Transcript Non-contraceptive benefits hormonal contraception after

Non-contraceptive benefits
hormonal contraception
after abortion
(hormonal rehabilitation)
Moscow Regional Research Center of
Obstetrics & Gynecology, Moscow
Olga Serova, M.D., professor
Long-term sequelae
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Inflammatory diseases
Menstrual disorders
Reproductive function’ disorders
High risk complications of subsequent pregnancies
High risk of perinatal pathology
Maternal mortality
Abortion Prevention
 Safe abortion technology
 Rehabilitation after abortion
 Effective contraception
Post-abortion bleeding
6,5 days
6 days
4,5 days
Medical abortion
Vacuumaspiration
Surgical abortion
Time of first menstrual period
after abortion
48,2
40,2
29,1
Medical abortion
Vacuumaspiration
Surgical abortion
Hormonal disorders after abortion
4%
12%
26%
Surgical abortion
Vacuum aspiration
Medical abortion
Decidua during medical abortion
Pathmorphological analysis of materials after
vacuum aspiration
Pathmorphological analysis of materials after
surgical abortion
7th day’s endometrial after medical abortion
7th day’s endometrial after
vacuum aspiration
7th day’s endometrial after
surgical abortion
Appropriate transformation after medical
abortion
Delayed endometrium’ transformation after
vacuum aspiration
Incomplete endometrium’ transformation after
surgical abortion
Hormonal rehabilitation
Medical abortion
3 months
Vacuum aspiration
3 months
• Monophasic COC
• Monophasic COC
Regulon
• Microdosis COC
Novinett
Regulon
• Microdosis COC
Novinett
Surgical abortion
3 months
Monophasic COC
Regulon
Post-abortion contraception
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efficacy
safe
no side-effects
prevention inflammatory diseases
Differential approach to choice of COC
Acne, hirsutism
Dismenorrea
Menstrual disorders
PCOS
Diabetus melitus
Endometriosis
Obesity
Teens/Young age
Regulon
Regulon
Regulon
Regulon, Novinett
Novinett
Novinett
Regulon, Novinett
Novinett
Benefits of the desogestrel-containing COC
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Efficacy
Acceptability
No side effects (anabolic, androgenic)
No influence on BP, lipid and carbohydrate
metabolism
Non-contraceptive benefits of desogestrelcontaining COC
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Menstrual cycle regulation
Reducing dysmenorrhea symptoms
Reducing blood bleeding
Hyperandrogenia
Endometriosis treatment
Protective effects of desogestrel-containing COC
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risk’s of an extrauterina pregnancy
risk’s of an endometrial and an ovarian carcinoma
risk’s of benign mammary gland
risk’s of ovarian cysts and benign ovary’ and uterus’ tumors
risk’s of inflammatory diseases
risk’s of haemorrhage in women with coagulopathy
risk’s of leiomyoma and endometriosis
Follow-up
 Control side effects, BP
 Laboratory tests in women with somatic diseases
(1 time in 6 months)
 Pelvic exam, including colposcopy and colpocytology
(1 time in a year)
 Ultrasound (1 time in a year, in require)
 Breast exam (1 time in 6 months), mammography
1 time in a year) and ultrasound (in some indications)
COC benefits
 Long application
 Return fertility just after stopping
 Possibility of cancel in case of side effects
or complications
Effectiveness of the rehabilitation after abortion
(1 year follow-up)
2,0%
1,8%
1,6%
1,4%
1,2%
1,0%
0,8%
0,6%
0,4%
0,2%
0,0%
2,0%
0%
surgical abortion
vacuum aspiration
menstrual disorders
0%
medical abortion