We are glad to have Prof. Liu in the Sohu interview room today. Chinese women have a lot of misconceptions about oral contraceptives, and today we have Prof. Liu Yan, director of the Department of Family Planning at Shanghai Ruijin Hospital, talking to us about the misconceptions about oral contraceptives.
Liu Yan: These misconceptions are caused by the inadequate education system in China and the lack of knowledge about contraception. Now we are all making up for it, for example, there are now youth education, including now there are university student unions also organized contraceptive knowledge and health education, I went to speak a few times, the acceptance rate is very high, we should also call for the early public education of contraceptive knowledge popular. It is understood that in Chongqing next spring, primary and secondary schools will offer bi-weekly health education, including drug use control strategies and safe sex and the correct use of condoms, especially the dangers of teenage pregnancy are included in the teaching materials, which is a relatively good trend, so it should be implemented as early as possible in the country.
The hormonal components of the pill can produce a lot of side effects. For some misconceptions about the oral contraceptive pill, people still look at it from an older perspective, because the ingredients of the early contraceptive drugs, such as the content of estrogen and progesterone are relatively high, so the side effects are relatively large, causing misunderstandings about the side effects of the pill. However, since the mid-1980s, through the efforts of scientists in various countries, the pill has adopted some new progestins and reduced the content of estrogen, which can achieve good contraceptive effects at low doses with few side effects, so the current pill should be re-understood. For example, in 1968, 30% of oral contraceptives contained more than 50 micrograms of estrogen, but nowadays, the estrogen content of all best-selling products generally does not exceed 35 micrograms, so the estrogen content of current contraceptives is basically 20 to 30 micrograms, which means that the estrogen content is basically halved, so the side effects are also halved. so the side effects are also halved. In the 1980s, with the birth of new oral contraceptives, the androgen content has been greatly reduced, most typically with the birth of levonorgestrel. In terms of oral contraceptives alone, the dosage form, type of drug and hormone content of oral contraceptives have been greatly improved.
Which contraceptive method is the safest: oral contraceptives, condoms, in vitro ejaculation and birth control Moderator: What are the main misconceptions about oral contraceptives among women in our country?
Liu Yan: The main focus is on two aspects, one is that the reliability of oral contraceptives is relatively low, and the other is worried about the side effects of oral contraceptives. In a recent survey, only 7.7% of women in our country think that oral contraceptives are the most reliable, 23% of women are worried that oral contraceptives will affect fertility, and 63% of women are worried that oral contraceptives have various side effects, such as gaining weight, affecting fertility, harmful to health and so on. In terms of the reliability of contraceptives, about 65% of people think that condoms are the most reliable, the second most reliable is IUD, the third is IVF, and the fourth is oral contraceptives. However, in foreign countries, oral contraceptive pill is the safest and most scientific way for women to use contraception, the utilization rate of oral contraceptive pill in Europe and America should reach 30% to 40%, but only 2% in our country, which is a big gap. The more they know about the advantages of the pill, the more they are inclined to take oral contraceptives.
Moderator: Now the abortion rate in our country is gradually increasing, is this related to the use of oral contraceptives or improper use of other contraceptive measures?
Liu Yan: In our country, the abortion rate is about 62% among women aged 20 to 29, but the abortion rate in the Netherlands is only 5.1%, and the use of oral contraceptives in our country is 2.3%, while the rate in the Netherlands is 36%. There is a survey that among women aged 15 to 45, in France, Australia, the United Kingdom, Sweden, their contraceptive pill use rate is between 20% and 30%, their abortion rate is at the level of a few tenths of a thousand, the last rank is Japan, its abortion rate is higher than our country, up to 84%, their contraceptive pill use rate is lower than our China, only 1%, so this also This proves the correlation between the abortion rate and the oral contraceptive pill. In our country, 56% of the married women who failed to use contraception used condoms and 24% used IUDs. From the clinical point of view, the main reason for the failure of contraception among unmarried women is the use of condoms, including some cases of failure to use condoms correctly, and some unsafe factors of condoms themselves, such as condom slippage or failure to check whether the condom is intact before use, and clinical data show that the pill is 10 to 15 times more reliable than condoms, and 1 time more reliable than IUDs. The pill is 10 to 15 times more reliable than the condom and 1.5 to 4 times more reliable than the birth control device.
How do birth control pills work? How does it work?
Moderator: Next, can Professor Liu tell us about the mechanism of action and the method of taking various oral contraceptives?
