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Janine consequence. Jeanine tablets (Jeanine) detailed instructions for use. Jeanine - official * instructions for use

Jeanine, hormonal pills, which belong to a new generation of contraceptives. They contain a reduced amount of the female hormones estrogen and progesterone. More and more women began to use contraceptives based on them. They have ceased to be terrible pills, from which more harm than good.

Indications

Jeanine contains ethinylestradiol, a synthetic estrogen. It performs all the functions of its own estrogen in the body.

The second substance that is part of the drug is dienogest. It is a substitute for natural progesterone and mimics the effect of the hormone on the body.

The pharmacological action of Zhanin is a contraceptive. It takes place in three stages:

1. when influencing the hypothalamic-pituitary system of a woman, ovulation is suppressed;
2. cervical mucus becomes more viscous and is an impenetrable barrier for spermatozoa;
3. there are changes in the structural and functional nature of the endometrium, so implantation becomes impossible.

In addition to protecting against unwanted pregnancy, Jeanine normalizes the menstrual cycle, suppresses pain and reduces the amount of discharge. It acts as a prophylactic against certain gynecological diseases, helps to restore the reproductive function of the body.

When using Janine tablets, the fairer sex has a stabilization of the hormonal background.

The drug suppresses the body's production of male hormones. Therefore, it is used to treat various forms of androgyny. Jeanine has a gentle effect on the body of a lady. It is quickly absorbed and excreted from the body. After the start of the application, the skin and hair of a woman changes for the better.

Which is better Janine or Clayra? When comparing the composition of the tablets, you can see that the dosage of hormones in the Qlaira preparation is lower relative to Zhanin. But the effectiveness of the drug does not suffer, it has a milder effect on the body. Therefore, if a woman has allergic reactions or she is simply sensitive to new substances, then it is recommended to take Qlaira. In any case, the first step is to consult a doctor.

pregnancy and hormones

Jeanine hormonal tablets with a therapeutic effect. By accepting them, the woman is protected from unwanted pregnancy, but time passes, and the couple decides to have a child.

It is worth noting that using contraceptives requires a break of up to three months after every 12 months of use. During the break, reproductive function is fully restored. In the case when the contraceptive was used for several years without a break, the chance of getting pregnant tends to zero. Then the question arises about IVF after Janine.

Oddly enough it sounds, but Jeanine's doctors prescribe it before the IVF protocol. This is done so that the woman's monthly cycle becomes more predictable and more, taking the drug, the ovaries are resting. Then during the IVF protocol they produce more follicles.

There is another option for Zhanin's non-standard appointment - this is before a planned pregnancy. According to research, the most productive period for conception is three months after stopping the use of contraceptives, which experts call the “rebound effect”. But for a successful operation, it is required to use Jeanine as prescribed by a doctor and strictly follow the course of admission, which can range from one month to a year.

claira

The hormonal drug Qlaira refers to contraceptives. However, it differs from others in that the composition of the drug includes estradiol. According to the chemical formula, it is identical to the natural hormone that is produced by the female body.

Which is better Silhouette or Clayra? These two hormonal drugs have the same composition and identical action. In fact, the Silhouette is an analogue of Qlaira. The only difference is their cost. The silhouette is cheaper than its fellow Qlaira.

Hormonal pills are required to start drinking correctly so that there are no disruptions in the body. If before the spouse did not take any contraceptive drugs, then it is necessary to start taking, for example, the hormonal drug Clotra, on the first day of the monthly cycle.

In the case of switching from other COCs, you need to start taking the next day after the last active tablet is drunk.

When switching from mini-pills, injections, implants or IUDs, it should be borne in mind that a change in the method of protection against unwanted pregnancy occurs on any day. If it is an IUD, then from the date of removal. If injections are refused, Qlaira hormones are taken from the day the injection was to be given. In any case, it is necessary, for the first nine days from the start of taking the drug, to insure and use additional condoms.

How to switch from Clayra to Janine? When switching from Qlaira to Jeanine, the dragee should be taken immediately the next day after the last tablet of Qlaira.

Contraindications

Consecrating the positive side of COC, one should not forget about the side effects on the body. All medications have side effects and contraindications for use. Hormonal pills are no exception. So, taking them, a woman may experience nausea, allergic reactions to constituent components, breast enlargement. It is required to take COC strictly daily, and only a doctor prescribes the course.

Pathologies in which hormonal drugs are prohibited:

• diseases of the heart and blood vessels;
• vein thrombosis;
• diabetes mellitus, in which there are vascular complications;
• oncology;
• vaginal bleeding that is abnormal;
• liver pathology.

This list includes the age of a lady over 35 and smoking. Before starting the use of hormonal tablets, you should carefully read the attached instructions.

Oral contraceptives, in addition to the contraceptive function, perform many more positive effects on the female body. They normalize menstruation, reduce blood loss, and alleviate premenstrual syndrome.

Hormonal pills are often included in the complex therapy for the treatment of dermatological diseases in women. They have a preventive effect on the oncology of the mammary glands, as well as the pelvic organs.

When taking hormonal drugs, the risk of ovarian cancer is reduced by 40%. This effect lasts for a long 15 years after the last intake of hormonal contraceptives.

Hormonal pills are a drug that is effective and unique, but at the same time it also has contraindications. Therefore, only the gynecologist decides which COCs to use and how long to take.

Janine is a popular contraceptive. In addition to the contraceptive effect, the use of the drug gives good results in the treatment of a large number of gynecological problems. Tablets do not harm a woman's health and can be used for many years, you can learn more from the reviews on the site.

This is a unique monophasic drug, in its composition it has synthetic analogues of female hormones, due to which contraceptive effect. The action of Janine tablets is no different from similar contraceptive drugs. The use of the drug in adolescents should be under the strict supervision of a gynecologist until the age of 18.

It is forbidden to take a contraceptive without a doctor's prescription, reviews on the Internet are only a method of research, and not a guide to action!

Release form

Jeanine contraceptive is produced in the form of milky, white or cream-colored pills for oral administration. The composition includes two main substances:

• ethinylestradiol;
• Dienogest (analogous to progesterone);

As well as excipients:

The cardboard pack contains 21 tablets packed in a blister. The package may contain one or three blisters. Also inside the package is an insert-instruction for use. In order not to become a victim of fakes, check out the reviews and appearance of Janine tablets on the Internet, photos will help you not to make a mistake.

The action of the drug

The main action of drugs and is carried out through the action of complementary mechanisms. Including an increase in the density of cervical mucus and inhibition of ovulation. Due to this, she does not miss sperm.

Proper use is a prerequisite for the use of the drug. Therefore, before starting the course, it is necessary to study the instructions and reviews. Otherwise, skipping pills or errors in the course can lead to an increase in the Pearl index.

Dienogest- the main progestogen component of janine tablets, the antiandrogenic activity of which is confirmed by clinical studies. It also increases the level of high density lipoproteins. Eliminates acne by inhibiting the activity of male hormones.

In addition to all of the above, the use of Janine tablets alleviates premenstrual syndrome in women. Long-term use normalizes the cycle, reduces pain, reduces the intensity and duration of discharge.

The drug is rapidly absorbed by the gastrointestinal tract after application, and dienogest is completely metabolized in the body. A certain amount of the component is excreted from the body in an unchanged state along with metabolites through urine and bile in a ratio of 3:1. Also, ethinylestradiol metabolites are excreted in the urine in a ratio of 4:6. Ethinylestradiol itself is completely absorbed in the body of a woman.

When choosing a drug, operate not only with reviews on the Internet, but also with the recommendations of your doctor.

It is necessary to take the drug strictly according to the instructions, 21 days 1 tablet per day. It is necessary to drink dragees with clean water. After consuming 1 pack, a seven-day break is required, during which the so-called withdrawal period is possible. These are menstrual-like discharges that begin a day or two after the last pill intake and can last until the start of the next package.

The drug janine is prescribed to women if any hormonal preparations were not taken in the previous months. In this case, the first tablet is consumed on the first day of bleeding. You can start on the second - fifth day of menstruation, but then the next seven days you need to use barrier contraception.

If a woman decides to switch to Janine after using the vaginal ring, oral contraceptives, transdermal patch. tablets should be taken one day after the previous drug, but no later than the last day of the seven-day break. When switching from a ring or patch, it is best to start taking pills immediately after removal and no later than the day the new ring or patch is inserted.

If the previous method of contraception was mini-pill, implant, injectable forms or Mirena, then a woman can switch to Janine any day, without a break from the mini-pill, and on the day of removal or the next injection. In all these cases, within a week after taking the starter pill, janine must be additionally protected by the barrier method.

If a woman has had an abortion in the third trimester of pregnancy, the use of dragees can begin immediately without additional protection.

After a postponed childbirth or abortion in the second trimester of pregnancy, the use of the drug occurs 21–28 days after the procedure. If more than 28 days have passed since the abortion or childbirth, then additional barrier contraception is required after the start of the course for seven days.

Persons under 18 years of age should be taken with extreme caution. In the first year of using the drug, carefully monitor your well-being.

If you forgot to take the drug

Delay in taking medications less than 12 hours does not reduce the effectiveness of protection, but the next dragee needs to be drunk as soon as possible. The next pill is taken as scheduled at the right time. A delay greater than 12 hours cancels the protective effect. (This refers to an interval of about 36 hours after taking the previous dragee.

Principles of taking contraceptives Jeanine:

• Adequate contraceptive effect is achieved within seven days after the start;
• Do not interrupt the drug for more than seven days;

So, what if the medicine has not been taken for more than 12 hours? It all depends on the period of taking the dragee and the stage of the course. In the first, second and third weeks of taking the drug, various measures are necessary. The closer the missed pill is to the seven-day break, the greater the likelihood of pregnancy. So, What should I do if I missed a dragee?

• Starting week of medication. The next dragee should be taken as quickly as possible, even if it requires drinking a couple of pieces at once. The subsequent administration of the drug is carried out at the standard time and during the week it is necessary to additionally use barrier contraception.
• The second week of taking the drug. It is necessary, as in the previous case, to take the next dragee as soon as the woman remembers this. The next pill is taken as usual. If during the previous seven days before the first missed pill, the woman took pills regularly, there is no need to use barrier contraception. However, if there was a recent break or this is not the first pass, additional barrier contraception must be used.
• Third week of taking the drug. The risk of pregnancy is very high due to the upcoming break in the course. Therefore, a woman has two options for action in such a situation. The first option includes the standard prim rules for being late. The next dragee is taken at the standard time, before the end of the pack. Then you must immediately start drinking dragees from the next package, that is, cancel the seven-day break. Breakthrough bleeding and spotting may occur during this time, and withdrawal periods are possible but unlikely. The second option is to interrupt the course of taking the drug for 7 days, including the missed day. Then you need to start taking a new pack.

