Biological contraceptives. Types and methods of contraception

Since the egg has not yet matured. Some couples prefer to use this method of contraception for religious, moral or other reasons. However, it cannot be said that the effectiveness biological methods contraception was high.

With lactational amenorrhea, the possibility of pregnancy is minimal. After the birth of a child, reversible disorders occur in the nervous regulation of the internal genital organs, which are manifested, in particular, by the fact that for some time after childbirth during breastfeeding menstrual cycle is disrupted and the eggs do not mature. Therefore, during sexual intercourse in this period conception does not occur.

The main difficulty of contraception is that it is difficult to accurately determine when this period will end, because for each woman the period of lactational amenorrhea is individual. According to doctors, it depends on the age, body type of the mother, the course of pregnancy, social conditions and many other factors.

On average, provided that a woman breastfeeds her baby only, without additional feeding, at least 6 times a day, lactational amenorrhea lasts about 6 months. However, in some women, ovulation resumes earlier than this, and it is not always manifested by the onset of menstruation.

The method of periodic abstinence (abstinence) is to avoid sexual intercourse on days when the likelihood of conceiving a child is high. However, these days partners can use other methods of contraception.

The calendar method can be classified as “folk” contraception. It lies in the fact that it is necessary to calculate the period during which fertilization of the egg is impossible. If the menstrual cycle is standard (28 days), then on the 10-14th day of the menstrual cycle the egg leaves the ovarian follicle and moves into the uterine cavity. The possibility of fertilization remains for another 2 days. If during this time she does not meet a sperm, then pregnancy does not occur.

The viability of spermatozoa caught during sexual intercourse in a woman’s vagina is 5 days. Based on this, fertilization and pregnancy most often occur from the 7th to the 18th day of the menstrual cycle.

Of course, every woman has characteristics of her menstrual cycle, so the period when conception is most likely (the period of high fertility) is calculated based on at least three consecutive menstrual cycles, if fluctuations in their duration are no more than 2-3 days. If the menstrual cycle is subject to more significant fluctuations, it is better to abandon this method of contraception, because its effectiveness will be low.

The next method of biological contraception is the assessment of canal mucus cervix. On average, 4-5 days before ovulation, the amount of mucus constantly released from the vagina increases, it becomes cloudy, white or yellowish in color. During ovulation, as well as 1-2 days before and after it, cervical mucus is abundant, transparent and viscous, reminiscent of the consistency of raw egg white. It is this period that is most favorable for fertilization and the beginning of pregnancy, therefore, during these 3-5 days, sexual intercourse should be avoided or other methods of contraception should be used.

INTERESTING

According to statistics, out of 100 women of reproductive age, 36 do not use any contraceptives: 4 - because they are infertile, 7 - have undergone sterilization, 5 - due to pregnancy, 13 - due to the lack of a partner, 7 - for other reasons various reasons. And the remaining 64 women practice contraception.

Regular measurement basal temperature-d- the most difficult method of contraception to use. Every morning during the entire menstrual cycle, immediately after sleep, at the same time, without getting out of bed, the woman measures the temperature in the rectum for 5-7 minutes. As a rule, in the first half of the menstrual cycle before ovulation, the basal temperature is 0.2-0.5 °C lower than in the second half. A day after ovulation, the temperature rises and remains so until the onset of menstruation. However, in approximately 10-15% of women, the basal temperature remains constant throughout the menstrual cycle.

Many women physically feel ovulation, because when the egg leaves the ovary, the follicle ruptures, accompanied by pain of varying intensity. These painful sensations, combined with assessment of mucus from the cervical canal and measurement of basal temperature, are combined into the so-called Belling symptothermal method.

Coitus interruptus involves removing the penis from the vagina before ejaculation occurs. However, this method requires a lot of responsibility and experience from a man. Otherwise, he is afraid of not having time to remove the penis from the vagina in time and does not receive satisfaction from the sexual act itself. A woman who practices interrupted coitus also does not receive sexual satisfaction, which leads to decreased libido and anorgasmia. In addition, single sperm can enter the vagina even before ejaculation. This is an ineffective method of contraception that is harmful to health, especially women's health.

Modern means of contraception: barrier, chemical, biological, hormonal, intrauterine contraception, surgical - there are a lot of them, but often a woman cannot decide what to choose. And she ends up unexpectedly pregnant. We will briefly describe different contraceptives for women, their advantages and disadvantages.

Intrauterine systems

These are those that are installed in the uterine cavity on long term. Usually recommended exclusively for women who have given birth due to possible side effects. But we'll start with the advantages.

1. You don’t have to worry about it for several years unwanted pregnancy, has a positive effect on sexual relationships.

2. High reliability. Just under 100%.

3. Availability. The most inexpensive intrauterine device costs about 200-300 rubles. Purchased once.

And these are disadvantages.

1. Unpleasant sensations during installation. Some women require local anesthesia.

2. The possibility of the IUD falling out and dislodging, which provokes a decrease or cessation of its contraceptive effect.

3. Inflammatory diseases. Installation of the system can provoke the penetration of pathogens into the uterine cavity, which sometimes causes endometritis, the occurrence of adhesions in the intestines, fallopian tubes Oh. Accordingly, the risk of infertility in the future increases. Therefore, spirals are usually recommended specifically for women who have given birth.

