Contraceptive methods: we understand the types and choose the most effective one. Natural contraception Natural methods of contraception

Fertility methods (i.e., the physiological ability of a female or male body to participate in fertilization), also called “natural family planning methods,” are a series of methods based on tracking changes in the body when it signals its readiness for fertilization. A woman may only be fertile during one part of her menstrual cycle. By controlling certain changes in her body, a woman can more or less predict the time of the fertile phase and during this time, if she does not want to become pregnant, abstain from sexual intercourse. She can also use barrier methods if they are not prohibited by religious beliefs.

Temperature method

To determine the most likely time of ovulation and therefore the time of maximum possible conception, a woman must measure her basal body temperature, which rises and falls in accordance with hormonal fluctuations.

Every morning, before getting up, a woman must measure her temperature with a special basal thermometer and mark the result on a graph - a paper map. It is measured in the rectum at the same time every morning (for example, before getting out of bed). She should pay attention to the days of menstruation and sexual activity. The so-called “fertile windows” are 6 days. They begin 5 days before ovulation and end on the day of ovulation.

It is believed that days 10-17 in the menstrual cycle give a high chance of fertility (from the 1st day of the period, ovulation occurs approximately 2 weeks later).

However, not all women are able to conceive during this time period. Women who have longer or shorter menstrual cycles may have different periods fertility time.

Immediately after ovulation, in about 80% of cases, body temperature rises sharply. Some women can usually ovulate without this temperature regime. By studying temperature fields over several months, a couple can anticipate ovulation and plan their sexual activity accordingly. In order not to lose spontaneity, couples should try to avoid being fixated on a schedule when planning their sexual activity and use, for example, barrier methods of contraception.

Here are some tips for using the temperature method:

Measure your body temperature every morning without getting out of bed, preferably at the same time and in the same area of ​​the body.
- If possible, use a special thermometer to measure basal temperature bodies.
- After each measurement, record the temperature readings in a special chart.
- During ovulation, basal temperature rises by 0.2-0.5°C.
- Days of greatest likelihood of conception, or days of fertility, last as long as the basal temperature remains elevated for three consecutive days.
– Monitor your health closely to ensure that your fever is not caused by any other conditions or illnesses.

The cervical mucus method (or ovulation method) requires a woman to monitor the condition of her cervical mucus. She must write down the amount every day for at least a month, appearance, consistency and note other physical signs associated with the reproductive system.

Cervical mucus changes in a predictable manner during each menstrual cycle:

Six days before ovulation, the mucus depends on estrogen and becomes clear and elastic. Ovulation may occur on the last day when the mucus has these properties;
- immediately after ovulation - mucus depends on progesterone, it is thick, sticky and opaque;
- separate models in the analysis of cervical mucus can provide high and accurate guidance to conception;

To monitor, use following rules:

Check the nature of your cervical mucus every day, three times a day after your period ends. To do this, wash your hands thoroughly with soap and take a sample of vaginal mucus. It is also possible to take a sample directly from the cervix with your finger.
- Look at the quality of the mucus (liquid, sticky, dry)
- Check if the mucus is sticky by simply spreading your fingers apart
- Check your underwear (if there are any stains)
- Try to make observations as often as possible (for example, when visiting the toilet)
- Determine the amount and color of mucus
- Try to identify cervical mucus (possibly the presence of male seminal fluid, lubricant. It could also be spermicides, if you use them)
- Record the results of the study daily and in detail. Note the consistency of the mucus (dry, sticky, creamy, egg white-like); its viscousness; presence of stains on linen; sensations in the vagina (dry, wet, slippery).

Calendar method

The calendar method (or rhythm method) is considered the least reliable fertility method. Women who have very irregular periods may have even less success with this method.