Please note: if during the break between packs a woman does not experience withdrawal bleeding, and there were missed pills in the previous month, it is necessary to consult a gynecologist and exclude pregnancy.

Nuances and features of taking the drug

If, after taking the drug, a woman had bouts of vomiting or diarrhea in the interval of 4 hours, absorption, most likely, did not occur completely. Must use barrier contraception. Further, be guided by the recommendations in the instructions, section. what to do when skipping a dragee.

By taking Janine, a woman can control the day of her next period. If it is necessary to delay the day of the start of the discharge, the woman should continue the course of the drug immediately without a break between packs. At this time, spotting and breakthrough uterine bleeding are possible. You can take medicines until the package runs out. The next pack must be started after a weekly interval.

If it is necessary to change the day of the week of the onset of menstruation, it is necessary to reduce the dragee break by the required number of days. The shorter the interval, the greater the likelihood of spotting and withdrawal bleeding at the beginning of the course of the next pack.

The price of the drug may vary depending on your region and country of residence. The average price in Ukraine is UAH 246; The price in Russia is 573 rubles.

Contraindications and side effects

The drug should not be taken by women with liver disease until the problem is resolved. it the main contraindication for taking pills. As well as:

• Jeanine is contraindicated in children under 18 years of age; shown only after the onset of the first menstruation;
• Not indicated for women after menopause;

Among other things, the drug has a number of side effects that you need to discuss with your doctor. Perhaps you will be assigned an analogue.

Janine side effects:

Starting for the first time taking the drug janine, you need to carefully monitor your well-being. If one of the following diseases is present, the drug is contraindicated, and if they occur during the reception, the use of the drug should be immediately discontinued. They may provoke the development of complications.

Janine during pregnancy and breastfeeding

Jeanine is contraindicated pregnant and lactating women, and if pregnancy was detected while taking a contraceptive, the drug should be stopped immediately. However, studies have not identified fetal developmental disorders due to the use of hormonal contraceptives in the period before pregnancy or in the early stages.

The use of janine oral contraceptives or analogues can lead to a decrease in the amount of breast milk. In addition, some hormones can be excreted in breast milk.

special instructions

The use of janine, similar drugs prohibited without a doctor's prescription. They can adversely affect a woman's health, so a full medical examination is necessary before starting the course. In zhanin, the composition has a unique formula, and, in addition to the contraceptive function, it eliminates many gynecological problems. However, taking synthetic hormones, if there are certain factors, is a risky business.

A woman who decides to use oral contraceptives must understand that they do not protect against HIV infection and other sexually transmitted diseases.

If you are in doubt about the choice of contraceptives, it is recommended to read the reviews on the Internet. Or you can read reviews on our website. They will help you weigh the pros and cons.

At the beginning of the use of the drug Janine, contraindications were frightened. Was it worth it for a long time? But after a detailed medical examination, she nevertheless decided and was satisfied.

Angela Kerch

I had never taken hormonal contraceptives before, I was very afraid to start. The Internet is full of different rumors on this topic, there is something to be afraid of. But now I'm extremely happy! My cycle returned to normal, and the discharge became less intense. Particularly pleased with the possibility of adjusting the cycle.

Tatiana Sumy

I have had problems with my menstrual cycle since childhood. In addition to being unstable, I was constantly in severe pain. But with the beginning of the course, I was pleasantly surprised by the changes, in addition to excruciating pain and heavy discharge, I got rid of the monthly acne that had always accompanied me these days.

Olga, Sevastopol

Jeanine is a low-dose combined oral contraceptive of an estrogen-progestin nature. The drug belongs to the group of monophasic, that is, each capsule contains the same dose of active ingredients. The dosage does not depend on the phase of the menstrual cycle. The drug can be taken only after the first menstruation and before menopause.

The effectiveness of Jeanine is due to complementary mechanisms of action, the most important of which is the suppression of ovulation. As a result of exposure to active substances, the viscosity of cervical mucus changes, it becomes impermeable to male germ cells. When taking combined oral contraceptives, the hormonal cycle stabilizes, the duration of menstruation and its intensity decrease. It helps reduce the risk of iron deficiency anemia, endometrial and ovarian cancer.

One package may contain one or three blisters, each containing 21 tablets. The average price of a pack of Jeanine is 900 rubles. Special packaging, designed for three months, costs about 2 thousand rubles.

An advantageous difference between Zhanin and other oral contraceptives is the low content of active substances. This provides high protection against unwanted pregnancy, and the intensity and frequency of side effects is reduced.

Who is assigned:

• girls in the early reproductive period who gave birth or did not give birth, if microdosed contraceptives are not suitable for them;
• women over 35 years old.

Therapeutic indications:

• pain with endometriosis;
• correction of menstrual irregularities;
• impact on the ovaries after the detection of cysts;
• hyperplastic processes in the uterine mucosa;
• normalization of hormonal levels after surgical treatment of endometriosis and leiomyoma;
• acne disease.

The main components of Jeanine are ethinyl estradiol and dienogest. The composition additionally includes lactose monohydrate, magnesium stearate, calcium carbonate, starch, gelatin, talc, sucrose, dextrose, titanium dioxide, povidone.

Ethinylestradiol is a synthetic analogue of the hormone estradiol, which belongs to the group of estrogens. The substance completely copies the chemical structure of natural estrogen, therefore it performs similar functions.

Ethinyl estradiol preparations are intended to treat infertility, uterine bleeding, vaginitis, ovarian dysfunction, menopause, acne, and even some forms of cancer. However, the compound is often included in the composition of combined contraceptives.

Dienogest is a derivative of nortestosterone. It has antiandrogenic activity and a strong progestogenic effect. Dienogest reduces the secretion of estradiol, weakening its effect on the endometrium of the uterus. Long-term use of drugs with dienogest causes atrophy of endometriosis foci, so they are often prescribed for uterine growth.

The substance is also able to reduce the concentration of androgens in the body of a woman. This is a useful property, because an excess of male sex hormones can cause acne, increase sweating and oily skin, provoke strong hair growth in places unusual for women. Jeanine will help fight these symptoms.

Active ingredients of the drug

Dienogest

The main progestogen component of the drug is dienogest. It has an antiandrogenic effect and improves the blood lipid profile by increasing the amount of high density lipoproteins.

When taken orally, dienogest is absorbed completely and very quickly. After 2.5 hours, its maximum concentration in the blood reaches 51 ng / ml. Bioavailability is 96%.

In serum, dienogest combines with albumin, but does not react with sex steroid-binding globulin and corticoid-binding globulin. The concentration of free dienogest in the blood is 10%, the rest is non-specifically bound to albumin.

Dienogest is metabolized almost completely. The half-life is 8-10 hours. Metabolites are excreted by the kidneys and through the gastrointestinal system within 14 hours, a small amount of unchanged dienogest is excreted in the urine.

The level of sex steroid-binding globulin in the blood does not affect the pharmacokinetics of the substance. With daily intake, the concentration of the substance in the blood serum increases one and a half times.

Ethinylestradiol

The substance is absorbed quickly and completely. The maximum concentration (67 ng / ml) is reached in 2-4 hours. When ingested, only 44% of the substance reaches the site of action, which is due to the peculiarities of absorption and its passage through the liver.

Up to 98% of ethinyl estradiol binds nonspecifically to albumin. The substance induces the synthesis of globulin that binds sex steroids. Ethinylestradiol is transformed in the mucosa of the small intestine and liver, but the main route of metabolism is aromatic hydroxylation. The clearance rate is 2.3-7 ml / min / kg.

The concentration of ethinylestradiol in the blood decreases during two phases: the first half-life is 1 hour, the second is 10-20 hours. The substance leaves the body only in an altered form. Metabolites are excreted in bile and urine. The equilibrium concentration of ethinylestradiol is reached in the second half of the treatment cycle.

Contraindications

Any of these conditions is a reason to choose another method of contraception. If violations occur against the background of the use of contraceptives, the drug should be discontinued.

What diseases should not take Jeanine:

• hypersensitivity to components;
• diseases of the cardiovascular system, in which the risk of blockage of veins or arteries is increased (stroke, varicose veins, heart defects, angina pectoris, hypertension);
• diseases of the endocrine system (disorders of the thyroid gland);
• venous and arterial thrombosis, thromboembolism (at the time of admission or in history);
• deep vein thrombosis;
• myocardial infarction;
• cerebrovascular disorders;
• precursors of thrombosis (angina pectoris, transient ischemic attacks);
• migraine with neurological symptoms;
• diabetes mellitus, which is accompanied by vascular disorders;
• risk factors for thrombosis (pronounced or multiple);
• heart valve damage, atrial fibrillation, cerebrovascular disease or heart arteries;
• severe arterial hypertension;
• major surgery;
• active smoking at the age of 35;
• pancreatitis and severe hypertriglyceridemia;
• severe liver disease, liver failure;
• tumor formations in the liver (benign and malignant);
• suspicion or presence of hormone-dependent malignant pathologies;
• vaginal bleeding of unknown nature;
• pregnancy and lactation.

With caution, Jeanine is prescribed for obesity, the presence of risk factors in a family history (for example, thromboembolism), migraine, hypertension, heart valve disease, dyslipoproteinemia, atrial fibrillation. The final decision is made by the doctor, based on the results of the examination.

Side effects

Common side effects of taking Jeanine:

• scanty bleeding between periods;
• nonspecific vaginal discharge;
• vaginal pain;
• nausea and vomiting;
• diarrhea;
• bloating;
• fluid retention in the body;
• headache;
• allergic reaction;
• discomfort in the chest;
• coarsening, soreness of the mammary glands;
• secretion of fluid from the mammary glands;
• mood swings;
• emotional outbursts and even depression;
• insomnia;
• strengthening or weakening of libido;
• visual discomfort when wearing contact lenses.

Some side effects occur only at the beginning of taking Jeanine, while others appear with long-term treatment. Often, women who were overweight even before therapy get better even more.

Rare but possible side effects:

• anemia;
• distraction of attention;
• disorders of autonomic regulation;
• drying of the mucous membrane of the eye;
• prolonged ringing in the ears;
• hypotension;
• dyspnea;
• inflammation of the gastrointestinal tract;
• gingivitis;
• hirsutism;
• dandruff;
• dermatitis;
• back pain;
• convulsions;
• infectious diseases of the urinary tract;
• hot flashes;
• dryness of the vagina;
• vaginal candidiasis;
• formation of cysts in the ovaries;
• pain in the pelvis;
• fibrocystic disease.

