Menstruation and its features. Menstruation and its characteristics Do menstruation stop when taking Diane 35

Diane 35 is a low-hormone contraceptive pill that can be used as a method of contraception, or as a treatment for acne, seborrhea, and other diseases accompanied by an increase in the level of androgens (male sex hormones) in the blood.

ATTENTION: The drug has contraindications. Do not start using this drug without first consulting your doctor.

Composition of tablets and packaging

Diane 35 belongs to the group of monophasic drugs. This means that all tablets (dragées) in the package contain the same dose of hormones. One tablet of Diane 35 contains 35 mcg of ethinyl estradiol and 2 mg of cyproterone acetate. Cyproterone acetate, which is part of Diane 35, provides an antiandrogenic effect (fights increased testosterone in the blood).

One blister contains 21 tablets. One package of Diane 35 contains 3 or 6 blisters.

Advantages of Diana 35

Diane 35 has a reliable contraceptive effect, which is achieved mainly by suppressing ovulation in the ovaries. The effect of the drug is reversible, so immediately after stopping Diane 35, pregnancy becomes possible again.

The oral contraceptive Diane 35 has a powerful antiandrogenic effect, so it can be prescribed for acne, seborrhea, hirsutism (excessive body hair growth), hair loss (androgenetic alopecia).

This drug can be prescribed in the treatment of infertility due to polycystic ovary syndrome. To achieve the effect, Diane 35 must be taken for 3-6 months. After stopping the pills, the chances of natural ovulation increase significantly.

While taking these pills, the menstrual cycle is restored, menstruation becomes less painful, and the amount of blood loss during menstruation decreases.

Rules for admission to Diana 35

Diana 35 should be taken one tablet per day, regardless of meals (before or after meals), at any convenient time of the day. The incidence of side effects is significantly reduced if you take the tablets in the evening, before bed.

It is advisable to take the tablets at the same time every day.

If you have not used any hormonal contraceptives in the past month

You need to start taking Diana 35 on the first day of the menstrual cycle. The first day of the menstrual cycle is considered the day when the first spotting appears, even if it is not heavy. After you start taking Diane 35, your periods may stop: this is normal and is associated with the start of taking hormones. It is also possible that your periods will not stop, but on the contrary, will drag on for 7-10 days or more. This is also normal.

Take one Diane 35 tablet once a day for 21 days in a row. After the pack is finished, take a break for 7 days and start a new pack on the eighth day. During a week-long break, menstrual-like bleeding (menstruation) may occur. Your periods may not be as heavy as usual. This is fine.

When will the contraceptive effect occur?

If you start taking the pills on the first day of your period, the contraceptive effect occurs immediately. You may no longer use other methods of protection against pregnancy.

If you take the first pill from the 2nd to the 5th day of your period, the contraceptive effect will occur after 7 days. In this case, Diana 35 needs to use condoms for another 7 days after starting to take it.

Will the contraceptive effect continue after a week's break?

Provided that the pills are taken correctly (without omissions and without factors that reduce the effect of OK), the contraceptive effect of Diane 35 is maintained even during the 7-day break between packs.

How to switch to Diana 35 from other birth control pills?

If your previous birth control pills contained 21 tablets in a blister pack:

You can start taking Diane 35 the next day after the last tablet taken of the previous OC, or

on the eighth day after the end of the previous OK

If your previous birth control pills contained 28 tablets per blister:

You can start taking Diane 35 the next day after the last active tablet you took, or

the next day after drinking 28 tablets of the previous OK

If you did not manage to start taking Diane 35 within the specified time frame, then you should wait until your next menstruation and take the first tablet on the first day of your period. To avoid unwanted pregnancy, you should use or before starting to take the pills.

How to switch to Diana 35 from a vaginal ring or from a hormonal patch?

You can take the first Diane 35 tablet on the day of removal of the vaginal ring or on the day when you needed to install a new vaginal ring or attach a new patch.

How to switch to Diana 35 from an intrauterine device (IUD)?

You need to start taking Diana 35 on the day of removal. To avoid unwanted pregnancy, use condoms for the first 7 days after starting birth control pills.

How to start taking Diana 35 after an abortion?

After an abortion in the early stages of pregnancy (up to 12 weeks), you need to start taking Diane 35 on the day of the abortion. In this case, the contraceptive effect occurs immediately and additional contraceptives are not needed.

After an abortion during a pregnancy of 12 weeks or more, you need to start taking Diane 35 on days 21-28 after the abortion (use condoms before starting Diane 35). In this case, the contraceptive effect occurs immediately and additional contraceptives are not needed. If taking the pills was started later, it is recommended to use additional contraception (condoms) for another 7 days after starting to take Diane 35.

How to start taking Diana 35 after giving birth?

You can start taking pills on days 21-28 after birth. In this case, the contraceptive effect occurs immediately and additional contraceptives are not needed. If you started taking Diane 35 later, you need to use condoms for another 7 days.