A woman first records her menstruation for 6-12 months, then subtracts 18 short-cycle days and 11 long-cycle days from the previous menstrual cycle. For example, if a woman's shortest cycle was 26 days and her longest cycle was 30 days, she should abstain from sexual intercourse from days 8 to 19 of each cycle;

Here are some tips to make this method easier:

Keep a menstrual calendar for 8 months, noting the length of each menstrual cycle starting with the first day of your period (the first day of your menstrual cycle) and ending the day before your next period (the last day of your menstrual cycle).
- Determine the longest and shortest menstrual cycles.
“Use the table to determine your likely fertile days.” The first day of fertility corresponds to the duration of your shortest menstrual cycle, and the last day corresponds to the duration of your longest menstrual cycle. Thus, the days with the maximum possible conception are in the interval from the first to the last - dangerous days.

Symptothermal method

This method combines the temperature method, the cervical mucus method and the calendar method. Therefore, it is considered the most effective method fertility. In addition, women monitor signs that can identify her fertile period. These symptoms include changes in the shape of the cervix, breast tenderness, pain and cramping.

Who is suitable for natural contraceptive methods?

Due to the high risk of pregnancy, natural methods of contraception are recommended only for those couples whose religious beliefs prohibit standard, especially barrier, methods of contraception. Couples who want a free sex life use barrier contraception during the fertile phase and no contraception during the rest of the cycle.

However, they should understand that there will be a higher risk of pregnancy with this method. To be effective against pregnancy, a cycle based on the method requires attention, and on the part of the people involved, dedication, discipline, persistence and cooperation with a partner.

Advantages of the method

Natural methods are safe and do not cause any side effects
- Acceptable to all faiths and cultures
- Involving the partner in the family planning process, increasing feelings of intimacy and trust.

Method-based fertility cycles are not recommended for women unless they are in a committed, monogamous relationship and can count on their partner's willing participation. Awareness-based birth control methods do not protect against sexually transmitted diseases.

Certain factors can disrupt normal fertility signs, such as:

Recent cessation of hormonal contraceptives
- recent miscarriage or abortion
- recent birth
- lactation
- regular travel in different time zones
- infection in the vagina, such as thrush or an STD

Other factors influencing the biological signs of ovulation:

Temperature measurement time
- alcohol consumption
- taking certain medications
- illness.

The effectiveness of natural contraceptive methods is about 60%, which means that up to 40 out of 100 women using this method become pregnant within a year.

The calendar method of birth control is the most affordable way reduce the likelihood of unwanted conception. Based on her menstrual cycle, a woman calculates the approximate date of ovulation and identifies dangerous and safe days for unprotected sex. On dangerous days, they abstain from sex. In short, the first 7-8 days of the cycle and the last week are considered the safest. But only those women who have a known exact duration of the menstrual cycle do not experience long delays. Otherwise, late ovulation and pregnancy may occur on days that were considered safe.

The most reliable method of birth control is the calendar method for women with a regular menstrual cycle. That is, for those whose cycle is always equal to, for example, 28 days. Ovulation, the day when an egg is ready to be fertilized by a sperm, is approximately the middle of the cycle. In a 28-day cycle, this is approximately the 14th day. However, there may be deviations in one direction or another for a couple of days. Thus, using the calendar method of protection, couples will not have sex from the 12th to the 16th day inclusive. Some people advise adding 1 more day on one side and the other, just in case, since sperm can remain ready for fertilization for several more days in the female genital tract.

If the cycle is irregular, then you need to remember the longest and shortest. This way you can find out the approximate date of the earliest possible ovulation and the latest. In this case, the calendar method of contraception will not be reliable unless a larger period of time is allocated. Capture the interval between possible ovulation dates, plus the days before and after them.

If you don’t want to count manually and you trust automatic programs more, then go ahead. The script on our website will help you use the calendar method of pregnancy protection; it will be able to accurately calculate online safe days specifically for you. More precisely, it will show you the most favorable days for conception. Well, your task will include exclusion on these days of sexual activity. At least without using contraception, preferably a barrier one.

If the calendar method shows you have a dangerous day, but you still can’t resist sex, or the condom breaks, you need to use emergency contraception. It can be purchased at a pharmacy without a doctor's prescription. However, you need to understand that emergency contraception is not always effective. And its effect largely depends on the speed of taking the pill after unprotected intercourse. In addition, emergency contraception has an effect on hormonal background women, can lead to disruption of the menstrual cycle.