Symptoms of an overdose of Jeanine include nausea and vomiting, spotting,. With a slight overdose, serious violations are not observed. Treatment of overdose is symptomatic.

Janine during pregnancy and lactation

The drug is not intended for use during pregnancy. If pregnancy is detected, the contraceptive should be discontinued. However, even when receiving hormones before pregnancy and in the early stages of bearing a baby, there is no increase in the risk of fetal developmental defects.

When lactating, combined oral contraceptives are also prohibited. They can reduce the production of breast milk and change its composition. A certain amount of sex steroids and their metabolites can enter the body of a newborn along with milk.

Methods of administration and dosage

Janine is taken orally with clean water. The drug must be taken at the same time of day. Follow the order indicated on the package.

The contraceptive is taken continuously for 21 days, one tablet per day. Start the next package after a week break. During the break, as a rule, withdrawal bleeding occurs on the 2-3rd day (abundant discharge, similar to menstruation). If the bleeding lasts for several days, you need to see a specialist, but often the bleeding continues until the start of a new package of contraceptives.

Reception features:

1. There is no hormone intake in the previous month. You should start on the first day of the cycle (the first day of menstruation). You can shift the time of admission by 2-5 days, but in this case it is necessary to resort to barrier contraception in the first week of taking the first package of Jeanine.
2. Switching from other oral contraceptives (vaginal ring, transdermal patch). Janine is taken on the next day after the last tablet, but no later than the next day after a week-long break (with 21 tablets per pack). If the package of contraceptives contains 28 pills, start taking after taking the last inactive capsule. When removing the vaginal ring or patch, Janine is taken on the same day, but no later than the day the new ring or patch is applied.
3. Switching from progestogen contraceptives or a progestogen-releasing intrauterine system. You can switch from "" to Janine any day. When switching from an implant or intrauterine system, you need to start taking it on the day of removal. If an injectable form was used, Jeanine is taken on the last day when the last injection was to be given.
4. After an abortion in the first trimester. You can start taking Janine right away (without additional protection).
5. After an abortion or childbirth in the second trimester. You can use the drug from 21-28 days after the procedure. If you start later, you need additional barrier protection in the first week of admission. When a woman had sexual intercourse after an abortion or childbirth, pregnancy should be excluded and menstruation should be expected.

What to do if you missed an appointment

If you are late up to 12 hours, the degree of protection is not reduced. It is necessary to take Jeanine as quickly as possible, and to carry out the next dose on time. If the delay time exceeds 12 hours, the protection is reduced.

You can not interrupt the reception of Zhanin for a week or more: in order for the suppression of the hypothalamic-pituitary-ovarian regulation to be sufficient, it is necessary to take a contraceptive continuously for a week.

If the delay was more than 12 hours, the following recommendations should be followed:

1. First week of admission. It is necessary to take a pill, even if you have to take two at once. The next one is taken at the usual time. Barrier protection should be used for a week. If sexual intercourse was in the week before the pass, you need to check for pregnancy. It is important to consider that the closer to the break the pass, the more likely it is to become pregnant.
2. Second week of admission. Dragees are taken as soon as possible. If a woman has been taking Janine correctly in the first week before the pass, there is no need for additional protection. Barrier contraception is needed if two or more capsules are missed or taken incorrectly in the first week.
3. Third week. During this period, the reliability of contraceptives decreases due to the upcoming break. If all pills were taken correctly in the first week before the skip, there is no need for additional contraception. You can act in different ways: take the missed pill faster and start the next pack immediately after the existing one, or interrupt the intake, take a break (including the day of the pass) and start a new pack. In the first case, withdrawal bleeding occurs after the second pack, but spotting may occur.

If there was no withdrawal bleeding after missing a tablet during the break, pregnancy should be excluded. If vomiting and diarrhea occur within four hours after taking the active dragee, the absorption of the drug may be impaired, so additional protection should be taken into account. In such a situation, you need to focus on the rules for skipping pills.

How to change the loop with Jeanine

To delay the onset of menstruation, you need to start taking from a new package of Jeanine immediately after the previous one. You can take the dragee even until the end of the package, but spotting and bleeding may appear. The next pack should be started after a week break.

If you want to postpone the onset of menstruation, you need to shorten the next interval by a few days. The shorter the break, the lower the risk of withdrawal bleeding and spotting and bleeding when taking the second pack of Jeanine.

Interaction with other drugs

The drug Jeanine is theoretically compatible with alcohol, which, when combined, significantly increases the load on the liver. The contraceptive and therapeutic effect of the drug weakens when Zhanin is combined with drugs that induce microsomal oxidation enzymes in the liver. These are some antibiotics (tetracyclines), barbiturates, phenytoins, rifampin, primidone, and carbamazepine. When treating with drugs that affect enzymes, you need to use barrier contraception for 28 days.

Combining oral contraceptives with other medicines can cause bleeding. Some medicines reduce the effectiveness of Jeanine. With caution, Jeanine should be combined with topiramate, felbamate, oxcarbazepine, griseofulvin and preparations with St. John's wort. In addition, hepatic metabolism is affected by HIV proteases and non-nucleoside transcriptase inhibitors.

Precautionary measures

In case of extensive injury, you need to stop taking Janine. Before the operation, it is necessary to give up contraception for a month, and resume taking it only two weeks after immobilization.

After the abolition of antibiotics for a week, additional protection should be applied. If the period of barrier contraception ends later than the capsules in the current package, you should proceed to the next one without interruption.

The effect of Jeanine on patients with impaired renal function has not been specifically studied, but the available data do not require dose adjustment. However, the drug is contraindicated in severe liver pathologies. In acute and chronic violations of the functionality of the liver, oral contraceptives are canceled until the indicators return to normal. If symptoms of recurrent cholestatic jaundice occur during contraception, it is necessary to stop taking hormones.

Despite the fact that combined contraception can affect glucose tolerance and insulin resistance, the therapeutic contraceptive regimen in patients with diabetes mellitus does not change if they take low-dose drugs. However, women with diabetes need to be closely monitored.

The increase in migraine attacks and the aggravation of the woman's condition is the basis for the urgent termination of hormonal contraceptives. It is necessary to undergo an additional examination to rule out cerebrovascular disorders.

Possible Complications

In patients with angioedema, exogenous estrogens cause or exacerbate symptoms. There are cases of nonspecific ulcerative colitis and Crohn's disease with combined contraception.

Women with a history of chloasma may relapse. If there is a predisposition to chloasma, sunbathing should be avoided when using oral contraceptives.

Other dangers:

1. Hypertriglyceridemia, increased risk of pancreatitis.
2. Increase in blood pressure. This complication is observed in many women who take combined contraceptives. A dangerous increase is rarely detected, but with the development of a persistent increase, Janine should be abandoned and arterial hypertension should be treated.

Some conditions can develop or get worse when taking combined contraceptives, but this can also happen during pregnancy. This includes jaundice, porphyria, kidney stones, systemic lupus erythematosus, herpes, hemolytic uremic syndrome, and otosclerosis.

Diseases of the cardiovascular system

The results of studies show that there is a relationship between the use of combined contraceptives and the development of thrombosis and thromboembolism. The risk of venous thromboembolism in the first year of taking contraceptives is maximum.

The danger is present after the first use of combined contraceptives or the resumption of the use of one or different means (provided that the break is more than 4 weeks). Studies show that the increased risk persists during the first three months.

The overall risk is 2-3 times higher in women who take low-dose oral contraceptives (ethinyl estradiol content less than 50 mcg) than in non-pregnant patients. However, the risk is still lower than in pregnant women and women giving birth. It must be remembered that in 1-2% of cases, severe VTE leads to death.

Notably, deep vein thrombosis and pulmonary embolism can occur with any other combined contraceptive. Less often, thrombosis of other vessels (hepatic, renal, cerebral, ocular) occurs. Some of the symptoms of these conditions are non-specific (shortness of breath and cough), so they are often misinterpreted. They may indicate other, more severe conditions.

Arterial thromboembolism can result in stroke, heart attack, and vascular occlusion. These are serious conditions that require emergency treatment, so you need to respond to any symptoms in time.

Tumors and cancer

The main risk factor for cervical cancer is, but with prolonged use of combined contraceptives, the likelihood of cancer also increases (although the relationship has not been experimentally proven). Sometimes this risk is associated with screening in the diagnosis of cervical pathologies and the characteristics of sexual activity.

Some studies show that long-term use of combined oral contraceptives increases the risk of developing breast cancer. The number of diagnoses among women who take or have recently taken Jeanine does not greatly outweigh the overall risk. This may be due to the early diagnosis of cancer: in patients who took combined oral contraceptives, breast cancer is detected earlier than in those who have never used such protection. The danger decreases within 10 years.

Sometimes the use of combined contraceptives is combined with the development of neoplasms in the liver. In rare cases, this condition can be life-threatening (intra-abdominal bleeding).

Jeanine for endometriosis

Jeanine is prescribed not only for contraception. Often, such hormonal drugs are prescribed for diseases of the reproductive system. With endometriosis, there is an overgrowth of the lining (endometrium) of the uterus. Therapy may include conservative and surgical methods. Jeanine helps to relieve the symptoms of endometriosis and improve treatment outcomes.

In a healthy woman, in the first phase, the formation of a dominant follicle in the ovary occurs. The uterus at this time builds up the epithelium and prepares to accept a fertilized egg. The second phase is the time for the production of progesterone, which maintains the pregnancy when it occurs. The hormone prevents uterine contractions and provokes the growth of the epithelium. During a failure, too many hormones begin to be produced that provoke the growth of the endometrium, and its active growth occurs.

The effectiveness of Jeanine in the treatment of endometriosis is due to its composition. Jeanine contains progestin and estrogen elements. Dienogest is a derivative of progesterone that inhibits the division of endometrial cells, relaxes the uterus and relieves unpleasant symptoms during menstruation. Ethinylestradiol inhibits the secretion of estrogen, a hormone that stimulates the growth of the uterine lining, including endometriosis.

Jeanine passed all the necessary tests that proved the effectiveness of the drug. In 85% of women who took it for six months with endometriosis, the symptoms weakened or disappeared. In the course of studies, the positive effect of Jeanine on the condition of the skin and body weight was noted. Women noticed the normalization of the cycle and the weakening of the symptoms of PMS.

How to take with endometriosis

With endometriosis, the drug can be prescribed for contraception and directly for treatment. In the first case, a cyclic intake of Jeanine is required, and for the treatment of endometriosis - continuous.

