Contraceptives for women. The importance of contraceptives in preserving a woman’s reproductive health

First a mystery. Let's say you have a hundred women. Of these, you gave a third into sexual slavery to the editorial office of the magazine (by the way, thank you). And of this third, another third are black. Attention, question: what is the Pearl index? Right. This is an index of failures, showing how many women out of a hundred, using the chosen means of protection for a year, will eventually become pregnant. The lower it is, the better remedy. For example, for condoms this index is up to 12, which is quite a lot. What does black concubines have to do with it, you ask. Yes, the image is beautiful.

We collected the data on the Pearl index in a table, and described the remaining pros and cons of all known contraceptives (both male and female) in detail.

1. Condoms

Better than anything they protect against infections. Efficiency - 85-90% (less only for mycoplasmosis and herpes).

Safe, even indifferent to health, if you are not allergic to latex.

They need to be bought, kept in your pocket and put on on time (according to the Sanders-Graham-Crosby study, 50% of women do not have this skill: they put their partner in protection after the start of the act).

There is nothing to add to what has been said. Just to get a little boring. According to science, to achieve an impressive 95% effectiveness of a condom, you need to:
● inspect the condom packaging for damage;
● do not put it on inside out...
● ...and on the erect penis, to the end (follow me, Beavis, we said “end”!);
● always leave a spout at the end to collect sperm (you will be surprised, but this actually somehow increases the effectiveness of your latex friend);
● use only water-based lubricants ( butter leave it to the heroes of “Tango in Paris”).

2. Barrier contraception

In our editorial office, full of hypocrites, and even Old Believers, there was not a person who could, without embarrassment, write down all the words of the expert on female contraception Tatyana Kaznacheeva, Ph.D., Associate Professor of the Department of Reproductive Medicine and Surgery of the Faculty of Education and Science of Moscow State Medical University. Therefore, warn your woman: it is better to get information about suppositories and sponges not from a men's magazine or even from a women's magazine, but from a conversation with a personal gynecologist. However, we learned something. The diaphragm and the female condom, according to Tatyana, have not taken root in our country, despite the fact that “this rare condom, due to its larger surface area, is capable of protecting against STIs to a greater extent than the male condom.” Well, as for spermicidal agents (creams, vaginal tablets and candles), their only advantage is their availability. There are at least three disadvantages.

Spermicides can cause irritation and allergies not only for her, but also for you.

They are so ineffective that young anemones are not recommended to use them at all due to frequent misfires.

Most products need to be administered 20–30 minutes before the act and renewed with each subsequent one, and this is not always convenient.

3. Vasectomy

This method, with a stretch, can also be classified as a barrier method, only the barrier to the sperm is not foam tablets and latex, but your surgically tied vas deferens. Vasectomy does not affect sperm count, which is something that lovers of sperm count will appreciate.

Contraception is always with you, it does not require you to download new firmware and generally take care of its maintenance.

A vasectomy is only suitable if you have already had some children. Because it may not work out anymore...

- ...since reconstructive surgery is a procedure several orders of magnitude more complex than basic knot tying. Its result is unpredictable. It often happens that it is completely impossible.

4. Female sterilization

Almost one hundred percent effective.

One operation for life.

It is regulated by law and even in our liberal (ha ha) country it is prohibited for nulliparous women under 35 years of age.

A real operation - with preparation, hospitalization, anesthesia.

Conditionally irreversible. Reconstructive surgery possible, but there are a lot of reservations.

There is, however, a method of reversible sterilization, when in the mouth fallopian tubes spiral-shaped devices are introduced, making it impossible for the egg and sperm to rendezvous. But this method is not widespread in our country, to put it mildly.

5. COC tablets

Few side effects. With continuous use for two years or more, they reduce the likelihood of developing various female diseases. No new ones are added.

Long history of observations and quality control: tablets have been used in the civilized world for 50 years.

They require daily intake and, as a result, the presence of a certain amount of gray matter in a woman’s head. If the dosage regimen is violated, COCs lose effectiveness.

They are not subject to strict male control: it is impossible to understand by the type of pills what your woman is drinking - contraceptives or glycine, which means that deception and intrigue are likely (well, suddenly).

Bad reputation: if your woman has decided that she will not “go on hormones,” then it will be logically impossible to convince her. Moreover, side effects like weight gain and headaches do occur even with the most modern wheels. True, noticeably less often than with “classical” drugs.

If your woman's prejudice only applies to the release form combined contraceptives, you can offer her a skin patch or vaginal ring. You don’t even have to blatantly lie that these remedies are more gentle and less hormonal. This is often true. Oh yes, there are also mini-pills! These do not contain estrogens at all, and besides, they are more harmless purely visually - due to their size.

Combined contraceptive male educational program

Gynecologist, Ph.D., Medical Adviser, MSD Pharmaceuticals LLC

COOK
Pills containing the female hormones estrogen and progesterone must be taken daily for three weeks, then week break during which menstruation occurs. The main mechanism of action is suppression of egg maturation. There are pills that do not contain estrogen, they contain analogues of progesterone (one of the female hormones) and are just as reliable as combination pills. Such drugs may be recommended for breastfeeding women or those for whom estrogens are contraindicated. The tablets are often packaged in a blister with a picture of flowers, but this is not necessary. They look like any other small tablets.

Patch
It also contains analogues of two female sex hormones. The patch, measuring 4.5 by 4.5 cm, is self-adhered by the woman to a clean, dry butt. That is, sorry, skin. The mechanism of action is the suppression of ovulation. The color is beige and does not peel off by itself.

Flexible vaginal ring
Designed on the principle of a multilayer membrane. Continuously releases minimal (due to localization they should not be large) doses of estrogen and progestogen, which are absorbed into the blood through the mucous membrane of you know what. It couldn’t be simpler: a flexible ring with a diameter of 5.4 cm is inserted by the woman herself, you know where (following the example of a tampon). The location of the ring does not affect its effectiveness. The ring remains inside for three weeks, and, like a cat’s litter box, it’s best not to forget to change it. There is a one-week break between the removal of the old and the introduction of the new. The ring effectively suppresses the release of the egg. By the way, as private surveys show, some people really like it when their partner knows where (in none of our articles has this bashful euphemism been repeated such a terrifying number of times. - Editor's note) there is such a nice ring. This supposedly improves the sensation.

6. Injections and implants

The merciless need to take pills every day often leads to truly Zen riddles like “I forgot to take them for three days. Can I take three pills at once now?” In order not to answer endless questions from endless forum visitors, doctors came up with long-lasting solutions.

Long-term effect: 3 months for injections and up to 5 years for implants.

They do not require feats of self-discipline. Injections need to be done quite rarely, which the organizer or secretary will always remind you of - after all, she is also interested in this.

All procedures are invasive and require a visit to the doctor. You can theoretically cope with an intramuscular injection, but not with subcutaneous implantation.

No matter how few side effects modern drugs cause, in this case they are irreversible: if the injection is given and something goes wrong, then the entire duration of the drug will expire.

7. Intrauterine devices

The effectiveness of some “spiral” solutions is up to 99%.

It’s very convenient to use: set it and forget it. Moreover, not for myself, but for her. And you have nothing to do with it at all. Although no, you will have to periodically monitor the position, forgive the details, of the “antennae” of the intrauterine device and monitor the service life. However, this mission is also unlikely to be entrusted to you.

Can be used as early as six weeks after birth. You're so paranoid.

There are no draconian restrictions on age and smoking, characteristic of COCs.

Any foreign object in the body reduces local resistance to infection and gladly aggravates and aggravates its course, if it has already appeared. This also applies to the spiral.

Your partner can no longer catch an STI. That is, both you and all her other men are now required to use condoms. So give them all this magazine - let them know that this is not a joke, and generally photocopy the article.

Conventional copper intrauterine devices can, especially at first, cause discomfort, pain and all sorts of bleeding. Expensive hormonal systems like the Mirena, they are almost devoid of such effects, their main disadvantage is the price, that is, the only parameter of the IUD that, for once, concerns you.

There is one more important point to remember. This hellish remedy is famous for one unpleasant fact: pregnancy is still possible when using it. The sperm unites with the egg - life actually begins, but things do not go further than that. The resulting zygote cannot adhere to the wall of the uterus due to local effects created by the spiral, so in some cases it doesn’t care about the mother’s health and nests wherever it wants. It's called an ectopic pregnancy, and it's no laughing matter. Go to the hospital immediately!

8. Natural methods

They are always with you, you don’t need to buy them at the pharmacy. That is, you only pay with them for sex!

Most so-called natural contraceptive methods do not work at all and are based on myths. Even for interrupted coitus, the Pearl index is very high, and for other tricks and subterfuges it is even higher.

Again, there are studies showing the harm of interrupted intercourse for prostate health. They are not supported by the proper apparatus of evidence, but they are still somehow alarming.

"I have without dangerous days", "She is breastfeeding. I read somewhere that it is possible”, “I went to the sauna, and sperm remain alive only at temperatures below 36 degrees” - what phrases do not resonate with joy in the hearts of irresponsible partners! Some even still believe in a lemon stuck in you know where (that’s it, this phrase will not be used again), and that you can’t get pregnant in the cowgirl position. Ha! I wouldn't believe it! Cash costs - zero. Zero hassle. Guarantees - well, let's say, not zero, but they are rather absent, if the word “guarantee” is correctly understood.

In general, natural methods are among the most unreliable. Indeed, overheating of the scrotum sometimes prevents conception. And during breastfeeding or severe stress In some women, the ovulation mechanism goes astray and even disappears completely. However, you should not rely on these vagaries of nature. Cunning spermatozoa are contained not only in sperm, but also in lubricant; they live in the communication routes, sometimes for ten days in a row (that is, they can hold out and greet the dawn of a “dangerous” day with a whoop). Do not consider all these dances with tambourines as serious methods of contraception and turn your attention, for example, to the most reliable method, according to experts. We saved it for last, of course.

Conclusion

Just so you know, our consultants tried not to use the word “contraception” at all. Allegedly, there is a connotation of undesirability in it, and it should say “family planning.” Because the thing here is this: today you don’t plan it, but tomorrow amniotic fluid may well hit your head.

Therefore, in most cases, especially with unfamiliar partners with whom you don’t even plan to have breakfast yet, doctors recommend using “double Dutch method" This is when a woman drinks COCs and a man uses a condom. Even in the case of the most chaotic lifestyle, such a tandem brings to zero not only the likelihood of pregnancy, but also the risk of contracting an STI.

Well, if you both realized that children are exactly the reason you need to take out another consumer loan from the bank, you can always abandon the Dutch method.

A reliable, correctly selected method of contraception can prevent unwanted pregnancy and at the same time get an unforgettable experience from intimacy.

