Oral contraceptives are one of the most widely used methods of preventing unwanted pregnancy. They are so widely used that in the Scandinavian countries more than 60% of young women prefer this method of contraception. In our country, oral contraceptives are increasingly being imposed as a means of choice, as their reliability is improving, and their use reaches 14%. Therefore, it is important to know what the “pill” represents, why it is used, what the composition is, but also what the unwanted effects of its use can be. Here’s more about the types of oral contraceptives and how they work… The main way birth control works is to suppress ovulation (see “When do I ovulate?” for more information). Due to the external intake of sex hormones in the form of a pill, the secretion of hypothalamic hormones, which have a stimulating effect on the sex endocrine function, is suppressed. Thus, by influencing the ovarian function to secrete hormones and the possibility of feedback between the individual regulatory levels, the entire neuro-endocrine axis is silenced. NEWS_MORE_BOX Absence of ovulation also means that no ovarian follicle has reached a mature stage in which a fertilized egg can be found. The third barrier against unwanted pregnancy, which is reinforced by contraceptives, is a change in the cervical mucus. It becomes thick and restricts the passage of spermatozoa into the female genital tract and also of infectious agents, which explains why the incidence of inflammatory diseases of the uterus and fallopian tubes is lower in women using oral contraceptives. Contraceptives exert their influence at the level of the functional layer of the uterine lining – the endometrium. Due to the lack of hormonal stimulation, the circulatory system does not proliferate (grow), and glandular cells reduce the storage of glycogen, which is their main food source. Thus, the endometrium thins, becomes unfit to support a possible implanted conceptus, but also reduces menstrual blood loss. Modern oral contraceptives do not differ significantly in terms of their contraceptive potential, but they differ in their composition. The main semi-synthetic estrogen that is used is ethinylestradiol (EE) and depending on the amount of estrogens, the pills are divided into: high-dose (35-50 micrograms EE), low-dose – up to 35 micrograms, ultra-low-dose – 20 μg EE and ultra-low-dose with a concentration of ethinylestradiol up to 15 micrograms. Some oral contraceptives contain progestogens that are different and usually these determine the difference between the individual preparations available on the market. For example, cyproterone and dienogest have a very pronounced anti-androgen effect, which means that they reduce unwanted hair, smooth the skin and make it less oily. Thus, depending on the amount of estrogens and progestogens, contraceptives are divided into: 1.Combined oral contraceptives: a. Monophasic: estrogen – progestagen in the same dose in all tablets for the month; b. Biphasic: the dose of estrogen is the same in all pills. The pills are divided by color into 11 tablets with a low amount of progestogen and the next 10 tablets with a higher amount; c. Triphasic: three types of tablets of different color, with increasing doses of progestin in the three phases. These preparations well mimic the natural fluctuation of female sex hormones during the menstrual cycle; 2. Sequential oral contraceptives: most completely mimic the normal cycle and contain 6 tablets of estrogen only followed by 15 tablets of estrogen and progestogen. Preparations for emergency contraception will be presented separately, so if you are interested, follow the articles on Puls.bg, and contraceptives containing only progestins are not of our concern, because there are no preparations in Bulgaria registered by this group. Oral contraceptives according to the amount of estrogen: High-dose (EE over 35 mcg) Gravistat 125, Non Ovlon, Tristiton, Anteovin, Tri-Regol, Triquilar Low-dose (EE – 30-35 mcg) Regulon, Diane 35, Microgynon, Marvelon, Jeanine, Cilest . Gestoden Femoden, Mirelle, Logest Noraethisteron acetate Trinovum, Non Ovlon Norgestimate Cilest Cyproteron acetate Diane 35 Dienogest Jeanine Desogestrel Marvelon, Novynette, Regulon, Mercilon Types of combined oral contraceptives according to the distribution of estrogen and progestogen: Monophasic oral contraceptives Gravitat 125, Logest, Marvelon, Regulon , Novynette, Diance 35, Mercilon, Microgynon, Rigevidon, Femoden, Cilest, Jeanine, Mirelle, Non Ovlon Biphasic oral contraceptives Anteovin Triphasic oral contraceptives Tristiton, Tri-Regol, Trinovum, TriquilarHigh-dose (EE over 35 mcg) Gravistat 125, Non Ovlon, Tristiton, Anteovin, Tri-Regol, Triquilar Low-dose (EE – 30-35 mcg) Regulon, Diane 35, Microgynon, Marvelon, Jeanine, Cilest, Femoden, Trinovum, Rigevidon Over-dose (EE – 20 mcg) Novynette, Mercilon, Logest Ultra low-dose (EE – 15 mcg) Mirelle Oral contraceptives according to the type of progestogen: Levonorgestrel Gravistat 125, Aneovin, Microgynon, Rigevidon, Tri-Regol, Trisiston, Triquilar Gestoden Femoden, Mirelle, Logest Noraethisteron acetate Trinovum, Non Ovlon Norgestimate Cilest Cyproteron acetate Diane 35 Dienogest Jeanine Desogestrel Marvelon, Novynette, Regulon, Mercilon Types of combined oral contraceptives according to the distribution of estrogen and progestagen: Monophasic oral contraceptives Gravistat 125, Logest, Marvelon, Regulon, Novynette, Diance 35, Mercilon , Microgynon, Rigevidon, Femoden, Cilest, Jeanine, Mirelle, Non Ovlon Biphasic oral contraceptives Anteovin Triphasic oral contraceptives Tristiton, Tri-Regol, Trinovum, TriquilarHigh-dose (EE over 35 mcg) Gravistat 125, Non Ovlon, Tristiton, Anteovin, Tri-Regol, Triquilar Low-dose (EE – 30-35 mcg) Regulon, Diane 35, Microgynon, Marvelon, Jeanine, Cilest, Femoden, Trinovum, Rigevidon Over-dose (EE – 20 mcg) Novynette, Mercilon, Logest Ultra low-dose (EE – 15 mcg) Mirelle Oral contraceptives according to the type of progestogen: Levonorgestrel Gravistat 125, Aneovin, Microgynon, Rigevidon, Tri-Regol, Trisiston, Triquilar Gestoden Femoden, Mirelle, Logest Noraethisteron acetate Trinovum, Non Ovlon Norgestimate Cilest Cyproteron acetate Diane 35 Dienogest Jeanine Desogestrel Marvelon, Novynette, Regulon, Mercilon Types of combined oral contraceptives according to the distribution of estrogen and progestagen: Monophasic oral contraceptives Gravistat 125, Logest, Marvelon, Regulon, Novynette, Diance 35, Mercilon , Microgynon, Rigevidon, Femoden, Cilest, Jeanine, Mirelle, Non Ovlon Biphasic oral contraceptives Anteovin Triphasic oral contraceptives Tristiton, Tri-Regol, Trinovum, Triquilar