4. Probability of occurrence ectopic pregnancy. Due to the spiral, the fertilized egg cannot be fixed in the uterine cavity and can return back to the fallopian tube and be implanted there.

5. Increased likelihood of heavy menstruation. Therefore, non-hormonal intrauterine systems are not recommended for use in women who experience severe cyclic and acyclic uterine bleeding.

Condoms

Barrier contraceptives have a number of advantages and can be used without consulting a doctor. Always welcome.

1. Reliability. Almost 100% protection not only from unwanted pregnancy, but also from sexually transmitted infections.

2. Ease of use and accessibility. Can be purchased at any pharmacy or supermarket. The abundance of models allows any couple to choose the right contraceptive for themselves.

3. No contraindications. Only sometimes allergic reactions occur to them. More often it is a matter of lubricant, dye or flavoring that is used to cover the condom. In this case, you need to try another, regular one, without any bells and whistles.

But there are also disadvantages. They tend to be especially scary for couples who have previously used other forms of contraception.

1. Negative effect on erection, sensitivity. Usually, a condom with ultra-thin walls helps in this case.

2. The condom falls off during intercourse. Again due to poor erection. It happens when a condom is worn when there is insufficient sexual arousal.

3. Damage to the condom. This often happens if you try to apply various substances on it in the form of a lubricant that are not intended for this. But damage can also be the result of a defective product. If the condom breaks, emergency contraception is used to prevent pregnancy.

By the way, you can use it as emergency contraception. intrauterine device. It should be installed a maximum of 5 days after unprotected sexual intercourse. Naturally, this method suitable for those women who were already thinking about installing an intrauterine system.

Spermicides

They have no contraindications and can be used, if necessary, by women who are breastfeeding. The chemical method of contraception also has pros and cons.

Some advantages.

1. Availability. 10 vaginal tablets (or suppositories), for 10 sexual acts, cost about 300 rubles. Sold in all pharmacies.

2. They do not affect the body like hormonal contraceptives, that is, they only have a local effect.

3. They have some antimicrobial and antibacterial effects.

4. They have no contraindications and can be used in cases where no other contraception is suitable.

And these are the disadvantages.

1. Often cause irritation of the vaginal mucosa and glans penis.

2. With regular use, 2-3 times a week or more, the vaginal microflora is disrupted.

3. Efficiency is significantly lower than declared if sexual intercourse begins before the time specified in the instructions. After introducing the drug into the vagina, you need to wait a little for it to start working.

Hormonal agents

They are considered one of the most reliable and convenient, but at the same time they have many contraindications and side effects. We will talk about oral contraceptives. First, the good stuff.

How to determine the period when there is a chance of conceiving a child. Rhythmic method.

It is well known that a girl can become pregnant only in certain days menstrual cycle. The essence of the rhythmic method is to avoid sexual intercourse on the days most likely to conceive.

On other days the probability is low, so you can do without any contraceptives. But in such cases, unwanted pregnancy often occurs, and this section will discuss how to use the rhythmic method, its positive and negative aspects. Let's talk about contraceptive effectiveness.

For example, 15-20 Western women experience an unwanted pregnancy out of 100 surveyed. To begin with, about positive aspects rhythmic method. This method has no side effects or contraindications, so it is suitable for everyone without exception, and there is no need to use mechanical means. The disadvantages of this method are: low contraceptive effectiveness and it cannot be used for irregular periods; you also have to abstain from sexual intercourse for a long time. But the latter can be avoided by combining it with other methods of contraception during the fertile period. What is the fertile period?

The fertile period is a period in a woman’s menstrual cycle when there is a chance of becoming pregnant. The word fertility comes from Latin language and means fertility. The fertile period does not last long, it lasts for 48 hours after ovulation, so the egg released from the ovary can be fertilized within two days. But it should be remembered that sperm remain viable in the female body for about five days. Thus, a newly released egg can be met by sperm that entered the female body in advance. Thus, the total duration of the fertile period is approximately 6-8 days.

Sometimes, due to certain factors, the length of this period is increased, since the dates of its beginning and end are not always accurately determined. If a woman has her period regularly, that is, every 28 days, then it is better for her to abstain from sexual intercourse from the 10th to the 17th day or use other methods of contraception. How to determine the timing of the fertile period? This is where the complexity of this method lies. But there are several methods that will help determine its timing. The simplest is the calendar method, but it is not the most reliable.

This period is determined by examining the duration of the menstrual cycle over the last 8-12 months, this is very important. It is calculated as follows: the beginning is determined as follows: from the duration of the short cycle subtract the number 18, for example, over the last 10 months the shortest cycle was 26 days, which means that the beginning of the fertile period will be the 8th day of the cycle, and the end is determined as follows: the number 11 is subtracted from the duration of the longest cycle, for example, over the last 10 months the longest long cycle was equal to 30 days, which means the end will be on the 19th day of the cycle.

We found out that the fertile period begins on the 8th day of the cycle and ends on the 19th day, the period is eleven days, since the menstrual cycle is not absolutely regular. This means that without the risk of getting pregnant, you can make love before the 8th day of the cycle and after the 19th, the cycle begins on the first day of menstruation. This method is not very reliable, since the timing of ovulation is strictly individual. Reliability is higher, the smaller the difference between the shortest and longest menstrual cycle over the past 8-12 months. For those whose periods come irregularly, this method is not suitable at all. The next method is temperature.

