Tri-Lo-Mili is a triphasic microdose contraceptive means. It is intended for pregnancy control.
Contents:
Indications for use
Tri-Lo-Mili is prescribed for hormonal contraception.
Mechanism of action
Central mechanism:
According to the negative feedback loop, Tri-Lo-Mili causes a sudden decrease in the frequency of impulsed secretion of gonadotropin-releasing hormone. As a result, the proliferative phase of the menstrual cycle inhibits the production of follicle-stimulating hormone by the pituitary gland (due to exogenous estrogen). It slows down the follicles’ growth and maturation in the ovaries. Exogenous progestins suppress the release of the interstitial cell-stimulating hormone by the pituitary gland. It contributes to the inhibition of ovulation. There is a decrease in the synthesis of endogenous estrogen and progestin.
Peripheral mechanism:
Tri-Lo-Mili magnifies the cervical mucus viscosity making it difficult for sperm to penetrate the uterine cavity.
There is a reduction in the peristalsis of the fallopian tubes caused by gestagens. It leads to untimely penetration of a fertilized egg into the uterine cavity. Under the influence of combined estrogen-progestin drugs, there are changes in the constitution of the endometrium which complicates the normal implantation of a fertilized egg.
Mode of application and dosage
Tri-Lo-Mili is prescribed for daily use for 28 days without any breaks at about the same time, with a small amount of water, in the order specified on the blister package. Intake of the pills from the new package starts the day after taking the last tablet from the prior package.
Overdose
The main symptoms of an overdose are vomiting, nausea, and vaginal bleeding. There is no specific antidote. In the case of overdose, it is necessary to do a gastric lavage (within the first hour after taking Tri-Lo-Mili) and to carry out symptomatic therapy.
Contraindications
Tri-Lo-Mili is a direct contraindication in the following medical conditions:
- venous thrombosis, including a history (including deep vein thrombosis, pulmonary thromboembolism);
- arterial thrombosis, including a history (including acute cerebrovascular accident, myocardial infarction, retinal artery thrombosis) or precursors of thrombosis (including angina pectoris or transient ischemic attack);
- the presence of serious or multiple risk factors for arterial thrombosis;
- thromboembolism;
- cerebrovascular disorders;
- arterial hypertension;
- diabetes mellitus complicated by vascular disease;
- hereditary dyslipoproteinemia;
- hypersensitivity;
- migraine with aura;
- carcinoma of the breast and endometrium, other estrogen-dependent formations;
- hepatic failure;
- hemolytic anemia;
- benign or malignant hepatic tumors;
- otosclerosis;
- cholestatic jaundice during pregnancy;
- sickle-cell anemia;
- coronary cardiac disease;
- vaginal bleeding of unclear genesis;
- postmenopausal period;
- age up to 18 years;
- 4 weeks after labor;
- pregnancy and breastfeeding.
Every woman should be careful in taking this birth control in the following cases:
- ulcerative colitis;
- venous or arterial embolism in siblings or parents at a relatively young age;
- long-lasting immobilization or extensive surgery;
- risk factors for coronary heart disease, such as smoking, hyperlipidemia, hypertension, or obesity;
- arterial hypertension;
- mastopathy;
- thrombophlebitis of the superficial veins and varicose veins;
- uterine fibroids;
- depression;
- hepatic and gallbladder dysfunctions;
- epilepsy;
- lesions of the valvular apparatus of the heart with complications (mitral stenosis with atrial fibrillation);
- adolescence;
- tuberculosis;
- Crohn’s disease;
- hypertriglyceridemia, including family history;
- systemic lupus erythematosus;
- renal disease;
- acute abnormal liver function during a previous pregnancy or prior use of hormones;
- violations of the menstrual cycle.
Side effects
If you take Tri-Lo-Mili to be ready for the following common side effects:
- kidney disease;
- depression;
- decreased libido;
- decreased glucose tolerance;
- changes in body weight.
As to speak about body systems’ division, the following negative reactions may be observed:
- cardiovascular system: arterial hypertension, myocardial infarction, cerebrovascular accident, deep vein thrombosis, arterial thromboembolism, pulmonary or other thromboembolism, edema.
- tumors: benign and malignant hepatic tumors, cervical and breast cancer.
- hepatobiliary system: cholestatic jaundice, Budd-Chiari syndrome, intrahepatic cholestasis, cholelithiasis.
- gastrointestinal tract: nausea, vomiting, abdominal pain, flatulence, colitis, anorexia.
- genital organs: intermenstrual bleeding, spotting, amenorrhea, changes in the menstrual cycle, increase in the size of uterine fibroids, vaginal candidiasis, increase in cervical secretion, erosion of the cervix, decreased libido, premenstrual syndrome, temporary infertility after the end of the drug
- breast glands: sensation of tension, galactorrhea, tenderness, increase in size, decrease in lactation when taken immediately after birth.
- skin: erythema nodosum, skin rash, chloasma, exudative erythema, acne, seborrhea, alopecia, hirsutism, pigment spots on the face, hypertrichosis, pemphigoid (gestational herpes), melasma with a tendency to persist.
- organs of vision: cataract, lesion of the optic nerve, change in the curvature of the cornea, discomfort when wearing contact lenses.
- central nervous system: headache, mood changes, irritability, depression, chorea, dizziness, migraine,
- metabolism: fluid retention, changes in body weight (decrease or increase), decreased glucose tolerance, changes in appetite.
- renal condition: reduced kidney function, hemolytic-uremic syndrome.
- others: kidney disease, decreased libido.
Interactions
There is strength of steroid hormones’ metabolism when taking together with Hypericum perforatum, barbiturates, carbamazepine, phenytoin, sulfonamides, derivatives of pyrazolone, rifampicin.
There is another type of interaction which stimulates a violation of the intrahepatic circulation of estrogen. It results in speeded excretion and decreased concentration of ethinyl estradiol.
If a woman takes some antibiotics (for example, ampicillin or tetracycline), there is insufficient cleavage of estrogen conjugates and fatty acids by intestinal bacteria.
Some protease inhibitors and some antiretroviral drugs affect the increase (for example, indinavir) or decrease (for example, ritonavir) of the concentration of birth control in the blood plasma.
What if I miss a dose?
A woman may ignore if she misses a placebo pill. Such pills should be thrown away for avoiding the problem with a longer period of placebo pills. The following recommendations apply only to missing tablets containing hormone dose:
if a woman is late in taking the drug for less than 12 hours, there is no reason to be anxious about the possible pregnancy. Before continuing the course it is necessary to take the missed pill.
If a woman is late in taking the pill for more than 12 hours, the risk of the contraceptive reliability reduction is high. In this case, it is necessary to apply backup birth control methods.
Note: the close the missing pill is to the end of the monthly course the higher the risk to become pregnant is.
Tri-Lo-Mili and pregnancy
Tri-Lo-Mili has defined as X FDA category. The drug is contraindicated in pregnant women.
The conducted epidemiological studies did not show an increase in the birth defects’ risk in future children whose mothers applied oral birth control before pregnancy. The most modern studies analyzing the teratogenic effects especially cardiac dysfunctions and shortening of the extremities were not revealed such defects in babies born by a woman who takes birth control on the early stages of pregnancy.
It is a confirmed fact that combined oral contraceptives can affect lactation, that is, reduce the amount and change the composition of breast milk.