At first glance, the calendar method makes preventing unwanted pregnancy safe. But really, only for the first one. Yes, you don't need to take any medications. Spoil the sensations with a condom too. But this method is very unreliable. And if he fails, conception occurs and you will have to have an abortion. Well, this is interference in female body much more unpleasant and dangerous than hormonal pills.

Natural (biological) contraception is one of the safest methods of contraception for a woman’s health, but it is not effective. Even in case correct application, these methods are not very reliable.

Natural contraception is based on observations of physiological signs that help identify cases when a woman is capable of conceiving (fertile) and when she is not capable of conceiving (infertile). The main goal of this method is to determine the period when fertilization ability is highest.

Natural contraception methods can be used by many couples: in the case when a woman cannot use other methods; if a woman has a regular menstrual cycle; couples who may refuse intimate relationships on certain days of the cycle; when other methods of protection are not available.

Natural contraception has a number of advantages: no side effects; free; both partners participate, which helps strengthen the relationship in the couple; can be used to plan pregnancy; for some couples - more pleasure after abstinence on dangerous days.

Natural contraception has the following disadvantages: pregnancy occurs in almost 50% of cases; does not protect against sexually transmitted infections; difficulties in determining dangerous days, especially for women with an irregular cycle; Requires up to three months of instruction and counseling; tension often arises due to uncertainty about the effectiveness of the methods used; well, etc.

Natural contraception includes: sexual abstinence, coitus interruptus, calendar method, temperature method, cervical method, symptothermal method.

If you need reliable method contraception, if you have contraindications to the use of hormonal drugs, if you are shocked that the IUD does not protect against conception, but only leads to mini-abortions every month at very early stages, if you know that the IUD can lead to infertility, and you want have children in the future if your husband does not want or cannot use condoms, if you do not want to use hormonal agents During the period of breastfeeding, if vaginal tablets or calendar/temperature methods of counting days are not suitable for you due to too much uncertainty, then this method is just for you.

Few people know about this method of contraception. Cervical method is a method for determining the fertile phase by changes in the nature of cervical mucus.
The method is based on the fact that before and during ovulation, a woman’s vaginal discharge changes. These changes are clearly visible if you know what's going on. But in order to figure it out, you will have to spend a month or two measuring your basal temperature every day and comparing changes in this temperature with changes in discharge. But then you can live happily for many years. Later I will write what to do if you are breastfeeding and the cycle has not yet recovered, but for this you still need to know the theory:

1. An egg after ovulation lives no more than 48 hours, if fertilization has not occurred, therefore, two days after ovulation and until menstruation, it is impossible to get pregnant (if a woman becomes pregnant on the 25th day of the cycle, this only means that her ovulation was delayed and did not occur on the 14th, and on the 25th day). The first thing that the natural control method gives is that the woman sees: ovulation is happening or is delayed, or will happen ahead of time.

2. After release, sperm can live up to 5-6 days, but only in the fertile cervical fluid, which is released from a woman shortly before and during ovulation (usually the middle of the cycle). At the beginning and end of the cycle, this fluid is absent and the sperm die within a few hours. The second thing the method gives is that the woman knows exactly what day before ovulation she needs to start using contraception or not have sexual intercourse if she does not want to get pregnant.

So, you only need to protect yourself for a few days in the middle of the cycle, and these days are precisely known.

For the first two months you will have to draw a temperature graph. Basal temperature is measured in the morning, without getting out of bed, preferably at the same time, preferably in the vagina (the main thing is not to fall asleep with a thermometer :-) During menstruation, it is unnecessary to measure the temperature.

In addition to the basal temperature, you will need to record changes in vaginal discharge during the cycle under the graph. Like this:

I decipher:

1. dry - when there is no discharge or there is very little discharge, sperm in such an environment die immediately.