It consists of systematically measuring body temperature. The procedure is not pleasant, since the temperature is measured in the rectum. In the morning, when you first wake up and are still in bed, take your temperature before you begin your daily activities or eat. Write down the result. Usually in the first half of the menstrual cycle the temperature is below 37°C. Approximately 12-24 hours before ovulation, the temperature in the rectum decreases by 0.1-0.2 ° C - this is called the preovulatory decline, and after the release of the egg, the temperature rises by 0.2-0.5 ° C (usually up to 37 ° C and above). This temperature level is maintained until the arrival of menstruation. Six days before the decline in body temperature in the rectum, the fertile period begins (on this day the probability of getting pregnant is maximum) and it lasts three days after it for about 9 days.

Another method for determining the fertile period is the cervical method. It consists of comparing changes in the nature of cervical mucus. How is this determined? After menstruation, the vaginal mucosa is immediately felt dry or insufficient. If there is mucus, it is usually sticky, thick, and opaque. Usually, during the preovulation period, the mucus becomes light, viscous, transparent, somewhat reminiscent of egg white, there is a lot of it, this gives a feeling of moisture, and mucous discharge appears. When the egg is released from the ovary, the amount of mucus becomes less, it is thick, opaque, sticky, the mucus is similar to the mucus of the first stage of the cycle.

And sometimes there is no mucus at all. Three days before mucus appears in large quantities The fertile period begins and lasts about 4 days from the moment copious discharge mucus, it all lasts about seven days. It is advised to determine the quantity and quality of cervical mucus. When your mucus discharge has disappeared, you should not have sexual intercourse for four days after that. Three days before the expected excessive mucus secretion, it is also better to abstain from sex. It is possible to determine the arrival of the fertile period using a multicomponent method, which involves a comprehensive assessment using the above methods. There is only one contraindication: irregular periods.

Preventing abortion is key to maintaining reproductive health girls. According to experts, artificial termination of pregnancy quite often leads to infertility. Today, approximately every fifth pregnant woman resorts to abortion. Despite the high effectiveness of contraceptives, many young ladies unreasonably neglect this opportunity. We should not forget that the main objectives of contraception are not only to prevent medical abortions, but also to prevent infection with sexually transmitted diseases.

Types of contraception

There are different methods of contraception. However, regardless of the type of contraception, female contraceptives must be highly effective, safe for health, easy to use and available for purchase.

Modern methods of contraception:

• Physiological.
• Barrier or mechanical.
• Chemical.
• Hormone.

Female contraceptives can be bought in pharmacy chains without a prescription.

Physiological

The peculiarity of the physiological method of contraception is that a girl must abstain from intimacy or actively use other contraceptives during a certain period of her menstrual cycle. As a rule, if the menstrual cycle lasts 28 days, then it is necessary to abstain from vaginal sex in the period from the 11th to the 18th day, when ovulation occurs. The physiological method is based on alternating periods of high and low fertility (ability to bear children). Scientists have found that the egg remains viable for 1–3 days, and the sperm for about 5 days. What methods can be used to clarify the time of ovulation:

1. Calendar. It is necessary to calculate the fertile period, taking into account the individual duration of the menstrual cycle.
2. Temperature. To determine the fertile period, rectal temperature measurements are taken. They should be held at the same time in the morning. While lying down, the woman inserts a special thermometer into the rectum for 5–6 minutes. Ovulation is recognized by analyzing the temperature curve. The defining moment is a temperature drop of 0.2–0.3 °C and a subsequent rise of 0.7–1.0 °C. Such changes are observed only 1–2 days after the completion of the ovulatory phase. Having determined the day of ovulation, the “dangerous period” is calculated.


3. Cervical. By the nature of changes in cervical mucus due to estrogen during the menstrual cycle, it will be possible to judge what phase the woman is in.
4. Multicomponent. Judging by the name, it is not difficult to guess that this method includes measuring basal temperature, recording changes in the properties of cervical mucus, calendar calculations and some subjective signs (in particular, the appearance of pain in the lower abdomen, discharge, etc.).

The main advantage of the physiological method is simplicity of implementation and absolute safety for female body, since no consequences or adverse reactions can be expected. However, it is worth noting that this method of contraception is suitable for women with normal menstrual cycles. But for teenagers and young girls, the physiological method is inappropriate to use for several reasons:

• Irregular ovulatory cycle.
• Young girls quite often experience random or extraordinary ovulation.
• Late ovulation is more common.
• Low efficiency.
• Girls find it difficult to make correct calculations and perform basic methods of physiological contraception.
• This method is not able to protect against sexually transmitted diseases.

Not all types of contraception can provide 100% protection against unwanted pregnancy.

Barrier or mechanical

Usage special means, preventing sperm from moving into the uterine cavity is called a barrier or mechanical contraceptive method. It is known that barrier contraceptives are provided for both women and men. The most common types of barrier protection against unplanned pregnancy:

• Condoms (female and male).
• Vaginal diaphragm.
• Cervical caps.

Condoms

Today, the main material for making condoms is latex. It helps not only protect against unplanned pregnancy, but also prevents infection with sexually transmitted diseases. The main disadvantage of the method is the frequent rupture of condoms made of thin elastic rubber. According to statistics, this happens approximately once every 50-300 times we have sex.

If a condom ruptures, it is recommended to inject a spermicidal substance into the vagina and/or use an oral contraceptive for emergency post-coital prevention of unwanted pregnancy. In addition, quite often when using a condom, both sexual partners note a decrease in sexual pleasure. Clinical studies show that many boys and men neglect this method of contraception.

