Резюме
Лахно І.В., Неєлова О.В., Пак С.А., Даниленко О.К. Контрацептивний вибір пацієнток : вплив на масу тіла і менструальний контроль.
Проведено дослідження ефективності, наявності побічних ефектів і переносимості пацієнтками вагінального комбінованого гормонального кільця Нува Ринг порівняно з мінідозованим КОК з дроспіреноном і мікродозірованним КОК з гестоденом. Показана краща переносимість пацієнтками застосування Нува Ринг за рахунок меншої кількості небажаних системних ефектів контрацептивних стероїдів, більш надійного менструального контролю та аналогічного представленим в роботі КОК відсутності впливу на масу тіла. Нува Ринг є високоефективним і безпечним методом контрацепції.
Ключові слова: контрацепція, побічні ефекти, менструальний котроль, маса тіла, Нува Ринг .

Резюме
Лахно И.В., Неелова О.В., Пак С.А., Даниленко О.К. Контрацептивный выбор пациенток: влияние на массу тела и менструальный контроль.
Проведено исследование эффективности, наличия побочных эффектов и переносимости пациентками влагалищного комбинированного гормонального кольца Нува Ринг по сравнению с минидозированным КОК с дроспиреноном и микродозированным КОК с гестоденом. Показана лучшая переносимость пациентками применения Нува Ринг за счет меньшего количества нежелательных системных эффектов контрацептивных стероидов, более надежного менструального контроля и аналогичного представленным в работе КОК отсутствия влияния на массу тела. Нува Ринг является высокоэффективным и безопасным методом контрацепции.
Ключевые слова: контрацепция, побочные эффекты, менструальный котроль, масса тела, Нува Ринг.

Summary
Lakhno I.V., Neelova O.V., Pak S.A., Danilenko O.K. Patients contraceptive choice: influence on body weight and menstrual control.
It was performed the investigation of efficacy, side effects assessment and acceptability of vaginal combined hormonal ring Nuva Ring comparatively to drospirenone- and gestodene-containig combined pills. It was shown better patients tolerance because of the less side-effects, more competent menstrual control and the most absolute absence of the body weight gain. Nuva Ring is an effective and safe method of contraception.
Key words: contraception, side effects, menstrual control, body weight, Nuva Ring.

Рецензент: д.мед.н., проф. О.В. Грищенко

УДК 618.14-002-07

Харьковская медицинская академия последипломного образования

Kharkov medical academy of Postgraduate Education

oksana.neelova78@gmail.com

Днепропетровская городская клиническая больница № 9

Dnipropetrovsk City Clinical Hospital № 9

danilenko_o.66@mail.ru

The goal of the work was realization of comparative research of efficiency, acceptability and tolerability by the patients of complex contraceptive ring Nuva Ring with combined oral contraceptives (COC) containing 30 mcg of ethinyl estradiol and 3 mgs of drospirenone, 20 mcg of ethinyl estradiol and 75 mcg of gestodene.

There were 300 patients of fertile age who needed realization of contraceptive measures under our supervision. Research lasted for 12 months and included 13 cycles. The examined patients were in the age from 18 to 28 years old that did not have defection of menstrual function. Before and after ending of the work it were conducted colposcopy and  oncocytological  researches for  all cohort. Comparison was made by groups including 100 women in each. Patients of the Ist group used the ring of Nuva Ring. The ІІnd group was prescribed COC containing 30 mcg of ethinyl estradiol and 3 mgs of drospirenone, and the IIId one was prescribed 20 mcg of ethinyl estradiol and 75 mcg of gestodene. All of the patients presented in the research were acquainted with the rules of the contraceptives usage. They got questionnaires in which were reflected the studied indexes. The estimation was conducted in a 1 week after the end of  1, 3, 6, 9 and 13 cycle of the contraceptive usage.

The middle age of the patients presented in the research was: 22,3±2,4 years; 23,1±2,6 years and 21,9±3,1 years in the Іst, ІІnd and ІІІd groups accordingly. Middle body mass for examined patients was by groups: 65, 8±6,8 kg; 66,1±7,3 kg and 65,7±6,4 kg.  BMI was 23,9±3,6 kg/м²; 24,1±4,6 kg/м² and 23,8±4,2 kg/м² in the  Іst, ІІnd and ІІІd groups accordingly. The amount of episodes of cephalalgias  during all cycles of contraceptives application was the following: 8,2±1,4; 10,3±2,1 and 12,1±2,4 for the patients of the  Іst, ІІnd and ІІІd groups accordingly. Breast tenderness made 10,6±1,8 cases for patients using Nuva Ring as a contraceptive, 22,8±4,5 for women on a background of usage  COC with drospirenone and 20,2±5,6 for users of ultra low dose  COC with gestodene. It is possible to suppose greater influence of estrogenic component on mammary glands for patients getting COC. Sicchasia was marked in 2,1±0,3 cases for the representatives of the Іst group, and in the ІІnd and ІІІd groups it was in 14,2±3,1 and 16,5±4,6 cases. On the whole it should be noted more evident adverse reactions of contraceptive steroids being included in composition of COC. Leucorrhoea was met considerably more often in the  Іst group in 18,6± 4,8 cases, and in the ІІnd and ІІІd groups it was marked  in 5,1±0,6 and 3,4±0,4 supervisions. It was related to the certain colpo trophic  effect of ethinyl estradiol at direct influence on the mucic sheath. It is necessary to mark that to 13 cycle the amount of episodes of leucorrhoea  has considerably decreased.

Concerning the influence on control of menstrual cycle the research results testify to  lower frequancy of the breakthrough bleeding and spotting for patients in all cycles of Nuva Ring usage in comparison with  COC users. According to  this index the combined hormonal ring Nuva Ring  showed  almost treble superiority in comparison with investigated COC in the first cycles of application (p<0,05). In spite of tendency to reduction of the breakthrough bleedings and spotting in the IInd and IIId groups it was not marked the complete reduction of the indicated phenomena even to 1 year of the usage.

The study of dynamics of body mass for the patients of the basic clinical groups did not show statistically meaningful differences even to the end of research. The middle increase of mass made: 0,36±0,02 kg, 0,34±0,02 kg and 0,38±0,04 kg for the patients of the Іst, ІІnd and ІІІd groups accordingly. In the process of work it were registered 3 contraceptive failures that were equally distributed by groups. Consequently the presented contraceptives showed identical efficiency.

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