The birth and raising of a child is a crucial stage in the life of a woman and a man, for which it is necessary to prepare morally and financially. Before deciding to take this serious step, young people try to get an education, make a career, and buy housing. To prevent an unwanted pregnancy from taking you by surprise and putting an end to your studies and work, you should always remember about contraception.

Methods of protection

Some methods of contraception came to us from the people and do not inspire much confidence, others are inventions of modern medicine and seem quite reliable. The most common methods of protection are:

• condoms for men and women
• hormonal birth control pills
• intrauterine contraceptives (spirals)
• hormone injections
• contraceptive suppositories
• plasters
• douching
• coitus interruptus
• calculation of “dangerous” days
• hormonal emergency contraception

IMPORTANT: No method of birth control can protect against unwanted pregnancy 100%

How to protect yourself with pills correctly?

Hormonal contraceptive pills are a fairly reliable and safe modern method of contraception. Pick up contraceptive drug should be administered by a gynecologist - only in this case the product is guaranteed not to cause harm to health and will not disrupt reproductive function.

Regular use of the pill suppresses ovulation and thickens the mucus so much that sperm lose the ability to move towards the egg.

Video: Hormonal contraception

IMPORTANT: Taking birth control pills must be regular. Omissions or time shifts of receptions are unacceptable.

How to properly protect yourself from pregnancy without pills?

If taking birth control pills is impossible for some reason, you will have to choose one of the following methods to prevent unwanted pregnancy:

• condoms– it is best to use if the partner is unstable, because in addition to pregnancy, unprotected sex is dangerous due to the possibility of contracting sexually transmitted diseases. A condom is highly likely to protect partners from all troubles. Condoms are available for men and women. If the use of a male condom does not raise any questions, then with a female condom not everything is so simple. To choose the correct size, you will have to contact a gynecologist, otherwise the likelihood of discomfort during sexual intercourse when using a female condom of the “wrong” size is guaranteed
• hormonal injections– carried out once every 3 months, injections are made by a gynecologist. The method is suitable for women over 35 years of age who do not plan to have children in the future
• patch- a hormonal product that is glued to the naked body and replaced every seven days. The reliability of this method is close to 99.5%. The action of the patch is similar to the action of birth control pills: hormones suppress the maturation of eggs, thereby making pregnancy impossible.
• creams, lubricants, candles– medicinal contraception containing substances that destroy sperm membranes and suppress their activity
• intrauterine devices– are established by a gynecologist and are valid from 2 to 5 years. Enough reliable method, suitable for women who have a permanent sexual partner and are not planning children in the near future
• douching- a folk method that is not suitable for regular use and does not provide a high guarantee. Consists of injecting weak acidic solutions that are harmful to sperm before or immediately after sexual intercourse.

IMPORTANT: The choice of contraception must be discussed with a gynecologist who will select the drug taking into account individual characteristics female body.

How to properly protect yourself after childbirth?

After childbirth female body completely restored and prepared for sexual activity in 4 to 6 weeks. It is generally accepted that if a woman breastfeeds a child, she will not be able to get pregnant. However, this opinion is erroneous, and young mothers who, after childbirth, do not protect themselves from the onset of new pregnancy, are in the so-called “risk group”: 10% of them will become pregnant after 3-6 months, and 55% - after 6-8 months. At the same time, the absence of a menstrual cycle does not play a big role, because the first ovulation can occur as early as 25–30 days after birth. That is why mandatory protection after childbirth is very important for women's health.

For women who have recently given birth, the following contraceptive methods are suitable:

• lactational amenorrhea method- a natural method in which the hormone prolactin, produced in a woman’s body during lactation, suppresses ovulation and prevents the onset of a new pregnancy. An important factor responsible for the reliability of this method is the time interval between putting the baby to the breast - it should not exceed 3 hours.

IMPORTANT: If a woman often breastfeeds her baby at any time of the day and does not offer the baby anything other than breast milk products, in the first few months she will be reliably protected from pregnancy by nature itself. You need to start protecting yourself with pills or other methods with the introduction of complementary foods and a decrease in lactation.

• oral contraceptives(contraceptive pills) - acceptable for breastfeeding from 6 weeks after birth, provided that their selection is carried out by a doctor
• condoms– use is permitted from the beginning of the resumption of sexual activity
• tubal ligation (female sterilization) is a surgical method performed under anesthesia. Carried out according to the indications and wishes of women who have previously given birth to 2 or more children
• interrupted coitus- a rather unreliable, but popular method of birth control among married couples. Often leads to pregnancy
• intrauterine devices(IUD) - compatible with breastfeeding and can be installed immediately after childbirth. However, it is best if the IUD is installed no earlier than 8 weeks after birth - this reduces the risk of it falling out. IUDs can cause discomfort in nursing women, since during lactation the uterus contracts and the IUD can change its position. The use of the IUD by women with inflammatory processes of the uterus or appendages is unacceptable.
• natural method– abstaining from sexual intercourse on “dangerous” days. The method is 50% effective and is suitable for couples who are not against further replenishment of the family

Video: Methods of contraception after childbirth and during lactation

How to protect yourself correctly for a man?

Usually it is the woman who is more concerned about protection from unwanted pregnancy, but this is not correct - both partners should think about contraception. In addition, modern medicine offers a sufficient choice of contraceptives for both women and men. The most accessible “male” means of protection are:

• male condoms– inexpensive, easy to use, available funds, which can not only prevent unwanted pregnancy, but also protect against venereal diseases. A must have in every man's arsenal
• male birth control pills– when taken regularly, they deprive sperm of the ability to fertilize an egg. Unlike female oral contraceptives, they have a number of serious side effects
• coitus interruptus– does not protect against pregnancy. Even before ejaculation begins, spermatozoa, which are necessarily contained in the natural male lubricant, are capable of quite successfully fulfilling their purpose
• vasectomy (male sterilization) – ligation of the vas deferens through a small incision in the scrotum. The method is good for those men who are confident in their decision never to have children in the future.

IMPORTANT: According to statistics 90% modern men protected by condoms. Of these, 25% noted that they were personally convinced of the unreliability of interrupted sexual intercourse.

Video: Contraception in men

How to protect yourself correctly as a woman?

Every woman who is sexually active dreams of finding a reliable method of contraception, long-term use which will not lead to undesirable consequences. But unfortunately not universal remedy protection that would suit everyone.

For example, individual allergic reactions latex makes it impossible to use condoms during sexual intercourse, and in case of untreated inflammation, the introduction of an intrauterine device is prohibited. Also, work schedule and features may prevent a woman from taking oral contraceptives regularly and strictly on schedule.

A highly effective option such as tubal ligation is not suitable for those who plan to have a child in the future. Based on such circumstances, a female contraceptive should be selected.

IMPORTANT: It is advisable that the selection of a contraceptive is carried out by a gynecologist who is previously informed about the characteristics of the woman’s body.

What is the best way to protect yourself?

If we talk about reliable protection, then you will have to choose between mechanical (condoms, coils), chemical (suppositories, creams) and hormonal (pills, injections) contraceptives. However, none of them can still guarantee one hundred percent protection.

IMPORTANT: There are only two most reliable methods of preventing unwanted pregnancy: abstinence from intimate life and sterilization.

Methods of contraception such as interrupted sexual intercourse, douching and the so-called calendar method do not deserve attention at all - they all leave a fairly large chance for pregnancy.

Do I need to use protection during menstruation?

The common myth that a woman cannot become pregnant during menstruation still continues to mislead young people and refuse contraception these days.

IMPORTANT: A woman can become pregnant during menstruation. However, the risk of pregnancy is still slightly lower than in common days cycle.

The highest probability of becoming pregnant during “critical days” is in women with short cycle(21 – 23 days). In this case normal ovulation occurs already on the 6th - 7th day, which means that it will exactly coincide with last days menstruation. And even if ovulation occurs a few days after the end of menstruation, there is no guarantee that a sperm that has retained its viability will not be waiting for it.

To the lucky owners long cycle Don't relax either. In the body of every woman at least once in her life, but it happens hormonal disbalance with shortening or lengthening of the menstrual cycle. And no one knows when exactly this failure will occur.

From this we can conclude: It is necessary to protect yourself during menstruation.

Emergency contraception

Emergency (postcoital) contraception is the use of special hormonal drugs or the introduction of an intrauterine contraceptive within 1 to 3 days after unprotected sexual intercourse in order to avoid pregnancy.

Oral postcoital medications Postinor, Ginepriston And Agest contain “shock” doses of the hormone levnorgestrel. These remedies are more effective the sooner they are taken after sexual intercourse. Their serious drawback is the noticeable Negative influence on ovarian health and a high probability of menstrual cycle disruptions.

Indications for taking emergency oral contraceptives may be:

• unprotected sexual intercourse
• failed interrupted coitus
• broken condom

Taking postcoital medications is contraindicated in women:

• who have had uterine bleeding
• suffering from severe headaches
• over 35 years old
• having a long history of smoking

IMPORTANT: Oral remedies Emergency contraception should not be used more than twice a year.

Video: Emergency contraception

The introduction of an intrauterine device within 5 - 7 days after unprotected contact does not allow the fertilized egg to enter the implantation phase. This remedy is an abortifacient and should be used only in the absence of inflammation of the uterus and ovaries.

IMPORTANT: Intrauterine device Only a gynecologist can diagnose it.

Biological (or calendar) method of contraception

To use the calendar method of birth control, you need to know the exact menstrual cycle. Women with irregular cycle should focus on the last 6 - 8 months. Among these cycles, you need to choose the shortest one and subtract 18 from the number of days in it. The resulting value is the first day when protection with condoms, pills or other means of protection is mandatory. The last day of using protection is determined in a similar way: subtract 11 from the number of days of the longest cycle.

IMPORTANT: Biological method protection is one of the most unreliable. It is suitable only for those couples who do not mind having a child.