Some women never experience “dry”, immediately after menstruation and after ovulation until the next menstruation - the second type of discharge:

2. sticky discharge - white, in small quantities, not viscous, if you try to stretch it between your fingers, droplets remain on the fingertips in the form of white tubercles. This is infertile discharge, sperm die within a few hours, and there are still several days before ovulation.

The main thing is not to miss when the sticky discharge begins to turn into the following form:

3. watery (or creamy) - transparent like water or whitish like highly diluted milk, completely liquid, and for some more like liquid hand cream. This is already fetal discharge, in which sperm can wait five days before ovulation.

4. “I. b." - during the day or on the day of ovulation, a discharge similar to egg white appears, the discharge becomes thick, viscous (stretched between the fingers), translucent, there is a lot of it. Many women have such discharge for at least 1 day, for some it is 2, 3 days. This time is the most favorable for conception. In some women, “protein” does not appear at all, but simply the amount of watery discharge increases greatly. It also happens that discharge appears only on the cervix and almost does not come out. In this case, you can take them directly from the neck with two fingers with cut nails. (You should also remember that sperm can greatly distort the nature of the discharge; do not confuse the remains of sperm with fetal fluid).

On the day of ovulation (on the last day the largest number secretions), the basal temperature has not yet increased, and for many it even drops by one tenth of a degree - the lowest temperature during the cycle (the graph shows a downward-pointing tooth).

As soon as ovulation has occurred, the discharge again becomes sticky or disappears altogether, and the temperature rises by about 0.5 degrees and remains elevated (about 37°C, but not lower than 36.8) until the end of the cycle, that is, about 16 more days. After ovulation, you can become pregnant within 48 hours, although there is no longer any fetal fluid, but there is an egg in the uterus, which sperm can reach faster than dying.

If the body reacts slowly to progesterone, then after ovulation the temperature rises slowly and reaches 37 degrees three to four days after ovulation, BUT during these 4 days there is no decrease in temperature. In this case, the barren period still begins 2 days after ovulation, and not 2 days after the highest temperature. If the temperature does not increase, then ovulation never occurred, then either it will occur later (and the pattern of discharge will be repeated) or this cycle will be non-ovulatory (and this happens).

So, you need to protect yourself or not have sexual contact:

Starting on the day the sticky discharge turns into creamy, and for even greater reliability - the day before the creamy discharge appears (if the cycle is regular, they will appear on a certain day of the cycle, if irregular, then when “dry” turns into “sticky.” If If you don’t have a “dry” state, then - when the amount of sticky discharge begins to increase).

Ending on the third day after ovulation - when the discharge decreases, and the basal temperature of the second day remains at a high level.

To do this, you need to monitor your discharge and measure your temperature for 5 days in the middle of the cycle: starting from the day of the largest discharge - egg white or very strong watery (you can start measuring earlier if you doubt the nature of your discharge) and three days after the reduction/cessation discharge to make sure that ovulation has occurred and the temperature does not drop for three days in a row.

When breastfeeding

Until the cycle has been restored, there is no point in measuring the temperature. After childbirth, when the bloody discharge stops, observe yourself for ~2 weeks. If there is no discharge (“dry”) or it is sticky within 2 weeks, you don’t have to use protection. But sometimes you will observe individual manifestations - the sticky liquid may become watery or “dry” will turn into “sticky”. In the first option, you can consider yourself safe 4 days after the disappearance of the watery liquid, in the second option - 2 days after the disappearance of the sticky liquid. And so on until the first menstruation appears. It may happen that a sticky liquid appears and remains for at least 2 weeks, then consider this a new version of your infertility, up to the appearance of a watery liquid. (And remember that on the day of sexual intercourse, sperm residues can distort the picture - do not mistake them for fetal fluid). In a small number of breastfeeding women, the discharge is consistently “watery” rather than sticky. In this case, it is recommended to protect yourself all the time until the cycle is restored.

Additional (not all women have them) signs of ovulation - a slight cutting pain in the lower abdomen (can only be felt when squatting quickly), small bloody brown discharge.

