Basic methods of contraception. Family Planning: The Natural Method

Talking to a gynecologist about family planning

In Russia, family birth control has long been a mass practice, but the transition to modern planning families are not completed - half of the pregnancies are interrupted by abortion, therefore, they were not desired, planned. That is why the obstetrician-gynecologist w \ consultation MBUZ City Clinical Hospital No. 9 Alina AlekseevnaFedorovskikh spoke about modern and well known methods contraception

There is a myth in the minds of many that family regulation of the birth rate is synonymous with its limitation and that wide access to contraception leads, allegedly, to a decrease in the birth rate. In fact, the main goal of family planning is to give birth to desired children at the optimal time for the couple, and in the case of Russia, also to quickly supplant abortion as a method of birth control more humane methods. Essentially, family planning means “responsible parenting.”

Modern methods of contraception should, first of all, be classified into reversible and irreversible.

An irreversible method is voluntary surgical sterilization. This method is suitable for those people who are sure that they do not want to have children in the future. In Russia, women over 35 years old and having 2 children can undergo DHS surgery. DHS can be performed during a caesarean section with a voluntary informed consent for this manipulation. This method is also available to men. Vasectomy in men does not affect erectile function and in no way violates the physiological and emotional component of sexual intercourse.

There are many reversible methods of contraception. All of them are sufficiently studied, safe and, after the abolition of the method, lead to a rapid restoration of fertility, that is, the ability to conceive. Reversible methods of contraception can be divided into elective and emergency.

Planned contraception.

Natural planning method.

The effectiveness of the method, depending on the correct application, varies from 88 to 75%. The method is based on determining the days of the menstrual cycle, the most favorable for conception, and refraining from sexual intercourse on these days. The method can be used only by those women whose menstrual cycle is regular and is 28-32 days. The method is good due to the absence of any material costs and side effects, as well as the knowledge of their fertile days, which allows the couple to plan the desired pregnancy in the future. The method does not protect against STIs and HIV.

Method of lactational amenorrhea.

It can be used by a woman after childbirth with strict observance of the following conditions:

No more than 6 months have passed since the birth;

The child is only breastfed, does not receive complementary foods, is applied to the breast at least 6 times a day, and the interval between night feedings is no more than 6 hours;

The woman has NOT resumed menstruation.

With strict fulfillment of all conditions, the efficiency of the method reaches 98%. Does not protect against STIs and HIV.

barrier methods.

Probably the most common. These are male and female condoms, vaginal diaphragms and cervical caps, spermicides. Male condoms are widely available for sale, do not require large material costs, effectively PROTECT against STIs and HIV, and also have practically no medical contraindications (except for individual intolerance, the possibility of an allergic reaction to latex). The efficiency of the method is high and amounts to correct application 85%.

Vaginal spermicides- these are substances in the form of a cream, gel, suppositories, tablets or even a small sponge that are inserted into the vagina before intercourse and destroy spermatozoa. Efficiency with proper use is up to 88%. Some of them (not containing a fatty base) can be used in conjunction with a condom, which increases the effectiveness of the methods. The use of spermicides reduces the risk of contracting STIs and HIV, but does not eliminate it. Barrier methods can be used by nursing mothers, since their action is only local. We will not dwell on vaginal diaphragms, cervical caps and female condoms, since their prevalence in Russia is low, and sales are rare, mainly through European online pharmacies.

Intrauterine contraceptives.

Intrauterine device- a small flexible object made of plastic and metal, which is inserted into the uterine cavity through the cervical canal by a gynecologist in a medical institution under sterile conditions. The efficiency of the method is 99%. The method does not require any action on the part of the woman or her partner and is relatively inexpensive. The method is invasive and has a number of medical contraindications, which the doctor will identify during a gynecological examination and clinical examination during contraceptive counseling. The method does not protect against STIs and HIV. Also, in some cases, side effects may occur in the form of more abundant and prolonged menstruation, which increases the risk of developing inflammatory diseases of the uterus and appendages.

Hormonal contraception .

The method is based on the suppression of ovulation under the action of hormones contained in the preparation used by the woman. No form of hormonal contraception will protect against STIs and HIV. There are several groups of drugs for hormonal contraception:

Combined hormonal contraceptives. They are presented in different dosage forms: tablets, patches, vaginal ring. The composition contains estrogen and progestogen - artificial analogues of sex hormones produced by the ovaries. The method is highly effective - 99%. Require compliance with the regimen of administration and dosing from a woman. Cannot be used by nursing mothers. Modern combined hormonal contraceptives have practically no side effects, but they have a number of medical contraindications that the doctor will identify when consulting on contraception. Prescribing drugs for contraception does not require extensive preliminary examination. Also, the method has positive additional properties - a regular menstrual cycle, a decrease in the volume and duration of menstrual bleeding, the treatment of premenstrual tension syndrome, ovulatory pain, and is also a prevention of a number of gynecological diseases.

Pure Progestin Tablets (CHPT).

The principle of action and effectiveness, subject to the regimen of administration and dosing, are the same as those of combined preparations. The difference from the latter is that POPs do not contain estrogens and can be used by women who, for a number of reasons, estrogens are contraindicated, as well as by nursing mothers, since they do not affect the amount and composition of breast milk. Their disadvantage is that they do not always provide such good control of the menstrual cycle as when using combination drugs.

Progestin-only injectables, implants, and hormone-releasing intrauterine systems.

The efficiency is up to 99%. Combine the benefits of hormonal contraception and IUDs, as they do not require the participation of a woman. It is necessary to consult a doctor in time for the next injection, replacement of an implant or intrauterine system. They are also used to treat certain gynecological diseases. Can be used by nursing mothers.

Emergency contraception (EC).

Used after unprotected intercourse to prevent unwanted pregnancy. Efficiency ranges from 56 to 93%, depending on the timeliness of application. The most common schemes for the use of the drug "Escapel" once or "Postinor" twice with an interval of 12 hours. The drugs can be taken no later than 120 hours (5 days) after unprotected intercourse, and the earlier they are taken, the higher the contraceptive effectiveness. EC drugs do not terminate an existing pregnancy, DO NOT protect against STIs and HIV, and CANNOT be used continuously. If a woman had to use the EC method, then she must definitely consult a doctor to select a planned effective method. EC is contraindicated in breastfeeding.

In the antenatal clinic of MBUZ City Clinical Hospital No. 9, a specialized reception is conducted on family planning and contraception.

Dear women! We will be happy to advise you on all your questions regarding birth control, we will select the method of contraception that is right for you, will be safe and convenient to use.

We hope that you will not have to resort to a dangerous induced abortion that cripples your soul and body, and you will be able to enjoy harmony in your intimate life, and when the time comes, the desired happy motherhood.

Lecture #2

Topic 1.109. Protection of the reproductive health of the population. Family planning.

Lecture plan

1. Relevance of the topic.

2. Definition of the concept of "family planning" according to WHO (1970);

3. Organization of the work of the family planning service in Russia and the region;

4. The role of a nurse in protecting a woman's health;

5. Activities of a nurse in improving and maintaining the reproductive health of the population;

6. Basic methods of contraception.

Educational goals:

• To acquaint students with the organization of the family planning service in Russia and the region;
• To form knowledge about methods of contraception.

Relevance of the topic: Unfortunately, in our country, the main method of pregnancy planning remains - abortion !!! Therefore, nurses should be well aware of the benefits and advantages of various modern methods of contraception. Since many of them are relatively simple, they can be distributed by nurses.

Lecture summary

Demographic situation in Russia is currently unfavorable. The birth rate is falling and the death rate is rising. The aging of the population of Russia is traced.

Factors that determine aging:

Ÿ Fertility decline

Ÿ Increasing mortality

Ÿ Increasing morbidity and disability among children

Ÿ Increase in child mortality.

In 1992 deaths exceeded births for the first time.

The average life expectancy has decreased. In 2005 it was 59 years for men and 73.3 years for women, respectively.

Birth rate - in 2007, 1610 thousand children were born, and in 2008 - 1717 thousand children. In 2008, the birth rate increased by 9% in the Altai Territory. This is 2547 newborns more than in 2007. In total, almost 33 thousand children were born.

In recent years, the demographic policy of the state has changed, new laws are being issued aimed at improving the social situation, and attention is paid to a young family.

Since 2007, a woman who has given birth to a second child has the right to maternity capital. The state provides an opportunity to receive about 500 thousand rubles for family needs, the amount of the payment will be reviewed every year depending on the growth of inflation. The right to dispose of capital can only be exercised three years after the birth or adoption of a child.