Prevention with folk remedies

Prevention with folk remedies can be used in cases where modern means contraception is unavailable for some reason. As they say: “It’s better than nothing.” The most popular ways to avoid unwanted pregnancy using folk wisdom relate:

• douching with acidified water. Immediately after sexual intercourse, water with lemon juice, vinegar or citric acid dissolved in it is introduced into the vagina. In theory, sperm should die in an acidic environment
• douching with your own urine. This is a rather risky method, since the risk of contracting an infection from the introduction of decay products inside is quite simple. So the desire to protect yourself from unwanted pregnancy can end in a hospital bed
• douching with a solution of potassium permanganate. An important condition for the reliability of this method is that the solution must be strong enough. But do not forget that a strong solution of potassium permanganate, introduced into the vagina, will inevitably cause severe burn mucous membrane
• hot bath for a man before sexual intercourse. A man must accept very hot bath a few minutes before intimacy. Sperm must lose their strength and ability to fertilize
• hot bath with mustard for a woman after sexual intercourse. Pour 1 tbsp into a hot bath. dry mustard and mix the water well. A woman should sit in such water for as long as possible
• laundry soap and tablets. Immediately before sexual intercourse, a woman inserts a piece of gray laundry soap into the vagina, and immediately after intimacy - 1-2 aspirin tablets.
• use of dried herb Shepherd's purse. A woman should take 1 tbsp orally daily. this crushed herb. According to popular beliefs, this remedy will protect her from pregnancy

IMPORTANT: Traditional methods of birth control not only do not provide reliable protection against unwanted pregnancy, but can also cause severe irritation and disruption of the vaginal microflora.

When choosing a particular method of contraception for yourself, think about whether its use will change your life in the near future. If the method seems quite acceptable and reliable enough to you, you can safely use it, having previously discussed the details with your partner.

Video: How not to get pregnant? Contraception

Gynecology: textbook / B. I. Baisova et al.; edited by G. M. Savelyeva, V. G. Breusenko. - 4th ed., revised. and additional - 2011. - 432 p. : ill.

Chapter 20. MODERN METHODS OF CONTRACEPTION

Chapter 20. MODERN METHODS OF CONTRACEPTION

Medicines used to prevent pregnancy are called contraceptives. Contraception - component family planning system and is aimed at regulating the birth rate, as well as preserving the health of women. Firstly, use modern methods Pregnancy protection reduces the frequency of abortions as the main cause of gynecological pathology, miscarriage, maternal and perinatal mortality. Secondly, contraceptives serve to regulate the onset of pregnancy depending on the health of the spouses, compliance with the interval between births, the number of children, etc. Third, some contraceptives have protective properties in relation to malignant neoplasms, inflammatory diseases of the genital organs, postmenopausal osteoporosis, they serve as a powerful aid in the fight against a number of gynecological diseases - infertility, ovarian apoplexy, menstrual irregularities, etc.

An indicator of the effectiveness of any contraceptive method is the Pearl index - the number of pregnancies occurring within 1 year in 100 women who used one or another method of contraception.

Modern methods of contraception are divided into:

Intrauterine;

Hormonal;

Barrier;

Natural;

Surgical (sterilization).

20.1. Intrauterine contraception

Intrauterine contraception (IUC)- this is contraception using means introduced into the uterine cavity. The method is widely used in Asian countries (primarily China), Scandinavian countries, and Russia.

The history of intrauterine contraception dates back to ancient times. However, the first such remedy was proposed in 1909 by the German gynecologist Richter: a ring made from the intestines of a silkworm, fastened with metal wire. Then they offered gold or silver ring with an internal disk (Ott ring), but since 1935 the use of IUDs has been prohibited

due to the high risk of developing inflammatory diseases of the internal genital organs.

Interest in this method of contraception was revived only in the 60s of the 20th century. In 1962, Lipps used flexible plastic in the form of a double Latin letter “S” to create a contraceptive, which allowed it to be inserted without significant expansion cervical canal. A nylon thread was attached to the device to remove the contraceptive from the uterine cavity.

Types of intrauterine contraceptives. IUDs are divided into inert (non-medicinal) and medicinal. The first include plastic IUDs of various shapes and designs, including the Lipps loop. Since 1989, WHO has recommended the abandonment of inert IUDs as ineffective and often causing complications. Medicinal IUDs have a plastic base of various configurations (loop, umbrella, number “7”, letter “T”, etc.) with the addition of metal (copper, silver) or a hormone (levonorgestrel). These supplements increase contraceptive effectiveness and reduce the number of adverse reactions. In Russia the most commonly used are:

Copper-containing Multiload- Si 375 (numbers indicate the surface area of ​​the metal, in mm 2), designed for 5 years of use. It has an F-shape with spike-like protrusions for retention in the uterine cavity;

-Nova-T- T-shaped with a copper winding area of ​​200 mm 2 for 5 years of use;

Cooper T 380 A - T-shaped with high content copper; period of use - 6-8 years;

The hormonal intrauterine system "Mirena" *, combining the properties of intrauterine and hormonal contraception, is a T-shaped contraceptive with a semi-permeable membrane through which levonorgestrel is released from a cylindrical reservoir (20 mcg/day). The period of use is 5 years.

Mechanism of action. The contraceptive effect of the IUD ensures a decrease in the activity or death of sperm in the uterine cavity (the addition of copper enhances the spermatotoxic effect) and an increase in the activity of macrophages that absorb sperm that enter the uterine cavity. When using an IUD with levonorgestrel, thickening of the cervical mucus under the influence of gestagen creates an obstacle to the passage of sperm into the uterine cavity.

In case of fertilization it appears abortifacient VMC:

Increased peristalsis of the fallopian tubes, which leads to the penetration of the fertilized egg into the uterine cavity, not yet ready for implantation;

The development of aseptic inflammation in the endometrium as a reaction to a foreign body, which causes enzyme disorders (the addition of copper enhances the effect) that prevents the implantation of a fertilized egg;

Increased contractile activity of the uterus itself as a result of increased synthesis of prostaglandins;

Endometrial atrophy (for an intrauterine hormone-containing system) makes the process of implantation of the fertilized egg impossible.

The hormone-containing IUD, having a local effect on the endometrium due to the constant release of gestagen, inhibits proliferation processes and causes atrophy of the uterine mucosa, which is manifested by a decrease in the duration of menstruation or amenorrhea. At the same time, levo-norgestrel does not have a noticeable effect systemic influence on the body while maintaining ovulation.

The contraceptive effectiveness of IUDs reaches 92-98%; The Pearl index ranges from 0.2-0.5 (when using a hormone-containing IUD) to 1-2 (when using an IUD with copper additives).

An intrauterine contraceptive can be inserted on any day of the menstrual cycle if you are sure there is no pregnancy, but it is more advisable to do this on the 4-8th day from the start of menstruation. An IUD can be inserted immediately after an artificial termination of pregnancy or 2-3 months after childbirth, and after a cesarean section - no earlier than 5-6 months. Before inserting an IUD, the patient should be interviewed to identify possible contraindications and gynecological examination and bacterioscopic examination of smears from the vagina, cervical canal, urethra for microflora and degree of purity. An IUD can be inserted only with smears of I-II degree of purity. When using a contraceptive, you should carefully follow the rules of asepsis and antisepsis.

For 7-10 days after insertion of the IUD, it is recommended to limit physical activity, not take hot baths, laxatives and uterotonics, and avoid sexual activity. A woman should be informed about the timing of using the IUD, as well as about the symptoms of possible complications that require urgent medical attention. A repeat visit is recommended 7-10 days after the insertion of the IUD, then, if the condition is normal, after 3 months. Clinical examination of women using an IUD involves visiting a gynecologist twice a year with microscopy of smears from the vagina, cervical canal and urethra.

The IUD is removed at the request of the patient, as well as due to the expiration of the period of use (when replacing an old IUD with a new one, there is no need to take a break), if complications develop. The IUD is removed by pulling the “antennae”. In the absence or breakage of the “antennae” (if the period of use of the IUD has been exceeded), it is recommended to carry out the procedure in a hospital setting. It is advisable to clarify the presence and location of the contraceptive using ultrasound. The IUD is removed after dilation of the cervical canal under hysteroscopy control. The location of the IUD in the uterine wall, which does not cause complaints from the patient, does not require removal of the IUD, since this can lead to serious complications.

Complications. When inserting an IUD, perforation of the uterus is possible (1 in 5000 insertions) up to the location of the contraceptive in abdominal cavity. Perforation is manifested by acute pain in the lower abdomen. The complication is diagnosed using pelvic ultrasound and hysteroscopy. In case of partial perforation, you can remove the contraceptive by pulling on the “antennae”. Complete perforation requires laparoscopy or laparotomy. Cha-

Strict perforation of the uterus often goes unnoticed and is detected only after an unsuccessful attempt to remove the IUD.

Most frequent complications IUDs include pain, menometrorrhagic bleeding, and inflammatory diseases of the internal genital organs. Constant intense pain most often indicates a discrepancy between the sizes of the contraceptive and the uterus. Cramping pain in the lower abdomen and blood discharge from the genital tract are a sign of ex-pulsion of the IUD (spontaneous expulsion from the uterine cavity). The frequency of expulsions (2-9%) can be reduced by prescribing one of the NSAIDs (indomethacin, diclofenac - voltaren*, etc.) after insertion of the IUD.

The combination of pain with increased body temperature, purulent or purulent vaginal discharge indicates the development of inflammatory complications (0.5-4%). The diseases are particularly severe, with pronounced destructive changes in the uterus and appendages and often require radical surgical interventions. To reduce the incidence of such complications, prophylactic antibiotics are recommended for 5 days after IUD insertion.

Uterine bleeding is the most common (1.5-24%) complication of intrauterine contraception. These are menorrhagia, less often - metrorrhagia. An increase in menstrual blood loss leads to the development iron deficiency anemia. Prescribing NSAIDs in the first 7 days after IUD insertion increases the acceptability of this method of contraception. A positive effect is achieved by prescribing combined oral contraceptives (COCs) 2-3 months before the introduction of an IUD and in the first 2-3 months after it, which facilitate the adaptation period. If menstruation remains heavy, the IUD must be removed. When metrorrhagia occurs, hysteroscopy and separate diagnostic curettage are indicated.

Pregnancy when using an IUD occurs rarely, but is not excluded. The frequency of spontaneous miscarriages when using an IUD increases. However, if desired, such a pregnancy can be maintained. The question of the need and timing of IUD removal remains controversial. There is an opinion about the possibility of removing the IUD for early stages, but this can lead to termination of pregnancy. Other experts consider it acceptable not to remove the contraceptive during pregnancy, believing that the IUD does not have any effect negative influence on the fetus due to the extra-amniotic location. Typically, the IUD is released along with the placenta and membranes in the third stage of labor. Some authors suggest terminating a pregnancy that occurs while using an IUD, since its prolongation increases the risk of septic abortion.

An IUD significantly reduces the possibility of pregnancy, including ectopic pregnancy. However, the incidence of ectopic pregnancy in these cases is higher than in the population.

In most cases, fertility is restored immediately after removal of the IUD. When using an IUD, there was no increase in the risk of developing cervical, uterine, or ovarian cancer.

