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 diseases  Menstrual 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 abortionVacuum- aspiration Surgical abortion 29,1 40,2 48,2

Hormonal 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 abortion

7th day’s endometrial after vacuum aspiration

7th day’s endometrial after surgical abortion

Appropriate transformation after medical abortion

Delayed endometrium’ transformation after vacuum aspiration

Incomplete endometrium’ transformation after surgical abortion

Hormonal rehabilitation Medical abortion 3 months Vacuum aspiration 3 months Surgical abortion 3 months Monophasic COC Regulon Microdosis COC Novinett Monophasic COC Regulon Microdosis COC Novinett Monophasic COC Regulon

Post-abortion contraception  efficacy  safe  no side-effects  prevention inflammatory diseases

Differential approach to choice of COC Acne, hirsutism Regulon Dismenorrea Regulon Menstrual disorders Regulon PCOS Regulon, Novinett Diabetus melitus Novinett Endometriosis Novinett Obesity 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

Effectiveness of the rehabilitation after abortion (1 year follow-up)