If after giving birth and before starting to take Diane 35 you had unprotected sexual intercourse, then you first need to rule out pregnancy and only then start taking birth control pills.

Can Diane be taken by 35 nursing mothers?

If you are breastfeeding, then taking Diane 35 is contraindicated for you.

What should I do if I mixed up the order of taking Diana 35?

All Diane 35 tablets contain the same dose of hormones. If you mixed up the order of taking the pills, but still took one pill per day, then the contraceptive effect remains at the same level. Continue drinking Diane 35 as usual.

What to do if you miss a Diane 35 tablet?

A delay of less than 12 hours in taking the next pill is not considered a miss and does not reduce the contraceptive effect. In this case, take the missed tablet as soon as possible and continue taking subsequent tablets at your usual time.

If you are 12 hours or more late in taking your next pill, the contraceptive effect may be reduced in the next 7 days. To understand what to do in this case, look at which pill you missed:

From 1 to 14 tablets (first and second weeks of use) : Take the missed tablet as soon as possible, even if you have to take 2 tablets at the same time. Then take the tablets as usual. For another 7 days after skipping, use additional means of protection against pregnancy (for example, condoms).

From 15 to 21 tablets (third week of use) : There are two possible actions.

1. Take the missed pill as soon as possible, even if you have to take two pills at the same time. Then take the tablets as usual. If you have not missed a dose in the previous 7 days, you do not need to use additional contraception. If you choose this option, then you need to skip the break: that is, immediately after finishing the current pack, start a new one the next day. Drink the second package to the end and only then take a break.

2. Throw away the current package of Diana 35 and after 7 days start a new one. This way you will go on break a few days earlier. Be sure to ensure that the break lasts no more than 7 days. Otherwise, the contraceptive effect may be reduced and pregnancy may occur. If you have not had any other absences in the last week, you do not need to use additional contraception.

What should I do if I missed several Diane 35 tablets?

If you missed 2 Diana 35 tablets in a row, then the contraceptive effect of the drug may be reduced. Pay attention to the numbers of missed tablets:

From 1 to 14 (first and second week of admission) : Take two tablets one day and two tablets the next day. Then continue taking the tablets as usual, one per day. For another 7 days after skipping, use additional contraception (for example, condoms).

From 15 to 21 (third week of admission) : Throw away the current package of Diana 35 and start a new package. You should drink the new package to the end and only then take a 7-day break. If you have not had any other absences in the week before your pass, you do not need to use additional contraception. If you have had other absences in the previous 7 days, then use condoms for another week after the absence.

If you missed 3 Diana 35 tablets in a row, then throw away the current pack of tablets and start a new one. The new package should be drunk to the end. Use additional contraception for 7 days after missing a dose.

If you had unprotected sexual intercourse in the previous 7 days before skipping, then there is a risk of pregnancy. To exclude a possible pregnancy, you can take a pregnancy test 3.5 weeks after your last unprotected intercourse, or take a blood test for hCG 11 days after your last unprotected intercourse.

If you know what to do in your situation, use additional contraception until you consult with your doctor.

How to delay your periods with Diane 35?

If for some reason the arrival of menstruation this month is undesirable for you, you can delay your period by one month. To do this, do not take a 7-day break between packs: immediately after finishing one pack, start a new one the next day.

In this case, your period most likely will not come. However, you may experience some spotting halfway through the second pack. This is a normal reaction. In this case, continue to take the tablets as usual until the end of the pack.

What to do if during the break Diana 35 did not get her period?

If you had any omissions in the last month or had other factors that reduced the effectiveness of Diane 35, then it is better for you not to start a new package of Diane 35 until pregnancy has been ruled out.

Pregnancy can be excluded by taking the test 3.5 weeks after the last unprotected intercourse, or by taking the test 11 days after the last unprotected intercourse.

If in the past month you took the pills without skipping, or if you were not sexually active and pregnancy is excluded, then you can continue taking Diane 35, despite the absence of menstruation. If menstruation does not occur after a month, consult a gynecologist. You can read about other reasons for the delay in the article.

In what cases can the effect of Diane 35 decrease?

The contraceptive effect of Diane 35 may be reduced if:

Missing one or more tablets.
Digestive disorders accompanied by vomiting or diarrhea. You can read about what to do in this case in the article.
Reception.
Reception.

What if the effect of Diane 35 could be reduced?

If you suspect that the effect of Diane 35 could be reduced due to certain circumstances, then use additional contraception for another 7 days after exposure to the adverse factor. If this happens in the last week of taking the pills, skip the week's break and start a new pack immediately after finishing the previous one.

If you don't know what to do in your situation, use condoms during sex until you consult your gynecologist.

What should you do if you experience spotting or menstruation while taking Diane 35?

While taking any contraceptive pills, including Diana 35, you may experience spotting in the middle of the cycle (in the middle of the package). This phenomenon is especially common in the first months of taking the pills.