Contraindications. TO absolute contraindications relate:

Pregnancy;

Acute or subacute inflammatory diseases of the pelvic organs;

Chronic inflammatory diseases of the pelvic organs with frequent exacerbations;

Malignant neoplasms of the cervix and uterine body. Relative contraindications:

Hyperpolymenorrhea or metrorrhagia;

Hyperplastic processes of the endometrium;

Algomenorrhea;

Hypoplasia and developmental anomalies of the uterus that interfere with the insertion of an IUD;

Cervical canal stenosis, cervical deformation, isthmic-cervical insufficiency;

Anemia and other blood diseases;

Submucous uterine fibroids (small nodes without deformation of the cavity are not a contraindication);

Severe extragenital diseases of inflammatory etiology;

History of frequent IUD expulsions;

Allergy to copper, hormones (for medicated IUDs);

No history of childbirth. However, some experts allow the use of IUDs in nulliparous women with a history of abortion, provided there is only one sexual partner. In nulliparous patients, the risk of complications associated with the use of IUDs is higher.

It must be emphasized that many contraindications for the use of conventional IUDs become indications for the use of hormone-containing IUDs. Thus, ♠ levonorgestrel contained in Mirena has a therapeutic effect in hyperplastic processes endometrium after establishing a histological diagnosis, with uterine fibroids, with menstrual irregularities, reducing menstrual blood loss and eliminating pain.

The advantages of intrauterine contraception include:

High efficiency;

Possibility of long-term use;

Immediate contraceptive effect;

Rapid restoration of fertility after removal of the IUD;

Lack of connection with sexual intercourse;

Low cost (except for the hormonal intrauterine system);

Possibility of use during lactation;

Therapeutic effect for certain gynecological diseases (for the hormonal intrauterine system).

The disadvantages are the need for medical manipulation during insertion and removal of the IUD and the possibility of complications.

20.2. Hormonal contraception

Hormonal contraception has become one of the most effective and widespread methods of birth control.

The idea of ​​hormonal contraception arose at the beginning of the 20th century, when the Austrian physician Haberland discovered that the administration of ovarian extract causes temporary sterilization. After the discovery of sex hormones (estrogen in 1929 and progesterone in 1934), an attempt was made to synthesize artificial hormones, and in 1960 the American scientist Pincus et al. created the first contraceptive pill, Enovid. Hormonal contraception developed along the path of reducing the dose of steroids (estrogens) and along the path of creating selective (selective action) gestagens.

At the 1st stage, drugs were created with a high estrogen content (50 mcg) and many serious side effects. At the 2nd stage, contraceptives with low content estrogens (30-35 mcg) and gestagens with selective action, which made it possible to significantly reduce the number of complications when taking them. III generation drugs include drugs containing low (30-35 mcg) or minimal (20 mcg) doses of estrogens, as well as highly selective gestagens (norgestimate, desogestrel, gestodene, dienogest, drospirenone), which have an even greater advantage over their predecessors.

Composition of hormonal contraceptives. All hormonal contraceptives (HCs) consist of estrogen and progestogen or only progestogen components.

Ethinyl estradiol is currently used as estrogen. Along with the contraceptive effect, estrogens cause proliferation of the endometrium, prevent the rejection of the uterine mucosa, providing a hemostatic effect. The lower the dose of estrogen in the drug, the higher the possibility of “intermenstrual” bleeding. Currently, GCs are prescribed with an ethinyl estradiol content of no more than 35 mcg.

Synthetic gestagens (progestogens, synthetic progestins) are divided into progesterone derivatives and nortestosterone derivatives (norsteroids). Progesterone derivatives (medroxyprogesterone, megestrol, etc.) when taken orally do not provide a contraceptive effect, since they are destroyed under the influence of gastric juice. They are used primarily for injectable contraception.

Norsteroids of the first generation (norethisterone, ethynodiol, linestrenol) and more active norsteroids of the second generation (norgestrel, levonorgestrel) and third generation (norgestimat, gestodene, desogestrel, dienogest, drospirenone) after absorption into the blood bind to progesterone receptors, exerting a biological effect. The gestagenic activity of norsteroids is assessed by the degree of binding to progesterone receptors; it is significantly higher than that of progesterone. In addition to the gestagenic effect, norsteroids produce androgenic, anabolic and mineralocorticoid effects expressed to varying degrees.

effects due to interaction with relevant receptors. Third generation gestagens, on the contrary, have an antiandrogenic effect on the body as a result of increased synthesis of globulin, which binds free testosterone in the blood, and high selectivity (the ability to bind to progesterone receptors to a greater extent than to androgen receptors), as well as an antimineralocorticoid effect (drospirenone ). Group classification:

Combined estrogen-progestin contraceptives:

Oral;

Vaginal rings;

Plasters;

Progestin contraceptives:

Oral contraceptives containing microdoses of gestagens (mini-pills);

Injectable;

Implants.

Combined oral contraceptives (COCs) - these are tablets containing estrogen and progestogen components (Table 20.1).

Mechanism of action COC is diverse. The contraceptive effect is achieved as a result of blockade of the cyclic processes of the hypothalamic-pituitary system in response to the administration of steroids (feedback principle), as well as due to a direct inhibitory effect on the ovaries. As a result, follicle growth, development and ovulation do not occur. In addition, progestogens, by increasing the viscosity of cervical mucus, make it impenetrable for sperm. Finally, the gestagenic component slows down the peristalsis of the fallopian tubes and the movement of the egg through them, and in the endometrium causes regressive changes up to atrophy, as a result of which implantation of the fertilized egg, if fertilization does occur, becomes impossible. This mechanism of action ensures high reliability of COCs. When used correctly, contraceptive effectiveness reaches almost 100%, the Pearl index is

0,05-0,5.

Based on the level of ethinyl estradiol, COCs are divided into high-dose (more than 35 mcg; currently not used for contraceptive purposes), low-dose (30-35 mcg) and micro-dose (20 mcg). In addition, COCs are monophasic, when all the tablets included in the package have the same composition, and multiphase (two-phase, three-phase), when the package, designed for a dosage cycle, contains two or three types of tablets of different colors, differing in the amount of estrogenic and gestagenic components. Stepped dosage causes cyclic processes in target organs (uterus, mammary glands), reminiscent of those during a normal menstrual cycle.

Complications when taking COCs. Due to the use of new low- and micro-dose COCs containing highly selective gestagens, side effects when using GCs are rare.

Table 20.1. Currently used COCs, indicating the composition and dose of their components

A small percentage of women taking COCs may experience discomfort during the first 3 months of use due to the metabolic effects of sex steroids. Estrogen-dependent effects include nausea, vomiting, swelling, dizziness, heavy menstrual-like bleeding, and gestagen-dependent effects include irritability, depression, increased fatigue, decreased libido. Headache, migraine, engorgement of the mammary glands, and bleeding can be caused by the action of both components of the COC. Currently, these signs are

are seen as symptoms of adaptation to COCs; usually they do not require the prescription of corrective agents and disappear on their own by the end of the 3rd month of regular use.

The most serious complication when taking COCs is the effect on the hemostatic system. It has been proven that the estrogen component of COCs activates the blood coagulation system, which increases the risk of thrombosis, primarily coronary and cerebral, as well as thromboembolism. The possibility of thrombotic complications depends on the dose of ethinyl estradiol included in the COC and risk factors, which include age over 35 years, smoking, hypertension, hyperlipidemia, obesity, etc. It is generally accepted that the use of low or micro-dose COCs does not have a significant effect on the hemostatic system in healthy people women.

When taking COCs, blood pressure increases, which is due to the influence of the estrogen component on the renin-angiotensin-aldosterone system. However, this phenomenon was noted only in women with an unfavorable history (hereditary predisposition, obesity, hypertension in the present, OPG-gestosis in the past). Clinically significant change Blood pressure was not detected in healthy women taking COCs.

When using COCs, a number of metabolic disorders are possible:

A decrease in glucose tolerance and an increase in its level in the blood (estrogenic effect), which provokes the manifestation of latent forms of diabetes mellitus;

Adverse effects of gestagens on lipid metabolism(increased levels of total cholesterol and its atherogenic fractions), which increases the risk of developing atherosclerosis and vascular complications. However, modern selective gestagens included in third-generation COCs do not have a negative effect on lipid metabolism. In addition, the effect of estrogens on lipid metabolism is directly opposite to the effect of gestagens, which is regarded as a factor protecting the vascular wall;

Increased body weight due to the anabolic effect of gestagens, fluid retention due to the influence of estrogens, and increased appetite. Modern COCs with low estrogen content and selective gestagens have virtually no effect on body weight.

Estrogens may have a slight toxic effect on the liver, manifested in a transient increase in the level of transaminases, cause intrahepatic cholestasis with the development cholestatic hepatitis and jaundice. Progestins, increasing the concentration of cholesterol in bile, contribute to the formation of stones in the bile ducts and bladder.

Acne, seborrhea, hirsutism are possible when using gestagens with a pronounced androgenic effect. The highly selective gestagens currently used, on the contrary, have an antiandrogenic effect, and they provide not only a contraceptive, but also a therapeutic effect.

A sharp deterioration in vision when using COCs is a consequence of acute retinal thrombosis; in this case, immediate discontinuation of the drug is required. It should be taken into account that when using COCs contact lenses cause swelling of the cornea with a feeling of discomfort.

Rare but concerning complications include amenorrhea that occurs after discontinuation of COCs. There is an opinion that COCs do not cause amenorrhea, but only hide hormonal disorders due to regular menstrual-like bleeding. Such patients must be examined for a pituitary tumor.

Long-term use of COCs changes the microecology of the vagina, promoting the occurrence of bacterial vaginosis, vaginal candidiasis. In addition, the use of COCs is considered a risk factor for the transition of existing cervical dysplasia to carcinoma. Women taking COCs should undergo regular cytological examinations of cervical smears.

Any component of the COC may cause an allergic reaction.

One of the most common side effects is uterine bleeding when using COCs (from spotting to breakthrough). The causes of bleeding are a lack of hormones for a particular patient (estrogens - when bleeding appears in the 1st half of the cycle, gestagens - in the 2nd half), impaired absorption of the drug (vomiting, diarrhea), missed pills, competitive effect of those taken with COCs medications (some antibiotics, anticonvulsants, β-blockers, etc.). In most cases, intermenstrual bleeding disappears on its own during the first 3 months of taking COCs and does not require discontinuation of contraceptives.

COCs do not have a negative effect on fertility in the future (it is restored in most cases within the first 3 months after discontinuation of the drug) and do not increase the risk of fetal defects. Accidental use of modern hormonal contraceptives in early pregnancy does not produce a mutagenic or teratogenic effect and does not require termination of pregnancy.