Therefore, a condom for women was invented, which is effective both as a contraceptive and in preventing infection with sexually transmitted diseases. It must be put on a few hours before intimacy and removed after sex. Repeated use is strictly prohibited.

Vaginal diaphragm

To explain in a nutshell, the vaginal diaphragm is a fairly good barrier contraceptive, shaped like a hemisphere and consisting of a rubber cap connected to a ring. To prevent the passage of sperm, it should be inserted into the vagina in such a way as to close the cervical canal. To increase contraceptive effectiveness, the vaginal diaphragm is used together with spermicidal agents, which can be purchased in the form of creams, foams, gels, etc.

Available various models and sizes, so it is recommended to select individually. As a rule, the insertion of the vaginal diaphragm is carried out immediately before intimacy, using a spermicide on both sides. Its removal is carried out 7–10 hours after completion of sexual intercourse. I would like to note that this barrier method of contraception does not help protect against diseases transmitted during sex, although it can protect the internal genital organs from certain types of infections.

Cervical cap

The mechanism of action and contraceptive effectiveness of cervical caps are almost the same as that of vaginal diaphragms. In shape they resemble a hemisphere with thickened edges. The negative pressure created helps the cap not to slip off the cervix. It should be administered 30–10 minutes before sexual intercourse. It can remain in the vagina for 6–9 hours (maximum period – 1.5 days). Unlike a condom, the vaginal diaphragm and cervical cap can be used more than once. Before using any method of barrier or mechanical contraception, it is recommended that you carefully read the instructions.

Modern contraceptives for women (contraceptives) must be available with a prescription.

Chemical (spermicidal)

The chemical or spermicidal method of contraception is based on the use of special agents that can inactivate sperm. This effect is realized due to the active component, which destroys the cell membrane of male germ cells in a few seconds. Spermicides are available in the form of gel, cream, suppositories, foam, tablets, etc. The effectiveness of the chemical method of contraception directly depends on its correct use. Features of application:

1. Spermicidal preparations are administered no later than 30–60 days before sexual intercourse.
2. Spermicides must come into contact with the cervix.
3. If you do not know how to use chemical contraception correctly, consult your gynecologist.

The active substances included in spermicides can not only destroy sperm, but also have a bactericidal and virusicidal effect. For example, the active component nonoxynol or benzalkonium chloride inhibits the growth and reproduction of such pathogenic microorganisms, such as chlamydia, mycoplasma, trichomonas, ureaplasma, etc. To increase contraceptive effectiveness, many experts advise combining the use of chemical and barrier contraceptive methods.

Pharmatex

One of the most popular spermicidal agents for chemical contraception is Pharmatex. To completely destroy sperm, 20 seconds of male germ cells being in an environment with Pharmatex is enough. Repeated sexual intercourse requires a new administration of the drug. In addition, it has antimicrobial activity against a number of sexually transmitted diseases (for example, gonorrhea, chlamydia, trichomoniasis, etc.). At the same time, Pharmatex does not affect normal microflora vagina and does not lead to menstrual irregularities.

It can be combined with intrauterine devices (IUD), condoms, vaginal diaphragm, cervical caps. Pharmatex is available in the following forms for vaginal use:

• Pills.
• Pills.
• Candles.
• Tampons.
• Cream.

Each form has its own characteristics of use, which can be found by reading the official instructions for the drug. It should be remembered that Pharmatex is contraindicated in case of hypersensitivity to its active components and inflammatory diseases of the genital organs. To avoid a decrease in spermicidal effect, simultaneous vaginal use of several drugs is not recommended.

Contraceptive sponge

A product that combines mechanical and chemical protection against unwanted pregnancy is called a contraceptive sponge. It acts as a barrier, preventing the movement of male germ cells in the cervical canal, and also secretes a spermicidal component that helps destroy sperm. The shape is a round pad with a small depression on one side, which should be adjacent to the cervix. However, due to its low contraceptive effectiveness, it is usually not recommended for use by adolescents and young girls. More experienced and older women are quite capable of installing this type of contraceptives and do not have any special problems with use.

The best method of contraception is the combined use of contraceptives (for example, hormonal drugs and a condom).

Hormone

Statistics show that almost 150 million girls and women around the world take oral contraceptives every day. At the same time, at present, the newest hormonal drugs are taken either orally or can be introduced into the body in other ways (injection, transdermal, intravaginal, etc.). Mechanism hormonal contraception is as follows:

• Slow down the production of gonadotropic hormones.
• Suppress the ovulation process.
• Increase the viscosity and density of cervical mucus, which is produced by the cervix.
• By changing the properties of cervical mucus, the motility of sperm in the direction of the uterine cavity is inhibited.

Taking oral contraception stops ovulation and prevents the fertilization of the egg. Also, due to the effect on the endometrium, there is a prevention of egg implantation in the uterine cavity.

Oral contraceptives

There are many types of hormonal contraceptives. Let's focus on the most clinically significant ones. Depending on the composition, oral contraception is divided into the following main groups:

1. Combined hormonal drugs containing progestogen and estrogen (Mersilon, Ovidon, Regulon, Rigevidon, Silest, Triziston, Triquilar, Belara).
2. Hormonal drugs whose active component is progestogen (Exluton, Ovret, Microlut, Charozetta). They are also called Mini-pills.