Money spent, maybe only on one of three things:

1. Acquisition of housing.

2. Education for one of the children.

3. On the formation of the funded part labor pension women.

In 1994, the Federal (Presidential) program "Children of Russia" was developed and adopted, one of the sections of this program is "Family Planning".

WHO family planning - these are those activities that are designed to help individuals and couples achieve certain results: to avoid unwanted pregnancies; produce desired children; regulate the interval between pregnancies; control the timing of childbearing depending on the age of the parents and determine the number of children in the family. The services that make this practice possible include health education and family planning counseling; provision of contraceptives; family and marriage education, as well as the organization of related services and activities.

Family planning is a set of measures aimed at reducing the incidence and maintaining the health of women and children.

A set of measures aimed at helping a married couple in solving the following tasks:

1. Avoid unwanted pregnancy;
2. Have only desired children;
3. Regulate intervals between pregnancies;
4. Set the number of children;
5. Control the choice of the time of birth of the child, depending on the age of the parents.

Some of these tasks are solved by:

1. Provision of contraceptives;
2. infertility treatments;
3. Miscarriage treatment.

In a narrow sense, family planning:

These are children by choice, not by chance;

This is responsible parenting;

This is ensuring the health of a woman for the birth of desired and healthy children.

Determining the age period of a woman for the birth of a child is of great importance. Women who give birth before the age of 20 are at risk for complications during pregnancy, childbirth and after childbirth. When giving birth to a woman over the age of 35, the risk of having a child with genetic "breakdowns" (for example, a child is down) increases.

Family planning plays an important role in reducing maternal mortality, one of the causes of which is illegal induced abortion. Termination of unplanned pregnancies through induced abortion sometimes causes irreparable harm to a woman's reproductive health. Studies have shown that if a woman under 16 years of age had a first pregnancy that ended in an abortion, then in the future, a high percentage of unsuccessful second pregnancies (spontaneous miscarriages, premature births).

Children's health and child (perinatal) mortality is closely related to the age of the mother, the intervals between births of children. Mortality among children born with an interval of less than one year is twice as high as among children born with an interval of 2 years or more.

Family planning is a state program for the protection of the reproductive health of the population. In Russia, work is currently underway to organize a family planning service. Centers, family planning clinics, and similar rooms in antenatal clinics have been created and are functioning. These centers are designed for all categories of women and men, for adolescents in puberty.

Main areas of work family planning services:

1. Prevention of unwanted pregnancy.

2. The fight against abortion.

3. Prevention of STDs and AIDS.

4. Promotion of contraceptive methods.

5. Sex education and education of adolescents.

6. Healthy lifestyle promotion.

The role of the nurse in family planning.

The successful functioning of the family planning service depends on the joint work of doctors and nurses. Nurses make a great contribution to the development and implementation of this most important medical and social problem. Nurses carry out health education work.

Special attention attention should be paid to explaining the need to limit induced abortion, which has traditionally been the leading method of birth control for many years. Every woman needs to understand that abortion can be used as a last resort to limit unplanned pregnancies only in case of failure of contraception. It is necessary to explain the danger of artificial termination of pregnancy, the immediate (perforation of the uterus, inflammation of the female genital organs, bleeding) and long-term (infertility, miscarriage) consequences of abortion. Complications of abortion account for about 1/3 of the causes of maternal death. If an unwanted pregnancy does occur, you should consult a doctor as soon as possible - this will reduce the risk of possible complications.

Nurses are involved in individual counseling of patients on family planning. Therefore, they should be well aware of the advantages and merits of various modern methods of contraception. Since many of them are relatively simple, they can be distributed by nurses. In the event that a contraceptive method can only be used as prescribed by a doctor (hormonal, IUD, surgical sterilization), the nurse needs to know the benefits and possible side effects method for explaining to patients.

In the prevention of unplanned pregnancy, a particularly important role belongs to nurses working independently in rural areas at FAPs, in outpatient clinics and district hospitals where there are no obstetrician-gynecologists. The duties of these nurses include promoting methods of rational family planning, selecting women for prescribing modern contraceptives and referring them to a doctor.

Some methods of family planning (sterilization, induced abortion) are performed in a hospital. In this case, the nurse assists in the operating room as an anesthetist or operating room nurse.

Health professionals are involved in sex education and sex education for children and adolescents, which helps to maintain their health, prepare them for future family life and instill a sense of responsible parenthood.

Promotion of contraceptive methods plays an important role in family planning. Contraception makes intimate life more harmonious, eliminates unnecessary worries and expectations.

Basic methods of contraception

Contraception - It is a method of preventing pregnancy in women of reproductive age.

There are currently the following methods of contraception:

1. Traditional ineffective methods of contraception:
1. barrier, or mechanical (condom, vaginal diaphragm);
2. chemical, or spermicides (vaginal balls, suppositories, tablets, pastes);
3. rhythmic, or biological (calendar, temperature methods);
4. interrupted sexual intercourse;
2. Modern(hormonal contraception, intrauterine contraception);
3. Irreversible contraception - voluntary surgical sterilization (tubal ligation).

In Russia, unfortunately, the main method of birth control is artificial abortion.

Medical indications for the use of contraception:

• Providing an interval of 2-3 years between births;
• After caesarean section, ectopic pregnancy;
• Frequent abortions;
• Age under 18;
• Alcoholism and drug addiction;
• Malignant neoplasms;
• Extragenital pathology.

Contraceptives must meet the following requirements:

Possess high contraceptive activity;

Do not have a pathological effect on the body of a woman and a sexual partner;

Not to have a teratogenic effect on subsequent offspring;

· Be easy to use;

Possess reversibility of action (i.e. provide temporary sterility);

· Be accessible, inexpensive, as well as aesthetically pleasing and confidential.

Leading criterion when choosing a method of contraception is efficiency (reliability) of the method, which is determined by the Pearl index. Pearl Index shows the percentage of contraceptive failures when using the method for one year.

The Pearl Index is calculated is the number of pregnancies per 100 women per year. The value of the index is inversely proportional to the effectiveness of the method.

The lower the Pearl index, the higher its contraceptive effectiveness:

Condom - 20

Spermicides - 30

Rhythmic method - 24

Coitus interruptus - 18

COC - less than 1

And now let's dwell on each of the methods of contraception.

Traditional methods:

Barrier (mechanical):

• diaphragms;
• neck caps;
• sponges with spermicides;
• Condoms are the only contraceptive used by men.

The barrier method is based on preventing the penetration of spermatozoa through the cervical canal into the upper reproductive system.

The Pearl Index when using condoms is 12 - 20%. Barrier methods, in addition to the contraceptive effect, protect against sexually transmitted infections, including AIDS. condoms - this is the prevention of cervical cancer (protection against infection with the human papillomavirus of oncogenic types).

Disadvantages and side effects of condoms:

ü Sometimes there is an allergy to latex rubber or lubricant, or to spermicides used with a condom;

ü Possible decrease in sexual sensation in one or both partners;

ü Possible breakage of the condom;

ü The need to use a condom at a certain stage of sexual intercourse.

Chemical methods (spermicides): spermicides destroy spermatozoa or reduce their activity and motility. The active ingredient in spermicides is capable of destroying spermatozoa within seconds. This requirement is explained by the ability of spermatozoa to penetrate the cervical canal after ejaculation, and after 90 seconds reach the fallopian tubes.

Spermicides are produced in the form of gels, foams, creams, pastes (Pharmatex, Patentex-Oval, Contraceptin-T). Pearl Index 15 - 30%..

Rhythmic (biological) methods: based on abstinence from sexual activity during the periovulatory period or the use of other methods of contraception during these periods.

Principles:

ª ovulation occurs on day 14-15,

ª the egg lives 24-48 hours after ovulation,

ª The sperm cell is viable for 48 hours.

1. calendar method (keeping the rhythm). Before using the method, it is mandatory to maintain a menstrual calendar, in which the duration of each menstrual cycle is noted for at least 8-12 months. The method is used in a woman with a normal menstrual cycle. The shortest and longest menstrual cycles are set. The beginning of the fertile period is determined by subtracting 18 days from the shortest menstrual cycle, and the end by subtracting 11 days from the longest cycle.

For example:

26-18 = 8th day of the cycle - the beginning of the fertile period

30-11 \u003d 19th day of the cycle - the end of the fertile period.

2. temperature method. The method is based on measuring body temperature shortly after ovulation (measurement of basal body temperature in the rectum). After ovulation, basal body temperature rises, and the elevated level persists until the next menstruation. The fall of the temperature curve is the day of ovulation, taken as "0" day. A woman should not live sexually 6 days before and 3 days after ovulation (9 days of the dangerous period).