Towards the contraceptive benefits of COCs include:

Highly effective and almost immediate contraceptive effect;

Reversibility of the method;

Low incidence of side effects;

Good fertility control;

Lack of connection with sexual intercourse and influence on the sexual partner;

Eliminating the fear of unwanted pregnancy;

Easy to use. Non-contraceptive benefits of COCs:

Reducing the risk of developing ovarian cancer (by 45-50%), endometrial cancer (by 50-60%), benign breast diseases (by 50-75%), uterine fibroids (by 17-31%), postmenopausal osteoporosis (increased mineralization bone tissue), colorectal cancer (by 17%);

Reduced incidence of inflammatory diseases of the pelvic organs (by 50-70%) as a result of increased viscosity of cervical mucus, ectopic pregnancy, retention tumors

ovarian cysts (up to 90%), iron deficiency anemia due to less blood loss during menstrual-like discharge than during normal menstruation;

Relieving symptoms of premenstrual syndrome and dysmenorrhea;

Therapeutic effect for acne, seborrhea, hirsutism (for third-generation COCs), endometriosis, uncomplicated cervical ectopia (for triphase COCs), for some forms of infertility accompanied by ovulation disorders (rebound effect after discontinuation

COOK);

Increasing the acceptability of ICH;

Positive effect on the course of rheumatoid arthritis. The protective effect of COCs appears after 1 year of use, increases with increasing duration of use and persists for 10-15 years after discontinuation.

Disadvantages of the method: the need for daily administration, the possibility of errors during administration, lack of protection against sexually transmitted infections, decreased effectiveness of COCs when taking other medications simultaneously.

Indications. Currently, according to WHO criteria, hormonal contraception is recommended for women of any age who wish to limit their reproductive function:

In the post-abortion period;

IN postpartum period(3 weeks after birth, if the woman is not breastfeeding);

With a history of ectopic pregnancy;

Having suffered from inflammatory diseases of the pelvic organs;

With menometrorrhagia;

With iron deficiency anemia;

With endometriosis, fibrocystic mastopathy(for monophasic

COOK);

With premenstrual syndrome, dysmenorrhea, ovulatory syndrome;

With retention formations of the ovaries (for monophasic COCs);

With acne, seborrhea, hirsutism (for COCs with third generation gestagens). Contraindications. Absolute contraindications to the use of COCs:

Hormone-dependent malignant tumors (tumors of the genital organs, breast) and liver tumors;

Severe dysfunction of the liver and kidneys;

Pregnancy;

Heavy cardiovascular diseases, vascular diseases of the brain;

Bleeding from the genital tract of unknown etiology;

Severe hypertension (blood pressure above 180/110 mm Hg);

Migraines with focal neurological symptoms;

Acute deep vein thrombosis, thromboembolism;

Prolonged immobilization;

A period including 4 weeks before abdominal surgery and 2 weeks after it (increased risk of thrombotic complications);

Smoking and age over 35 years;

Diabetes mellitus with vascular complications;

Obesity III-IV degree;

Lactation (estrogens pass into breast milk).

The possibility of using oral contraception for other diseases, the course of which may be affected by COCs, is determined individually.

Conditions requiring immediate discontinuation of GC:

Sudden severe headache;

Sudden loss of vision, coordination, speech, loss of sensation in the limbs;

Acute chest pain, unexplained shortness of breath, hemoptysis;

Acute abdominal pain, especially prolonged;

Sudden pain in the legs;

Significant increase in blood pressure;

Itching, jaundice;

Skin rash.

Rules for taking COCs. COCs are started to be taken from the 1st day of the menstrual cycle: 1 tablet daily at the same time of day for 21 days (as a rule, the drug package contains 21 tablets). It should be remembered that multiphase drugs must be taken in a strictly specified sequence. Then they take a 7-day break, during which a menstrual-like reaction occurs, after which they begin a new cycle of administration. When performing an artificial abortion, you can start taking COCs on the day of the operation. If a woman does not breastfeed, the need for contraception arises 3 weeks after birth. If it is necessary to delay menstrual-like bleeding, there is no need to take a break in taking medications, continuing to take the pills next package(for multiphase contraceptives, only tablets of the last phase are used for this).

For microdosed COC Jess*, containing 28 tablets per pack, the dosage regimen is as follows: 24 active tablets followed by 4 placebo tablets. Thus, the effect of hormones is extended for another 3 days, and the presence of placebo tablets makes it easier to comply with the contraceptive regimen.

There is another scheme for using monophasic COCs: taking 3 cycles of tablets in a row, then a 7-day break.

If the interval between taking pills is more than 36 hours, the reliability of the contraceptive effect is not guaranteed. If a pill is missed in the 1st or 2nd week of the cycle, then the next day you need to take 2 tablets, and then take the pills as usual, using additional contraception for 7 days. If you missed 2 tablets in a row on the 1st or 2nd week, then in the next 2 days you should take 2 tablets, then continue taking the tablets according to the usual scheme using additional methods of contraception until the end of the cycle. If you miss a pill in the last week of your cycle, it is recommended to start taking the next pack without interruption.

When used correctly, COCs are safe. The duration of use does not increase the risk of complications, so you can use COCs for as many years as necessary, until the onset of postmenopause. It has been proven that taking breaks from taking medications is not only unnecessary, but also risky, since during this period the likelihood of an unwanted pregnancy increases.

Vaginal ring "NovaRing" ♠ refers to estrogen-gestagen contraception with parenteral supply of hormones to the body. "No-Varing" * is a flexible plastic ring that is inserted deep into the vagina from the 1st to the 5th day of the menstrual cycle for 3 weeks and then removed. After a 7-day break, during which bleeding appears, a new ring is introduced. While in the vagina, NuvaRing * daily releases a constant small dose of hormones (15 mcg ethinyl estradiol and 120 mcg of the gestagen etonogestrel), which enter the systemic blood flow, which provides reliable contraception (Pearl index - 0.4). "NovaRing" * does not interfere with active Lifestyle, play sports, swim. There were no cases of the ring falling out of the vagina. The vaginal ring does not cause any unpleasant sensations in partners during sexual intercourse.

Using transdermal contraceptive system "Evra" * a combination of estrogen and progestogen enters the body from the surface of the patch through the skin, blocking ovulation. 20 mcg of ethinyl estradiol and 150 mcg of norelgestramine are absorbed daily. One package contains 3 patches, each of which is applied alternately for 7 days on the 1st, 8th, 15th days of the menstrual cycle. The patches are attached to the skin of the buttocks, abdomen, and shoulders. On the 22nd day, the last patch is removed, and the next package begins to be used after a week's break. The patch is securely attached to the skin, does not interfere with an active lifestyle, and does not come off during water procedures or exposure to the sun.

Transvaginal and transdermal routes of entry of contraceptive hormones into the body have a number of advantages over the oral route. Firstly, a smoother flow of hormones throughout the day provides good control of the cycle. Secondly, due to the absence of the primary passage of hormones through the liver, less of them is required daily dose, which reduces the negative side effects of hormonal contraception to a minimum. Thirdly, there is no need for daily intake pills, which eliminates violation of the correct use of contraceptives.

Indications, contraindications, negative and positive effects of NuvaRing ♠ and Evra patches ♠ are the same as those of COCs.

Oral progestin contraceptives (OGC) contain small doses of gestagens (mini-pills) and were created as an alternative to COCs. OGK is used in women for whom drugs containing estrogens are contraindicated. The use of pure gestagens, on the one hand, reduces the number of complications of hormonal contraception, and on the other, reduces the acceptability of this type of contraception. Due to the lack of estrogens, which prevent the endometrium from being rejected, intermenstrual discharge is often observed when taking OGK.

OGKs include demoulene * (ethinodiol 0.5 mg), microlute * (levonor-gestrel 0.03 mg), exluton * (linestrenol 0.5 mg), charosette * (desogestrel

0.075 mg).

ActionOGK is caused by an increase in the viscosity of cervical mucus, the creation in the endometrium of conditions unfavorable for the implantation of a fertilized egg, and a decrease in the contractility of the fallopian tubes. The dose of steroids in the minipill is not sufficient to effectively suppress ovulation. More than half of women taking OGK have normal ovulatory cycles, therefore, the contraceptive effectiveness of OGK is lower than that of COCs; The Pearl index is 0.6-4.

Currently, only a few women use this method of contraception. These are mainly breastfeeding women (OGCs are not contraindicated during lactation), smokers, women in the late reproductive period, with contraindications to the estrogen component of COCs.

Mini-pills are taken from the 1st day of menstruation, 1 tablet per day continuously. It should be remembered that the effectiveness of OGK decreases if a dose is missed for 3-4 hours. Such a violation of the regimen requires the use of additional methods of contraception for at least 2 days.

To the above contraindications caused by gestagens, it is necessary to add a history of ectopic pregnancy (gestagens slow down the transport of the egg through the tubes) and ovarian cysts (gestagens often contribute to the occurrence of retention formations of the ovary).

OGK advantages:

Less systemic effect on the body compared to COCs;

No estrogen-dependent side effects;

Possibility of use during lactation. Disadvantages of the method:

Less contraceptive effectiveness compared to COCs;

High probability of bleeding.

Injectable contraceptives used for prolonged contraception. Currently, Depo-Provera * containing medroxyprogesterone is used for this purpose. The Pearl index of injection contraception does not exceed 1.2. First intramuscular injection done in any of the first 5 days of the menstrual cycle, the next - every 3 months. The drug can be administered immediately after an abortion, after childbirth if the woman is not breastfeeding, and 6 weeks after birth if she is breastfeeding.

Mechanism of action and contraindications to the use of Depo-Provera * are similar to those for OGK. Advantages of the method:

High contraceptive effectiveness;

No need to take the drug daily;

Duration of action;

Few side effects;

Absence of estrogen-dependent complications;

The ability to use the drug for therapeutic purposes in case of hyperplastic processes of the endometrium, benign diseases of the mammary glands, uterine fibroids, adenomyosis.

Disadvantages of the method:

Delayed restoration of fertility (from 6 months to 2 years after discontinuation of the drug);

Frequent bleeding (subsequent injections lead to amenorrhea).

Injection contraception is recommended for women who need long-term reversible contraception during lactation, who have contraindications to the use of estrogen-containing drugs, and who do not want to take hormonal contraceptives daily.

Implants provide a contraceptive effect as a result of the constant long-term release of a small amount of gestagens. In Russia, Norplant * is registered as an implant, containing levonorgestrel and consisting of 6 silastic capsules for subcutaneous administration. The level of levonorgestrel required for contraception is achieved within 24 hours after administration and is maintained for 5 years. Capsules are injected under the skin inside the forearm in a fan-shaped manner through a small incision under local anesthesia. The Pearl index for norplant is 0.2-1.6. The contraceptive effect is achieved as a result of suppression of ovulation, increased viscosity of cervical mucus and the development of atrophic changes in the endometrium.