The ethinyl estradiol content plays a significant role when choosing the optimal combined oral contraceptive. Considering the amount of estrogens, hormonal drugs are divided into three large groups: high-, low- and micro-dose. Popular representatives of each of these groups:

• The first is Anteovin, Silest, Non-ovlon. They contain more than 35 mcg of ethinyl estradiol.
• The second is Regulon, Belara, Microgynon, Femoden (30 mcg each).
• Third - Mercilon, Mirrel, Miniziston (20 mcg each).

Main advantages and disadvantages

Among all hormonal oral contraceptives, priority is given to monophasic drugs containing a stable amount of both female hormones(for example, Mercilon). Two- and three-phase drugs have different amounts of estrogens and gestagens, which helps them act on different periods menstrual cycle. The main advantages of monophasic oral contraceptives:

• They are more effective than other types of non-invasive contraceptives.
• Available for most girls and women.
• They do not have serious consequences for the body.
• After stopping use, fertility is restored fairly quickly.
• It is considered a highly safe method.
• Long-term use possible.

A distinctive feature of most new combined oral contraceptives is their high efficiency and safety. In addition, according to clinical studies, the contraceptive effect is not their only property. What else is typical for contraceptive hormonal drugs:

• Able to regulate the menstrual cycle, especially in young girls.
• Helps get rid of algodismenorrhea (painful menstruation).
• If you choose the right contraceptive, you don't have to worry about weight gain.
• They do not affect the main types of exchange.
• Eliminate deficiency of female hormones.
• Reduce the likelihood of a number of gynecological and somatic diseases.

The appearance of side effects is possible in the first 3 months of taking combined hormonal drugs. In most cases, they gradually disappear over time. Long-term use usually does not provoke such adverse reactions as headache, dyspeptic disorders, swelling of the mammary glands, painful menstruation, etc.

Unlike combined oral contraceptives, mini-pills containing only progestogens have less pronounced contraceptive effectiveness. However, they do not cause serious harm to the young body. In addition, they are recommended for girls and women who have contraindications to the use of other oral contraceptives.

Use latest methods Contraception for women is recommended after consultation with a specialist.

Contraindications

Hormonal contraceptives can boast a fairly long list of various contraindications. Those that have a high lethal risk deserve the most attention. Diseases that are absolute contraindications for the use of hormonal oral contraceptives:

• Heart and vascular diseases (uncontrolled high pressure, myocardial infarction, atherosclerotic lesions of the bloodstream).
• Severe pathologies of the blood coagulation system and other diseases that provoke the formation of blood clots (venous thrombosis, thromboembolism).
• Tumors of the reproductive system and mammary glands.
• Severe pathology of the liver and kidneys with the development of functional failure.

How to take oral contraceptives?

To reduce the development of side effects and increase contraceptive properties, new regimens for the use of hormonal contraceptives have been developed. One of the latest innovations has been the introduction into clinical practice of a prolonged regimen of combined oral contraceptives. Continuous use of the drug was proposed for 3–5 menstrual cycles, after which a 7-day break was taken and use was resumed.

A regimen called “63+7” has successfully passed a clinical trial. Its essence is that the contraceptive is taken for 63 days, then there is a pause in taking it for exactly a week. In certain cases, the prolonged regimen can be extended to 126+7. With prolonged use of oral contraceptives with minimal interruption, a decrease in the occurrence of “withdrawal symptoms” is observed. The prolonged dosage regimen made it possible for girls and women to experience fewer headaches and menstrual irregularities of various nature, breast pathology and other side effects.

In addition, another innovative approach to taking hormonal contraceptives, called quick start, is being actively developed. What are its features:

1. It is allowed to start taking combined oral contraceptives at absolutely any period of the menstrual cycle.
2. Lack of significant negative influence on pregnancy and fetal development from the newest contraceptive drugs allowed scientists to come to such conclusions.
3. If pregnancy is diagnosed while using oral contraception, the medication must be stopped. It has been established that short-term use of hormonal contraceptives during pregnancy does not affect the risk of miscarriage.

The combined method is the most reliable way to protect against unwanted pregnancy, involving the simultaneous use of several types of contraceptives.

Modern contraceptives for women may have contraindications and side effects, which should be read before using them.

Emergency contraception

Despite the wide range of contraceptives, the problem of unplanned pregnancy remains very relevant for millions of girls and women. As a rule, the risk of unwanted pregnancy is associated with having sex without using contraception or its ineffectiveness. Oddly enough, many women believe that in such situations the only thing they can do is wait to see whether the next period will come or not.

However, using methods emergency contraception, you can significantly reduce the likelihood of unexpected conception. It is worth noting that this approach is practically unknown to many girls and women. At the same time, popularizing the basic principles of emergency contraception among the masses would significantly reduce the number of abortions.

When is emergency contraception indicated?

It's no secret that the chance of conceiving a child varies throughout the menstrual cycle. According to some data, the probability of pregnancy after unprotected intercourse is approximately 20%, regardless of the day of the menstrual cycle. At the same time, if sex without contraception occurred during the periovulatory period, then the chances of getting pregnant increase to 30%.