3. cervical method - determination of the fertile period by the nature of changes in the mucous discharge from the cervix.

4. Multicomponent Method (a combination of all of the above biological methods).

The Pearl Index when using biological methods is 14 - 50%.

Coitus interruptus: based on the extraction of the penis from the vagina before ejaculation. Has a low contraceptive effect, with constant use can lead to sexual dysfunction.

The Pearl Index is 15-30%. Side effects:

• a woman has a fear of unwanted pregnancy;
• violation of orgasm in a man;
• psycho-emotional breakdown in a man.

Modern methods of contraception:

1. intrauterine contraception(IUD or IUD) is a fairly reliable method of contraception, but an invasive method that provokes and maintains an infection of the genital area. Currently, more than 50 types of IUDs have been created. There are neutral or inert IUDs and medications (containing copper, gold, progesterone). Currently, a qualitatively new intrauterine hormonal agent is widely used - the Mirena system containing levonorgestrel (52g).

The IUD is considered the best method of contraception for women who have given birth and have one sexual partner. The use of VA in young women who have not given birth is undesirable.

The mechanisms of action of the IUD are substantiated in several theories:

ü Abortive

ü The theory of accelerated peristalsis of the tubes

ü Luteolytic effect

ü Aseptic inflammation

ü Spermatotoxic effect

ü Enzyme disorders in the endometrium

Advantages: high efficiency (Pearl index is 0.3 - 0.8%)

Absolute contraindications to the introduction of the IUD:

1) acute and subacute inflammatory processes of the female genital organs;

2) pregnancy;

3) teenage years;

4) no childbirth in history;

5) endometrial cancer;

6) undiagnosed uterine bleeding.

Relative contraindications to the introduction of the IUD:

1) uterine fibroids,

2) endometriosis,

3) anomalies in the development of the uterus,

4) cervical deformity,

5) endocervicitis,

6) algomenorrhea,

7) hyperpolymenorrhea,

8) anemia,

10) allergy to IUD components,

11) ectopic pregnancy in history,

12) stenosis of the cervical canal.

The Navy is introduced:

on the 3rd-8th day of the menstrual cycle,

no later than 5 days after unprotected intercourse,

ü 2 months after birth,

o after an abortion.

Complications:

Violation of the menstrual cycle;

The onset of pregnancy, including ectopic;

· Pain syndrome;

· Perforation of the uterus;

· Infection;

Inflammation of the uterine appendages;

Prolapse (expulsion) from the uterine cavity.

In women who have used the IUD for 3-5 years, the generative function is not impaired.

2. Hormonal contraception.

Possesses near advantages:

Ø High contraceptive efficiency. The Pearl Index is 0.0-0.9%.

Ø Prevention of ovarian and uterine cancer.

Ø Reducing the likelihood of developing benign tumors of the mammary glands.

Disadvantages or adverse reactions are purely individual, depending on the characteristics of the receptor apparatus:

the appearance of intermenstrual discharge;

ü nausea, vomiting, headache;

ü tension of the mammary glands;

ü change in body weight, libido;

low mood, depression,

ü pathological cosmetic defects (acne, hirsutism, skin pigmentation).

Mechanism of contraceptive action:

v suppression of ovulation or its prevention.

v compaction and thickening of the cervical mucus, which prevents the advancement of spermatozoa into the uterine cavity.

v inhibits secretory changes in the endometrium, which leads to disruption of implantation.

Contraindications:

1) severe somatic pathology;

2) uterine bleeding of unknown etiology;

3) migraine, depression;

4) pregnancy;

5) hypersensitivity to the components of the drug;

6) smoking women older than 35 years.

Classification:

• combined - estrogen-progestin contraceptives:
• oral (COC):
• monophasic;
• multi-phase (two-phase, three-phase)

1) high-dose - 50 mcg EE/day (non-ovlon, ovidone);

2) low-dose - 30-35 EE / day (Diana-35, Janine, Yarina, Marvelon);

3) microdosed - 15-20 EE/day (Logest, Mirelle);

o parenteral:

§ injection (Depo-prover, mezigin);

§ vaginal ring (Nova-Ring);

§ patches (norplant).

Progestin-only contraceptives:

o Oral mini-pills - microlute, charozetta, excluton. Recommended for nursing mothers and women of older reproductive age.

o Parenteral - intrauterine hormonal system "Mirena", vaginal rings with progesterone.

· Postcoital contraception. It consists in the intermittent release of large doses of hormones, leading to desynchronization of the physiological cycle and menstrual chaos.

o Postinor - 1 tablet for an hour, then - after 3 hours.

Combined oral contraceptives are: monophasic, biphasic, triphasic. Monophasic preparations contain two types of hormones, the dose of hormones is constant. (Microgynon, Marvelon, Rigevidon, regulon, Novinet, Logest, Diane-35, etc.)

Biphasic preparations contain a constant dose of estrogens and a varying dose of gestagens in different phases of the menstrual cycle. (Anteovin).

Three-phase preparations contain variable doses of hormones according to the phases of the menstrual cycle, which ensures the course of cyclic processes close to natural. (Three-regol, Triziston and others)

An important role belongs to contraceptive methods, the use of which allows you to regulate the birth rate, mainly by preventing unwanted pregnancy, which can reduce maternal mortality from induced abortions by 25-50%. As you know, artificial termination of pregnancy has an adverse effect on the body of a woman. However, obviously. that only a healthy woman can have a healthy child. According to the WHO, the term "health" means "a state of complete physical, mental and social well-being and not merely the absence of disease and/or malformation". Of course, an important component of a woman's health is the normal functioning of the reproductive system, i.e. her reproductive health, which an induced abortion (especially the first one) can cause irreparable harm.

Despite the progress made in contraceptive technology in the second half of the 20th century, planning remains one of the most urgent medical and social problems. In 1952, the International Federation (IFSF) was created, which is the largest non-governmental organization that has consultative status with the UN Economic and Social Council. IPPF covers with its activities more than 134 countries of the world in which family planning services have been established.

"Family planning"- in accordance with the WHO definition, it includes a set of measures that contribute to the solution of several tasks at the same time:
avoid the onset of unwanted;

to have only wanted children; to regulate the interval ... between pregnancies; to control the choice of time depending on the age of the parents; to establish the number of children in the family.

The practical solution of these problems is health education and counseling on family planning and marriage, medical genetic counseling.

An important role belongs to contraceptive methods, the use of which allows you to regulate the birth rate, mainly by preventing unwanted pregnancy, which can reduce maternal mortality from induced abortions by 25-50%. As you know, artificial termination of pregnancy has an adverse effect on the body of a woman. However, obviously. that only a healthy woman can have a healthy one. According to the WHO, the term "health" means "a state of complete physical, mental and social well-being and not merely the absence of disease and/or malformation". Of course, an important component of a woman's health is the normal functioning of the reproductive system, i.e. her reproductive health, which an induced abortion (especially the first one) can cause irreparable harm.

The range of adverse effects of induced abortion is quite wide and includes both immediate (inflammatory diseases and appendages, bleeding, traumatic complications) and long-term complications (infertility, menstrual irregularities). In addition, induced abortion leads to an increase in the frequency of miscarriage (for example, in the second trimester of pregnancy by 8-10 times), perinatal morbidity and mortality (by 2-3 times), as well as obstetric complications during pregnancy and in the early postpartum period. . With the rational use of contraceptive methods, a married couple has the opportunity to postpone the appearance of the desired child until a certain material and social well-being is achieved and / or regulate the intervals between births (it is known that an interval of less than two years increases the risk of obstetric and perinatal pathology). Moreover, a number of contraceptives protect against sexually transmitted diseases (including AIDS), have a therapeutic effect on the reproductive system, and prevent the development of tumor processes.

It is accepted to classify as follows:

A special type of birth control is voluntary surgical sterilization (VCS), which is characterized by irreversibility.

Contraceptives must meet the following requirements:

have high contraceptive efficacy,

not have a pathological effect on the body of a woman and a sexual partner,

do not have for subsequent offspring,

be easy to use

be reversible (i.e. provide temporary sterility),

be accessible and inexpensive, as well as aesthetic and confidential.

The contraceptive efficacy (reliability) of a drug is usually determined using the Pearl index (pregnancy rate, R), which is calculated by the formula:

R = number of conceptions x 1200 / observation time (months)

This indicator reflects the number of pregnancies that occurred during the year among 100 women using a particular contraceptive: the lower the Pearl index, the higher the contraceptive effectiveness of the agent.