This discharge is not dangerous and does not threaten your health. Continue to take the pills as usual, despite the discharge.

Usually, spotting goes away by the end of the first pack or the beginning of the second pack of tablets. Some women may normally experience discharge during the first 3 months of taking Diane 35.

How to properly stop taking Diane 35?

If you decide to stop taking Diane 35 birth control pills, then use the following advice from gynecologists:

Never stop taking pills halfway through the pack. This can lead to menstrual irregularities or uterine bleeding.

To properly stop taking Diana 35, finish the current package to the end and after a break, simply do not start a new one.

Keep in mind that the contraceptive effect of Diane 35 lasts only for the duration of taking this drug. You can get pregnant in the first month after stopping OK. If pregnancy is not desirable for you, start using additional contraception as soon as you stop taking birth control pills.

If you are planning a pregnancy, start taking it at least 1 month before the expected conception.

Before starting to take hormonal contraceptives, a woman must undergo a medical examination. The doctor, among other things, should examine her personal and family history. During the course of treatment, a woman should also undergo regular examinations so that the doctor can evaluate how successful the treatment is, as well as monitor the occurrence of possible side effects. During the examinations, a gynecological examination is required and blood pressure is measured. If you had unusual vaginal bleeding before starting Diane 35, be sure to tell your doctor about this - such a symptom is a reason to conduct a more thorough medical examination.

In the following cases, you should stop taking Diane 35 and consult a doctor:

Disorders the development of which may be associated with taking Diane 35

Venous thromboembolism

Women taking Diane 35 (as well as other combined contraceptives) are at risk of developing venous thromboembolism, including deep vein thrombosis and pulmonary embolism. - significantly higher than those who do not take such drugs. The likelihood of developing these disorders is especially high in the first year of taking Diane 35. However, this risk is still lower than during pregnancy - venous thromboembolism develops in approximately 60 out of 100,000 pregnant women.

It is not always possible to completely cure disorders of this type; in 1-2% of cases they lead to the death of the patient.

The risk of developing venous thromboembolism increases with age and in those who are obese and have a family history of venous or arterial thromboembolism. If it is believed that a woman has a predisposition to developing such disorders, she should be referred for additional examination before she is prescribed Diane 35. Prolonged immobilization in combination with Diane 35 also significantly increases the likelihood of developing venous thromboembolism. It is not yet entirely clear how varicose veins and superficial thrombophlebitis affect the likelihood of developing venous thromboembolism, however, doctors take into account the presence of these disorders in the patient when deciding whether to prescribe Diane 35 to her.

Arterial thromboembolism and related disorders

Taking Diane 35 may increase the likelihood of developing disorders of this type, including stroke and myocardial infarction. The risk of the disease is especially high if a woman taking Diane 35 smokes, is over 35 years of age, suffers from obesity, dyslipoproteinemia, hypertension, valvular heart disease, atrial fibrillation and migraine (for this reason, the drug should be stopped if migraine symptoms appear).

Breast cancer

Several studies suggest that women taking Diane 35 and other combination hormonal medications have an increased risk of developing breast cancer. However, it is not yet clear whether this is due to the fact that these women are diagnosed with breast cancer more often and earlier (as they undergo regular examinations), or to the biological properties of the drugs.

Breast cancer in women under 40 years of age is rare, regardless of whether they take combined hormonal drugs or not. However, after 40 years of age, the risk of cancer is higher in those who take Diane 35. The most significant risk factor for the development of breast cancer is the cessation of Diane 35 in older women. The older a woman was when she stopped taking the drug, the higher her risk of developing breast cancer.

The duration of treatment is less important. In addition, the risk of getting cancer gradually decreases after a woman stops taking Diane 35, and 10 years after the end of treatment, it no longer exceeds the norm.

The doctor should discuss the increased risk of breast cancer with the patient before she starts taking Diane 35. It should also be taken into account that taking this drug significantly reduces the risk of some other types of cancer (for example, ovarian and endometrial cancer). .

Cervical cancer

Some studies have shown that long-term use of Diane 35 may increase the risk of cervical cancer.

Liver cancer. In rare cases, after using Diane 35 and other drugs containing similar ingredients, benign and malignant liver tumors were detected. In some patients this led to life-threatening internal bleeding. For this reason, if you complain of pain in the upper abdomen and signs of liver enlargement, you should immediately undergo a thorough medical examination.

Hyperlipidemia

In women with a personal or family history of hyperlipidemia, the risk of developing pancreatitis increases while taking Diane 35.

Arterial pressure

Although many women taking Diane 35 experience a slight increase in blood pressure, a clinically significant increase is quite rare. However, if a significant and stable increase in blood pressure is observed during the course of treatment, the doctor may prescribe the patient another hormonal drug. If the pressure reaches 160/110 mm/Hg, medications to treat hypertension are usually prescribed.