Reception schemes:

1. Cyclical. Reception starts from the first day of the cycle. Tablets are drunk every day for three weeks at regular intervals. After the course, take a break until the next menstruation begins. Cyclic therapy is effective at an early stage of endometriosis, when it is necessary to suppress small foci and prevent unwanted pregnancy.
2. Continuous. Janine is taken daily for six months or more. Continuous treatment is prescribed to patients with severe endometriosis, which is accompanied by pain and disturbances in the cycle.

With continuous intake of Jeanine, dienogest provokes the creation of a hypoestrogenic environment, which is favorable for decidualization of endometrial tissues. As a result, atrophy of endometrioid foci develops, which leads to a weakening of the symptoms of endometriosis.

Is pregnancy possible after treatment?

When used correctly, Jeanine does not reduce the ability to conceive. Every year you need to take a break to give the reproductive system a chance to recover. Otherwise, the chances of pregnancy can really decrease, and the risk of fetal fading can increase.

However, in the treatment of endometriosis, the drug is often prescribed to achieve a rebound effect: after the abolition of contraceptives, the ovaries begin to work more efficiently, ovulation is restored and the chances of conception increase. The maximum effect persists for 2-3 months after the abolition of Zhanin, but doctors recommend waiting this period to minimize the risk of fetal fading.

Zhanin's analogs

Birth control pills provide reliable protection, are easy to use and versatile, but all oral contraceptives have a large number of contraindications and unpleasant side effects.

Regulon can be distinguished from a large list of Zhanin analogues. This is another effective remedy that also has a combined composition, acts on a monophasic principle and contains a low dose of hormones.

However, desogestrel, which is part of Regulon, does not affect the concentration of male hormones in a woman's body, and therefore does not help fight the symptoms of their overabundance. Regulon is usually cheaper than Jeanine.

Another popular tool is . If the estrogen in the composition of Zhanin and Yarina is similar, then drospirenone is used as a progestogen in the latter.

Drospirenone, like dienogest, has an antiandrogenic effect, but additionally removes excess fluid from the body. For this reason, Yarina is recommended for women who suffer from edema and overweight.

Zhanin's analogues can also include Silhouette and Diana-35. The silhouette is similar in composition, so it is considered a cheap alternative to Jeanine. Diane-35 uses cyproterone acetate as a progestogen. The contraceptive is classified as a medium-dose drug, since the concentration of estrogen in it is higher. Such oral contraceptives are intended for women who have given birth over 30 years of age.

Microdosed analogues

When choosing a replacement, you can pay attention to microdosed drugs. They include a minimum of hormones, so they have fewer side effects. The effectiveness of such funds is due to the new generation of progestogens.

Jess belongs to this group. The drug is prescribed for girls under 25 who have not given birth and have a regular sex life, as well as for women over 35 who use hormonal contraceptives for the first time. You can also replace Jeanine with the help of Qlaira, Dimia, Novinet and Logest.

Mirena is considered an alternative to oral hormonal contraception. This is a sterile system that is placed in the uterus, and it begins to secrete levonorgestrel, which has a contraceptive effect.

The advantages of the spiral include long-term. The coil can be placed for 3-5 years, and the installation procedure causes only mild discomfort.

The hormonal coil does not cause side effects that are noted when taking oral contraceptives. In addition to protecting against unwanted pregnancy, Mirena can be used as a therapy for certain diseases of the reproductive system. A hormonal spiral can be installed immediately after childbirth or an abortion. Mirena will provide protection even while breastfeeding.

Use is dangerous due to displacement and even ingrowth of the device into the uterine cavity, as well as the possibility of injury to the genitals during installation. Oral contraceptives are safer if the woman has chronic infections or inflammation.

Conclusion

Jeanine is one of the best combined hormonal contraceptives. Despite the fact that taking the drug is associated with the risk of side effects, it creates powerful protection against unwanted pregnancy and even helps to cure endometriosis. Given the large list of contraindications, you should entrust the choice of a contraceptive to an experienced doctor.

Latin name: JEANINE
ATX code: G03A A16
Active substance: ethinylestradiol, dienogest
Manufacturer: BAYER PHARMA (Germany)
Vacation from the pharmacy: On prescription
Storage conditions: in the dark, at t up to 25 °C
Best before date: 3 years

Jeanine is one of the most effective means of modern oral contraception.

Composition and dosage form

One dragee Jeanine contains components:

• Active: 30 mcg ethinyl estradiol, 2 mg dienogest
• Additional: lactose (in the form of monohydrate), potato starch, gelatin, E572, talc, sucrose, glucose syrup, macrogol-35000, calcium carbonate, povidone K-25, E171, palm wax.

Contraceptive drugs are available in the form of dragees - small pills under a white coating. The product is packaged in blisters of 21 pieces. In a pack of cardboard - 1 or 3 plates, an accompanying annotation.

Medicinal properties

The contraceptive effect of Jeanine is due to the directed action of two components - ethinyl estradiol and dienoget. The processes launched by them cause multiple biochemical reactions, the most significant among them are the blocking of ovulation, changes in the structure and composition of the cervical secret. As a result of the influence of OK, spermatozoa lose the ability to penetrate into the uterine cavity.

When maintaining all the conditions of admission, the value of the Pearl index is less than 1. If the pills are taken with gaps or there are other violations, then the value increases.

Due to the progestogenic properties of dienogest, OK has an antiandrogenic effect, which has been confirmed by numerous studies and observations. In addition to the contraceptive effect, the substance simultaneously favorably affects the characteristics of the blood, increasing the content of dense lipoproteins.

Patients who took Janine noted that as a result of OK, MC returned to normal, the intensity of PMS decreased or disappeared completely, the duration or intensity of menstruation was reduced, which sharply reduced the risk of IDA. In addition, there is medical evidence that the contraceptive is able to prevent the occurrence of ovarian and/or endometrial cancer.

• Dienogest

Belongs to the group of nortestosterone derivatives, has pronounced antiandrogenic properties, has a strong progestogenic effect. After penetration into the uterine cavity, it acts on the nerve endings of the endometrium, suppressing trophic effects. With prolonged use, it contributes to the attenuation of endometrioid foci, reduces the increased synthesis of estrogens by the ovaries.

The substance after taking the dragee is quickly absorbed from the gastrointestinal tract, peak concentrations are formed after 2.5-3 hours. It has a high bioavailability - almost 96%. Almost completely metabolized.

It is excreted from the body mainly with urine, a small amount is excreted with bile. The duration of the process ranges from 8 to 10 hours.

• Ethinylestradiol

The substance is a synthetic analogue of the hormone estrogen, therefore it has almost the same effect. It activates the formation of the uterus, tubes and secondary signs of sex, affects the state of the endometrium, increases the excitability of the uterus. In addition, the artificial compound is involved in nitrogen metabolism, reduces lipid content, and regulates the presence of cholesterol. In large doses, it can retain fluid in the body, contributing to swelling.

After oral administration, it is rapidly and completely absorbed. The highest concentrations are formed within 1-4 hours. It is transformed with the formation of metabolites in the small intestine and liver. It is excreted from the body in two stages along with urine and bile.

Mode of application

Take Jeanine instructions for use prescribes one tablet per day, at the same time and in accordance with the calendar index on the blister. Dragee is undesirable to bite or break - you need to drink only whole with a small amount of water. After the contents of the blister are over, a week-long break is observed, during which menstrual-like bleeding should occur. It usually occurs 2-3 days after taking the last pill. After a week, they resume taking OK from a new blister.

When to start drinking OK

If before the appointment of Janine, the patient was not protected by other OKs or there was a break in the reception for at least a month, then the first dragee should be drunk on the 1st day of the MC. If this is done later - between the 2nd and 5th day, then it will take a week to additionally protect yourself with condoms.

In the case of other OKs before Jeanine, they drink the dragee the next day after taking the previous active tablet (or placebo). In this case, a break of more than a week should not be allowed.

If a woman was protected with a TD patch or vaginal ring, then the pills are drunk on the day the remedy is withdrawn. In the case of injections - on the day of the next injection.

After stopping the course of drugs with gestagens, start taking pills on the next day after taking the pill from the previous OK, on ​​the day the uterine contraceptive is removed or on the day of the next hormonal injection. In this case, in all cases, additional protection by barrier means will be required.

After a miscarriage or abortion in the first 3 months of pregnancy, Jeanine is taken immediately after the interruption of gestation.

If the pregnancy ended at the 2nd term, then before taking Jeanine, it is necessary to withstand from 21 to 28 days. A later appointment should be accompanied by the use of condoms. If an unprotected PA occurred before taking the dragee, then you will need to make sure that there is no pregnancy or postpone the course until the onset of menstruation.

What to do when skipping OK

If for some reason a woman could not drink the pills on time, and the delay was less than 12 hours, then there is nothing to worry about, since the content of substances in the blood, although it will decrease somewhat, the contraceptive effect will remain. She'll just have to take the pills as soon as the opportunity presents itself.

If more than 12 hours are missed, the contraceptive concentration of the medication will decrease more strongly, and in order to restore the normal intake schedule, the woman can use one of the following methods:

• Skip the 1st week of the course: take the forgotten pill, and the next - according to the schedule. If the methods coincide - drink two pieces at once and then use additional protective equipment for a week.
• Pass in the 2nd week of the course: drink the missed one, and the next - according to the schedule, if the receptions coincide - two pieces at once. If in the first 7 days there were no violations in the course, then there is no need for condoms. In case of the same forgetfulness, use them for a week.
• Skip on the 3rd week of the course: take a forgotten pill and another at the usual hours. After the end of one blister, start a new one without observing any intervals. Withdrawal bleeding should not occur, but may present as "spotting" or breakthrough bleeding.

Another option for correcting the situation is also possible: do not replenish the intake of dragees, but take a 7-day break, and after it ends, proceed to a new package of OK.

A decrease in the concentration of substances can occur due to vomiting or diarrhea in the first 4 hours after ingestion. In this case, you will need to drink another dragee.

• How to postpone or reschedule the day of the MC

To transfer the period to another day, you do not need to observe a break, but immediately start taking a new blister and drink the number of pills that you need, up to the end. Then incubated for 7 days without tablets before taking from the next pack.

To change the beginning of the MC to a different date, you need to shorten the break by the desired number of days.

Reception features

Teenagers should only take Janine after their first bleeding.

Elderly women in menopause do not require OK.

If the patient has problems with the liver, then OK can be taken only after the condition is completely stabilized.

The nuances of admission in women suffering from kidney pathologies have not been studied. Therefore, it is better to check with the gynecologist whether or not you can drink OK and how to take Jeanine correctly.

Jeanine therapy for endometriosis

Thanks to the active substances contained, the contraceptive medication can be used in the treatment of endometrial pathology. A significant advantage of OK is that it can be taken in various forms of the disease: both in the early stages and in advanced cases. Depending on the indications, the most effective option is developed for each patient. On average, treatment with the drug takes about 63 days, that is, you need to drink 3 blisters of 21 tablets.