Undoubtedly ideal remedy contraception does not exist: traditional methods have a relatively low contraceptive efficacy, and the use of modern ones is limited by a number of contraindications and adverse reactions. There is also no universal method for a particular patient, since during the reproductive period it is necessary to use various contraceptives depending on age, characteristics of sexual life, attitudes towards contraception of sexual partners. the presence of gynecological and somatic diseases. Thus, the choice of a contraceptive method is a complex task, the solution of which should be carried out jointly by the gynecologist and the patient (and often the partner), taking into account such basic factors as:a) contraceptive effectiveness, b) acceptability, c) safety, d) non-contraceptive properties of the method, which can give a therapeutic effect,e) the possibility of developing adverse reactions,f) the degree of risk in case of an unwanted pregnancy,g) restoration of fertility,h) planning future pregnancies.

Contraception - a modern approach

As society develops, the issues of protection from unwanted pregnancies are becoming increasingly important. For each modern woman contraception becomes essential.

That is why the variety of contraceptive methods is becoming wider every year. Which method of contraception to choose? This is a task that must be solved jointly with the doctor. The main criteria are the effectiveness and convenience of the contraceptive method used.
It is very important to remember that if a method is perfect for a friend, then this does not mean that it is suitable for you. Only a specialist can give advice and explain the features of the application of a particular method. Each method of contraception has its own advantages and disadvantages. In an individual selection, a specialist takes into account age, characteristics of sexual behavior, social conditions, the nature of relationships, the number of sexual partners, health status, including the presence of gynecological or other diseases.

Currently, the following types of contraception are distinguished:
1. Barrier (condoms);
2. Chemical (spermicides - suppositories, tampons, cream);
3. Biological method (calendar);
4. Hormonal (, patch, vaginal ring);
6. Emergency (postcoital);
7. Sterilization (female, male).

Barrier methods of contraception include condoms. The main advantage of this method is the possibility of protection against sexually transmitted infections. This is due to the fact that latex condoms do not allow water, air and many microorganisms to pass through.
The disadvantage of the barrier method is, first of all, its insufficient contraceptive effectiveness - this method provides 85-87% protection against unwanted pregnancy. Many couples explain the inconvenience of using this method by a decrease in sexual sensations during intercourse, the appearance of an allergy in some people to latex or lubricant. The disadvantage of condoms is also the need to use before each sexual intercourse.

Chemical contraception is the use of spermicidal agents, which consist of substances that can completely or partially deprive the activity of spermatozoa. These include, for example, preparations "Farmateks" or "Erotex" (candles, tampons, cream).
The advantage of using them is quick effect, ease of use, additional hydration during intercourse and the possibility of use during breastfeeding.
The disadvantages of chemical contraception include low contraceptive activity - about 80%, the need to use it before each sexual intercourse and effectiveness within 2-6 hours after administration, the possibility of irritation of the vaginal mucosa and skin of the penis.

Calendar (biological) - the idea of ​​\u200b\u200bthe method is to calculate the estimated date of ovulation of the egg and it is during this period to refrain from sexual intercourse. Unfortunately this technique can be used by those women whose menstrual cycle is already established and takes place regularly on the same days of the month. It is necessary to conduct detailed observations of the cycle for several months - to keep an ovulation calendar - and even better, for a woman to keep a calendar and have cycle data for the last 2 years.
The main disadvantage of the calendar method is its unreliability, since it assumes a perfectly regular menstrual cycle in a woman, which neither of them possesses. Too often there are various failures. Even the healthiest women have situations when ovulation does not occur at all, and menstruation begins on time.
This method can be called a pregnancy planning method rather than a contraceptive method, it depends too much on various unforeseen circumstances.

Hormonal contraception is a method of preventing unwanted pregnancy by introducing female sex hormones into the body in physiological doses.
Modern hormonal contraceptives, depending on the composition and method of their use, are divided into:
a) combined estrogen-gestagen preparations (, patch, vaginal ring);
b) mini-pills (pure progestogens);
c) injection (prolonged injections);
d) subcutaneous implants (introduction of special capsules under the skin).
In fact, this is the most extensive section of contraception, so extensive that entire books are devoted to it.
Hormonal contraception is the most reliable contraceptive method available today. Its efficiency approaches 98%. These methods of contraception prevent the release of an egg from the ovaries, cause cervical mucus to thicken, which prevents seminal fluid from entering the uterus, and reduce the thickness of the lining of the uterus to prevent engraftment of the ovum in the uterus.

Hormonal contraceptives, in addition to the actual contraceptive action, have other beneficial influences on the female body:
reduce the risk of many gynecological diseases;
make the cycle regular, and menstruation - shorter and less plentiful; prevent the development of both uterine and ectopic pregnancy;
reduce pain in the lower abdomen in the middle of the menstrual cycle;
improve the condition of the skin of the face (acne, pimples);
increase sexual desire and sexual activity of a woman;
do not subsequently affect the course of pregnancy, childbirth and the postpartum period;
allow you to “postpone” menstruation, for example, during a vacation.

Contraindications to the use of hormonal contraception are: thrombosis, diabetes mellitus with vascular damage, severe liver disease, hormone-dependent malignant tumors, pregnancy, hypersensitivity to the components of the drug.

Intrauterine contraception is the introduction into the uterine cavity of a foreign body, the so-called intrauterine device (IUD) or intrauterine device. A foreign body in the uterine cavity disrupts the processes of fertilization and implantation, i.e. engraftment of the egg to the wall of the uterus. Currently, there is a large selection of IUDs. All modern intrauterine devices are a polymer base in combination with metals or hormonal agents.

Intrauterine contraception is indicated for women who do not have chronic inflammatory diseases of the genitals, who have one reliable permanent sexual partner. Before installing the IUD, an examination by a gynecologist is necessary. If there is any infection, it is necessary to be treated before the intrauterine device is placed. The IUD is installed by the doctor in the first week of the menstrual cycle after identifying all possible contraindications for a period not exceeding 5 years. At the end of this period, the intrauterine device must be removed and a new one inserted! It is unacceptable to walk with the IUD longer, even if nothing bothers you.

Emergency contraception is used by a woman immediately after unprotected intercourse. This method of contraception is not suitable for continuous use and can only be used in emergency cases, no more than 1 time in 2-3 months. Postcoital drugs ("Postinor", "Escapel") are currently not recommended for use due to the high incidence of menstrual dysfunction (40%), a relatively low contraceptive effect (90%), and a high likelihood of ectopic pregnancy.
As an "urgent" or "emergency" contraception of the so-called "uncovered" sexual intercourse (when a condom breaks, rape), special schemes are used using monophasic oral contraceptives.

Surgical contraception (sterilization) is used if a woman no longer plans to have children in the future. Sterilization is irreversible, so there are very specific indications for it. If you are over 35 years old and have children, you can consult your doctor about this surgery.

The sterilization method is applicable to men as well.

Thus, a woman, after consulting with a doctor, can choose a highly reliable and convenient means of preventing unwanted pregnancy.

Modern contraception for women and men

barrier methods of contraception.

Barrier methods are traditional and the most ancient. In the first half of our century, various forms of barrier methods were the only contraceptives available. The appearance of more effective ways contraception over the past 20 years has significantly reduced the popularity of barrier methods. However, the complications that can occur with the use of more modern methods of contraception, contraindications to use, as well as a significant prevalence of sexually transmitted diseases, make it necessary to improve barrier methods of contraception.

There are the following types of barrier contraceptives:
1. Women: non-drug barrier and medication.
2. Male barrier products.

The principle of action of barrier contraceptives is to block the penetration of sperm into the cervical mucus. The advantages of barrier methods of contraception are as follows: they are applied and act only locally, without causing systemic changes; they have few side effects; they largely protect against sexually transmitted diseases; they have practically no contraindications for use; they do not require the involvement of highly qualified medical personnel.

Indications for their use:
1) contraindications to the use of oral contraceptives and IUDs;
2) during lactation, since they do not affect either the quantity or the quality of milk;
3) in the first cycle of taking oral contraceptives from the 5th day of the cycle, when the own activity of the ovaries is not yet completely suppressed;
3) if necessary, admission medicines that are not combined with OK or reduce their effectiveness;
4) after a spontaneous abortion until a period favorable for a new pregnancy occurs;
5) as a temporary means before the production of sterilization of a man or woman.