A British study showed that unprotected intercourse during ovulation can result in conception in 50% of cases, even during the first menstrual cycle. It has long been proven that sperm in a woman’s genitals remain viable for 3–7 days, and an unfertilized egg remains viable for 12–24 hours. According to most experts, it is advisable to carry out emergency contraception in the first 1–3 days after intimacy. In what cases is it indicated:

• Any unprotected sexual intercourse. Simply put, vaginal sex occurred without the use of contraceptives (condom, vaginal diaphragm, combined oral contraceptives, etc.).
• During intimacy, the condom broke or fell off.
• Premature removal of the vaginal diaphragm or cervical cap.
• Skipping a dose of oral contraceptives or taking the drug more than 12 hours late.
• A girl or woman was forced to have sex without her consent.

Clinical experience shows that modern contraceptives for women, regardless of the type, method and route of administration, are highly effective in preventing unplanned pregnancy.

Emergency contraception methods

1. Use of combined oral contraceptives (Yuzpe method).
2. Specially developed drugs for emergency protection.
3. Use of intrauterine contraception.

Combined hormonal oral medications are used quite often as emergency contraception. This method was named after the Canadian scientist Albert Yuzpe, who first used it and widely promoted it. Its essence was reduced to 2 times the use of a large dosage of estrogens and progestogens for 3 days from the moment of completion of sexual intercourse. The break between doses should have been at least 12 hours.

The effectiveness of the method was more than 95% and depended on two factors:

• The duration of the interval between intimacy and the prescription of emergency contraception. The earlier contraceptives are taken, the higher the expected effect.
• The day of the menstrual cycle when there was sex.

Despite the high effectiveness of the Yuzpe method, it requires the use of high doses of oral contraceptives and is associated with a high risk of adverse reactions. It has been recorded that in 30% of cases quite pronounced side effects are observed, including nausea, vomiting, migraine attacks, pain in the mammary glands, etc.

In addition, specially developed drugs based on levonorgesterel are also successfully used for emergency contraception. They are characterized by a pronounced gestagenic effect and the absence of estrogenic action. Among the female population, the two most popular drugs that contain levonorgesterel are Postinor and Escalep. According to the results of global clinical studies, the effectiveness of these contraceptives is slightly higher than that of the Yuzpe method. Also, the tolerability of Postinor and Escalep is much better.

Properly selected female contraception will help maintain reproductive health.

Non-hormonal drugs for emergency contraception

Most non-hormonal drugs for emergency protection against unplanned pregnancy contain the active component mifepristone, which is a synthetic antiprogestin. It is quite often used as a means for artificial termination of pregnancy. early stages(medical abortion). However, it can also be used for emergency contraception, especially when the patient cannot be prescribed hormonal contraceptive methods. Taking into account the phase of the cycle, the drug realizes its contraceptive effect due to:

• Interfering with the release of luteinizing hormone.
• Blocking or delaying ovulation.
• Disruption of natural changes in the endometrium.

During some scientific research mifepristone was found to be more effective and better tolerated than levonorgesterel. One of the main advantages of mifepristone over other methods of emergency contraception for women was the absence of a decrease in effectiveness with increasing interval between sex and use. contraceptive(up to 120 hours).

On post-Soviet space The drug Ginepristone, used for emergency contraception, has become widespread. Its distinctive feature is that it is well tolerated and has a low dosage of the active component, compared to other existing non-hormonal drugs that are used for “quick” protection against unwanted pregnancy. Ginepristone must be taken once for 3 days after intimacy, excluding the period of the menstrual cycle. If there have been repeated coitus after taking the drug, you should use additional contraceptive methods (for example, a condom). Since the contraceptive effect of Ginepristone during subsequent sexual intercourse is somewhat reduced.

Benefits of emergency contraception

I would like to clarify that hormonal and non-hormonal drugs for “urgent” contraception are intended exclusively for emergency cases and are not used on a regular basis. The main advantages of postcoital protection against unplanned pregnancy:

1. Ability to take contraceptives occasionally. This method will be especially interesting for girls and women who have an irregular sex life.
2. In most cases, there is a high contraceptive effect.
3. There are no significant adverse reactions.
4. Accessibility for many patients.

It should be remembered that emergency contraception drugs do not affect the implanted egg. Most of the recommended methods are safe for the fetus and the course of pregnancy. Therefore, even if conception occurred while using the above drugs, the pregnancy can be maintained. In addition, do not forget that contraceptives used in emergency situations do not protect against sexually transmitted diseases. If you suspect a sexually transmitted infection after intimacy, you should immediately contact a specialist.

Bagdan Shandor et al. Modern pregnancy prevention and family planning. – Budapest, 1998.

Baichurina A.Z. Contraception. – M., 1999

Vainer E.N., Volynskaya E.V. Valeology: Training workshop. – M.: Flinta: Science, 2002.- p.38-43.

Egides A. Planned child//Family and school. – 1989-№9., p.41-44.

3. Markov V.V. Fundamentals of a healthy lifestyle and disease prevention: Textbook for students of higher pedagogical educational institutions. - M.: Publishing Center "Academy", 2001, - pp. 225-240.

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Additional block of information.

Contraception ( lat. contra - against and conceptio - conception) – methods and means of preventing unwanted pregnancy.

Contraception is used

as a means of family planning and birth control;

as an effective method of primary prevention, allowing to preserve the health of women and the future generation (for example, in adolescents or women over 35 years of age, in whom pregnancy is associated with the greatest risk to health, including the health of the child);

as a method of preventing possible genetic diseases or birth defects in children;

as a means of protection against many sexually transmitted diseases, including HIV infection.