Scheme of application - one tablet per day strictly at one hour. After completion of the reception, a seven-day break is observed for menstrual-like bleeding.

After analyzing the results of therapy, the gynecologist decides whether to continue taking OK. But usually one course of Janine therapy for endometriosis is enough to eliminate excess tissue growth.

If the pathology is more advanced, then the course of therapy may take a longer time - 84 days.

During pregnancy and lactation

Average price: No. 21 - 1005 rubles, No. 63 - 2480 rubles.

The drug should not be used during childbearing and breastfeeding. If during the course it turns out that the woman is pregnant, you should immediately stop taking the medication in order to avoid unforeseen consequences. but so far, various epidemiological studies have not confirmed any pathologies in the development of children born from women who took Janine hormonal tablets in the early stages of pregnancy.

Lactating women should not use the medication, as the active substances can adversely affect the production and volume of milk. In addition, a small amount of sex hormones and their metabolites can be excreted into milk. If a woman needs to take OK, lactation should be abandoned for the duration of the course of tablets.

Contraindications

Jeanine birth control pills should not be taken if at least one of the following factors is present. If during the course such conditions or pathologies arose for the first time, then hormonal OK should be immediately canceled. The drug is prohibited for:

• Thrombosis or thromboembolism at the time of prescription or in the past
• Diseases or conditions that increase the risk of thrombosis (currently or in the past)
• Congenital or acquired tendency to thrombosis
• Existing high risk of vein/arterial thrombosis
• Migraines with associated neurological manifestations at the time of appointment or in the past
• DM with damage to the vascular system
• Pancreatitis with severely elevated plasma triglycerides (current and past)
• Renal failure, severe organ damage (use is possible only after
• Neoplasms of the liver (benign and malignant) at the time of Zhanine's appointment or existing in the past
• Confirmed by the examination of benign hormone-dependent neoplasms and the assumption of their presence
• Vaginal bleeding of unspecified origin
• Confirmed or suspected pregnancy, GV
• Individual hypersensitivity to Janine components
• Congenital lactose intolerance, deficiency in the body of lactase, sucrase, GG malabsorption syndrome (due to lactose and sucrose in the composition).

Use OK should be used with caution if a woman has:

• Predisposition, threats of risk of pulmonary embolism, thrombosis and conditions preceding them
• Tobacco smoking
• Overweight, obesity
• Hypertension, amenable to correction by drugs
• Migraine without focal symptoms
• Congenital tendency to thrombosis.
• Pathologies that can provoke the development of thrombosis due to circulatory disorders (SLE, diabetes, SC anemia, Crohn's disease, etc.)
• Liver diseases that are not included in the list of categorical contraindications
• Pathologies that first appeared during pregnancy or aggravated during gestation
• Postpartum period (about one and a half months).

Precautionary measures

OK Jeanine should be prescribed by a gynecologist after a thorough analysis of the patient's condition through a general and gynecological examination, passing tests and clarifying the intricacies of a family history, dysfunctional conditions in the past, the presence of bad habits and other risk factors. In the case of indications for long-term use, the patient should be informed of the need for regular medical examinations (usually once a year). In addition, she should be warned that OCs cannot protect against sexually transmitted infections and HIV infection.

If a woman has any signs of risk that can accelerate or intensify the onset of new diseases or the complication of existing ones, then the question of the possibility of using OK should be decided individually. In the case of an appointment, the patient must be aware of the possible consequences and know what to do if they occur.

The results of numerous studies have confirmed the presence of a relationship between taking OCs and an increase in cases of pathologies of the heart and blood vessels: myocardial infarction, thrombosis, PE, VTE, etc. Although such complications occur quite rarely, a threat cannot be ruled out.

The occurrence of VTE occurs especially often in the first year of taking OCs. An increase in risk is also noted when the course of OK is resumed after a break (at least a month). This usually happens in the first three months of taking contraceptives.

In addition, there are data on isolated cases when the use of OK led to death.

Damage to the vessels of other organs is less common, so the opinions of physicians are divided on the issue of "guilt" OK. Manifestations of HV thrombosis include the development of unilateral swelling of the leg (possible soreness in the region of the vein), pain and discomfort in the limb when walking or standing, local temperature, change in skin tone.

PE can be recognized by the following features:

• Complicated breathing
• Unexplained cough (comes with blood)
• Severe chest pain, worse on inspiration
• Vertigo
• Violation of the normal heartbeat.

In addition, dyspnea and cough can be harbingers of PE, so it is important to interpret them correctly, not to confuse them with manifestations of other diseases.

Arterial TE can provoke a stroke, myocardial infarction, and vascular damage. Its manifestations are:

• Unexpected Weakness
• Insensitivity of the face, limbs (specific symptom - unilateral paresthesia)
• Spontaneous confusion
• Speech disorder
• A sharp deterioration in vision
• Gait disorder
• Disorientation in space
• Uncoordinated movements, loss of balance
• Spontaneous severe head pain
• Fainting (may be with an epileptic seizure).

Typical signs of MI are:

• Pain and discomfort in the chest, feeling of heaviness or fullness
• Unpleasant sensations radiating to the back, arm, stomach
• Cold perspiration, sweat
• Nausea (with or without vomiting)
• Unexplained weakness, dyspnea
• Increased anxiety
• Rapid heartbeat.

The threat of thrombosis increases:

• As age increases
• Smokers (especially women 35+ with a long history)
• With obesity
• The presence of pathology in relatives
• Prolonged immobility (including during long flights)
• With hypertension, pathology of the heart valves, damage to the atria
• Postnatal period.

Women who have recently given birth, diabetics, patients with systemic lupus erythematosus, chronic intestinal inflammation, and MC anemia are also at risk.

The occurrence of migraines or worsening attacks is a reason to cancel OK.

Cross-drug interactions

Combining OCs with other medications may cause breakthrough bleeding or reduce the effect of OCs, increasing the risk of unintended pregnancy. Therefore, Janine's instructions for use advise taking contraceptive pills, taking into account possible complications. Such undesirable reactions appear with the following combinations:

• The use of drugs-inducers of liver enzymes can increase the clearance of sex hormones. Such reactions are manifested when Jeanine is combined with barbiturates, Phenytoin, anti-tuberculosis Rifampicin. It is assumed that the same actions have Oxcarbazpin, Griseofulvin, medications based on St. John's wort.
• Similar effects can be observed when combined with HIV protease inhibitors (PI) and NNRTIs: Ritonavir and Nevirapine, since drugs directly affect the rate of hepatic metabolism.
• Separate antibiotic drugs (primarily tetracycline and penicillin groups) are able to reduce the content of ethinyl estradiol by reducing the circulation of estrogens in the liver and intestines. Therefore, if treatment with these agents is necessary, the patient is advised to additionally protect herself with other barrier agents or products.
• The action of OK changes under the influence of drugs inhibitors of cytochrome enzymes CYP3A4. The plasma content of Jeanine substances will be increased when the contraceptive drug is combined with Ketoconazole and other antimycotics, Cimetidine, Erythromycin, psychotropic drugs (antidepressants), as well as grapefruit juice.
• If drugs that affect liver enzymes were used during the Janine course, then after their cancellation, auxiliary means of protection against pregnancy should be used within 28 days.
• Antibiotics reduce the contraceptive effect of OK (except Rifampicin, griseofulvin), therefore, during their course and within a week after cancellation, you should either refrain from intimacy or additionally protect yourself.
• Oral contraceptives can also change the actions of other drugs. Jeanine increases the plasma content of Cyclosporine and reduces Laomtrigine.

If at the time of Zhanin's appointment the conditions for combining with other medications were not agreed, then in the case of other drugs being prescribed, it is necessary to inform the doctor about the OK being taken and clarify the nuances of the joint intake.

Side effects and overdose

During the use of Janine tablets, the following responses of the body are possible:

• Infectious pathologies: vaginitis, thrush, salpinogo-oophoritis, herpes lesions of the oral cavity, flu-like condition, bronchitis, diseases of the urinary tract, respiratory system
• Neoplasms of any etiology, uterine fibromyoma, lipoma (wen) of the mammary gland
• Hematopoietic organs: anemia
• Individual reactions due to hypersensitivity
• virilism
• Metabolic processes: increased or lack of appetite
• Psycho-emotional state: mental disorders, depression, depression, sleep disturbance, insomnia, unmotivated aggression, mood lability, loss of sexual interest
• NS: headache, vertigo, migraine, stroke, circulatory disorders in the brain, dystonia
• Organs of vision: dryness of the mucous tissues of the eyes, irritation, decreased visual acuity, pain, inability to wear contact lenses
• Hearing organs: temporary hearing loss or reduction, tinnitus
• CCC: cardiovascular complications, palpitations, a sharp increase or decrease in blood pressure, thrombosis, thrombophlebitis, varicose veins, flushing of the face, dilation and soreness of the veins
• Respiratory system: asthma attacks, hyperventilation
• Gastrointestinal tract: pain in the peritoneum, nausea, vomiting, diarrhea, gastritis, inflammation of the small intestine, difficult digestion
• Skin: acne, rash, hair loss, alopecia, itching, dermatitis (allergic and atopic), hyperpigmentation, chloasma, seborrhea, male pattern hair, cellulitis, nevus, urticaria, erythema multiforme
• Locomotor system: pain in the spinal muscles, bones, limbs
• Reproductive system: chest discomfort and soreness, intermenstrual bleeding, cyst (uterus, mammary glands), mastopathy, MC disorder, nipple discharge
• Other disorders: fatigue, chest pain, peripheral edema, flu-like condition, irritability, accumulation of fluid in the body, weight change (increase or decrease), increased TG content in the blood.

Possible risks of using Jeanine

• Women who use hormonal OCs are slightly more likely to be diagnosed with breast cancer than women who do not take contraceptives. So far, there is no evidence of a direct dependence of the occurrence of pathology on the intake of OK.
• In patients with congenital angioedema, the risk of exacerbation increases.
• Increased risk of liver damage
• Impaired glucose tolerance, insulin resistance
• Bleeding of a breakthrough, if other drugs were used during the use of Zhanine OK.

Consequences of taking overdose

The active ingredients practically do not have acute toxicity, so the development of intoxication is unlikely. It is assumed that Jeanine's medicine, taken in overdose, can cause an increase in side effects, but mostly the consequences are manifested in the form of nausea, bouts of vomiting, and girls may experience spotting.

Due to the lack of a specific antidote to Jeanine, the unfavorable condition that has arisen is removed with the help of symptomatic therapy.