The disadvantages of barrier methods are as follows: they are less effective than most oral contraceptives and intrauterine devices; in some patients, use is not possible due to allergies to rubber, latex or polyurethane; their successful application requires constant attention; use requires certain manipulations on the genitals; most barrier contraceptives are used during or immediately before sexual intercourse.
Vaginal diaphragm, or vaginal pessary.
It is used for the purpose of contraception alone or in combination with spermicides. The diaphragm is a domed rubber cap with a flexible rim that is inserted into the vagina prior to sexual intercourse so that the posterior rim is in the posterior fornix of the vagina, the anterior rim would touch the pubic bone, and the dome would cover the cervix. Apertures come in different sizes: from 50 to 150 mm. For nulliparous women, a 60-65 mm vaginal diaphragm is usually suitable, and women who have given birth use a 70-75 mm vaginal diaphragm. After childbirth or emaciation, the size should be adjusted again.

Instructions for use. A woman who chooses the diaphragm as a method of contraception should be instructed by her doctor. The doctor introduces her to the anatomy of the pelvis and genital organs in order for the woman to imagine the location of the diaphragm in relation to the cervix and the uterus itself.

The installation procedure is as follows:
1. Examination of a woman and selection of a diaphragm by size and type.
2. Introduction of the diaphragm: with two fingers of the right hand, a woman, squatting or lying on her back, inserts the diaphragm into the vagina (with her left hand, the woman spreads her labia) in a compressed form from above and advances it along back wall vagina until it reaches the posterior fornix of the vagina. Then the part of the edge that passed last is pushed up until it comes into contact with the lower edge of the pubic bone.
3. After the insertion of the diaphragm, the woman should palpate the location of the diaphragm covering the cervix.
4. The health worker rechecks to determine if the woman inserted the diaphragm correctly.
5. Removal of the vaginal diaphragm should be done with the index finger by pulling down the front edge. If difficulties arise, then the woman should push. After removing the diaphragm, it should be washed with hot soapy water, wiped and placed for 20 minutes in a 50-70% alcohol solution.

The advantages of the vaginal diaphragm are ease of use, reusability, harmlessness, and largely protection against sexually transmitted infections.

Contraindications for use: endocervicitis, colpitis, cervical erosion, allergy to rubber and spermicides, anomalies in the development of the genitals, prolapse of the walls of the vagina and uterus.

Side effects: 1) infection of the urinary tract is possible due to the pressure of the diaphragm on the urethra; 2) the occurrence of inflammatory processes is possible at the points of contact of the diaphragm with the walls of the vagina.

Efficiency. The pregnancy rate when using the diaphragm in combination with spermicides is 2 pregnancies per year per 100 women using this method regularly and correctly throughout the year, and 10 pregnancies per year per 100 women who are not counseled.

Neck caps.

There are currently three types of cervical caps made from latex rubber.

Cervical cap Prentif - deep, soft, rubber, with a hard rim and a notch to enhance suction. With its rim, it fits tightly near the junction of the cervix and vaginal vaults. Prentif cap sizes: 22, 25, 28, 31 mm (outer rim diameter).

Vimul's cap is bell-shaped, its open end is wider than the body. It is installed directly above the cervix, but its open end also covers part of the vaginal fornix. The cap is made in three sizes - with a diameter of 42, 48 and 52 mm.

The Dumas cap, or vaulted cap, has a flat-dome configuration and resembles a diaphragm, with the only difference being that it is made of a denser material and has no spring in its rim. The cap is available in sizes from 50 to 75 mm.

The fitted cap covers the cervix, fornix, and upper vagina and is held in place by the walls of the vagina, not by engagement with the cervix.

Instructions for use. The appropriate type and size of the cervical cap is determined during the examination by the shape and size of the cervix. Its introduction through the entrance to the vagina is facilitated by compressing the edges, and placement over the neck is facilitated by tilting the cap into the vagina. Before inserting the cap, a spermicidal preparation must be applied to its inner surface. After the medical worker has installed the cap on the woman, he should explain to her how to check the correct installation of the product and whether the cervix is ​​closed with it. The woman then removes the cap and reinserts it, and the health worker checks to see if she is doing it correctly. It is not recommended that the cap be in the vagina for more than 4 hours.

contraceptive sponge.

In some countries - the USA, Great Britain, the Netherlands - the vaginal sponge has gained popularity as an acceptable method of contraception. The medical-grade polyurethane sponge is a soft, flattened sphere with a recess on one side for insertion over the cervix and a nylon loop on the other side to aid in extraction. this remedy. The sponge contains 1 g of nonoxynol-9 as a spermicide. The sponge acts as a barrier over the cervix, a spermicide carrier, and a reservoir of ejaculate. The sponge can be inserted a day before sexual intercourse and left in the vagina for 30 hours.
Condom. The condom is the only contraceptive used by men. The condom is a baggy formation of thick elastic rubber, about 1 mm thick, which makes it possible to increase the condom depending on the size of the penis. Condom length 10 cm, width 2.5 cm.

Application. A twisted condom is put on the penis, which is in a state of erection, when the head is not covered by the foreskin.

Prevalence. The prevalence of this method is 20-30%.

Efficiency. The theoretical efficacy is three pregnancies per 100 woman-years, clinical efficacy is 15-20 pregnancies per 100 woman-years.

The disadvantages and side effects of a condom are as follows: a decrease in sexual sensation in one or both partners is possible; the need to use a condom at a certain stage of sexual intercourse; you may be allergic to latex rubber or to the lubricant used in the condom; the condom may break.

The advantages of a condom are as follows: the condom is easy to use; a condom is used immediately before sexual intercourse; A condom protects against sexually transmitted diseases and HIV infection. Today, it is this quality of the condom that comes to the fore.

Advances in contraception have reduced the risk of unwanted pregnancies. At the same time, in the last decade after the advent of AIDS, more and more attention is paid to the problem of sexually transmitted diseases, especially when it became clear that AIDS is not a "privilege" of special groups of the population. If contraception was not used during sexual contact, then two options remain - postcoital contraception or termination of pregnancy.If AIDS prevention measures have not been used, then there is no way to secure.In addition, if most sexually transmitted infections can be treated, then there are no effective methods of treating AIDS, which predetermines its fatal outcome.Therefore, a condom should be used not only as a method of contraception, but also as effective method protection against sexually transmitted diseases, including AIDS.

Chemical means of contraception.

The mechanism of action of spermicides is to inactivate sperm and prevent it from entering the uterus. The main requirement for spermicides is the ability to destroy spermatozoa in a few seconds. Spermicides are available as creams, jellies, foam sprays, melting suppositories, foaming suppositories, and tablets. Some women use for the purpose of contraception douching after intercourse with solutions that have a spermicidal effect, acetic, boric or lactic acid, lemon juice. Given the data that 90 seconds after intercourse, spermatozoa are determined in the fallopian tubes, douching with a spermicidal preparation cannot be considered a reliable method of contraception.

Modern spermicides consist of a sperm-killing substance and a carrier. Both components play an equally important role in providing a contraceptive effect. Carrier provides dispersion chemical into the vagina, enveloping the cervix and supporting it so that no sperm can escape contact with the spermicidal ingredient. The active ingredient for most modern spermicides are potent surfactants that destroy the cell membrane of spermatozoa. These are nonoxynol-9 (Delfin, Contracentol), menfegol (Neosampuun), octooctinol (Coromex, Ortoginal) and benzalkonium chloride (Pharmatex). The form of release of the spermicidal preparation depends on its carrier.

Application. Spermicides can be used with condoms, diaphragms, caps, and on their own. Spermicides are injected into the upper part of the vagina 10-15 minutes before sexual intercourse. For one sexual intercourse, a single use of the drug is sufficient. With each subsequent sexual intercourse, additional administration of spermicide is necessary.

Benefits of spermicides: ease of use; providing some degree of protection against certain sexually transmitted diseases; they are a simple backup in the first cycle of taking oral contraceptives.

The disadvantages of the method are the limited period of effectiveness and the need for some manipulations on the genitals.

Efficiency. The failure rate of spermicide use alone ranges from 3 to 5 pregnancies per 100 women per year with the correct use of this method. On average, it is about 16 pregnancies per 100 woman-years.

condoms

What is the contraceptive effect of using a condom?

12-20 unplanned pregnancies per 100 women who used a condom during the year.

First of all, people who have an increased risk of sexually transmitted infections (through casual contact, with several partners), as well as adolescents. Modern boys and girls start their sexual life early, and the condom is the most acceptable for them. Also, a condom can be recommended to people who have rare sexual intercourse, in between taking birth control pills or using an IUD.

What are the benefits of using a condom?

First of all, it is protection against sexually transmitted infections, as well as the possibility of using, if there are contraindications to other methods of contraception, at any age, ease of use, low cost compared to other means.