In case of illness/cold, when the general body temperature rises, the basal temperature also rises, and if this happens in the middle of the cycle, it is difficult to determine whether ovulation has occurred or not. In this case, after recovery, it is recommended to wait for three days to measure your body temperature (should be 36.6) and monitor your basal temperature (around 37 degrees for three days in a row).

There are other signs of ovulation, they are not used in the method described above, but maybe they will be useful to someone if the cycle is very irregular or there are some gynecological problems:

1. There is a test for determining glucose in urine, a paper strip that changes color depending on the amount of glucose. Around the day of ovulation, the amount of glucose in the cervical fluid increases; the strip, if this fluid is dropped onto it, begins to change color two to three days before ovulation and stops changing color two to three days after ovulation. Most saturated color the stripe appears on the day of ovulation;

2. during the period of ovulation, the cervix opens and becomes soft, and immediately after ovulation it closes (in women who have given birth, a small gap remains) and becomes hard.

Note: if you do not have sexual intercourse on “dangerous” days, then the reliability of the method is very high - 98%. If you use condoms on dangerous days, then the reliability of the method will be equal to the reliability of protection using a condom.

Physiological, or biological methods contraception refers to natural methods family planning. Consists of abstaining from sexual intercourse during the fertile phase of the menstrual cycle (the period during which a woman can become pregnant). During the menstrual cycle, a woman’s body prepares for conception and pregnancy. If conception does not happen, this process repeats again. The duration of the menstrual cycle is determined from the first day of menstruation (beginning bloody discharge), until the first day of the next and is 21-36 days, more often - 28 days.

Phases of the menstrual cycle

In the first phase of the menstrual cycle (in the first 14 days of a 28-day cycle) ovaries the follicle (a vesicle with an egg inside) grows and matures. The growing bubble releases estrogens (female sex hormones). Under the influence of estrogens, the mucous membrane grows uterus- endometrium. On days 14-16 of the cycle, the follicle bursts, and a mature egg comes out of its cavity, capable of fertilization, that is, ovulation . Ovulation occurs under the influence of pituitary hormones and estrogens. During each cycle, several follicles begin to develop, but only one of them reaches ovulation. Thus, in each menstrual cycle, as a rule, only one egg is available for fertilization. But sometimes (on average in one in 200 cycles) two follicles mature at the same time, so that two eggs can be fertilized, resulting in fraternal twins. The egg from the ovary enters the abdominal cavity and is captured by the fimbriae. fallopian tube and heads into its gap. Due to contraction of the fallopian tube, the egg moves into the uterine cavity. If there are sperm in the lumen of the fallopian tube, fertilization of the egg occurs. Meanwhile, the burst follicle collapses, leaving a small blood clot in its emptiness. Next, from the follicle cells, which are yellow, a temporary endocrine gland develops - corpus luteum , which begins to produce the hormone - progesterone . There is a distinction between the corpus luteum of menstruation and, in the case of fertilization of the egg, the corpus luteum of pregnancy. The corpus luteum of menstruation usually functions throughout the second half of the menstrual cycle (14 days). The corpus luteum of pregnancy begins to function upon fertilization of the egg and continues throughout pregnancy. If fertilization does not take place, the corpus luteum is in the stage of reverse development, the maturation of a new follicle begins, and rejection of the endometrium occurs in the uterus, which is manifested by bleeding (menstruation). Probability conception is highest on the day of ovulation and is estimated at approximately 33%. A high probability is also observed on the day before ovulation - 31%, as well as two days before it - 27%. Five days before ovulation the probability conception According to experts, it is 10%, in four days – 14% and in three days – 16%. Six days before ovulation and the day after it, the probability conception very small. Considering that the average “lifespan” of sperm after ejaculation is 2-3 days (in rare cases it reaches 5-7 days). A woman's egg remains viable after ovulation for about 12-24 hours. The maximum duration of the “dangerous” period during which pregnancy can occur is 6-9 days. Ovulation divides the menstrual cycle into two phases: the follicle maturation phase, which with an average cycle length is 10-16 days, and the corpus luteum phase, which is stable, independent of the duration of the menstrual cycle, and is 12-16 days. The phase of the corpus luteum belongs to the so-called period of absolute sterility (pregnancy is impossible under any conditions), it begins 1-2 days after ovulation and ends with the onset of a new menstruation.