Liu Yan: The mechanism of action of contraceptive pills is mainly the joint action of estrogen and progesterone, its effect is mainly three aspects, one is to thicken the cervical mucus through the influence of some hormones, which plays a barrier role to prevent the penetration of sperm; another is to inhibit ovulation, generally speaking, the method of taking is to start taking on the first day of menstruation, one tablet a day, usually 21 tablets a box, after taking a cycle of the next The next time you get your period, you can take it again. The mechanism of action of the long-acting oral contraceptive pill is similar to the short-acting one, but the hormones in it are mainly stored in the body’s fat to play a slow-release, long-acting contraceptive effect, basically a monthly pill. There is also the mechanism of action of the family visit pill, most of which contains progestin, which can change the shape and function of the endometrium, so that the fertilized egg is not easily formed, so it is more suitable for couples who live apart for a short period of time to visit their families to prevent pregnancy. The mechanism of action of the emergency contraceptive pill is only to protect against unprotected intercourse once in a cycle, but its hormone content is very high, equivalent to 8 days of conventional short-acting contraceptive pills, and its side effects are also very large, and the contraceptive efficiency is also significantly lower than that of conventional contraceptive methods, so we only use it as an occasional emergency after unprotected intercourse. It is not recommended to be used more than once during a menstrual cycle.
Can I take oral contraceptives for a long time? Does it increase the risk of cancer?
Moderator: Nowadays, people’s misconceptions about contraceptive pills mainly focus on short-term contraceptive pills, we ask Professor Liu to clarify these misconceptions for us?
Liu Yan: There are several major misunderstandings, one is that people think that long-term oral contraceptives are harmful to the body or that it is best not to take them for more than 5 or 10 years at a time, this problem is not only raised by the public, in fact, for us medical workers also have such misunderstandings, often come to consult, in fact, this view is also wrong.
There is no clinical study that shows that women without contraindications to oral contraceptives have any adverse health effects after long-term use. In fact, foreign women who insist on taking oral contraceptives usually continue to go through menopause, and they have a lot of information that there are no serious adverse reactions or side effects because the hormone content of oral contraceptives has been reduced by nearly 50% compared with the earliest oral contraceptives, especially the content of estrogen, so the incidence of hormone-related side effects, including nausea, headache, breast tenderness, spot bleeding, etc., has been reduced to a minimum. The incidence of side effects caused by hormones, including nausea, headache, breast tenderness, spotting and bleeding, etc., has been reduced to a minimum, and even if these side effects exist, they will gradually disappear after three months of continuous use. For example, for women with menstrual disorders or painful periods, taking oral contraceptives can improve menstrual pain if gynecological examinations are performed to rule out organic lesions, and in the long term, oral contraceptives can reduce the incidence of ovarian cancer, endometrial cancer, benign breast hyperplasia and certain gynecological diseases such as pelvic inflammatory disease, ectopic pregnancy and osteoporosis.
Studies have found that the incidence of endometrial cancer decreases the longer you take the pill, and this protection lasts for 15 years after you stop taking it. With a complete gynecological examination once a year, oral contraceptives are perfectly acceptable for long-term use.
Do I have to stop taking oral contraceptives for 3-6 months if I want to get pregnant?
There is also a misconception that it is necessary to stop taking any kind of oral contraceptive for three to six months if you plan to get pregnant. The short-acting contraceptive pill is more suitable for newlyweds or women who have no plans to have children in the short term.
Will long-term use of oral contraceptives affect women’s fertility?
The third misconception is that some people worry that long-term use of oral contraceptives will affect women’s fertility and lead to infertility, so after taking oral contraceptives for a while they think they should stop for a while. This phenomenon is also highlighted in the survey, 23.84% of women feel that oral contraceptives will affect fertility, but in fact, any information shows that after long-term use of short-acting oral contraceptives, women’s fertility will not be inhibited. In addition, it can reduce the occurrence of pelvic cancer and other diseases, so you do not have to worry about the oral contraceptive pill affecting fertility, and the recovery of fertility is not related to the duration of the oral contraceptive pill.
Can oral contraceptives cause fatness and acne?
The fourth aspect is that many women feel that oral contraceptives can lead to side effects such as fatness and acne, especially young women, including some young women who have repeated abortions in hospitals, including those I talked to in the university town, and these young women are especially concerned about this. This is actually a misconception. In fact, this is also a misunderstanding, in the past, the progestin contained in oral contraceptives has the effect of endogenous androgens, so long-term use of oral contraceptives will make the body fat, while the current oral contraceptives progestin changes have almost no affinity for androgen receptors, and even have a better anti-androgen effect, such as the anti-androgen effect of the contraceptive pill Daying-35 can treat many Kaohsiung vegetation In fact, these drugs are not only used by us, but also by women with hirsutism and acne in the dermatology department. Therefore, we should not worry that oral contraceptives will cause acne and other side effects. On the one hand, menstruation is restored, and on the other hand, acne disappears. During the course of taking the pill, some women may have some side effects, but they are relatively mild and will not affect normal life, and this is only a small percentage of the population.