Analogues

If a woman for some reason cannot take a medication, she needs to contact a gynecologist so that he can determine how to replace Jeanine. To date, there are many drugs that are no less effective: Bonade, Vidora, Jess and Jess Plus, Microgenon, Leia, etc. Which drug is best suited - only an experienced specialist will determine.

Laboratorios Leon-Farma (Spain)

Average cost:(21 pcs.) - 395 rubles, (63 pcs.) - 876 rubles.

An oral contraceptive containing the same composition of active ingredients and in an identical dosage as in Jeanine. A slight difference lies only in the composition of the auxiliary ingredients that make up the structure of the core and shell, and the dosage form: the medication is produced in tablets.

The scheme of reception is also similar: one piece per day.

Pros:

• Helps with serious violations of the reproductive system
• Can be drunk for a long time.

Flaw:

• side effects
• Decreased sensitivity in erogenous zones.

GEDEON RICHTER (Hungary)

Average cost: No. 21 - 723 rubles, No. 63 - 1813 rubles.

A contraceptive medication, the action of which is provided by ethinyl estradiol and chloramadinone in the form of acetate.

OK is available in tablets. The drug is designed for a 21-day intake with the obligatory observance of a week break for withdrawal bleeding.

Pros:

• Good quality
• Protects against unwanted pregnancy.

Flaws:

• Pimples appear
• Reduces interest in sex.

Monophasic oral contraceptive with antiandrogenic properties

Active ingredients

Ethinylestradiol (ethinylestradiol)
- dienogest (dienogest)

Release form, composition and packaging

Dragee white, smooth.

Excipients: lactose monohydrate - 27.97 mg, potato starch - 15 mg, gelatin - 1.5 mg, talc - 1.5 mg, magnesium stearate - 0.5 mg.

Shell composition: sucrose - 23.6934 mg, dextrose - 1.65 mg, macrogol 35,000 - 1.35 mg, calcium carbonate - 2.4 mg, polyvidone K25 - 0.15 mg, titanium dioxide (E171) - 0.74244 mg, carnauba wax - 0.01416 mg.

21 pcs. - blisters (1) - packs of cardboard.
21 pcs. - blisters (3) - packs of cardboard.

pharmachologic effect

Low-dose monophasic oral combined estrogen-progestogen contraceptive drug.

The contraceptive effect of Jeanine is mediated through complementary mechanisms, the most important of which are the suppression of ovulation and the change in the viscosity of the cervical mucus, making it impermeable to spermatozoa.

When used correctly, the Pearl Index (an indicator that reflects the number of pregnancies in 100 women taking a contraceptive during the year) is less than 1. If pills are missed or used incorrectly, the Pearl index may increase.

The gestagenic component of Zhanin - dienogest - has antiandrogenic activity, which is confirmed by the results of a number of clinical studies. In addition, dienogest improves the lipid profile of the blood (increases the amount of high density lipoproteins).

In women taking combined oral contraceptives, the menstrual cycle becomes more regular, painful periods are less common, the intensity and duration of bleeding decreases, resulting in a reduced risk of developing iron deficiency anemia. In addition, there is evidence of a reduced risk of endometrial cancer and ovarian cancer.

Pharmacokinetics

Dienogest

Suction

After oral administration, dienogest is rapidly and completely absorbed from the gastrointestinal tract. C max is reached after 2.5 hours and is 51 ng / ml. Bioavailability is approximately 96%.

Distribution

Dienogest binds to blood serum and does not bind to sex steroid-binding globulin (SHBG) and corticoid-binding globulin (CBG). In the free form is about 10% of the total concentration in the blood serum; about 90% - non-specifically associated with serum albumin. The induction of SHBG synthesis by ethinylestradiol does not affect the binding of dienogest to serum protein.

The pharmacokinetics of dienogest is not affected by the level of SHBG in the blood serum. As a result of daily administration of the drug, the level of dienogest in serum increases by about 1.5 times.

Metabolism

Dienogest is almost completely metabolized. Serum clearance after a single dose is approximately 3.6 l/h.

breeding

T1 / 2 is about 8.5-10.8 hours. A small part of dienogest is excreted by the kidneys in an unchanged state. Metabolites are excreted in the urine and bile in a ratio of about 3:1 with a T 1/2 equal to 14.4 hours.

Ethinylestradiol

Suction

After oral administration, ethinylestradiol is rapidly and completely absorbed. C max in blood serum is reached after 1.5-4 hours and is 67 pg / ml. During absorption and "first pass" through the liver, ethinylestradiol is metabolized, resulting in its oral bioavailability averaging about 44%.

Distribution

Ethinylestradiol is almost completely (approximately 98%), although non-specifically bound to albumin. Ethinylestradiol induces the synthesis of SHBG. The apparent V d of ethinylestradiol is 2.8-8.6 l / kg.

C ss is achieved during the second half of the treatment cycle.

Metabolism

Ethinylestradiol undergoes presystemic conjugation, both in the mucosa of the small intestine and in the liver. The main metabolic pathway is aromatic hydroxylation. The rate of clearance from the blood is 2.3-7 ml / min / kg.

breeding

The decrease in the concentration of ethinylestradiol in the blood serum is biphasic; the first phase is characterized by T 1/2 of the first phase - about 1 hour, T 1/2 of the second phase - 10-20 hours. It is not excreted unchanged from the body. Metabolites of ethinylestradiol are excreted in the urine and bile in a ratio of 4:6 with a T 1/2 of about 24 hours.

Indications

- contraception.

Contraindications

Jeanine should not be used in the presence of any of the conditions/diseases listed below. If any of these conditions develop for the first time while taking it, the drug should be immediately discontinued.

- the presence of thrombosis (venous and arterial) at present or in history (for example, deep vein thrombosis, pulmonary embolism, myocardial infarction, cerebrovascular disorders);

- the presence or history of conditions preceding thrombosis (for example, transient ischemic attacks, angina pectoris);

- diabetes mellitus with vascular complications;

- the presence or history of migraine with focal neurological symptoms;

- the presence of severe or multiple risk factors for venous or arterial thrombosis (including complicated lesions of the valvular apparatus of the heart, atrial fibrillation, diseases of the cerebral vessels or coronary arteries of the heart, uncontrolled arterial hypertension, major surgery with prolonged immobilization, smoking at an older age 35 years);

- liver failure and severe liver disease (before the normalization of liver tests);

- the presence or history of pancreatitis with severe hypertriglyceridemia;

- the presence or history of benign or malignant liver tumors;

- identified hormone-dependent malignant diseases of the genital organs or mammary glands or suspicion of them;

- vaginal bleeding of unknown origin;

- pregnancy or suspicion of it;

- the period of breastfeeding;

- Hypersensitivity to the components of the drug.

Carefully

The potential risk and expected benefit of using combined oral contraceptives should be carefully weighed in each individual case in the presence of the following diseases / conditions and risk factors:

- risk factors for the development of thrombosis and thromboembolism (smoking, obesity, dyslipoproteinemia, arterial hypertension, migraine, valvular heart disease, prolonged immobilization, major surgery, extensive trauma, hereditary predisposition to thrombosis / thrombosis, myocardial infarction or cerebrovascular accident at a young age in any of the next of kin /);

- other diseases in which peripheral circulatory disorders may occur (diabetes mellitus, systemic lupus erythematosus, hemolytic uremic syndrome, Crohn's disease, UC, sickle cell anemia, phlebitis of superficial veins);

- hereditary angioedema;

- hypertriglyceridemia;

- liver disease;

- diseases that first arose or worsened during pregnancy or against the background of a previous intake of sex hormones (for example, jaundice, cholestasis, gallbladder disease, otosclerosis with hearing loss, porphyria, herpes pregnant, Sydenham's chorea);

- postpartum period.

Dosage

Dragee should be taken orally in the order indicated on the package, every day at about the same time, with a small amount of water. Jeanine should be taken 1 tablet / day continuously for 21 days. Reception of each next pack begins after a 7-day break, during which withdrawal bleeding (menstrual-like bleeding) is observed. It usually starts on the 2-3rd day after taking the last pill and may not end before the start of a new package.

Start taking Jeanine

At not taking any hormonal contraceptives in the previous month Janine's intake begins on the 1st day of the menstrual cycle (i.e. on the 1st day of menstrual bleeding). It is allowed to start taking it on the 2nd-5th day of the menstrual cycle, but in this case it is recommended to use a barrier method of contraception during the first 7 days of taking the pills from the first package.

At switching from combined oral contraceptives, vaginal ring, transdermal patch Janine should be taken the next day after taking the last active tablet from the previous package, but in no case not later than the next day after the usual 7-day break in admission (for preparations containing 21 tablets) or after taking the last inactive tablet ( for preparations containing 28 tablets per package). When switching from a vaginal ring, a transdermal patch, it is preferable to start taking Janine on the day the ring or patch is removed, but no later than the day a new ring is to be inserted or a new patch is pasted.

At switching from contraceptives containing only gestagens ("mini-pill", injectable forms, implant) or from a progestogen-releasing intrauterine contraceptive () a woman can switch from taking a "mini-drink" to Jeanine on any day (without a break), from an implant or intrauterine contraceptive with a progestogen - on the day it is removed, from an injectable contraceptive - on the day when the next injection should be made. In all cases, it is necessary to use an additional barrier method of contraception during the first 7 days of taking the dragee.

After abortion in the first trimester of pregnancy a woman can start taking the drug immediately. In this case, the woman does not need additional methods of contraception.

After childbirth or abortion in the second trimester of pregnancy it is recommended to start taking the drug on the 21-28th day after childbirth or abortion in the second trimester of pregnancy. If the reception is started later, it is necessary to use an additional barrier method of contraception during the first 7 days of taking the pills. However, if a woman has already had a sexual life, pregnancy should be excluded before taking Zhanin, or it is necessary to wait for the first menstruation.

Taking missed pills

If the delay in taking the dragee less than 12 hours, contraceptive protection is not reduced. A woman should take the missed pill as soon as possible, the next pill is taken at the usual time.

If the delay in taking the dragee was more than 12 hours, contraceptive protection may be reduced.

In this case, you can be guided by the following two basic rules:

- taking the drug should never be interrupted for more than 7 days;

- to achieve adequate suppression of the hypothalamic-pituitary-ovarian system, 7 days of continuous intake of dragees are required.

Accordingly, if the delay in taking active dragees was more than 12 hours (the interval from the moment of taking the last active dragee is more than 36 hours), the following can be recommended:

First week of taking the drug

It is necessary to take the last missed tablet as soon as possible, as soon as the woman remembers this (even if this requires taking two tablets at the same time). The next dragee is taken at the usual time. Additionally, a barrier method of contraception (such as a condom) must be used for the next 7 days. If sexual intercourse took place within a week before skipping the dragee, the likelihood of pregnancy should be considered. The more pills missed, and the closer they are to a break in taking active substances, the greater the likelihood of pregnancy.

