A new approach towards an old problem. Combined oral contraceptives in
uterine bleedings and dysmenorrhea in girls
E.V. Uvarova, N.M. Veselova, I.G. Gainova, I.A. Salnikova
Research Centre of Obstetrics, Gynecology and Perinatology, Moscow, Russia
Combined oral contraceptives (COC) have been used in the practice of juvenile
gynecology for many years. Most authors suggest using high-dose monophasic COC,
4 –6 pill per day. In such cases haemostatic dose often reaches 200 – 250
mcg EI per day. On the basis of our 8-years experience it was proved that in a
whole good haemostasis was noted after 2 pills of highdose COC (100 mcg EI), at
the same time the use of a high dose of medicament caused marked side effects in
the form of vomiting and sickness. After the bleeding has been arrested the
patients as a rule used low-dose medicaments during 1–3 months. A control
examination 3 – 6 months after the medicament withdrawal revealed preservation
of cycle disorders in all patients. Hormonal haemostasis with a low-dose Regulon
(ethinylestradiol 30 mcg, desogestrel 150 mcg) allowed not only to reduce
haemostatic dose of oral contraceptives to 60–75mkg reducing the dosage but
also to eliminate side effects in 95% of patients. Indications of pill every 4
hours and possibility to achieve haemostasis within 24–36 hours contributed to
that fact. Regulon was further indicated for 3 – 6 months during that period a
successful correction of somatic status and the coexisting endocrine and
metabolic disorders caused by the forming syndrome of polycystic ovaries.
Recurrence was found in 5% of patients. An important aspect of juvenile
gynecology is also treatment of dysmenorrhea. Up to now there haven’t been
clear criteria for patients enrollment for gestagen and OC treatment. Our study
demonstrated that there were clear criteria that allowed choosing hormonal
effect. It turned out that for patients with severe course of the disease on the
background of premenstrual ratio of estradiol and progesterone towards reducing
progensteron on the background of normal or elevated estradiol level as well as
parasymptomatic direction of tonus of vegetative nervous system the most of an
effect could be achieved with low-dose OC: Novynette (ethtinylestradiol 20 mcg,
desogestrel 150 mcg), Lindynette, logest (ethinylestradiol 20 mcg, gestoden 75
mcg). It is worth to note that COC are reliable preparations of choice for girls
with dysmenorrhea having sexual life. The data demonstrate the possibility of
good correction of the traditional methods of treatment of girls of pubertal age
with more frequent diseases leading to frequent loss of working abilities and
significant decrease of life quality.
