Hormonal contraceptives are among the most thoroughly studied classes of drugs. Their therapeutic effects not only change the pattern of gynaecological morbidity, but in some cases prevent the birth of children with serious abnormalities. In which situations does the use of hormonal contraceptives – and sometimes emergency contraception – become mandatory?
Clinical pharmacology has a vast body of knowledge on the teratogenic effects of drugs on foetal development. Nevertheless, new drugs and vaccines are still studied for teratogenicity to prevent a repeat of the thalidomide tragedy of 1957–1961. Experts call it the worst man‑made catastrophe in human history caused by a drug.
Thalidomide, introduced in the 1950s, was hailed as a sensation – a sleeping pill and sedative unlike any other. It became especially popular among pregnant women, who were prescribed it as a tranquilliser that also relieved morning sickness. It first went on sale in West Germany, where it was developed, and from 1958 it was used in 47 countries across Europe, Asia, Africa and South America, marketed under 37 different brand names.
The consequences of the “wonder drug” became apparent soon after the children were born. According to official statistics, between 8,000 and 12,000 children were born with deformed or missing limbs. It later emerged that 40% of infants whose mothers had taken the drug died within the first year of life.
Today it is known that certain antibiotics, non‑steroidal anti‑inflammatory drugs, central nervous system agents, antiepileptics, immunosuppressants, retinoids, statins and other drugs can have a negative effect on the health of pregnant women and their foetuses.
These are not rare drugs; many women take them in courses or continuously throughout their lives. Moreover, their consumption is rising both globally and in Russia. According to RNC Pharma, sales of systemic retinoids in Russia grew 24% last year, and spending on acne treatments has nearly tripled over several years. Sales of antiepileptic drugs in the first half of 2025 rose almost 32% compared with the same period in 2024.
Clearly, these drugs are prescribed not by gynaecologists but by doctors of other specialties, who do not always inform patients of the dangerous side effects.
“It is not part of a doctor’s formal duties to have such a conversation, but a responsible physician should draw a woman’s attention to the fact that the drugs are teratogenic,” Yevgenia Shikh, director of the Institute of Professional Education and head of the Department of Clinical Pharmacology and Propaedeutics of Internal Medicine at Sechenov University, told a press conference.
When a woman needs to undergo treatment with teratogenic drugs and does not plan to become pregnant in the near future, she faces the choice of an effective and suitable contraceptive method. According to the annual nationwide survey “Women’s Health Index 2026” by Gedeon Richter, 43% of women aged 18‑45 choose barrier methods, and 13% rely on withdrawal.
Clearly, as the number of drugs with teratogenic effects used to treat various conditions increases, reliable contraception is essential both during therapy and for months after discontinuation. To eliminate the risk of birth defects, effective contraception should be used for at least six months.
However, even reliable contraceptive methods can lose effectiveness for various reasons – for example, combined oral contraceptives may fail during prolonged diarrhoea, vomiting or when taking antibiotics. In such cases, emergency contraception is an option.
“Levonorgestrel‑containing drugs are an accessible over‑the‑counter method, and the sooner they are taken, the more effective they are. Such drugs can be kept in the medicine cabinet ‘just in case’. This is part of responsible and safe pregnancy planning,” said obstetrician‑gynaecologist and surgeon Olga Krumkach.
Reliable contraception is also needed for patients of endocrinologists. As it turns out, weight‑loss drugs with the active ingredient semaglutide increase fertility in women.
According to Yevgenia Shikh, weight‑loss drugs were even credited with treating infertility.
“That is an incorrect formulation, because it is all tied to the fact that it is the weight loss that improves insulin resistance. These drugs are used, among other things, to correct insulin resistance, reduce weight and achieve ovulation,” the expert explained.
Thus, as body weight decreases, fertility increases, and the risk of unplanned pregnancy in such women becomes significantly higher. Many women using weight‑loss drugs are also taking retinoids, which, Shikh stresses, have a proven teratogenic effect in early foetal development.
“When the possibility of giving birth to an unhealthy child arises, emergency contraception methods become a responsible approach to one’s own health and the child’s life,” the expert said.
Although emergency contraception as a method of preventing unwanted pregnancy has no medical contraindications, it remains stigmatised in Russia – not only among women but also among healthcare professionals, said Olga Krumkach. Any method of contraception has its pros and cons, but all are safer than the consequences of an abortion performed on a pregnancy that was not planned but has already occurred.