Second week of taking the drug

It is necessary to take the last missed tablet as soon as possible, as soon as the woman remembers this (even if this requires taking two tablets at the same time). The next dragee is taken at the usual time. Provided that the woman has taken the pill correctly within 7 days preceding the first missed pill, there is no need to use additional contraceptive measures. Otherwise, as well as skipping two or more pills, you must additionally use barrier methods of contraception (for example, a condom) for 7 days.

Third week of taking the drug

The risk of pregnancy increases due to the upcoming break in taking pills. A woman must strictly adhere to one of the two following options. Moreover, if during the 7 days preceding the first missed tablet, all the tablets were taken correctly, there is no need to use additional contraceptive methods.

1. It is necessary to take the last missed tablet as soon as possible, as soon as the woman remembers it (even if this requires taking two tablets at the same time). The next dragee is taken at the usual time until the dragees from the current package run out. The next pack should be started immediately without interruption. Withdrawal bleeding is unlikely until the second pack is finished, but spotting and breakthrough bleeding may occur while taking the pills.

2. A woman can also stop taking the dragee from the current package. Then she should take a break for 7 days, including the day she skipped the dragee, and then start taking a new package.

If a woman misses taking the pills, and then during the break in taking she does not have withdrawal bleeding, pregnancy should be excluded.

If a woman had vomiting or diarrhea up to 4 hours after taking active pills, absorption may not be complete and additional contraceptive measures should be taken. In these cases, you should be guided by the recommendations when skipping the dragee.

Changing the start date of the menstrual cycle

To delay the onset of menstruation, the woman should continue taking the pills from the new Jeanine package immediately after all the pills from the previous one have been taken, without interruption in the reception. Dragees from this new package can be taken for as long as the woman wishes (until the package runs out). While taking the drug from the second package, a woman may experience spotting or breakthrough uterine bleeding. Resume taking Janine from a new package after the usual 7-day break.

To move your period to another day of the week, a woman should shorten the next break in taking pills for as many days as she wants. The shorter the interval, the higher the risk that she will not have withdrawal bleeding and will have further spotting and breakthrough bleeding during the second pack (just as she would like to delay her period).

Additional information for special categories of patients

Children and teenagers Jeanine is indicated only after the onset of menarche.

After menopause Jeanine is not indicated.

Jeanine is contraindicated women with severe liver disease until liver function tests return to normal.

Jeanine has not been specifically studied in patients with impaired renal function. Available data do not suggest a change in treatment in these patients.

Side effects

When taking combined oral contraceptives, irregular bleeding (spotting or breakthrough bleeding) may occur, especially during the first months of use. While taking the drug Jeanine in women, other undesirable effects were observed, as indicated in the table below. Within each group, allocated depending on the frequency of an undesirable effect, undesirable effects are presented in order of decreasing severity.

Determining the frequency of adverse reactions: often (≥1 / 100 and<1/10), нечасто (≥1/1000 и <1/100), редко (≥1/10 000 и <1/1000). Для дополнительных побочных реакций, выявленных только в процессе постмаркетинговых наблюдений и для которых оценку частоты провести не представляется возможным, указано - частота неизвестна.

Often (≥1/100 and<1/10)	Infrequently (≥1/1000 and<1/100)	Rarely (≥1/10,000 and<1/1000)	Frequency unknown
Infections and contagion
	Vaginitis/vulvovaginitis Vaginal candidiasis or other vulvovaginal infections	Salpingoophoritis (adnexitis) Urinary tract infections Cystitis Mastitis cervicitis Fungal infections Candidiasis Herpetic lesions of the oral cavity Flu Bronchitis Sinusitis Upper respiratory tract infections Viral infections
Benign, malignant and unspecified tumors (including cysts and polyps)
		uterine fibroids Breast lipoma
Blood and lymphatic system
		Anemia
Endocrine system
		virilization
Metabolism
	Increased Appetite	Anorexia
Psychiatric disorders
	Decreased mood	Depression Mental disorders Insomnia Sleep disorders Aggression	Mood changes Decreased libido Increased libido
Nervous system
Headache	Dizziness Migraine	Ischemic stroke Cerebrovascular disorders Dystonia
sense organs
		Dryness of the mucous membrane of the eyes Irritation of the mucous membrane of the eyes Oscillopsia Sudden hearing loss Noise in ears Dizziness Hearing loss	Contact lens intolerance (discomfort when wearing them)
The cardiovascular system
	Arterial hypertension Arterial hypotension	Cardiovascular disorders Tachycardia, including increased heart rate Thrombosis/thromboembolism of the pulmonary artery Thrombophlebitis diastolic hypertension Orthostatic circulatory dystonia tides Phlebeurysm Vein pathology Pain in the veins
Respiratory system
		Bronchial asthma Hyperventilation
Digestive system
	Abdominal pain, including upper and lower abdominal pain, discomfort/bloating Nausea Vomit Diarrhea	Gastritis Enteritis Dyspepsia
Dermatological reactions
	acne Alopecia Rash, including macular rash Itching, including generalized itching	Atopic dermatitis/neurodermatitis Eczema Psoriasis Hyperhidrosis Chloasma Impaired pigmentation/hyperpigmentation seborrhea Dandruff hirsutism Pathological skin changes Orange peel Vascular asterisks	Erythema multiforme
allergic reactions
		Manifestations of allergic reactions, including allergic dermatitis	Hives erythema nodosum
Musculoskeletal system
		Back pain Feeling of discomfort in the muscles and bones Myalgia Pain in the limbs
Reproductive system and mammary glands
Breast pain, discomfort, breast engorgement	Abnormal withdrawal bleeding, including menorrhagia, hypomenorrhea, oligomenorrhea, and amenorrhea Intermenstrual bleeding, including vaginal bleeding and metrorrhagia An increase in the size of the mammary glands, swelling and a feeling of fullness of the mammary glands Swelling of the mammary gland Dysmenorrhea Discharge from the genital tract/discharge from the vagina ovarian cysts Pain in the pelvic area	cervical dysplasia Adnexal cysts Pain in the uterine appendages Breast cysts Fibrocystic mastopathy Dipareunia Galactorrhea Menstrual irregularities	Discharge from the mammary glands
General symptoms
	Fatigue Asthenia Bad feeling	Chest pain Peripheral edema Flu-like symptoms Inflammation Temperature rise Irritability	Fluid retention
Survey results
	Changes in body weight (increase, decrease and fluctuations in body weight)	An increase in the level of TG in the blood Hypercholesterolemia
Congenital and genetic disorders
		Detection of an additional mammary gland / polymastia

In women receiving combined oral contraceptives the development of the following undesirable effects has been reported: venous thromboembolic complications, arterial thromboembolic complications, cerebrovascular complications, arterial hypertension, hypertriglyceridemia, changes in tolerance to or influence on insulin resistance of peripheral tissues, liver tumors (benign or malignant), liver dysfunction, chloasma.

In women with hereditary angioedema, exogenous estrogens may exacerbate symptoms.

The occurrence or aggravation of conditions for which the relationship with the use of combined oral contraceptives has not been clearly proven: jaundice and / or itching associated with cholestasis, the formation of gallstones, porphyria, systemic lupus erythematosus; hemolytic-uremic syndrome, Sydenham's chorea, herpes of pregnancy, otosclerosis with hearing impairment, Crohn's disease, ulcerative colitis, cervical cancer.

In women using combined oral contraceptives, there is a very small increase in the incidence of breast cancer. Because breast cancer rarely occurs in women under 40 years of age, given the overall risk of developing breast cancer, the additional number of cases is very small. The relationship with the use of combined oral contraceptives is not known.

Overdose

Serious violations in case of overdose have not been reported.

Symptoms: nausea, vomiting, spotting or metrorrhagia.

Treatment: carry out symptomatic therapy. There is no specific antidote.

drug interaction

Interactions of oral contraceptives with other medicinal products may result in breakthrough bleeding and/or reduced contraceptive reliability.

The following types of interaction have been reported in the literature.

Effect on hepatic metabolism

The use of drugs that induce microsomal liver enzymes can lead to an increase in the clearance of sex hormones. These drugs include phenytoin, barbiturates, primidone, rifampicin; there are also suggestions for oxcarbazepine, topiramate, felbamate, griseofulvin and preparations containing St. John's wort.

HIV protease inhibitors (eg, ritonavir) and non-nucleoside reverse transcriptase inhibitors (eg, ) and combinations thereof can also potentially affect hepatic metabolism.

Effects on enterohepatic circulation

According to separate studies, some antibiotics (eg, penicillins and tetracyclines) can reduce the enterohepatic circulation of estrogens, thereby lowering the concentration of ethinyl estradiol.

While taking any of the above medicines, a woman should additionally use a barrier method of contraception (for example, a condom).

Substances that affect the metabolism of combined hormonal contraceptives (enzyme inhibitors)

Dienogest is a cytochrome P450 (CYP)3A4 substrate. Known inhibitors of CYP3A4, such as azole antifungals (eg, ketoconazole), cimetidine, verapamil, macrolides (eg, erythromycin), diltiazem, antidepressants, and grapefruit juice, may increase dienogest plasma levels.

While taking drugs that affect microsomal enzymes, and within 28 days after their withdrawal, you should additionally use a barrier method of contraception.

While taking antibiotics (with the exception of rifampicin and griseofulvin) and within 7 days after their withdrawal, you should additionally use a barrier method of contraception. If the period of using the barrier method of protection ends later than the pills in the package, you need to move on to the next package of Jeanine without the usual break in taking the pills.

Oral combined contraceptives may interfere with the metabolism of other drugs, leading to an increase (eg, cyclosporine) or a decrease (eg, lamotrigine) in plasma and tissue concentrations.

special instructions

Before starting or resuming the use of the drug Jeanine, it is necessary to familiarize yourself with the history of life, the family history of the woman, conduct a thorough general medical (including measurement of blood pressure, heart rate, determination of body mass index) and gynecological examination, including examination of the mammary glands and a cytological examination of a scraping from the cervix (test for Papanicolaou), exclude pregnancy. The volume of additional studies and the frequency of follow-up examinations is determined individually. In general, follow-up examinations should be carried out at least once a year.

A woman should be informed that Jeanine does not protect against HIV infection (AIDS) and other sexually transmitted diseases.