Norplant is recommended for women who need long-term (at least 1 year) reversible contraception, with estrogen intolerance, and who do not want to take hormonal contraceptives daily. Upon expiration or at the request of the patient, the contraceptive is removed surgically. Fertility is restored within a few weeks after the capsules are removed.

In addition to Norplant, there is a single-capsule implantation contraceptive Implanon p* containing etonogestrel - a highly selective gestagen of the latest generation, a biologically active metabolite of deso-gestrel. Implanon is administered and removed four times faster than a multicapsule drug; complications are observed less frequently (less than 1%). Implanon provides long-term contraception for 3 years, high efficiency, more low frequency adverse reactions, rapid restoration of fertility and medicinal effects inherent in progestin contraceptives.

Advantages of the method: high efficiency, duration of contraception, safety (few side effects), reversibility, absence of estrogen-dependent complications, no need to take the drug daily.

Disadvantages of the method: frequent occurrence of bleeding, the need for surgery to insert and remove capsules.

* This drug is currently being registered with the Ministry of Health and social development RF in the Department of State Regulation of Medicines Circulation.

20.3. Barrier methods of contraception

Currently, due to the increase in the number of sexually transmitted diseases, the number of people using barrier methods has increased. Barrier methods of contraception are divided into chemical and mechanical.

Chemical methods of contraception (spermicides) - These are chemicals that are harmful to sperm. The main spermicides included in the finished forms are nonoxynol-9 and benzalkonium chloride. They destroy the cell membrane of sperm. The contraceptive effectiveness of spermicides is low: the Pearl index is 6-20.

Spermicides are produced in the form of vaginal tablets, suppositories, pastes, gels, creams, films, foams with special nozzles for intravaginal administration. Benzalkonium chloride (pharmatex *) and nonoxynol (patentex oval *) deserve special attention. Suppositories, tablets, films with spermicides are inserted into the upper part of the vagina 10-20 minutes before sexual intercourse (the time required for dissolution). Cream, foam, gel immediately after administration exhibit contraceptive properties. Repeated sexual intercourse requires additional administration of spermicides.

There are special polyurethane sponges impregnated with spermicides. Sponges are inserted into the vagina before sexual intercourse (can be a day before sexual intercourse). They have the properties of chemical and mechanical contraceptives, since they create a mechanical barrier to the passage of sperm and secrete spermicides. It is recommended to leave the sponge in for at least 6 hours after sexual intercourse to ensure a reliable contraceptive effect, but no later than 30 hours later it should be removed. If a sponge is used, then additional spermicide is not required for repeated sexual intercourse.

In addition to the contraceptive effect, spermicides provide some protection against sexually transmitted infections, since the chemicals have bactericidal and viruscidal properties. However, the risk of infection still remains, and for HIV infection it even increases due to the increased permeability of the vaginal wall under the influence of spermicides.

Advantages of chemical methods: short duration of action, no systemic effect on the body, few side effects, protection against sexually transmitted infections.

Disadvantages of methods: the possibility of developing allergic reactions, low contraceptive effectiveness, connection of use with sexual intercourse.

TO mechanical methods of contraception These include condoms, cervical caps, and vaginal diaphragms, which create a mechanical barrier to the penetration of sperm into the uterus.

Condoms are the most widely used. There are male and female condoms. The male condom is a thin, cylindrical pouch made of latex or vinyl; some condoms are treated with spermicides. The condom is put on

erect penis before sexual intercourse. The penis should be removed from the vagina before the erection stops in order to avoid the condom slipping and sperm entering the woman’s genital tract. Cylindrical female condoms are made of polyurethane film and have two rings. One of them is inserted into the vagina and put on the cervix, the other is taken outside the vagina. Condoms are disposable products.

The Pearl index for mechanical methods ranges from 4 to 20. The effectiveness of a condom is reduced if it is used incorrectly (use of fatty lubricants that destroy the surface of the condom, repeated use of the condom, intense and prolonged sexual intercourse leading to microdefects of the condom, improper storage, etc.) . Condoms are good protection against sexually transmitted infections, but infection viral diseases, syphilis is still possible when the damaged skin of the patient comes into contact with healthy partner. Side effects include latex allergy.

This type of contraception is indicated for patients who have casual sex, with a high risk of infection, and who are rarely and irregularly sexually active.

For reliable protection against pregnancy and against sexually transmitted infections, the “double Dutch method” is used - a combination of hormonal (surgical or intrauterine) contraception and a condom.

The vaginal diaphragm is a dome-shaped device made of latex with an elastic rim around the edge. The diaphragm is inserted into the vagina before sexual intercourse so that the dome covers the cervix and the rim fits closely to the walls of the vagina. The diaphragm is usually used with spermicides. If sexual intercourse is repeated after 3 hours, repeated administration of spermicides is required. After sexual intercourse, you should leave the diaphragm in the vagina for at least 6 hours, but no more than 24 hours. The removed diaphragm is washed with soap and water and dried. Using a diaphragm requires special training. It is not recommended to use a diaphragm for prolapse of the vaginal walls, old perineal ruptures, large vaginal sizes, diseases of the cervix, inflammatory processes genitals.

Cervical caps are metal or latex cups that are placed over the cervix. The caps are also used together with spermicides, administered before sexual intercourse, removed after 6-8 hours (maximum after 24 hours). After use, wash the cap and store it in a dry place. Contraindications to birth control using this method include diseases and deformities of the cervix, inflammatory diseases of the genital organs, prolapse of the vaginal walls, and the postpartum period.

Unfortunately, neither diaphragms nor caps protect against sexually transmitted infections.

TO benefits mechanical means of contraception include the absence of a systemic effect on the body, protection against sexually transmitted infections (for condoms), to shortcomings- connection between the use of the method and sexual intercourse, insufficient contraceptive effectiveness.

20.4. Natural methods of contraception

The use of these methods of contraception is based on the possibility of pregnancy in the days close to ovulation. To protect against pregnancy, abstain from sexual activity or use other methods of contraception on the days of the menstrual cycle with the highest probability of conception. Natural methods of birth control are ineffective: the Pearl index ranges from 6 to 40. This significantly limits their use.

To calculate the fertile period use:

Calendar (rhythmic) Ogino-Knaus method;

Rectal temperature measurement;

Examination of cervical mucus;

Symptothermal method.

Application calendar method is based on determining the average timing of ovulation (on average on the 14th day ± 2 days with a 28-day cycle), the lifespan of sperm (on average 4 days) and the egg (on average 24 hours). With a 28-day cycle, the fertile period lasts from the 8th to the 17th day. If the duration of the menstrual cycle is not constant (the duration of at least the last 6 cycles is determined), then the fertile period is determined by subtracting from the short cycle 18 days, of the longest - 11. The method is acceptable only for women with a regular menstrual cycle. With significant fluctuations in duration, almost the entire cycle becomes fertile.

Temperature method based on determining ovulation by rectal temperature. The egg survives for a maximum of three days after ovulation. The fertile period is considered to be the period from the beginning of menstruation to the expiration of three days from the moment the rectal temperature rises. The long duration of the fertile period makes the method unacceptable for couples who are sexually active.

Cervical mucus During the menstrual cycle, it changes its properties: in the preovulatory phase, its quantity increases, it becomes more extensible. The woman is taught to evaluate cervical mucus over several cycles to determine when she ovulates. Conception is likely within two days before the mucus leaves and 4 days after. This method cannot be used for inflammatory processes in the vagina.

Symptothermal method based on monitoring rectal temperature, properties of cervical mucus and ovulatory pain. The combination of all methods allows you to more accurately calculate your fertile period. The symptothermal method requires scrupulousness and perseverance from the patient.

Interrupted sexual intercourse - one of the options for a natural method of contraception. Its advantages can be considered simplicity and lack of ma-

material costs. However, the contraceptive effectiveness of the method is low (Pearl index - 8-25). Failures are explained by the possibility of pre-ejaculatory fluid containing sperm entering the vagina. For many couples, this type of contraception is unacceptable because self-control reduces the feeling of satisfaction.

Natural methods of birth control are used by couples who do not want to use other means of contraception, fear side effects, or for religious reasons.

20.5. Surgical methods of contraception

Surgical methods of contraception (sterilization) are used in both men and women (Fig. 20.1). Sterilization in women causes obstruction of the fallopian tubes, making fertilization impossible. During sterilization in men, the vas deferens is ligated and crossed (vasectomy), after which sperm cannot enter the ejaculate. Sterilization is the most effective method birth control (Pearl index is 0-0.2). Pregnancy, although extremely rare, is explained by technical defects in the sterilization operation or recanalization of the fallopian tubes. It should be emphasized that sterilization is an irreversible method. Existing options for restoring the patency of the fallopian tubes (microsurgical operations) are complex and ineffective, and IVF is an expensive procedure.

Before the operation, a consultation is carried out, during which the essence of the method is explained, they are informed about its irreversibility, and the details of the history are clarified.

Rice. 20.1. Sterilization. Coagulation and division of the fallopian tube

problems that prevent sterilization, and also conduct a comprehensive examination. All patients are required to obtain written informed consent for the operation.

In our country it is voluntary surgical sterilization allowed since 1993. According to the Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens (Article 37), medical sterilization as a special intervention with the aim of depriving a person of the ability to reproduce offspring or as a method of contraception can be carried out only upon a written application from a citizen at least 35 years old or having at least 2 children, and if available medical indications and with the consent of the citizen - regardless of age and presence of children.

For medical indications These include diseases or conditions in which pregnancy and childbirth pose a health risk. Is the list of medical indications for sterilization determined by order? 121n dated 03/18/2009 Ministry of Health and Social Development of Russia.

Contraindications sterilization are diseases in which the operation is impossible. As a rule, these are temporary situations; they only cause the postponement of surgical intervention.

The optimal timing for the operation is the first few days after menstruation, when the likelihood of pregnancy is minimal, and the first 48 hours after childbirth. Sterilization during caesarean section is possible, but only with written informed consent.

The operation is performed under general, regional or local anesthesia. Laparotomy, mini-laparotomy, and laparoscopy are used. Laparotomy is used when sterilization is performed during another operation. The other two accesses are most often used. With a mini-laparotomy, the length of the skin incision does not exceed 3-4 cm; it is performed in the postpartum period, when the uterine fundus is high, or in the absence of appropriate specialists and laparoscopic equipment. Each access has its own advantages and disadvantages. The time required to perform the operation, regardless of the approach (laparoscopy or mini-laparotomy) is 10-20 minutes.

The technique for creating occlusion of the fallopian tubes is different - ligation, cutting with ligatures (Pomeroy method), removal of a segment of the tube (Parkland method), coagulation of the tube (see Fig. 20.1), application of titanium clamps (Filshi method) or silicone rings compressing the lumen of the tube .

