For medical professionals only
This fruit is grapefruit!
Contraceptives are commonly used drugs in obstetrics and gynecology, and the family is also very large, and the compound oral contraceptive pill (COC), that is, the short-acting oral contraceptive, is the most widely used in clinical practice.
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Contraceptives are the miracle medicine of obstetrics and gynecology,
Clinical applications are very extensive
In addition to contraception, there are many clinical uses for contraceptives:
1. Abnormal uterine bleeding
Abnormal uterine bleeding (AUB) refers to bleeding from the uterine cavity during non-pregnancy, including irregular menstrual cycles, inexhaustible menstrual cycles, excessive or too little menstrual flow, contact bleeding, etc., and is one of the most common symptoms of gynecological diseases.
Causes of abnormal uterine bleeding include endometrial polyps, adenomyosis, uterine fibroids, endometrial malignancy, and atypical hyperplasia, in addition to coagulation-related diseases, ovulation dysfunction, endometrial abnormalities, and the use of intrauterine devices can also cause abnormal uterine bleeding.
Multiple related guidelines indicate that COCs can be used to reduce abnormal uterine bleeding.
2. Premenstrual syndrome
Premenstrual syndrome (PMS) refers to a syndrome that occurs periodically before menstruation that affects a woman's daily life and work, involves physical, mental and behavioral symptoms, occurs during the luteal phase, and can disappear naturally after menstruation.
The cause of PMS is currently unclear, and COCs and antidepressants are preferred for treatment.
3. Effect on endometriosis, adenomyosis and dysmenorrhea
COC is a first-line treatment for pain associated with primary dysmenorrhea and endometriosis (endometriosis), and can treat adenomyosis-related pain and increased menstrual volume, with the option of periodic or continuous medication.
COC can prevent pain and recurrence of ectopic cysts after endeopathic surgery.
Adenomyosis can cause severe dysmenorrhea and increased menstrual flow. COC can shrink the endometrium and ectopic endometrium, reduce menstrual flow, and reduce dysmenorrhea.
4. Pelvic pain (CPP)
Pelvic pain is also a common symptom of gynecological diseases for many reasons, and pelvic inflammation is a common cause. COC reduces pelvic inflammation and is the most affordable drug of choice for the treatment of CPP, helping to reduce the incidence of CPP.
5. Uterine fibroids
One in 4 women of childbearing age may have uterine fibroids, and COCs cannot shrink the volume of uterine fibroids, but can reduce menstrual volume and control menstrual cycles.
6. Polycystic ovary syndrome (PCOS), hirsutism
COCs are first-line agents for adjusting the menstrual cycle and treating hyperandrogenemia in patients with PCOS, and are generally inclined to recommend low-dose formulations. For PCOS patients of childbearing age who do not have fertility requirements to adjust their menstrual cycles, COC is the first choice and is recommended for continuous use.
The most common cause of hirsutism in women is polycystic ovary syndrome (PCOS). COCs containing 3rd generation progestin, and COCs containing progesterone with antiandrogenic effects are first-line medications for the treatment of hirsutism. For people with thrombophilia, coCs containing 2nd generation progestin may be considered for hirsutism to reduce the risk of thrombosis.
7. Acne
Increased androgen levels or increased androgen receptor sensitivity can lead to excessive secretion of sebum, which is an important cause of acne. All COCs have a potential therapeutic effect on acne and are ideal for female acne patients with contraceptive requirements.
8. Postpone menstruation
Some women want to have less or postpone menstruation due to dysmenorrhea, exams and other reasons. To suppress menstruation and reduce the number of months, the method of continuous cocing is undoubtedly the best choice.
Therefore, we must look at the contraceptive pill with the right eye.
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When taking birth control pills,
Don't eat grapefruit!
When taking contraceptives, the most feared thing for most people is to miss them, which will affect the contraceptive effect.
In fact, the efficacy of contraceptives will also be affected by certain foods, and it is also one of the most popular fruits in winter - grapefruit!
One study showed that taking 1-2 grapefruit after taking the pill, or taking the contraceptive pill directly with grapefruit juice, led to a significant reduction in the efficacy of the pill. If it is contraception, it may be "like to be a mother".
This is because the active ingredients such as furancoumarin contained in grapefruit, especially grapefruit, can inhibit the activity of liver drug enzymes in the human body, thereby affecting drug metabolism and excretion. It is recommended that women should avoid eating grapefruit or drinking grapefruit juice for 3 days before taking the pill and for 6 hours after taking the pill. Citrus fruits and juices, which are close relatives of grapefruit, have a similar effect, and it is best not to consume them in large quantities while taking birth control pills.
Insert a hot knowledge often used in speculative fiction and comics: grapefruit can affect the efficacy of many drugs, in addition to contraceptives, there are sildenafil citrate (commonly known as Viagra), antihypertensive drugs, lipid-lowering drugs, sleeping pills, antiallergic drugs, immunosuppressants (such as cyclosporine) and so on.
In a chapter in Moriarty, an uncle dies because he took heart medicine with grapefruit.
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There are also these drugs
It can also affect the efficacy of contraceptives
Some commonly used medications may also affect the effectiveness of contraceptives:
1. Rifampicin: it is a commonly used anti-tuberculosis drug, which can accelerate the metabolism of norethindrone and ethinyl estradiol, the main components of oral contraceptives, reduce the concentration of drugs in the blood, and may also make the endometrium partially detached and drip bleeding or dripping, so that the efficacy of contraceptives is reduced.
2. Antibiotics: Antibiotics will inhibit the intestinal bacterial population, so that the amount of glucuronidase produced is greatly reduced, thereby affecting the absorption of contraceptives in the intestine, so that the concentration of contraceptives in the blood decreases.
3. Antiepileptic drugs: Such drugs are inducers of enzymes, including phenobarbital, phenytoin, carbamazepine, primidone, etc. When taking such drugs, it can promote the increase of intracellular drug replacement enzymes, accelerate the destruction of oral contraceptives, and also increase the binding rate of progesterone and globulin, so that the free drug concentration is greatly reduced.
4. Griseofulvin: is an antifungal drug, when used in conjunction with contraceptives, it can change the activity of liver microsomal enzymes, so that steroid hormones decrease and menstrual blood is reduced.
5. Enzyme enhancers: sedative sleeping pills such as sleeping ertong have enzymatic effects, which can promote the metabolic activity of liver microsomal enzyme catalytic drugs, accelerate the metabolism of oral contraceptives, and reduce the contraceptive effect. If sleeping pills are necessary, use tranquilizers instead.
Therefore, women who need to take the above drugs for a long time need to take contraceptives under the guidance of a doctor.
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Precautions for taking birth control pills
1. Long-term use of COC can lead to an increased risk of cardiovascular diseases such as venous thromboembolism (VTE), stroke and myocardial infarction. Therefore, do not take it for a long time.
2. Women who regularly take contraceptives should regularly monitor blood pressure, liver and kidney function to avoid harm to the body.
3. Since the contraceptive pill can reduce the content of VitB6 and folic acid in the blood, women who take contraceptives for a long time should eat more fresh vegetables and fruits and supplement folic acid.
bibliography:
Chinese expert consensus expert group on the clinical application of compound oral contraceptives. Chinese expert consensus on the clinical application of compound oral contraceptives[J]. Chinese Journal of Obstetrics and Gynecology, 2015(2):81—91.
Source of this article: Medical Community Obstetrics and Gynecology Channel
Author: Red bean barley
Editor-in-Charge: Ichikawa