If any of the conditions, diseases and risk factors listed below are currently present, then the potential risk and expected benefit of using combined oral contraceptives should be carefully weighed in each individual case and discussed with the woman before she decides to start taking drug. With weighting, strengthening, or at the first manifestation of risk factors, drug withdrawal may be required.

Diseases of the cardiovascular system

The results of epidemiological studies indicate a relationship between the use of combined oral contraceptives and an increase in the incidence of venous and arterial thrombosis and thromboembolism such as deep vein thrombosis, pulmonary embolism, myocardial infarction, cerebrovascular disease) when taking combined oral contraceptives. These diseases are rare.

The risk of developing venous thromboembolism (VTE) is highest in the first year of taking these drugs. An increased risk is present after the initial use of oral contraceptives or the resumption of use of the same or different combined oral contraceptives (after a break between doses of 4 weeks or more). Data from a large prospective study in 3 groups of patients show that this increased risk is predominantly present during the first 3 months.

The overall risk of VTE in patients taking low-dose combined oral contraceptives (< 50 мкг этинилэстрадиола), в 2-3 раза выше, чем у небеременных пациенток, которые не принимают комбинированные пероральные контрацептивы, тем не менее, этот риск остается более низким по сравнению с риском ВТЭ при беременности и родах. ВТЭ может привести к летальному исходу (в 1-2% случаев).

Venous thromboembolism (VTE), manifested as deep vein thrombosis or pulmonary embolism, can occur with any combined oral contraceptive.

Very rarely, when using combined oral contraceptives, thrombosis of other blood vessels occurs, for example, hepatic, mesenteric, renal, cerebral veins and arteries or vessels of the retina. There is no consensus regarding the relationship between the occurrence of these events and the use of combined oral contraceptives. Symptoms of deep vein thrombosis (DVT) include: unilateral swelling of the lower extremity or along a vein in the leg, pain or discomfort in the leg only when standing or walking, localized fever in the affected leg, and redness or discoloration of the skin on the leg.

Symptoms of pulmonary embolism (PE) are as follows: difficulty or rapid breathing; sudden cough, incl. with hemoptysis; sharp pain in the chest, which may worsen with a deep breath; sense of anxiety; severe dizziness; fast or irregular heartbeat. Some of these symptoms (eg, shortness of breath, cough) are nonspecific and may be misinterpreted as symptoms of other more or less severe events (eg, respiratory tract infection).

Arterial thromboembolism can lead to stroke, vascular occlusion, or myocardial infarction. Symptoms of a stroke: sudden weakness or loss of sensation in the face, arm or leg, especially on one side of the body, sudden confusion, problems speaking and understanding; sudden unilateral or bilateral loss of vision; sudden disturbance of gait, dizziness, loss of balance or coordination of movements; sudden, severe or prolonged headache with no apparent cause; loss of consciousness or fainting with or without an epileptic seizure. Other signs of vascular occlusion: sudden pain, swelling and slight blueness of the extremities, acute abdomen.

Symptoms of a myocardial infarction include: pain, discomfort, pressure, heaviness, a feeling of tightness or fullness in the chest, arm, or chest; discomfort with irradiation to the back, cheekbone, larynx, arm, stomach; cold sweat, nausea, vomiting or dizziness, severe weakness, anxiety, or shortness of breath; fast or irregular heartbeat.

Arterial thromboembolism can be fatal.

The risk of developing thrombosis (venous and / or arterial) and thromboembolism increases:

- with age;

- in smokers (with an increase in the number of cigarettes or an increase in age, the risk increases, especially in women over 35 years old);

- with obesity (body mass index more than 30 kg / m 2);

- if there is a family history (for example, venous or arterial thromboembolism ever in close relatives or parents at a relatively young age). In the case of a hereditary or acquired predisposition, a woman should be examined by an appropriate specialist to decide on the possibility of taking combined oral contraceptives;

- with prolonged immobilization, major surgery, any operation on the legs or extensive trauma. In these situations, it is advisable to stop the use of combined oral contraceptives (in the case of a planned operation, at least four weeks before it) and not resume taking within two weeks after the end of immobilization;

- with dyslipoproteinemia;

- with arterial hypertension;

- with migraine;

- in diseases of the heart valves;

- with atrial fibrillation.

The question of the possible role of varicose veins and superficial thrombophlebitis in the development of venous thromboembolism remains controversial. An increased risk of thromboembolism in the postpartum period should be taken into account.

Peripheral circulatory disorders can also occur in diabetes mellitus, systemic lupus erythematosus, hemolytic uremic syndrome, chronic inflammatory bowel disease (Crohn's disease or ulcerative colitis), and sickle cell anemia.

An increase in the frequency and severity of migraine during the use of combined oral contraceptives (which may precede cerebrovascular disorders) may be grounds for immediate discontinuation of these drugs.

Biochemical indicators indicating a hereditary or acquired predisposition to venous or arterial thrombosis include: resistance to activated protein C, hyperhomocysteinemia, lack of antithrombin III, protein C deficiency, protein S deficiency, antiphospholipid antibodies (anticardiolipin antibodies, lupus anticoagulant).

In assessing the risk-benefit ratio, it should be taken into account that adequate treatment of the respective condition may reduce the associated risk of thrombosis. It should also be borne in mind that the risk of thrombosis and thromboembolism during pregnancy is higher than when taking low-dose oral contraceptives (< 50 мкг этинилэстрадиола).

Tumors

The most significant risk factor for cervical cancer is persistent papillomavirus infection. There are reports of a slight increase in the risk of developing cervical cancer with long-term use of combined oral contraceptives. However, the relationship with the use of combined oral contraceptives has not been proven. Controversy remains about the extent to which these data are related to screening for cervical pathology or to sexual behavior (less use of barrier methods of contraception).

A meta-analysis of 54 epidemiological studies showed that there is a slightly increased relative risk of developing breast cancer diagnosed in women who used combined oral contraceptives. The increased risk gradually disappears within 10 years after stopping these drugs. Due to the fact that breast cancer is rare in women under 40 years of age, the increase in the number of breast cancer diagnoses in women currently taking combined oral contraceptives or who have recently taken it is insignificant in relation to the overall risk of this disease. Its relationship with the use of combined oral contraceptives has not been proven. The observed increase in risk may also be due to earlier diagnosis of breast cancer in women using combined oral contraceptives. In women who have ever used combined oral contraceptives, earlier stages of breast cancer are detected than in women who have never used them.

In rare cases, against the background of the use of combined oral contraceptives, the development of liver tumors was observed, which in some cases led to life-threatening intra-abdominal bleeding. In the event of severe pain in the abdomen, liver enlargement, or signs of intra-abdominal bleeding, this should be taken into account when making a differential diagnosis.

Other states

Women with hypertriglyceridemia (or a family history of this condition) may have an increased risk of developing pancreatitis while taking combined oral contraceptives.

Although a slight increase in blood pressure has been described in many women taking combined oral contraceptives, clinically significant increases have been rare. However, if a persistent, clinically significant increase in blood pressure develops while taking combined oral contraceptives, these drugs should be discontinued and treatment of arterial hypertension should be initiated. Taking combined oral contraceptives can be continued if normal blood pressure values ​​are achieved with antihypertensive therapy.

The following conditions have been reported to develop or worsen both during pregnancy and when taking combined oral contraceptives, but their relationship with taking combined oral contraceptives has not been proven: jaundice and / or itching associated with cholestasis; the formation of stones in the gallbladder; porphyria; systemic lupus erythematosus; hemolytic uremic syndrome; chorea of ​​Sydenham; herpes of pregnant women; hearing loss associated with otosclerosis. Cases of Crohn's disease and non-specific ulcerative colitis have also been described with the use of combined oral contraceptives.

In women with hereditary forms of angioedema, exogenous estrogens may cause or worsen the symptoms of angioedema.

Acute or chronic liver dysfunction may require the withdrawal of combined oral contraceptives until liver function returns to normal. Recurrent cholestatic jaundice that develops for the first time during pregnancy or previous use of sex hormones requires discontinuation of combined oral contraceptives.

Although combined oral contraceptives may have an effect on insulin resistance and glucose tolerance, there is no need to change the therapeutic regimen in diabetic patients using low-dose combined oral contraceptives (less than 50 micrograms of ethinyl estradiol). However, women with diabetes should be closely monitored while taking combined oral contraceptives.

Occasionally, chloasma may develop, especially in women with a history of chloasma of pregnancy. Women with a tendency to chloasma while taking combined oral contraceptives should avoid prolonged exposure to the sun and exposure to ultraviolet radiation.

The effectiveness of combined oral contraceptives may be reduced by missing pills, vomiting and diarrhea, or as a result of drug interactions.

Effect on the menstrual cycle

While taking combined oral contraceptives, irregular bleeding (spotting or breakthrough bleeding) may occur, especially during the first months of use. Therefore, evaluation of any irregular bleeding should be done only after an adaptation period of approximately three cycles. If irregular bleeding recurs or develops after previous regular cycles, a thorough examination should be carried out to exclude malignant neoplasms or pregnancy.

Some women may not develop withdrawal bleeding during the pill break. If combined oral contraceptives were taken as directed, it is unlikely that the woman is pregnant. However, if previously combined oral contraceptives were taken irregularly or if there are no consecutive withdrawal bleedings, pregnancy should be excluded before continuing to take the drug.

Impact on lab test scores

Taking combined oral contraceptives may affect the results of some laboratory tests, including liver, kidney, thyroid, adrenal function, plasma transport proteins, carbohydrate metabolism, coagulation and fibrinolysis parameters. Changes usually do not go beyond the boundaries of normal values.

Preclinical safety data

Preclinical data obtained in the course of standard studies for the detection of toxicity with repeated doses of the drug, as well as genotoxicity, carcinogenic potential and toxicity to the reproductive system, do not indicate a particular risk to humans. However, it should be remembered that sex steroids may promote the growth of certain hormone-dependent tissues and tumors.

Influence on the ability to drive vehicles and control mechanisms

Not found.

Pregnancy and lactation

Jeanine is not prescribed during pregnancy and during breastfeeding.

If pregnancy is detected while taking Janine, the drug should be discontinued immediately. However, extensive epidemiological studies have not found an increased risk of malformations in children born to women who received sex hormones before pregnancy, or teratogenic effects when sex hormones were inadvertently taken early in pregnancy.

Taking combined oral contraceptives can reduce the amount of breast milk and change its composition, therefore, their use is contraindicated during lactation. Small amounts of sex steroids and/or their metabolites may be excreted in milk.

Terms of dispensing from pharmacies

The drug is dispensed by prescription.

Terms and conditions of storage

The drug should be stored out of the reach of children at a temperature not exceeding 25°C. Shelf life - 3 years.