Are there any disadvantages?

Unfortunately they are always there. This is a relatively low reliability of contraception, since there is always a risk of breaking or slipping off the condom. For many, an important disadvantage is the decrease in the intensity of sensations during sexual intercourse. Sperm, which contains a large amount of biologically active substances, does not enter the woman's body. There is always the possibility of developing an allergy to latex.

Intrauterine device

Intrauterine devices also belong to contraceptives that allow you not to think about, but they do not give a 100% guarantee of protection against and do not protect against diseases, and besides, they are not suitable for women who have not yet given birth.

Hormonal oral contraceptives are the most reliable among their counterparts, plus at the same time they can even out hormonal imbalances and get rid of many health and appearance problems.
On the one hand, hormones prevent the maturation of the egg, on the other hand, they act on the mucus, thickening it, that is, it becomes physically difficult for sperm to enter the uterus. The only drawback of the most modern contraceptives: it is very strictly necessary to observe the regimen, take very small pills every day at the same time.

For those who don't list punctuality on their list of virtues, the pharmaceutical industry is coming up with new contraceptives that are both reliable and easy to use.

State educational institution

Higher professional education

"Bashkir State Medical University

Federal Agency for Health and Social Development"

Department of Obstetrics and Gynecology IPO

COURSE WORK

Specialty: Obstetrics and Gynecology

"FAMILY PLANNING AND CONTRACEPTION"

Supervisor: Head of the Department, Doctor of Medical Sciences, Professor Kulavsky V.A.

Completed: cadet of the Department of Obstetrics and Gynecology, IPO Tyumeneva L.P.

1. Family planning and reproductive health

2. History of contraception

3. Modern methods of contraception

4. Hormonal contraception

5. Postcoital contraception

6. Intrauterine contraception.

7. Traditional methods of contraception.

8. Natural contraception.

9. Surgical methods of contraception.

10. Teenage contraception.

11. Postpartum contraception.

12. Contraception in perimenopausal age.

14. Analysis of a clinical case.

15. List of references.

1. Family planning and reproductive health

Family planning- a concept that is actively entering our lives. What is it and why is family planning so important for each of us, for each family? For many years, family planning was misunderstood as birth control. But family planning is a set of measures aimed at reducing morbidity and maintaining the health of women and children.

Family planning is essential for:

¨ the birth of desired healthy children;

¨ regulation of intervals between pregnancies;

¨ establishing the number of children;

¨ controlling the choice of the time of birth of the child, depending on the age of the parents;

¨ maintaining a woman's health;

¨ achieving harmony in psychosexual relationships in the family;

¨ implementation of life plans.

In order for parenthood to be responsible, so that desired and healthy children are born, every modern person must know how to maintain their reproductive health:

reproductive health- this is a state of complete physical, mental and social well-being in the absence of diseases of the reproductive system at all stages of life.

reproductive system- this is a set of organs and systems of the body that provide the function of reproduction (childbirth).

The state of reproductive health is largely determined by a person's lifestyle, as well as a responsible attitude towards sexual life. In turn, all this affects the stability family relations, the general well-being of the person. One of the factors affecting the state of reproductive function is the prevention of unwanted pregnancy. Often a woman stands in front of difficult choice- Have a baby or have an abortion? This issue is especially difficult to resolve when an unwanted pregnancy occurs in a teenage girl. Abortion, especially during the first pregnancy, can cause serious psychological trauma and even lead to reproductive disorders. At the same time, the decision to give birth means for her a separation from her peers, leaving school (as a rule), jeopardizes further studies and the acquisition of a profession. Each such situation should be considered individually, carefully and with a greater understanding of the problem.

Some parents, teachers, community and religious leaders express concern that introducing young people to family planning, sex education and contraception will encourage irresponsible behavior and increase sexual activity among young people outside of marriage. The experience of many countries shows otherwise. Where sex education programs have been developed, youth sexual activity has not increased. On the contrary, the programs form a responsible attitude towards sexuality in adolescents, in connection with this, there is an increase in the age of onset of sexual activity, which helps boys and girls to fully realize their life potential, maintain physical and moral health, protect themselves from mistakes, and have healthy offspring.

However, for adults, the problem of unwanted pregnancy is no less important. That is why in the activities of family planning services, a large place is given to the prevention of unwanted pregnancy and abortion, as well as the problems of medical and social counseling, so that a woman does not make a decision about an abortion under the influence of temporary emotional experiences or life failures.

Abortion is one of the main problems of modern health care. It is well known that the health of children depends on the health of parents, the course and outcome of pregnancy and childbirth.

There are 78.1 million women in Russia

Most of them (38.6 million) are of childbearing age.

Only 25% of them use modern methods contraception.

Seven out of ten pregnancies in Russia end in abortion.

Physicians agree: modern contraception is the only alternative to abortion. To solve the problem of abortion, 70-75% of women should use modern contraceptives.

2. History of contraception

A person used contraceptive methods, preventing the development of pregnancy for a very long time. Some methods of contraception that were used in primitive society still exist today. Below are the most curious methods of contraception that have been used at different times.

Already in ancient Africa, various substances of plant origin were known, which were used like a "cocoon inserted high into the vagina." In ancient Africa, "interrupted copulation" was described. In America, the Indians, even before the arrival of immigrants from Europe, used washing the vagina with a decoction of mahogany bark and lemon. They also believed that after chewing parsley, a woman bleeds for 4 days. In Australia, for example, contraceptive lumps were prepared from fucus extract. Opium was also used in Sumatra and neighboring islands. The issue of preventing pregnancy came to the fore in the Greco-Roman Empire, in connection with the spread of orgies at that time. To prevent pregnancy, various substances of plant and animal origin, or their decoctions, were used with some success. The attitude to these methods, for example, to the droppings of an elephant or a crocodile, of course, must take into account the conditions and level of development of a given era. The world-famous Casanova said that lemon peel placed in front of the uterus perfectly prevents pregnancy. While this is hilarious today, the recommendation is nonetheless sound, given lemon's acidifying effect on the contents of the vagina.

The use of various intrauterine devices, in order to prevent pregnancy, primarily a variety of balls, was also known on Far East, in China and Japan. The introduction of a loop into the uterine cavity was first used to prevent pregnancy at the beginning of the 20th century. The first such tool was proposed in 1909 by the German gynecologist Richter: a ring from the intestines of a silkworm, fastened with a metal wire. Then a gold or silver ring with an internal disk (Ott ring) was proposed, but since 1935 the use of intrauterine contraceptives was prohibited due to the high risk of developing inflammatory diseases of the internal genitalia. Only in the 60s of the XX century, interest in this method of contraception revived again. In 1962, Lipps used flexible plastic in the form of a double Latin letter "8" to create a contraceptive, which made it possible to insert it without significant expansion of the cervical canal. A nylon thread was attached to the device to remove the contraceptive from the uterine cavity.

In the 20th century, methods and methods of contraception have undergone tremendous development. In 1933, a book was published that already described 180 different spermicidal substances. Subsequent research developed certain spermicidal contraceptives that could be used as powders, tablets, or vaginal boluses. Animal skin male condoms have been used since the ancient world, but became widespread mainly in the first half of the 20th century. Somewhat later, rubber condoms appeared, the improvement of the reliability of which continued until the end of the last century. Of particular note important date in the first half of the 20th century - 1908 - when the cervical cap was developed. Intrauterine devices, not only intrauterine loops, but also spirals of various shapes, became widespread only by the end of the 50s and the beginning of the 60s. Of great importance was the creation of more effective intrauterine devices containing copper.

The creation of hormonal contraception was a new milestone in the prevention of pregnancy. The idea of ​​hormonal contraception arose at the beginning of the 20th century, when the Austrian physician Haberland discovered that the administration of an ovarian extract causes temporary sterilization. After the discovery of the sex hormones - estrogen in 1929 and progesterone in 1934, an attempt was made to synthesize artificial hormones, and in 1960 the American scientist Pincus and his colleagues created the first contraceptive pill, Enovid.

The birthday of the contraceptive pill is June 1, 1961, when Anovlar appeared, developed by Schering, the first oral contraceptive in Europe. It contained three times less hormones than its American predecessor and was suitable for long-term use. Since that time, the history of the development of combined Hormonal contraception developed along the path of reducing the dose of steroids (estrogens) and along the path of creating selective (selective action) gestagens.