Man has used contraceptive methods from the very beginning of his existence. A number of methods that were used in primitive society still exist today.

It should be emphasized that There is no universal method of preventing pregnancy yet. The choice of a contraceptive method depends on many factors - age, desire to have children in the future, habits and sexual behavior, health status, cost of the drug and other factors, including social and personal factors.

Modern methods of contraception include the following:

hormonal method;

intrauterine devices;

mechanical means;

chemical method;

natural (rhythmic) method;

surgical method;

interruption of sexual intercourse;

postcoital (urgent) contraception.

Hormonal method of contraception was introduced into practice in the 60s by American doctors. It is considered one of the most effective means of preventing unwanted pregnancy (95-99% effective). All contraceptive hormonal drugs are synthetic analogues of the ovarian sex hormones - estrogen and progesterone, which regulate the menstrual cycle and prepare for possible pregnancy.

Mechanism of action of hormonal drugs is based on their blocking of the normal cycle of secretion by the pituitary gland of hormones that affect the maturation of the egg and its ovulation - ovulation does not occur. In addition, progesterone makes implantation difficult by suppressing the development of the uterine lining and causing thickening of the mucus in the cervix, which makes it difficult for sperm to move through.

Hormonal contraceptives, depending on the composition and method of their use, are divided into the following types:

- Combined oral contraceptives(OK), each tablet of which contains both hormones - estrogen and progesterone (Marvelon, triziston, etc.)

- Mini pills– contain only one hormone (progesterone) in a minimal amount (micronor, femulen, etc.).

- Long-acting injection medications, containing one hormone, providing contraception for 2-3-5 months (Depo-Provera).

- Subcutaneous implants, are administered subcutaneously in the shoulder area and provide contraception for 5 years (norplant)

The safest and effective method Combined oral contraceptives are considered the preferred method of contraception for young women around the world.

Positive effects of oral contraceptives:

1.regulation of the menstrual cycle;

2. weakening of menstrual bleeding and premenstrual syndrome (malaise, discomfort before menstruation);

3. protection against iron deficiency anemia;

4. reduction in the incidence of “female” inflammatory diseases;

5.reducing the risk of tumor diseases of the genital area;

6.slowing the development of osteoporosis;

7.prevention of ectopic pregnancy;

8.therapeutic effect for certain skin diseases (disappearance of acne).

The advantages of oral contraceptives include ease of use.

Negative effects of oral contraceptives:

Increased risk of blood clots, which can cause angina attacks, stroke and pulmonary embolism (especially in women who smoke);

Increased blood pressure (arterial hypertension), worsening of existing hypertension;

Stone formation in gallbladder and its inflammation;

Headaches (migraine);

Exacerbation of diabetes;

Subsequent decrease in milk supply in nursing mothers.

It should be noted that modern OCs - fourth-generation drugs with low hormone content - are much safer than they ever were before. However, it must be remembered that these The pills do not protect against HIV.

Intrauterine mechanical contraceptives (IUDs) occupy the second place in the world in terms of frequency of use (after hormonal contraceptives). They are a loop, spiral or other structure made of polymer materials, introduced into the uterine cavity using an applicator and left there for up to several years.

Currently, there are more than 50 types of IUDs, belonging to two types: non-medicinal(the most widely used is the Lipps loop) and medicinal, containing chemicals on their surface that increase the contraceptive effect and reduce the likelihood of complications (copper, silver, Lately additionally, hormones on the “leg” of the T-shaped helix).

There are several theories mechanism of action of the IUD:

The IUD enhances the contraction (peristalsis) of the fallopian tubes and uterus, so the fertilized egg enters the uterus prematurely, when the uterine lining is not ready to receive it, as a result of which the implantation of the egg does not occur. Thus, the IUD does not affect hormonal processes and does not interfere with fertilization, but only prevents pregnancy from developing;

IUD like foreign body causes inflammatory changes in the endometrium, an increase in the number of macrophages that phagocytize sperm. Adding copper and silver to the IUD enhances the spermotoxic effect.

IUDs are recommended for use by women who have already given birth and especially after childbirth. The insertion of the IUD should only be performed by a doctor in a medical facility after examining the woman, because There are a number of contraindications to its use (chronic inflammatory diseases of the genital organs, congenital anomalies of the uterus, severe allergies, especially to copper, etc.).

Advantages of the IUD:

Reversibility (after removal of the IUD, the ability to conceive is restored);

Reliability (low failure rate, efficiency 91-98%);

Maintaining normal hormone levels;

Possibility of long-term use (from 3 to 7 years).

Disadvantages of the IUD:

relative high cost;

slight increase in blood loss during menstruation;

the risk of pelvic inflammatory diseases and infertility (especially in women who have more than one partner, since changing sexual partners leads to a change in microflora, which often leads to inflammatory gynecological diseases);

the need to see a doctor for insertion and removal of the IUD;

high likelihood of pain and bleeding for several months after installation;

not recommended for young women who have not given birth, difficult to use among young people (due to high physical activity, which leads to frequent spontaneous expulsions of the IUD, due to frequent changes of partners, which leads to an increase in inflammatory diseases, due to frequent menstrual irregularities in adolescents, in whom the use of an IUD is contraindicated).

Mechanical means (MS) prevent sperm from penetrating into the vagina or from the vagina into the uterine cavity.