The operation is associated with the risk of anesthetic complications, bleeding, hematoma formation, wound infections, inflammatory complications from the pelvic organs (during laparotomy), injuries to the abdominal organs and great vessels, gas embolism or subcutaneous emphysema (during laparoscopy).

Except abdominal method sterilization, there is a transcervical method, when during hysteroscopy occlusive substances are injected into the mouths of the fallopian tubes. The method is currently considered experimental.

Vasectomy in men is a simpler and less dangerous procedure, but in Russia few resort to it due to the false fear of adverse effects on sexual function. Inability to conceive occurs in men 12 weeks after surgical sterilization.

Advantages of sterilization: a one-time intervention that provides long-term protection against pregnancy and no side effects.

Disadvantages of the method: the need for surgery, the possibility of complications, irreversibility of the intervention.

20.6. Postcoital contraception

Postcoital, or emergency, contraception is a method of preventing pregnancy after unprotected intercourse. The purpose of this method is to prevent pregnancy at the stage of ovulation, fertilization, and implantation. The mechanism of action of postcoital contraception is diverse and manifests itself in desynchronization of the menstrual cycle, disruption of the processes of ovulation, fertilization, transport and implantation of the fertilized egg.

Emergency contraception cannot be used regularly, it should be used only in exceptional cases (rape, condom rupture, diaphragm displacement, if the use of other methods of birth control is impossible) or in women who have rare sexual intercourse.

The most common methods of post-coital contraception are the introduction of an IUD or the use of sex steroids after intercourse.

With the aim of emergency protection against pregnancy, an IUD is administered no later than 5 days after unprotected sexual intercourse. In this case, possible contraindications for using an IUD should be taken into account. This method can be recommended to patients who wish to continue using permanent intrauterine contraception, in the absence of a risk of infection of the genital tract (contraindicated after rape).

For hormonal postcoital contraception, COCs (Yuzpe method), pure gestagens or antiprogestins are prescribed. The first dose of COCs according to the Yuzpe method is necessary no later than 72 hours after unprotected sexual intercourse, the 2nd - 12 hours after the 1st dose. The total dose of ethinyl stradiol should not be less than 100 mcg at each dose. The drugs postinor ♠, containing 0.75 mg of levonorgestrel, and escapelle ♠, containing 1.5 mg of levonorgestrel, have been created specifically for postcoital gestagenic contraception. Postinor ♠ should be taken 1 tablet 2 times according to a scheme similar to the Yuzpe method. When using escapelle * 1 tablet must be used no later than 96 hours after unprotected sexual intercourse. The antiprogestin mifepristone in a dose of 10 mg binds progesterone receptors and prevents or interrupts the process of preparing the endometrium for implantation, caused by the action of progesterone. A single dose of 1 tablet is recommended within 72 hours after sexual intercourse.

Before prescribing hormones, it is necessary to exclude contraindications.

The effectiveness of various methods of this type of contraception ranges from 2 to 3 on the Pearl index (average degree of reliability). High doses of hormones can cause side effects - uterine bleeding, nausea, vomiting, etc. A failure should be considered pregnancy, which, according to WHO experts, must be terminated due to the danger of the teratogenic effect of high doses of sex steroids. After using emergency contraception, it is advisable to conduct a pregnancy test; if the result is negative, choose one of the methods of planned contraception.

20.7. Teenage contraception

According to WHO definition, adolescents are young people aged 10 to 19 years. Early onset of sexual activity puts teenage contraception in one of the first places, since the first abortion or childbirth at a young age can seriously affect health, including reproductive health. Sexual activity among adolescents increases the risk of sexually transmitted diseases.

Contraception for young people should be highly effective, safe, reversible and affordable. Several types of contraception are considered acceptable for adolescents.

Combined oral contraception - microdosed, low-dose COCs with the latest generation of gestagens, triphasic COCs. However, estrogens contained in COCs can cause premature closure of the growth centers of the epiphyses of bones. Currently, it is considered acceptable to prescribe COCs with a minimum content of ethinyl estradiol after a teenage girl has completed her first 2-3 menstruation.

Postcoital contraception with COCs or gestagens is used for unplanned sexual intercourse.

Condoms combined with spermicides provide protection against sexually transmitted infections.

The use of pure gestagens in view frequent occurrence bleeding is not acceptable, and the use of an IUD is relatively contraindicated. Natural methods of birth control and spermicides are not recommended for adolescents due to their low effectiveness, and sterilization is unacceptable as an irreversible method.

20.8. Postpartum contraception

Most women in the postpartum period are sexually active, so contraception after childbirth remains relevant. Several types of postpartum contraception are currently recommended.

The lactational amenorrhea method (LAM) is a natural method of birth control, based on the inability to conceive when

regular breastfeeding. Prolactin released during lactation blocks ovulation. The contraceptive effect is ensured for 6 months after birth if the baby is breastfed at least 6 times a day, and the intervals between feedings are no more than 6 hours (the “three sixes” rule). During this period there are no menstruation. The use of other natural methods of contraception is excluded because the timing of the resumption of menstruation after childbirth cannot be predicted, and the first menstruation is often irregular.

Postpartum sterilization is currently performed even before discharge from the maternity hospital. Progestin-based oral contraception is allowed to be used during lactation. Prolonged progestin contraception (Depo-Provera *, Norplant *) can be started from the 6th week after birth while breastfeeding.

Condoms are used in combination with spermicides.

In the absence of lactation, it is possible to use any method of birth control (COCs - from the 21st day, IUD - from the 5th week of the postpartum period).

The creation of contraceptive vaccines based on the achievements of genetic engineering is promising. HCG, sperm, egg, and fertilized egg antigens are used as antigens.

A search is underway for contraceptives that cause temporary sterilization in men. Gossypol, isolated from cotton, when taken orally, caused the cessation of spermatogenesis in men for several months. However, many side effects did not allow this method to be put into practice. Research into developing hormonal contraception for men continues. It has been proven that the production of male germ cells can be stopped by introducing androgen and progestogen in the form of an injection or implant. After stopping the effect of the drug, fertility is restored within 3-4 months.

Modern methods of contraception for women are the calendar method, barrier, chemical, hormonal, IUD - there are plenty to choose from. We will describe the advantages and disadvantages of each of these methods of preventing unwanted pregnancy.

Without interfering with the body

There are so-called methods of natural contraception, they do not affect the body, but have very low effectiveness.

1. Measuring basal temperature and creating graphs. A woman is fertile only 1-2 days a month. These days, ovulation occurs - the release of a mature egg, ready for fertilization, from the follicle. Define this dangerous period This can be done using daily morning temperature measurements in the rectum.
It's better to use the regular one, not electronic thermometer, since it is more accurate. Place it at arm's length in the evening. In the morning, immediately after waking up, without getting out of bed, you need to take this thermometer, lubricate the tip with cream, Vaseline or some kind of lubricant, lie on your side, and insert it shallowly into the anus. The measurement should take approximately 10 minutes. Afterwards, the data obtained is entered into a special chart. Before ovulation, which occurs approximately in the middle of the menstrual cycle, usually on days 12-18, depending on its duration, the temperature drops slightly. And immediately after, it increases sharply due to the production of the hormone progesterone. Actually, the days when the temperature drops and a couple of days after is the time period when you just need to abstain from sexual intercourse. However, it should be noted that not all women have sufficient quantity progesterone receptors in anus, and therefore the calendar method of contraception is not applicable for every woman.

2. Track preovulation signs. If you don’t want to measure your temperature every day, you can try to analyze your feelings during the period of ovulation and thus calculate dangerous days. Common signs of ovulation include:

• slight bleeding in the middle of the menstrual cycle (caused by a slight detachment of the endometrium due to a slight drop in certain hormones);
• pain in the lower abdomen, often stabbing, on the side of the ovary where ovulation occurred;
• copious mucous discharge that does not cause discomfort and is not associated with sexual intercourse;
• increased sexual desire.

3. Non-drug methods of contraception include interrupted sexual intercourse; it protects many couples. True, the failure rate is also high. There is an opinion that the pre-ejaculation fluid that ends up in a woman’s vagina contains a small amount of sperm, that is, conception becomes possible even if ejaculation did not occur in the vagina. But many recent studies refute this conclusion. But one way or another, this is not the best method of contraception, including from the psychological side. Neither partner is able to completely relax and enjoy the process.

Prevent fertilization

A barrier method of contraception helps prevent sperm from entering the vagina or directly into the cervix. These means primarily include condoms, both male and female, uterine caps, as well as so-called chemical contraception.

Good this method because it can be used at any age and has no contraindications, only individual allergic reactions. Barrier methods of contraception for nulliparous girls who do not have a permanent healthy partner are ideal because they can almost 100% eliminate infection with various sexually transmitted infections. Plus the protection against pregnancy is very high. Condoms rarely break if the instructions are followed. Main rules:

• the condom is used only once;
• it cannot be lubricated with anything other than lubricants;
• You cannot put on two or three or more condoms at the same time for greater reliability, as this will only break faster.

If the condom suddenly breaks, you need to use emergency contraception. high probability conception.

The method of chemical contraception also has its own characteristics. This a sharp decline effectiveness in case of violations of the rules of the instruction. For example, if it is written that you can begin sexual intercourse only 10 minutes after the suppository is deep inside the vagina, then this means that you need to wait no less than this. It’s better to use a little more so that the spermicide has time to evenly cover the vaginal mucosa. You should not wash yourself with soap 2 hours before sexual intercourse and 2 hours after it. Although using just water is possible, it will not destroy the current Chemical substance contraceptive The recommendation concerns spermicides containing benzalkonium chloride.

These means of contraception are often used after childbirth, since at this time sexual intercourse is usually not very frequent, the likelihood of pregnancy in the case of breastfeeding is not so great, and spermicides are very accessible and have no contraindications. However, many couples complain about the burning sensation that occurs when using spermicides. In this case, you can replace the drug. For example, if Patentex Oval is not suitable, then Pharmatex may be suitable.

However, you should not use spermicides too often - they disrupt the vaginal microflora. Thrush may get worse or bacterial vaginosis. It should also be taken into account that spermicides, unlike condoms, do not reliably protect against sexually transmitted infections.

Let's protect ourselves with hormones

For decades now, hormonal female contraceptives have been available in our pharmacies. And modern, educated gynecologists prescribe them to their patients without fear. Young women extremely rarely have contraindications for this type of contraception. More often than not, women do not want to use hormonal drugs due to prejudice. Many people believe that “hormones” have a very negative impact on health, reducing reproductive abilities and lead to excess weight gain. But these are quite rare side effects, since modern drugs contain minimal concentrations of hormones. So, what are your options for hormonal contraception?

