non-contraceptive benefits hormonal contraception after abortion (hormonal rehabilitation) moscow...
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Non-contraceptive benefits hormonal contraception
after abortion(hormonal rehabilitation)
Moscow Regional Research Center of Obstetrics & Gynecology, Moscow
Olga Serova, M.D., professor
Long-term sequelae
Inflammatory diseasesMenstrual disorders Reproductive function’ disorders High risk complications of subsequent pregnancies High risk of perinatal pathology Maternal mortality
Abortion Prevention
Safe abortion technology
Rehabilitation after abortion
Effective contraception
Post-abortion bleeding
Medical abortion Vacuum-aspiration
Surgical abortion
6 days
4,5 days
6,5 days
Time of first menstrual period after abortion
Medical abortion Vacuum-aspiration
Surgical abortion
29,1
40,2
48,2
Hormonal disorders after abortionHormonal disorders after abortion
26%
4%12%
Surgical abortion
Vacuum aspiration
Medical abortion
Decidua during medical abortion
Pathmorphological analysis of materials after vacuum aspiration
Pathmorphological analysis of materials after surgical abortion
7th day’s endometrial after medical abortion7th day’s endometrial after medical abortion
7th day’s endometrial after 7th day’s endometrial after vacuum aspirationvacuum aspiration
7th day’s endometrial after 7th day’s endometrial after surgical abortionsurgical abortion
Appropriate transformation after medical abortion
Delayed endometrium’ transformation after vacuum aspiration
Incomplete endometrium’ transformation after surgical abortion
Hormonal rehabilitation
Medical abortion3 months
Vacuum aspiration3 months
Surgical abortion3 months
• Monophasic COC Regulon• Microdosis COC Novinett
• Monophasic COCRegulon
• Microdosis COCNovinett
Monophasic COC Regulon
Post-abortion contraception
efficacyefficacy safesafe no side-effectsno side-effectsprevention inflammatory diseasesprevention inflammatory diseases
Differential approach to choice of COC
Acne, hirsutism RegulonDismenorrea RegulonMenstrual disorders RegulonPCOS Regulon, NovinettDiabetus melitus NovinettEndometriosis NovinettObesity Regulon, Novinett Teens/Young age Novinett
Benefits of the desogestrel-containing COC
• Efficacy• Acceptability• No side effects (anabolic, androgenic)• No influence on BP, lipid and carbohydrate
metabolism
Non-contraceptive benefits of desogestrel-containing COC
Menstrual cycle regulation Reducing dysmenorrhea symptoms Reducing blood bleeding Hyperandrogenia Endometriosis treatment
Protective effects of desogestrel-containing COC
risk’s of an extrauterina pregnancy
risk’s of an endometrial and an ovarian carcinoma
risk’s of benign mammary gland
risk’s of ovarian cysts and benign ovary’ and uterus’ tumors
risk’s of inflammatory diseases
risk’s of haemorrhage in women with coagulopathy
risk’s of leiomyoma and endometriosis
Follow-up
Control side effects, BP
Laboratory tests in women with somatic diseases
(1 time in 6 months)
Pelvic exam, including colposcopy and colpocytology
(1 time in a year)
Ultrasound (1 time in a year, in require)
Breast exam (1 time in 6 months), mammography
1 time in a year) and ultrasound (in some indications)
COC benefits
Long application
Return fertility just after stopping
Possibility of cancel in case of side effects
or complications
2,0%
0% 0%
0,0%
0,2%
0,4%
0,6%
0,8%
1,0%
1,2%
1,4%
1,6%
1,8%
2,0%
surgical abortion vacuum aspiration medical abortion
menstrual disorders
Effectiveness of the rehabilitation after abortion(1 year follow-up)