Male condom , or condom (named after the inventor - the English doctor Condom) is made of very thin high-quality rubber (especially latex is reliable). It has no contraindications for use.

Advantages of the method:

cheap, easy to use, which is especially important among young people;

does not require a prescription or medical intervention;

high efficiency (up to 95-97% when used correctly);

protects both partners from contracting sexually transmitted diseases, including HIV infection. Today, it is precisely this quality of the condom that comes to the fore;

reduces the risk of precancerous diseases of the cervix;

makes sexual intercourse longer, which harmonizes sexual relationships.

Disadvantages of the method:

Possible allergy to latex or the lubricant used;

decreased intensity of sexual sensations;

Condom rupture is possible (1 in 225 used ones with an unexpired expiration date).

Barrier methods of female contraception include:

andfemale condom - a relatively new means of contraception, it is a cylinder made of elastic polyurethane 15 cm long and 7 cm in diameter, one of the ends of which is closed and contains a fixing ring ,

vaginal caps - a cap-shaped device made of soft rubber that fits over the cervix and is held in place by creating negative pressure between the rim of the cap and the surface of the cervix, comes in several sizes, and can be used by the woman independently. The effectiveness of the method is from 82% to 95% (in combination with spermicides);

aperture – ring-shaped devices with a rubber cap and a metal spring along the outer edge. There are several types and sizes of diaphragms, selected taking into account anatomical features This woman must be treated by a doctor; the woman must be trained to insert the diaphragm. It is inserted with spermicidal cream pre-applied on the inner and outer edges and left for at least 6 hours after intercourse to ensure that all sperm die in the vagina before the cervix is ​​exposed. Advantages of the method: harmlessness and the possibility of repeated use, protection against some sexually transmitted diseases. Disadvantages – certain inconveniences during introduction, possibility of development allergic reaction, exacerbation of cystitis, etc.

contraceptive sponge combines the effects of barrier and chemical methods– prevents the penetration of sperm into the cervical canal and releases a spermicidal substance (nonoxynol-9), provides a contraceptive effect for 24 hours.

Chemical method contraception is traditional, consists in using spermicides– chemical vaginal preparations that suppress the vital activity of sperm and deprive them of their fertilizing ability. They can be used in the form of vaginal balls, pastes, creams, jellies, foams, solutions, suppositories. Some of them also have a therapeutic anti-inflammatory effect (pharmatex) and neutralize some STD pathogens. They can be used either independently or in combination with other methods of contraception (usually with barrier methods). The disadvantages of the method include: low efficiency (about 70% when used independently), some unaesthetic and unhygienic method, risk of allergic reactions, itching, burning sensation, etc.

Natural (rhythmic) method is based on the fact that in the menstrual cycle there are “safe” days, on which the likelihood of pregnancy is low, and “dangerous” days, on which pregnancy is especially likely (abstaining from sexual relations on such days can prevent unwanted pregnancy). “Dangerous” days can be defined as follows:

according to special tables;

by calculation method– analyzing the menstrual calendar for 8-12 months, identifying the shortest and longest menstrual cycle; the number 18 is subtracted from the duration of the short cycle and the day of the beginning of the “dangerous” period is obtained, and the number 11 is subtracted from the duration of the longest cycle and the last day of the “dangerous” period is found out;

temperature method– determining the basal body temperature (in the rectum with a medical thermometer for 3-5 minutes in the morning at the same time, without getting out of bed) for 6-12 months, draw a graph of the basal temperature, determine the day of the peak of the basal temperature (increase by 0.2-0.6 degrees) is the day of ovulation (for example, the 16th day of the cycle); then, to determine the boundaries of the “dangerous” period, it is necessary to subtract 6 from this number (16-6=10) and add 4 to it (16+4=20); the segment of the cycle obtained in this way (from the 10th to the 20th day) is possible for pregnancy to occur

The advantages of the rhythmic method include its harmlessness and the absence of adverse reactions, but it is ineffective (slightly more than 50%) and is not suitable for women with irregular menstrual cycles.

Surgical method (sterilization), its effectiveness is 100%. Female sterilization, in which the fallopian tubes are crossed, is carried out only in a hospital, and male sterilization (the vas deferens are excised) is carried out in an outpatient clinic under local anesthesia. Sterilization does not affect male potency.

This method is irreversible and is acceptable only for those who are absolutely sure that they will no longer want to have children or in cases where there are medical indications.

Interruption of sexual intercourse requires extreme care from a man. The effectiveness of the method is 30%. Psychiatrists and urologists do not approve of it, since men who use this method develop congestion in the pelvis, orgasm is often disturbed, which leads to impotence and neurosis, and the woman constantly experiences fear, which interferes with sexual release, which can lead to the development neurosis and diseases of the appendages .

Postcoital (urgent) contraception. Such contraception is used only in emergency situations: unexpected sexual contact without the use of contraceptives, unsuccessful use of a contraceptive (condom breaks), rape, etc. In this case, hormonal tablets with a high content of hormones are used (according to a certain scheme). But to get the effect, you must urgently consult a doctor (no later than 48 hours after the “accident”).

Classify means of preventing unwanted pregnancy.

Describe the advantages and disadvantages of each method.

Describe the mechanism of contraceptive action of various methods.

List the methods of male and female contraception.

Calculate the “dangerous” period using the calendar and temperature method.

Explain the therapeutic capabilities of some contraceptives

Define “emergency” contraception.