of slight disturbances in sugar metabolism, a slight increase in blood pressure, benign liver disorders and possibly a slightly increased chance of developing breast cancer. However, compared to pregnancy, the risks of these side effects are considerably less.
When to the doctor?
Combination preparations are only available on prescription. This means that a visit to the doctor is necessary when a pill, patch or ring is started for the first time. If the chosen preparation is satisfactory then this can be repeated by the pharmacist without further intervention of the doctor. Repeat requests can also be handled by online pharmacies. If the preparation is changed, a new prescription and therefore a new visit to the doctor are also required.
A visit to the doctor is also necessary at:
- irregular bleeding during the use of the pill, patch or ring with the exception of intermediate bleeding that occurs during the first 3 months of use
- the absence of bleeding during the stopping week to exclude pregnancy
- unexplained (muscle) pain in one of the calves, possibly. in combination with redness to exclude thrombosis
- unexplained chest pain to rule out heart disease or embolism
- a lump in the chest
- increased secretion from the sheath
- increasing pain during sex
- decrease in the desire to make love
- strong weight gain
- aggravation of headache complaints
- the development or worsening of depressive feelings
- the onset or onset of acne (pimples)
Contraceptive combination preparations, are they suitable for you?
For most women, a combination preparation (pill, patch or ring) is a suitable form of birth control. However, combination preparations should not be prescribed to women who:
- be pregnant
- suffer from irregular bleeding, the cause of which is not (yet) clear
- have severely elevated blood pressure
- have a seriously elevated cholesterol level
- have a liver disease
- have a clotting abnormality
- have diabetes (diabetes) in combination with severe vascular disease, such as high blood pressure
- have (had) a thrombosis or embolism
- have (had) breast cancer
- have (had) liver cancer
- have ever had a brain haemorrhage or a TIA
- be over 35 years old and smoke
- use drugs that reduce efficacy such as some drugs in the treatment of epilepsy
- are hypersensitive to one or more components of the chosen preparation
Plaster and ring are preferred for women with irregular lives such as flight attendants, pilots and women, who have a profession with varying services such as in nursing or care. Also with women with chronic gastrointestinal disorders such as with Crohn’s disease, a patch or ring is preferred. The patch is not suitable for women weighing more than 80 kg.
General advice and precautions
The pill only protects against pregnancy, not against sexually transmitted diseases (venereal diseases). To be protected against sexually transmitted diseases, the use of a barrier agent such as a condom or female condom is necessary. More about this can be read in the brochure barrier means.
Extra protection is not required only in a stable sexual relationship. It is recommended to use extra protection in a new relationship and to test both partners after 3 months for the most common sexually transmitted diseases such as chlamydia and HIV. Testing can be done via the doctor, or if desired anonymously via a GGD institution.
There are a number of situations that can reduce the effect of the pill such as vomiting, diarrhea or medication use. If vomiting occurs within 4 hours after taking the pill, the pill must be considered as not taken. Often the pill can then be taken again within 12 hours after the normal time of intake. If this does not work or if the pill is then vomited again, the rules for forgetting the pill must be followed. See also the failed contraceptive brochure .
Diarrhea is as a rule a condition of the last part of the intestines. Because the pill is already absorbed in the first part of the gastrointestinal tract, namely in the stomach and duodenum, diarrhea does not generally have any effect on the effect of the pill. The effect of the pill is reduced if the diarrhea is treated with drugs such as Norit® or Agarol®. The effect of the pill can also be reduced if there are longer-lasting watery diarrhea.
The effect of the pill is reduced when using the following medications:
- the tuberculostatic rifampicin
- the antimycotic griseofulvine
- the antiepileptic drugs phenytoin, phenobarbital, primidone, carbamezapine and ethosuximide
- the anti-epileptic lamotrigine (Lamictal®) may only be used together with combination preparations if the stopping week is skipped
- St. John’s wort (in a number of homeopathic remedies)
The use of antibiotics has no influence on the effect of the pill. However, sometimes the effect may be reduced by additional complaints during use such as vomiting and diarrhea.
With prolonged use of medicines that influence the reliability of the pill, it may be wise to switch to another contraceptive.
Source : dokterdokter