Diabetes

For women with diabetes who do not have vascular changes caused by the disease, taking Diane 35 is considered safe. However, it must be remembered that all diabetics have an increased risk of developing various vascular diseases, therefore, during the course of treatment, patients must be observed by a doctor.

Chloasma

While taking Diane 35, there is an increased likelihood of developing chloasma - especially in women who have previously suffered from this disorder. Women who are prone to chloasma should limit their exposure to sunlight on their skin during the course of treatment and avoid visiting solariums.

Menstruation while taking Diane 35

In women taking Diane 35, menstrual bleeding becomes significantly less heavy and prolonged. This is completely normal, and even desirable for patients who have previously experienced heavy bleeding during menstruation. Sometimes there may be no bleeding at all for several menstrual cycles. If the patient took Diane 35 correctly, pregnancy is unlikely, but still, before starting a new course of taking the drug, it is necessary to do a pregnancy test.

In the first months of taking Diane 35, women may occasionally experience bleeding between periods. As a rule, they do not cause significant discomfort and are not signs of serious problems in the body. If such bleeding begins three or more cycles after the patient started taking Diane 35, you need to consult a doctor.

INSTRUCTIONS
(information for specialists)
on medical use of the drug

Registration number P No. 012240/01

Tradename
Diane-35®

Dosage form
Dragee

Compound
Each dragee contains:
Active substances: 2 mg cyproterone acetate and 0.035 mg ethinyl estradiol.
Excipients: lactose monohydrate, corn starch, povidone, magnesium stearate, sucrose, povidone 700000, polyethylene glycol (macrogol 6000), calcium carbonate, talc, glycerol, titanium dioxide, iron (II) oxide, mountain glycol wax.

Description
Round, biconvex, light yellow dragees

Pharmacotherapeutic group
Contraceptive (estrogen + antiandrogen)

ATX codeО03НВ01

Pharmacological properties

Pharmacodynamics

Diane-35 is a low-dose monophasic oral combined estrogen-antiandrogen contraceptive drug.

The contraceptive effect of Diane-35 is carried out through complementary mechanisms, the most important of which include suppression of ovulation and changes in the properties of cervical secretion, as a result of which it becomes impenetrable to sperm.

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

While taking Diane-35, the increased activity of the sebaceous glands, which plays an important role in the occurrence of acne and seborrhea, decreases. After 3-4 months of therapy, this usually leads to the disappearance of the existing rash. Excessive oiliness in hair and skin disappears even earlier. Hair loss, which often accompanies seborrhea, is also reduced. Therapy with Diane-35 in women of reproductive age reduces the clinical manifestations of mild forms of hirsutism (in particular, increased growth of facial hair); however, the effect of treatment should be expected only after several months of use. Along with the above-described antiandrogenic effect, cyproterone acetate also has a pronounced gestagenic effect.

Pharmacokinetics

Cyproterone acetate

Absorption. When taken orally, cyproterone acetate is completely absorbed over a wide dose range. After oral administration of Diane-35 tablets, the maximum concentration (Cmax) of cyproterone acetate in serum, equal to 15 ng/ml, is achieved after 1.6 hours. The absolute bioavailability of cyproterone acetate is almost complete (88% of the dose). Distribution.

Cyproterone acetate binds exclusively to serum albumin. Only about 3.5-4% of the total concentration of blood serum is found in free form. The increase in SHPS induced by ethinyl estradiol does not affect the binding of cyproterone acetate to serum proteins. The average apparent volume of distribution is 986±437 l

Metabolism. Cyproterone acetate is metabolized in two ways, including hydroxylation and conjugation. The main metabolite in human plasma is a 15P-hydroxyl derivative.

Excretion. Some of the dose is excreted unchanged in bile. Most of the dose is excreted as metabolites in urine or bile in a 1:2 ratio. Metabolites from plasma are eliminated with a half-life of 1.8 days.

Equilibrium concentration. Since protein binding is not specific, changes in sex steroid binding globulin (SHBG) levels do not affect the pharmacokinetics of cyproterone acetate. During cyclic treatment, the maximum steady-state serum concentration of cyproterone acetate is achieved in the second half of the cycle.

Ethinyl estradiol

Absorption. After oral administration, ethinyl estradiol is rapidly and completely absorbed. The maximum concentration (Cmax) in the blood serum, equal to approximately 71 pg/ml, is achieved in 1.6 hours. During absorption and first passage through the liver, ethinyl estradiol is metabolized, resulting in its bioavailability when taken orally averaging about 45%.

Distribution. Ethinyl estradiol is almost completely (approximately 98%), although nonspecifically, bound by albumin. Ethinyl estradiol induces the synthesis of GSPC. The apparent volume of distribution of ethinyl estradiol is 2.8-8.6 l/kg.

Metabolism. Ethinyl estradiol undergoes presystemic conjugation, both in the mucosa of the small intestine and in the liver. The main route of metabolism is aromatic hydroxylation. The clearance rate from blood plasma is 2.3-7 ml/min/kg.