In fact, women should have a correct understanding of these side effects and should not be afraid to talk about them, because there are two sides to everything, women should think about the question, whether the side effects of taking oral contraceptives are harmful to the body or abortion is harmful to the body, if you think about it this way will certainly make a wise and The right choice. Now there are more painless abortions, we all feel that painless abortions may not do much harm to the body, because it may wake up after a sleep after anesthesia, so people repeatedly abortion will not cause a certain fear, in fact, this is the opposite situation, because the operation of abortion and operation without anesthesia are the same, in addition there is a risk of anesthesia, one is the risk of mechanical damage and anesthesia. The risk of abortion, even if it is painless or medication, all kinds of abortions are very harmful to the body, if you do not plan to get pregnant, you should still do a good job of contraception. Some people think that long term use of oral contraceptives may appear amenorrhea, generally speaking amenorrhea is mainly after the discontinuation of oral contraceptives more than 6 months, but experts believe that oral contraceptives and amenorrhea there is no causal relationship between the two, this and oral contraceptives oral time and type are not related to the appearance of amenorrhea there are many factors, such as premature ovarian failure, polycystic ovary syndrome and other diseases, experts recommend Menorrhagia should all be seen by a doctor and receive appropriate treatment.
Who is not suitable for taking oral contraceptives Moderator: Thank you very much Professor Liu for your in-depth explanation, so Professor Liu what groups of people are not suitable for taking oral contraceptives?
Liu Yan: Any drug has its advantages and certain side effects, and oral contraceptives are the same. We clinically refer to women over 35 years old who smoke or have cardiovascular disease, these women taking oral contraceptives for a long time may increase the incidence of venous thrombosis and myocardial infarction. It is also not recommended for people with systemic diseases, such as hepatitis, myocarditis, diabetes, etc. In addition, women over 40 years old, suffering from epilepsy or depression, abnormal menstruation and breastfeeding should not choose this contraceptive method.
Liu Yan: In my clinic, many women who come to see me for infertility often have a history of multiple abortions, up to 8 abortions, because the endometrium is damaged after repeated mechanical scraping or multiple abortions, and the embryo is not easily implanted or causes secondary inflammation, because these women often do not pay attention to rest after the abortion. These women often do not take care of their rest after abortion, which may bring some inflammation and cause blockage of the fallopian tubes. These women feel guilty about not being able to get pregnant after marriage, which can affect the stability of their marriage, so they regret that their previous incorrect contraceptive methods have affected their sexual life. Now some medical institutions are not very formal, some women are afraid to go to the regular hospital, so they go outside to private abortion, our hospital has received a patient due to private abortion haemorrhage, the patient almost to the state of shock, this is also very harmful to women, if the bleeding is not only may also have to remove the uterus, etc., I should say that the risk of abortion is very big.
Host: In fact, many women are not aware of the dangers of abortion.
Liu Yan: For women there are serious complications not only during childbirth, abortion also has serious complications, in 1996 there are about 50 million people worldwide have experienced abortion, there are 12 million serious complications, such as various bleeding, perforation, and even take the uterus are there, this 12 million among the deaths caused by 67,000 people, from this figure, abortion is also quite harmful. The danger of abortion is also quite large. As a woman to decide when to have children, when to have children within their own plans is the best, if every time do not pay attention to contraception, and through abortion to make up for the damage to their own body is also very big.
The use of oral contraceptives in China is only 2.3%, and this situation needs to be improved. We also found that the trend of unplanned pregnancy among women is getting younger. Our hospital has a 24-hour contraceptive hotline, and we often get calls from underage women who don’t know what to do after an unplanned pregnancy, including a woman who was only 16 years old when she came to our hospital, and she was already more than 6 months pregnant. The older the pregnancy is, the more damage it will do to her body, and the more she will be unable to bear the pain of childbirth because she is not an adult.
In addition, some women who have repeated abortions often choose painless abortions, as if each abortion was harmless and painless to them, but in fact, there is still damage to the uterus after multiple abortions. This means that in the process of abortion, the uterus of these women who have repeated abortions is prone to perforation, which will also bring certain harm to her future fertility.
The harm of using emergency contraceptive pills: Now many friends think that there is no difference between emergency contraceptive pills and regular contraceptive pills, and use emergency contraceptive pills frequently and repeatedly, is it reasonable to do so?