1. Tablets (oral contraceptives). Exactly this popular remedy. The downside is that the drug must be taken daily, preferably at the same time. If there is a delay of more than 12 hours - yes Great chance pregnancy and intermenstrual bleeding.
Birth control pills are also widely used for medicinal purposes. For example, they are taken for endometriosis to get rid of unpleasant symptoms this disease in the form of heavy menstrual and intermenstrual bleeding. Oral contraceptives also relieve symptoms of premenstrual syndrome (PMS).

2. NuvaRing ring. This contraceptive has a number of advantages over pills:

• there is no risk of missing an appointment and thus jeopardizing your health, the ring is inserted into the vagina once at the beginning of the cycle;
• acts predominantly locally, but effectively;
• contains less estrogen than combined oral contraceptives;
• its effectiveness does not decrease with diarrhea and vomiting.

Sometimes a ring installed in the vagina interferes with sexual intercourse; the partner feels it. You should know that short term the ring can be removed from the vagina, this will not reduce its effectiveness.
The depth to which the ring is installed does not affect its effectiveness. There is only one condition - the woman should be comfortable, she should not feel a foreign body in the vagina. If it is comfortable, then the NuvaRing ring is installed correctly.

3. Contraceptive patch. Known under the brand name "Evra". It costs a little more than 1000 rubles, about the same as good birth control pills. One package contains 3 patches. Each patch is designed for exactly 7 days. Scientists have not yet identified any advantages over oral contraceptives. All the same contraindications and side effects.

4. Contraceptive injections. The advantage is that they contain only one hormone - gestagen, which makes their use more accessible to women for whom combination preparations containing estrogen are not recommended. One injection lasts for three months, which is also very convenient. Assign this drug also for the treatment of endometriosis. The name is “Depo-Provera”.

5. Subcutaneous implants Implanon. They are convenient because they are valid for three years, but if necessary, they can be removed before this period. They are inconvenient because installation and removal are carried out only by a doctor who is familiar with this technique. The cost of the contraceptive is high - about 8,000 rubles. But they can be safely divided into 36 months. This will cost you just over 200 rubles a month for reliable protection against pregnancy. Subdermal implants are recommended for women who do not want to have children for several years.

6. Emergency contraception. Of all the above, they are the most unfavorable for the body, since they contain high doses of hormones and very often cause side effects in the form of uterine bleeding. These methods are good in an emergency; there are many safe contraceptives for women - there is plenty to choose from. And emergency contraception does not always save you; pregnancy can still occur, and in this case, many gynecologists recommend an abortion.

Well-known drugs in Russia are “Escapelle”, “Postinor”, ​​“Ginepriston”, “Zhenale”. The last two are considered more modern and less dangerous for the body, since they simply block the action of progesterone for a short time and do not add “extra hormones.”

Intrauterine protection

It is considered very reliable, but is not suitable for everyone. Intrauterine systems (spirals) come in different forms and may contain metals - gold, silver, copper - it is believed that they provide preventive protection of the endometrium from inflammation.

Advantages of this type of contraception:

• duration (up to 5-7 years can be in the uterus), but if desired, you can remove the device at any time and immediately plan a pregnancy if everything is in order with your health;
• reliability (almost 100% effectiveness), slightly lower than that of hormonal contraception;
• Convenience - set it once and forget it.

The disadvantages are the following:

• painful installation (very individual);
• recommended for women who have given birth, as it can provoke inflammatory reactions and promote the penetration of pathogens from the vagina into the uterus;
• causes painful and heavy menstruation, and sometimes intermenstrual discharge;
• can move and fall out of the uterus, which provokes an unwanted pregnancy;
• Sometimes, when an intrauterine system is installed, an ectopic pregnancy occurs, since the contraceptive does not block ovulation, it only prevents the fertilized egg from attaching to the endometrium.

As you can see, there are a lot of reliable, albeit not without drawbacks, contraceptives approved by gynecologists. There is no need to risk your health by using so-called natural methods.

To correctly choose a method of protection from unwanted pregnancy, in this topic we will tell you what methods and methods of contraception exist. Having learned about methods of contraception, you will be able to choose a more convenient contraceptive for yourself and enjoy love games without fear of getting pregnant. The term contraception refers to the prevention of pregnancy different ways: Mechanical, Chemical, etc., moreover, some methods prevent the transmission of sexual diseases.

To determine the reliability of a particular method of contraception, we will use the Pearl index, which indicates how many women out of a hundred became pregnant using one of the types of contraception for a period of time.

NATURAL TYPES AND METHODS OF CONTRACEPTION

SEXUAL INTERRUPTION: It consists in the fact that a man, at the moment of receiving pleasure, removes the penis from a woman. The Pearl index for this type of contraception ranges from 4 to 18. In most cases, the unreliability of this method of protection lies in the man’s insufficient self-control when receiving pleasure, which leads to untimely removal of the male organ from the woman and her fertilization. Also, at the time of sexual intercourse, the male organ secretes pre-seminal fluid, which may contain live sperm and, even if the man managed to remove his organ at the moment of pleasure, this does not mean the absence of pregnancy, the woman could be fertilized with pre-seminal fluid, which of course very rarely happens and has no basis scientific evidence. Moreover, after a man has had pleasure, part of the ejaculate remains in the canals of his organ, which, when re-entering a woman, can lead to the release of ejaculate and pregnancy, so that the remaining ejaculate does not enter the woman, the man is advised to urinate. This type of contraception is psychologically negative for a man.

CALENDAR METHOD OF CONTRACEPTION: With this method of protection, it is necessary to calculate the days of ovulation of the egg; read how to do this here: . The Pearl index with this method of contraception ranges from 9 to 40. Remember that male ejaculate can live inside a woman from several hours to 7 days, and the average lifespan is 2-3 days. Moreover, this type of contraception is not suitable for women whose menstrual cycle is irregular.

TEMPERATURE TYPE OF CONTRACEPTION: It consists in the fact that a woman measures her basal temperature and keeps a chart, almost the same as the calendar method, but based on temperature. The pearl index ranges from 0.8 to 3.

CHURCH TYPE OF CONTRACEPTION: The woman monitors her vaginal discharge using tests, somewhat similar to the calendar method. The pearl index is 15.

SYMPTOTHERMAL TYPE OF CONTRACEPTION: A method of protection that includes temperature and church type of contraception. Pearl index 0.3.

MEASUREMENT OF HORMONE LEVEL: Pregnancy using this method requires tests that measure the hormones LH and FSH in morning urine, indicating ovulation. Pearl index from 4 to 18.

LACTATION AMENorrhea METHOD: Method of protection in the form of the effect of breastfeeding for 6 months after the birth of the child. Pearl index from 2 to 3.

MECHANICAL OR BARRIER TYPES OF CONTRACEPTION

CONDOM: A type of protection that involves placing a latex or thin rubber shell on the male organ, in which male ejaculate remains after pleasure. This type of contraception protects not only from unwanted pregnancy, but also from sexually transmitted diseases. When using, beware of applying oily lubricants, as oils corrode latex and the contraceptive may tear. The pearl index ranges from 2 to 12.

FEMALE CONDOM: Unlike male contraceptives, they are not worn on the male organ, but are inserted inside the woman. In all other respects, the principle of action is the same as that of the male contraceptive. Pearl index ranges from 5 to 25.

FEMALE DIAPHRAGM: A type of contraception that is a latex dome-shaped cap with a flexible rim that covers the female cervix. Pearl index from 6 to 20.

FEMALE UTERINE CAP: The type of contraceptive is very similar to the diaphragm, the only difference is that it is half the size of the diaphragm and is worn at the entrance to the uterus. Pearl index from 9 to 20.

HORMONAL TYPES OF CONTRACEPTION

Hormonal contraceptives have various protection effects. Some hormonal pills suppress ovulation, which is reflected in the obstruction of the development and release of the egg, other hormonal pills change the structure of the lining of the uterus (endometrium) and the fertilized egg cannot attach to the walls of the uterus, others can thicken cervical mucus, which prevents the progress of ejaculate. Independent choice Hormonal contraceptives are not recommended; it will be better if a doctor prescribes it to you with a preliminary conclusion based on the tests obtained. Frequently asked questions and general information about oral contraceptives can be found here: .

COMBINED ORAL CONTRACEPTIVES: These tablets contain hormonal substance estrogen and progestin. Pearl index from 0.1 to 0.9.

MINI-PILI: They contain only progestin and do not contain estrogen, which, according to research, has a detrimental effect on a woman’s health. Pearl index from 0.5 to 4.3.

HORMONAL INJECTIONS: Intramuscular injections are given every 3 months and contain progestin. Pearl index from 0.3 to 1.4.

NORPLANT: A type of contraceptive inserted under the skin containing the substance levonorgestin. Pearl index from 0.08 to 0.09.

NOVARING RING: A type of contraceptive containing estrogen and progestogen. Pearl index from 0.4 to 0.65.

EURA PATCH: A type of contraception in the form of a patch attached to a woman’s skin and delivering hormones through the bloodstream to the woman’s body: Pearl index from 0.4 to 0.9.

INTRAUTERINE DEVICE: A type of contraceptive that is a plastic device with a copper spiral inserted into female uterus. It prevents the advancement of ejaculate, the attachment of the egg to the walls of the uterus and shortens the life of the egg. The pearl index ranges from 0.1 to 0.5.

TYPE OF POSTCOITAL CONTRACEPTION: Applicable this type during unprotected sexual intercourse and ejaculate getting inside the woman. It consists of urgently taking a hormonal pill after sexual intercourse. Due to the high harmfulness of this type of contraception, it should only be used in in case of emergency no more than once every six months. Pearl index 2.

CHEMICAL TYPES OF CONTRACEPTIVES

CREAMS, AEROSOLS, CANDLES, ETC.: Entered into female vagina Before starting sexual intercourse, about 10-15 minutes, look at the instructions for the contraceptive in more detail. Pearl index from 3 to 21.

INTRAUTERINE DEVICE: Yes, this type of contraception can be attributed not only to hormonal, but also to chemical methods protection, since the spiral may contain a metal that is harmful to the ejaculate.

SURGICAL TYPES OF CONTRACEPTION

The type of contraception in the form of sterilization is used for people who have children, since reverse restoration is almost impossible.

MALE CONTRACEPTION: This type of contraception is called a vasectomy or sterilization, which is a simple operation to block the seminal ducts. Pearl index 0.4.

FEMALE CONTRACEPTION: Sterilization of a woman is a more complicated operation than for men and involves tying the tubes to block the patency of the fallopian tubes. Pearl index from 0.01 to 0.1.