The birth of a child, especially if it is planned, is an extremely important event for every couple. At the same time, the birth of an unwanted child, when the parents (parent) are not ready for this, often turns into a tragedy, especially for the baby. In this regard, family planning, planning of childbearing is of great importance, which is largely determined by contraception (measures aimed at preventing pregnancy). Concentration matters also, when pregnancy is contraindicated or there is an extremely frequent occurrence of pregnancy and childbirth, which are not indifferent to the health of the mother.

Contraception leads to a decrease in the frequency of abortions, contributing to the preservation of the woman's health, and in the subsequent onset of pregnancy - a decrease in the frequency of miscarriage and other obstetric complications.

The use of contraception allows you to choose the optimal interval between the birth of children. Presumably, some contraceptives have protective properties against cancer, inflammatory diseases of the female genital organs, and some prevent infection with infections such as HIV, syphilis, gonorrhea, etc.

Of great importance is sexual hygiene and the use of contraceptive measures in adolescents, for whom abortion is extremely dangerous.

The following requirements are imposed on contraceptive methods: they must be reliable, safe for the health of a woman and a partner, not lead to infertility after their cancellation, not be teratogenic, and easy to use.

The degree of reliability, effectiveness of the use of contraceptives is expressed pearl index: the number of pregnancies during the year in 100 women who used the same method of contraception. The lower the Pearl index, the higher the effectiveness of the contraceptive used.

Contraceptive methods are divided into:

Biological (calendar);

barrier;

Intrauterine;

Hormonal;

Surgical (sterilization).

BIOLOGICAL (CALENDAR) METHOD

The biological (calendar) method is based on abstinence from sexual activity or the use of any methods of contraception during the periovulatory days of the menstrual cycle. The use of this method of contraception is associated with knowing the date of ovulation, which is calculated either according to the calendar, depending on the duration of the menstrual cycle, or according to rectal temperature. It should be borne in mind that the sperm in the genital tract remain viable for 8 days, and the egg for 24 hours.

The Pearl Index for this method is extremely high (up to 40).

BARRIER METHODS

Barrier methods are classified by some authors as traditional, since most of them have been used for many centuries. The essence of barrier contraception is to create a mechanical obstacle to the penetration of spermatozoa into the cervix. With the advent of new modern hormonal and intrauterine contraceptives, interest in them declined for some time. However, with the rise of sexually transmitted infections, they have become very popular again. There are mechanical and chemical means of protection against pregnancy.

Mechanical means contraceptives are divided into male and female. Male condoms are male condoms.

a thin cylindrical pouch made of latex or vinyl. Some condoms are treated with spermicides, substances that destroy spermatozoa (see below). The condom is put on the erect penis before intercourse. The penis should be removed from the vagina before the erection ceases to prevent the condom from slipping off and semen from entering the woman's genital tract.

The effectiveness of a condom decreases if it is used incorrectly: repeated use of a condom, intense and prolonged sexual intercourse, leading to macro- and micro-defects of the condom, improper storage, etc. Condoms are good protection against sexually transmitted infections, but infection viral diseases, syphilis is still not excluded when the damaged skin sick and healthy partner. Side effects include an allergy to latex. The Pearl Index for this type of contraception ranges from 2 to 20.

Women's means of protection against pregnancy include the vaginal diaphragm and the cervical cap. The vaginal diaphragm is a latex dome-shaped cap with a flexible rim, the diameter of which ranges from 50 to 150 mm. It is advisable to cover the diaphragm from the outside with spermicides. The doctor carries out an individual selection of the diaphragm and trains the patient in the method of inserting it into the vagina. The rim of the diaphragm should be located in the posterior fornix of the vagina, and then its opposite edge is placed in front so that it touches the inside of the pubic bone. More often for nulliparous, a diaphragm with a diameter of 60-65 mm is used, and for those who have given birth - 70-75 mm.

A woman inserts her diaphragm while squatting or lying on her back. With his left hand, he spreads the labia, and with his right hand he brings the diaphragm compressed from the sides along the back wall of the vagina to the arch, and then, pushing it in front, positions it so that it corresponds to the inside of the pubic bone. After inserting the diaphragm into the vagina, the patient should check with her fingers inserted into the vagina whether it covers the cervix.

After intercourse, the diaphragm should be left in the vagina for at least 6 hours and no more than 24 hours.

The diaphragm should be removed with the finger of the right hand, pulling it by the front edge. After removal, the diaphragm must be rinsed in warm water with soap and dry. The diaphragm can be used repeatedly.

Contraindications to the use of the diaphragm are: endocervicitis, colpitis, cervical erosion, rubber allergy, anomalies in the development of the genitals, prolapse of the walls of the vagina and uterus.

Side effects include infection of the urinary tract and inflammatory changes in the vaginal wall at the point of contact with the diaphragm ring.

The Pearl Index with the correct use of the diaphragm is 2. Incorrect insertion of the diaphragm significantly increases this figure.

Cervical caps are metal or latex cups that are worn over the cervix. Caps are also used with spermicides. Caps are introduced before sexual intercourse, removed after 6-8 hours, maximum after 24 hours. The cap is washed after use and stored in a dry place. Contraindications to contraception in this way are diseases and deformation of the cervix, inflammatory diseases of the genital organs, prolapse of the walls of the vagina, the postpartum period (Fig. 33.1).

The Pearl Index is higher than when using aperture.

Chemical methods of contraception(spermicides) consist in the introduction into the vagina of substances that can destroy the cell membrane of spermatozoa within a few seconds. For this purpose, you can use vaginal lavage immediately after sexual intercourse with acetic, boric, lactic, citric acids. Currently, the main spermicides that are part of the finished forms are benzalkonium chloride, which destroy the cell membrane of spermatozoa.

Spermicides are available in the form of vaginal tablets, suppositories, gels, creams, films, foams with special nozzles for intravaginal administration. Their contraceptive effect is manifested immediately after administration. With repeated sexual intercourse, additional administration of spermicides is required.

There are special polyurethane sponges impregnated with spermicides. Sponges are inserted into the vagina before sexual intercourse (it is possible a day before sexual intercourse). They have the properties of chemical and mechanical contraceptives and secrete spermicides, creating a mechanical barrier to the passage of spermatozoa. It is recommended to leave the sponge for at least 6 hours after intercourse for the reliability of the contraceptive effect, but it must be removed no later than 30 hours.

Pearl index when using chemical methods contraceptives is quite large - up to 20. The use of spermacids together with mechanical means is more effective.

The positive side of barrier methods is their easy application by partners. Can be used during lactation.

The disadvantages include the possibility of allergic reactions, the need for manual manipulations on the genitals before or during intercourse.

HORMONAL CONTRACEPTION

A huge step forward was the introduction of hormonal contraception into genetic practice, which is not only a means of preventing unwanted pregnancy, but also a method of treating certain gynecological diseases.

All hormonal contraceptives contain either estrogens and gestagens, or only gestagens. The most commonly used estrogen is ethinyl estradiol.

The mechanism of action of hormonal contraceptives ultimately occurs due to the blockade of ovulation, since externally administered daily hormones disrupt the cyclic activity of the hypothalamic-pituitary system. At the same time, regressive changes occur in the endometrium up to atrophy, as a result of which the implantation of the egg, if fertilization does occur, becomes impossible.

In addition, gestagens, by increasing the viscosity of cervical mucus, make it impassable for spermatozoa; slow down the peristalsis of the fallopian tubes and the movement of the egg through them.

Over the past 45 years, work has been constantly carried out to improve the quality of hormonal contraceptives: by choosing the optimal ratio of estrogens and progestins, as well as selecting the dose of each of the drugs.

Depending on the composition, dose and method of use of hormonal contraceptives, they are divided into the following groups:

Combined oral contraceptives (COCs);

Gestagen contraceptives:

a) oral contraceptives containing microdoses of gestagens (mini-pill);

b) injection;

c) implants;

d) vaginal rings containing hormones;

Postcoital contraception (large doses of estrogens, progesterone, corticosteroids) used in the first hours after unprotected intercourse.

Combined oral contraceptives are tablets containing estrogen and progestogen components. Currently tend to use low-dose (30-35 mcg) or microdose (20 mcg) preparations containing extremely low doses of estrogens.

Combined oral contraceptives are divided into monophasic, biphasic and triphasic.

Monophasic drugs include drugs that contain strictly dosed estrogens and gestagens. These include mersilon, marvelon, femoden, regulon, khanin, novinet, logest.

Biphasic and triphasic contain combinations of estrogens and progestogens, the dose of which depends on the day of the menstrual cycle, simulating it.

A biphasic (antevin) contraceptive in the form of large doses of both estrogens and progestogens is not used to prevent pregnancy.

Three-phase COCs, often used in practice, include the following: trisiston, triquilar, triregol.