Excretion. The decrease in the concentration of ethinyl estradiol in the blood serum is biphasic; the first phase is characterized by a half-life of about 1 hour, the second - 10-20 hours. It is not excreted from the body unchanged. Ethinyl estradiol metabolites are excreted in urine and bile in a ratio of 4:6 with a half-life of about 24 hours.

Equilibrium concentration. Equilibrium concentration is achieved during the second half of the treatment cycle

Indications for use

Contraception in women with androgenization phenomena.

Treatment of androgen-dependent diseases in women, such as acne, especially common forms and forms accompanied by seborrhea, inflammation or nodule formation (papular-pustular acne, nodular-cystic acne); androgenetic alopecia and mild forms of hirsutism.

Contraindications

Diane-35 should not be used if you have any of the conditions listed below. If any of these conditions develop for the first time while taking the drug, the drug should be discontinued immediately.

Thrombosis (venous and arterial) and thromboembolism currently or in history (including deep vein thrombosis, pulmonary embolism, myocardial infarction, cerebrovascular disorders).
Conditions preceding thrombosis (including transient ischemic attacks, angina) currently or in history.
History of migraine with focal neurological symptoms
Diabetes mellitus with vascular complications.
Multiple or severe risk factors for venous or arterial thrombosis, including heart valve disease, heart rhythm disturbances, cerebrovascular disease or coronary artery disease; uncontrolled arterial hypertension.
Pancreatitis with severe hypertriglyceridemia, currently or in history.
Severe liver disease (until liver function tests return to normal).
Liver tumors (benign or malignant) currently or in history.
Identified hormone-dependent malignant diseases (including genital organs or mammary glands) or suspicion of them.
Vaginal bleeding of unknown origin.
Pregnancy or suspicion of it.
Breastfeeding period.
Hypersensitivity to any of the components of the drug Diane-35

Carefully

If any of the conditions/risk factors listed below currently exist, the potential risks and expected benefits of combined oral contraceptives should be carefully weighed in each individual case:

Risk factors for the development of thrombosis and thromboembolism: smoking; thrombosis, myocardial infarction or cerebrovascular accident at a young age in one of the immediate family; obesity; dyslipoproteinemia (eg, hypertension; migraine; heart valve disease; cardiac arrhythmias, prolonged immobilization, major surgery, major trauma
Other diseases in which peripheral circulatory disorders may occur: diabetes mellitus; systemic lupus erythematosus; hemolytic uremic syndrome; Crohn's disease and ulcerative colitis; sickle cell anemia; as well as phlebitis of superficial veins
Hypertriglyceridemia
Liver diseases
Diseases that first appeared or worsened during pregnancy or against the background of previous use of sex hormones (for example, jaundice, cholestasis, gallbladder disease, otosclerosis with hearing impairment

Pregnancy and lactation
Diane-35 is not prescribed during pregnancy and breastfeeding. If pregnancy is detected while taking Diane-35, the drug should be discontinued immediately. Cyproterone acetate is excreted in milk, so the use of Diane-35 is contraindicated during lactation

Directions for use and doses
Dragee Diane-35 should be taken orally in the order indicated on the package, every day at approximately the same time, with a small amount of water. Take one tablet per day continuously for 21 days. The next package begins after a 7-day break from taking the pills, during which withdrawal bleeding usually occurs. Bleeding usually begins 2-3 days after taking the last pill and may not stop until you start taking a new package.

The duration of use depends on the severity of androgenization symptoms, as well as their response to treatment. As a rule, treatment should be continued for several months. With acne and seborrhea, the response usually occurs earlier than with hirsutism or alopecia.

After the symptoms have subsided, it is recommended to take Diane-35 for at least 3-4 more cycles. If a relapse occurs a few weeks or months after stopping taking the pills, treatment with Diane-35 can be resumed. If signs of androgenization recur after stopping treatment, the possibility of earlier resumption of Diane-35 should be considered.

How to start taking Diane-35

If you have not taken any hormonal contraceptives in the previous month.
Taking Diane-35 begins on the first day of the menstrual cycle (i.e., on the first day of menstrual bleeding). It is allowed to start taking it at 2-5 menstrual cycles, but in this case it is recommended to additionally use a barrier method of contraception during the first 7 days of taking pills from the first package.
When switching from other combined oral contraceptives.
It is preferable to start taking Diane-35 the day after taking the last active tablet from the previous package, but in no case later than the next day after the usual 7-day break (for preparations containing 21 tablets).
When switching from contraceptives containing only gestagens (mini-pills, injectable forms, implant) or from a gestagen-releasing intrauterine contraceptive.
A woman can switch from the “mini-pill” to Diana-35 on any day (without a break), from an implant or intrauterine contraceptive with gestagen - on the day of its removal, from the injection form - from the day when the next injection would have been given. In all cases, it is necessary to use an additional barrier method of contraception during the first 7 days of taking the pill.
After an abortion in the first trimester of pregnancy.
A woman can start taking the drug immediately. If this condition is met, the woman does not need additional contraceptive protection.
After childbirth or abortion in the second trimester of pregnancy. It is recommended to start taking the drug 21-28 days after childbirth or abortion in the second trimester of pregnancy. If use is started later, it is necessary to use an additional barrier method of contraception during the first 7 days of taking the pill. However, if a woman has already been sexually active, pregnancy should be excluded before starting Diane-35 or she must wait until her first menstruation.

