non-contraceptive benefits hormonal contraception after abortion (hormonal rehabilitation) moscow...

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)