Three-phase oral contraceptives are especially indicated for women younger than 18 years old and older than 35-40 years old, as well as for patients with a high risk of developing thrombotic complications due to smoking, cardiovascular pathology, and metabolic disorders.

The drug Yarina deserves special attention, which, in addition to 30 mg of ethinylestradiol, contains 3 mg of drospirenone (veroshpiron). Drospirenone has antimineralcorticoid and antiandrogenic activity. In this regard, when taking Yarina, there is no increase in body weight, the tension of the mammary glands before menstruation decreases, and unpleasant skin manifestations often disappear: acene vulgaris.

Combined oral contraceptives should be used from the 1st day of the menstrual cycle for 21 days daily, preferably at the same time of day. This is followed by a 7-day break, during which a menstrual-like reaction occurs. Next, a 21-day COC is taken again.

In practice, oral contraceptives are most often used, but, as noted, hormonal preparations can be administered in another way: by injection under the skin, in the form of implants, intrauterine devices or in the form of a cervical ring loaded with hormones.

Injectable contraception recommended for women who do not want to use hormonal drugs daily or during lactation. For this purpose, the drug Depo-Provera, which is progesterone, may be recommended. The drug as a contraceptive is administered 1 time in 3 months at a dose of 150 mg. The first injection is made within the first 5 days from the onset of menstruation or immediately after an abortion, and in non-breastfeeding women - after childbirth. If breastfeeding is carried out, then Depo-Provera, in order to protect against possible pregnancy, is introduced no earlier than 6 weeks after birth.

The disadvantage of such contraception is the possibility of acyclic bleeding and the restoration of fertility only after 0.5 years, and sometimes even 1-2 years after discontinuation of Depo-Provera.

The efficiency of the method is quite high - the Pearl index is 1-2.

Subcutaneous implant involves the introduction under the skin of capsules containing gestagens (levonorgestrel), constantly entering the body in small doses. An example of an implant is a norplant, consisting of silastic capsules that are inserted under the skin. inside forearms through a small incision. Manipulation is carried out under local anesthesia. The action of the contraceptive begins after 24 hours and lasts up to 5 years.

The Pearl Index indicates high efficiency, amounting to 0.2-1.6.

The disadvantage of the method is, firstly, the possible appearance of blood discharge from the uterus outside the menstrual cycle and, secondly, the need to surgically remove the capsules.

As intrauterine device, having a shell that contains gestogens that are dosed into the body, is Mirena.

The hormone-containing coating is also used in the form vaginal ring- Nova-Ring. The way to prevent pregnancy hormonal contraception is the constant release of hormones by a ring, which is located in the vagina. An easily compressible ring, consisting of a substance that does not cause allergies, is inserted into the vagina (the method of insertion does not differ from that of the diaphragm). Being in the vagina a complex system Nova-Ring membranes continuously release estrogens and a progesterone metabolite at a dose that provides a stable hormonal background on which contraception is based.

A significant advantage of such an introduction into the body of hormones is the absence of the need for daily intake of combined oral contraceptives, and hormones with such intake into the body do not enter the liver.

The efficiency of the method is quite high. The Pearl Index is 0.6. observed pregnancies (6 per 1100 women) are determined by the violation of the method used.

Complications when taking hormonal contraceptives. In connection with the use of new low- and microdose COCs containing highly selective gestogens, side effects are rare. A small percentage of women taking COCs may experience discomfort during the first three months of use due to the metabolic effects of sex steroids. Some women experience nausea, vomiting, swelling, dizziness, heavy menstrual bleeding, irritability, depression, fatigue, decreased libido, headache, migraine, breast engorgement. These signs are considered as symptoms of adaptation, they usually do not require the appointment of corrective agents and disappear on their own by the end of the 3rd month of regular use of the drug.

The most serious complication when taking hormonal contraceptives is a change in the blood coagulation system: an increase in the formation and activation of fibrinogen, thrombin, factors VII and X, which increases the risk of developing venous thrombosis in the coronary and cerebral vessels, as well as thromboembolism. The possibility of thrombotic changes depends on the dose of ethinylestradiol included in the hormonal contraceptive.

Risk factors for the development of coagulation disorders under the influence of hormonal contraceptives include age over 35 years, arterial hypertension, obesity, varicose veins.

Contraindications to the use of combined oral contraceptives are:

Acute deep vein thrombosis, thromboembolism;

Severe violations of the liver and kidneys;

Liver disease;

Severe cardiovascular diseases; vascular diseases of the brain; bleeding from the genital tract of unknown etiology;

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

Migraines with focal neurological symptoms;

Lactation (estrogens pass into breast milk).

Conditions requiring immediate withdrawal of hormonal contraceptives:

sudden severe headache;

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

Acute chest pain, unexplained shortness of breath, hemoptysis;

Acute pain in the abdomen, especially prolonged;

sudden pain in the legs;

Significant increase in blood pressure;

Itching, jaundice;

Skin rash.

The effectiveness of hormonal contraceptives is extremely high -

the Pearl index is 0.05-0.5.

POSTCOITAL CONTRACEPTION

Emergency contraception should not be used regularly and should only be used in exceptional cases (rape, condom rupture, diaphragmatic displacement, in cases where the use of other methods of contraception is not possible) or in women who have infrequent sexual intercourse.

Most often, either combined oral contraception or pure gestagens are used.

The first dose of hormones should be carried out no later than 72 hours after unprotected intercourse, the second - 12 hours after the first dose.

Postinor, a Hungarian drug containing 750 mg of levonorgestrel, was created specifically for postcoital progestational contraception.

The effectiveness of this contraception is not high enough - the Pearl index is 2-3.

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. If pregnancy does occur, then it should be interrupted, since a teratogenic effect of large doses of hormones is possible.

INTRAUTERINE CONTRACEPTION

Intrauterine contraception (IUD) is associated with the introduction into the uterus of intrauterine devices (IUDs) made from inert substances (silver; gold; plastic; plastic; containing copper or silver). Some IUDs contain hormones that are gradually released into the body. The history of the creation and widespread introduction into the practice of VMC began in the 60s of the last century. Currently, the forms of IUDs and their materials are very different. Intrauterine contraceptives end with threads, for which, if necessary, it is possible to remove the IUD from the uterine cavity by sipping.

The most commonly used are the following IUDs (Fig. 33.2): copper containing (Copper T-380, Multiload); Mirena, which is a T-shaped contraceptive with a semi-permeable membrane that releases daily gestagens (levonorgestrel).

The method of introducing the IUD is as follows: the cervix is ​​exposed with mirrors, treated with a disinfectant, its front lip is captured with bullet forceps. Measure the length of the uterine cavity with a probe and select the appropriate size of the contraceptive. The IUD is placed in the uterus with a special tube - a conductor, which, without expanding the cervical canal, is inserted into the uterine cavity to the bottom and the contraceptive is pushed out with a special pusher. The threads are cut, leaving 2-3 cm of their length.

Usually, the contraceptive is located in its cavity without difficulty if its size is comparable to the size of the uterus.

After childbirth, the IUD is advisable to use after 2-3 months, after cesarean section - after 5-6 months. Before using the IUD, it is extremely important to exclude infection of the genital tract. When inserting an IUD, you should follow the rules of asepsis and antisepsis.

The benefits of intrauterine contraception include:

High efficiency;

Possibility of long-term use;

Immediate contraceptive action;

Rapid establishment of fertility after removal of the IUD;

Low cost;

Possibility of use during lactation.

Unfortunately, the use of IUDs does not exclude the presence of serious complications. The most frequent and adverse complication VMK are inflammatory diseases of the internal genital organs, often with the development of purulent tubal-ovarian formations, endometritis, peritonitis. However, more often these complications occur when intrauterine devices are used without taking into account contraindications.

Contraindications:

Pregnancy;

Inflammatory diseases of the female genital organs;

Violation of the menstrual cycle;

Tumor diseases of the genital organs;

Allergy to VMC.

SURGICAL CONTRACEPTIVE METHODS

Surgical methods of contraception consist in the sterilization of women or men. In women, obstruction of the tubes is created.

Such sterilization in women is as follows: by mini-laparotomy or laparoscopy, they enter the abdominal cavity and either coagulate the fallopian tube section, or apply ligatures, rings, special clamps to the fallopian tube.

In women, it is subsequently possible to restore the patency of the tubes by performing plastic surgery.

In men, the spermatic cords are tied and cut (vasectomy), after which sperm cannot enter the ejaculate.

The Pearl Index is 0-0.2. Isolated cases of pregnancy may be in violation of operations on the pipes.