Taking missed pills

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

If the delay in taking the pill is more than 12 hours, contraceptive protection may be reduced. In this case, you can be guided by the following two basic rules:

The drug should never be interrupted for more than 7 days.

7 days of continuous administration of the pills are required to achieve adequate suppression of hypothalamic-pituitary-ovarian regulation.

Accordingly, the following advice can be given if the delay in taking the pill is more than 12 hours (the interval since the last pill was taken is more than 36 hours):

First week of taking the drug

A woman should take the last pill she missed as soon as she remembers (even if this means taking two pills at the same time). The next pill is taken at the usual time. Additionally, a barrier method of contraception (for example, a condom) should be used for the next 7 days. If sexual intercourse took place within a week before missing the pills, the possibility of pregnancy must be taken into account. The more tablets are 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

A woman should take the last pill she missed as soon as she remembers (even if this means taking two pills at the same time). The next pill is taken at the usual time.

Provided that the woman took the pill correctly during the 7 days preceding the first missed pill, there is no need to use additional contraceptive measures. Otherwise, as well as if you miss 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 decreased reliability is inevitable due to the upcoming break in taking the pill.

A woman must strictly adhere to one of the following two options. Moreover, if in the 7 days preceding the first missed pill, all pills were taken correctly, there is no need to use additional contraceptive methods.

A woman should take the last pill she missed as soon as she remembers (even if this means taking two pills at the same time). The next pill is taken at the usual time, until the pills from the current package run out. The next pack should be started immediately. Withdrawal bleeding is unlikely until the second pack is finished, but spotting and breakthrough bleeding may occur while taking the pill.
A woman can also stop taking pills from the current package. She should then take a break for 7 days, including the day she missed the pills, and then start taking a new pack.

If a woman misses taking the pill and then does not have withdrawal bleeding during the break from taking the pill, pregnancy must be ruled out.

Recommendations in case of vomiting and diarrhea
If a woman has vomiting or diarrhea within 4 hours of taking active tablets, absorption may not be complete and additional contraceptive measures should be taken. In these cases, you should follow the recommendations when skipping pills.

Changing the start day of the menstrual cycle
In order to delay the onset of menstruation, a woman should continue taking pills from the new Diane-35 package immediately after taking all the pills from the previous one, without interruption. The pills 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. You should resume taking Diane-35 from a new pack after the usual 7-day break.

In order to postpone the start of menstruation to another day of the week, a woman should be advised to shorten the next break in taking the pills by as many days as she wants. The shorter the interval, the higher the risk that she will not have withdrawal bleeding, and will continue to have spotting and breakthrough bleeding while taking the second pack (just as if she wanted to delay the onset of menstruation.

Side effect
When taking combined oral contraceptives, irregular bleeding (spotting or breakthrough bleeding) may occur, especially during the first months of use. Other undesirable effects have been observed in women while taking combined oral contraceptives.

Organ system	Often (≥1/100)	Uncommon (≥1/1000 and ≤1/100)	Rarely (≤1/1000)
Organ of vision			intolerance to contact lenses
Gastrointestinal tract	nausea, abdominal pain	vomiting, diarrhea
The immune system			hypersensitivity reactions
General symptoms	weight gain		Weight loss
Metabolism		fluid retention
Nervous system	headache	migraine
Psychiatric disorders	decreased mood, mood swings	decreased libido	increased libido
Reproductive system and mammary glands	pain in the mammary glands, engorgement of the mammary glands	mammary hypertrophy	vaginal discharge, breast discharge
Skin and subcutaneous tissues		rash, hives	Erythema nodosum, multiforme

As with other combined oral contraceptives, in rare cases the development of thrombosis and thromboembolism is possible (see also “Special Instructions”).

Overdose
No serious adverse events have been reported following overdose. Symptoms that may occur in case of overdose: nausea, vomiting, spotting or metrorrhagia. There is no specific antidote; symptomatic treatment should be carried out.

Interaction with other drugs
Interaction of oral contraceptives with other drugs may lead to breakthrough bleeding and/or decreased contraceptive reliability. The following types of interactions 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. Such drugs include: phenytoin, barbiturates, primidone, carbamazepine, rifampicin; There are also suggestions for oxcarbazepine, topiramate, felbamate, ritonavir and griseofulvin and products containing St. John's wort.

Effect on enterohepatic circulation: According to individual studies, some antibiotics (for example, penicillins and tetracyclines) may reduce the enterohepatic circulation of estrogens, thereby lowering the concentration of ethinyl estradiol.