Liu Yan: This contraceptive point of view is very wrong, because the emergency contraceptive pill contains more than 8 times the conventional hormone content, the damage to the body is very big, so often take on the one hand will cause menstrual disorders, in addition to the body has serious side effects, the effectiveness of contraception will also be greatly reduced. Clinically, it is found that some women have ectopic pregnancies caused by the indiscriminate use of emergency contraceptives. We usually meet a lot of abortion patients, we must ask her what her contraceptive measures are, there are a lot of young women one is to calculate the safe period, and most of them have the experience of taking emergency contraceptive pills, but they are not accurate enough, the contraceptive effect of emergency contraceptive pills is not high, so it causes a lot of unintended pregnancy, in addition, some women already have menstrual disorders, and then In addition, some women already have disrupted menstruation, and after abusing the emergency contraceptive pill, their menstrual cycle is disrupted, and when they come to the clinic, they are even pregnant for more than 3 months without knowing it, because they use the oral contraceptive pill every time they have intercourse, but they don’t know that they are already an unwanted pregnancy. Therefore, the emergency contraceptive pill is recommended to be used once in a cycle without protection, but it should never be used as a regular contraceptive pill during a cycle.
The oral contraceptive pill is not recommended for mothers who are just out of breastfeeding Host: Is it better to use some oral contraceptive pill for mothers who are just out of breastfeeding?
Liu Yan: not recommended, because after the birth of a child has to consider the long-term contraceptive measures, since the consideration of long-term contraception can use the IUD, most women are still more suitable, and we now have more types of IUDs, so you can avoid long-term medication, of course, if you do not want to put the IUD can also take oral contraceptives.
Moderator: We now look at the problems of netizens.
Netizen: twice a month oral emergency contraceptive pill is harmful Netizen: twice a month oral emergency contraceptive pill, will not cause some adverse effects on the body, will not play a contraceptive role?
Liu Yan: If the emergency contraceptive pill is taken within 72 hours of unprotected sex, its protective effect is still there, but this emergency contraceptive pill contraceptive effect is only 80%, and can not be said to be 100%, I suggest that we should make a correct choice of contraceptive methods, not every cycle always use the emergency contraceptive pill to solve the problem, if the short-term do not want children can use oral contraceptive pill The pill is not harmful to the body.
Netizen: how to use the long-acting oral contraceptive pill Netizen: I had a baby, has been using the long-acting oral contraceptive pill and condoms alternate contraception, how long to take the pill continuously to be considered long-term, long-term service to the body is there any effect?
Liu Yan: In fact, this issue has a little misunderstanding, we refer to the long-acting contraceptive pill is to take a piece every month, this is called long-acting contraceptive pill, long-acting contraceptive pill inside the hormone is stored in the fat slowly released, so it can maintain a month, and then alternate with condoms, it seems not much need, long-acting contraceptive pill to stop taking must use three months of short-acting contraceptive pill, once you stop taking the pill may affect your The long-acting contraceptive pill must be used for three months after stopping the short-acting pill, which may affect your menstrual condition, so it must be used for three months to give the body a recovery period.
Netizen: What kind of contraception do I need to choose after I get married?
Netizen: Do I still need to use contraception for the first few months of pregnancy? If I don’t have a period, do I have to be pregnant? What kind of contraception do I need to choose after I get married?
Liu Yan: We still advocate family planning, if a normal woman, then once a month ovulation, without protective measures, every month can be pregnant, so no plan to get pregnant should take contraceptive measures every month. The absence of menstruation is only a sign, because it is related to many factors, and the pregnancy can be verified by a urine test. It is better to take oral contraceptives if you don’t want to get pregnant for a while after marriage.
Netizen: What is the most appropriate contraceptive pill for women who have never had children and are still planning to have children in the future?
Liu Yan: Now there are some better birth control pills on the market, such as Tegui Le, which is a three-photo, its hormone amount is relatively small, its contraceptive effect is also more reliable, and Ma Fu Long or Min Ding even, these contraceptives are a new generation of oral contraceptives, its hormone content is relatively low, the side effects are small, fertility can be restored immediately after stopping the pill, will not affect future conception.
The new generation of oral contraceptives is a new generation of oral contraceptives with low hormone content and low side effects.
Liu Yan: In this case, it is best to take Daying-35, because on the one hand, it can control the entire menstrual cycle, and on the other hand, there is a cyproterone acetate in Daying-35, which has an anti-androgen effect, so it is better for acne in all aspects, and of course, the reasonable arrangement of one’s life is also an important issue.
Netizen: Can hepatitis B carriers take this type of contraceptive pill?
Liu Yan: This is to confirm whether the liver function is normal, if normal, it is possible to take, because the metabolism of the contraceptive pill is through the liver to metabolize.
The most harmful thing for women is not the pill but abortion, so new women should have new concepts instead of sticking to them, so that they can face all kinds of challenges in the new society with more ease and confidence and be a new woman in the new era.