While taking medications that affect microsomal enzymes, and for 28 days after their discontinuation, you should additionally use a barrier method of contraception.

While taking antibiotics (such as ampicillins and tetracyclines) and for 7 days after their discontinuation, you should additionally use a barrier method of contraception. If the period of using the barrier method of protection ends later than the pill in the package, you need to move on to the next package of Diane-35 without the usual break in taking the pill. Oral combined contraceptives may affect the metabolism of other drugs (including cyclosporine), which leads to changes in their concentrations in plasma and tissues.

special instructions
If any of the conditions/risk factors listed below currently exist, the potential risks and expected benefits of treatment with Diane-35 should be carefully weighed in each individual case and discussed with the woman before she decides to start taking the drug. If any of these conditions or risk factors worsen, intensify, or appear for the first time, a woman should consult her doctor, who may decide whether to discontinue the drug.

Diseases of the cardiovascular system
There is evidence of an increased incidence of venous and arterial thrombosis and thromboembolism (such as deep vein thrombosis, pulmonary embolism, myocardial infarction, stroke) when taking combined oral contraceptives.

The risk of developing venous thromboembolism (VTE) is greatest in the first year of taking such drugs. Estimated incidence of VTE among women taking low-dose oral contraceptives (The risk of thrombosis (venous and/or arterial) and thromboembolism increases:

with age
in smokers (with increasing number of cigarettes or increasing age, the risk further increases, especially in women over 35 years of age); if there is:
family history (i.e., venous or arterial thromboembolism ever in close relatives or parents at a relatively young age); in case of hereditary predisposition, the woman should be examined by an appropriate specialist to decide on the possibility of taking combined oral contraceptives;
obesity (body mass index more than 30 kg/m);
dyslipoproteinemia;
arterial hypertension;
migraine;
heart valve diseases;
atrial fibrillation;
prolonged immobilization, major surgery, any leg surgery or major trauma. In these situations, it is advisable to stop using combined oral contraceptives (in the case of planned surgery, at least four weeks before it) and not to resume use for two weeks after the end of immobilization.

The possible role of varicose veins and superficial thrombophlebitis in the development of venous thromboembolism remains controversial. The increased risk of thromboembolism in the postpartum period should be taken into account. Peripheral circulatory disorders may 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 use of combined oral contraceptives (which may precede cerebrovascular events) may be grounds for immediate discontinuation of these drugs. Tumors There have been reports of a slight increase in the risk of developing cervical cancer with long-term use of combined oral contraceptives. The connection with the use of combined oral contraceptives has not been proven. Controversy remains regarding the extent to which these findings are related to screening for cervical pathology or to sexual behavior (lower use of barrier methods of contraception). The most significant risk factor for developing cervical cancer is persistent papilloma viral infection.

It was also found 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 of stopping these drugs. Its connection with the use of combined oral contraceptives has not been proven. The observed increased risk may also be a consequence of earlier diagnosis of breast cancer in women using combined oral contraceptives. Women who have ever used combined oral contraceptives are diagnosed with earlier stages of breast cancer than women who have never used them. In rare cases, during the use of combined oral contraceptives, the development of liver tumors has been observed, which in some cases led to life-threatening intra-abdominal bleeding. If severe abdominal pain, liver enlargement, or signs of intra-abdominal bleeding occur, this should be taken into account when making a differential diagnosis.

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

Although slight increases in blood pressure have been described in many women taking combined oral contraceptives, clinically significant increases have rarely been reported. However, if a persistent, clinically significant increase in blood pressure develops while taking combined oral contraceptives, these drugs should be discontinued and treatment of 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 while taking combined oral contraceptives, but their relationship with taking combined oral contraceptives has not been proven: jaundice and/or pruritus associated with cholestasis; formation of gallstones; porphyria; systemic lupus erythematosus; hemolytic uremic syndrome; chorea; herpes during pregnancy; hearing loss associated with otosclerosis. Cases of Crohn's disease and ulcerative colitis have also been described during the use of combined oral contraceptives.

Chloasma can sometimes develop, especially in women with a history of chloasma during pregnancy. Women prone to chloasma should avoid prolonged exposure to the sun and ultraviolet radiation while taking combined oral contraceptives. Acute or chronic liver dysfunction may require discontinuation of combined oral contraceptives until liver function tests return to normal. Recurrence of cholestatic jaundice, which developed 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 (If a woman with hirsutism has had recent or severe symptoms, treatment should be A differential diagnosis was carried out to identify the possible cause of the disease (androgen-producing tumor, deficiency of adrenal enzymes).

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

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, any irregular bleeding should be assessed only after an adaptation period of approximately three cycles. If irregular bleeding recurs or develops after previous regular cycles, careful evaluation should be performed to rule out malignancy or pregnancy.

Some women may not develop withdrawal bleeding during a break from taking the tablets. If combined oral contraceptives are taken as directed, the woman is unlikely to be pregnant. However, if combined oral contraceptives have not been taken regularly before or if there are no consecutive withdrawal bleeds, pregnancy should be ruled out before continuing to take the drug.

Medical examinations
Before starting to use the drug Diane-35, a woman is recommended to undergo a thorough general medical and gynecological examination (including examination of the mammary glands and cytological examination of cervical secretions) and exclude pregnancy. In addition, disorders of the blood coagulation system should be excluded.

In case of long-term use of the drug, it is necessary to conduct control examinations every 6 months.

A woman should be warned that drugs like Diane-35 do not protect against HIV infection (AIDS) and other sexually transmitted diseases!

Impact on the ability to drive a car and equipment.
Not found.

Release form
Dragee. 21 tablets per blister made of PVC and aluminum foil. The blister along with instructions for use is placed in a cardboard box

Storage conditions
At a temperature not higher than 30°C. Keep out of the reach of children.

Best before date
5 years. Do not use after expiration date!

Conditions for dispensing from pharmacies
On prescription.

Manufacturer
Bayer Schering Pharma AG, produced by Schering GmbH & Co. Productions KG, Germany
Bayer Schering Pharma AG, manufactured by Schering GmbH & Co. Products KG, Germany

Additional information can be obtained at: 107113 Russia, Moscow, 3rd Rybinskaya st., 18, building 2.

Almost all girls at one time or another have a question: what are periods for? How should they proceed normally? What is the normal length of menstruation? What kind of discharge should there be? And if you don’t have your period, what should you do?

Basic physiology: what are periods for?

Menstruation is the process of separation of the functional layer of the endometrium, accompanied by bloody discharge from the genital tract, while an unfertilized egg is removed from the uterine cavity. What are periods for? This process is necessary so that by the time of the next ovulation a new layer of endometrium has formed and optimal conditions for implantation have been formed. During the entire menstrual cycle (a continuous process lasting from the beginning of one menstruation to the beginning of the next), under the influence of changing hormonal levels, changes occur in the structure of the inner layer of the uterus - the endometrium. In the first period of the cycle, this layer increases and becomes loose, preparing the conditions for pregnancy. This increases the concentration of the hormone progesterone. If fertilization does not occur, the concentration of progesterone gradually decreases, by the end of the cycle the functional layer of the endometrium is rejected, and menstruation occurs.

Duration of menstruation

The duration of menstruation is a very important parameter indicating the normal functioning of a woman’s reproductive system. The duration of menstruation varies from woman to woman, but there are minimum and maximum limits. Normally, menstruation should last 3-7 days. Short or longer periods are a reason to seek advice from a gynecologist. The specialist will prescribe a specific examination to exclude possible diseases and, if necessary, prescribe treatment. Longer periods may be a variant of the norm if they are not accompanied by large blood loss, and if the stomach hurts mildly during menstruation. Prolonged periods should be a cause for concern, and in this case you should definitely consult a doctor.

Many girls are concerned about the question, why does the stomach hurt during menstruation? This happens because when the functional layer of the endometrium is separated, bleeding occurs from damaged vessels, and to reduce it, a spasm of these vessels occurs.

What to do if your period is late

This issue occupies a special place in the lives of women. Normally, the menstrual cycle should be regular, that is, it should last approximately the same number of days (on average 28-30 days). But when menstruation does not occur on the expected day, anxiety arises. If you don't have your period, what should you do? The simplest solution is to take a home pregnancy test. If it is positive, the reason for the delay is obvious. But what if it is negative? Many women say: “I thought my period was supposed to come, but it didn’t happen. Maybe this is a pathology? First of all, there is no need to panic. A delay of several days is quite acceptable. The reason for this may be nervous tension, climate change, intense physical activity. A delay in menstruation can occur when you start using hormonal contraceptives, for example, Diana 35. Menstruation in this situation can be delayed even by a week. And this is a variant of the norm, since the body experiences hormonal changes and adapts to them. But normally, this can only happen in the first few months of taking hormonal contraceptives, then the cycle should be restored. In most cases, when taking Diana, 35 months, on the contrary, become regular.

The duration of menstruation and its regularity are not the only parameters that need to be paid attention to. The degree of blood loss, as well as the nature of the discharge, is very important.

Heavy menstruation

Normally, menstruation should not be accompanied by heavy blood loss, when you have to change the pad every 2 hours. Such blood loss can be a sign of hormonal imbalances and cause the development of anemia. Loss of up to 150 ml of blood through menstrual flow is considered normal.

The nature of discharge during menstruation

Normally, menstrual flow should be bloody and liquid. Menstruation is normally accompanied by the separation of clots, which represent the sloughing off functional layer of the endometrium. Brown spotting before and after menstruation should alert you, as it may be a sign of endometriosis. Yellow periods are dangerous because they are a sign of bacterial inflammation. In such a situation, you should immediately consult a doctor to start treatment in a timely manner.