Addiction conception from cycle phases

Keeping in mind the possibility of fertilization, three phases can be distinguished in the menstrual cycle (relative sterility, fertility and absolute sterility). Relative sterility (phase 1) lasts from the first day of the menstrual cycle (the beginning of bleeding) until ovulation. The duration of this phase of the menstrual cycle depends on the speed of the follicle’s “response” to the action of pituitary hormones, which, in turn, may depend on the emotional background, environmental, climatic conditions and so on. That is, ovulation may occur a little earlier or a little later, depending on certain factors external environment. During this period, difficulties with contraception sometimes arise, since the duration of the phase of relative sterility can vary from cycle to cycle within a few days, even with a stable duration of the menstrual cycle as a whole. This fact should be taken into account if you want to get pregnant in this cycle, that is, you should not count on conception after one sexual intercourse on the day of expected ovulation. The result will be guaranteed if you have sexual intercourse once every 2-3 days during the “dangerous period”. Fertility phase (phase 2) begins from the moment of ovulation and ends 48 hours after ovulation. These 48 hours include the time during which a mature egg is capable of fertilization (24 hours); the next 24 hours are reserved for inaccuracy in determining the time of ovulation. Absolute sterility (phase 3) begins 48 hours after ovulation and continues until the end of the menstrual cycle. The duration of this phase is quite constant and is 10-16 days. If we're talking about about contraception, it is rational to consider the last 10 days of the cycle as the phase of absolute sterility. Knowing the physiology of the reproductive system and the fertile periods of her menstrual cycle, a woman can use natural methods of family planning:

• with the aim of conception – planning sexual intercourse for the middle of the cycle (10-15th day), when fertilization is most likely;
• for the purpose of contraception - abstinence from sexual intercourse during that phase of the menstrual cycle during which the probability conception the greatest.

Advantages of EMPS:

• no health risk
• no side effects
• free
• involving men in family planning
• Possibility of use for pregnancy planning
• deepening knowledge about the reproductive system
• closer marital relationships are possible

Disadvantages of EMPS:

• low efficiency (9-25 pregnancies per 100 women within 1 year of use)
• keeping daily records
• the need for a thermometer (for the temperature method)
• the need to abstain from sexual activity during the fertile phase of the menstrual cycle
• effective only for women with regular menstrual cycles
• do not protect against sexually transmitted diseases

Natural family planning methods can use:

• women of reproductive age who have a regular menstrual cycle
• couples whose religious, ethical, or other beliefs do not allow them to use other methods of contraception;
• women who, for health reasons, etc., cannot use other methods;
• couples willing to abstain from sexual activity for more than one week each cycle.

These methods should not be used:

• women whose age, number of births or health conditions make pregnancy dangerous for them;
• women with an unsteady menstrual cycle (breastfeeding, immediately after an abortion);
• women with irregular menstrual cycles;
• women who do not want to abstain from sexual activity on certain days of the menstrual cycle.

Types of physiological methods

Biological (physiological) or natural methods of family planning (EMFP) include: calendar (or rhythmic), temperature, cervical mucus method, symptothermal (a combination of the two methods listed above), coitus interruptus, lactational amenorrhea method (physiological suppression is observed during lactation ovulation due to the baby sucking at the breast), abstinence (abstinence from sexual intercourse). Calendar (rhythmic) method To determine the fertile phase, it is necessary to analyze at least 6-12 menstrual cycles. During this period, it is necessary to abstain from sexual activity or use barrier methods of contraception. When analyzing menstrual calendar over 6-12 months, the shortest and longest cycles are distinguished. The number 18 is subtracted from the number of days of the shortest one and the day of the beginning of the “dangerous” period is obtained, and the number 11 is subtracted from the number of the longest menstrual cycle and the last day of the “dangerous” period is found out. Let us give an example of calculating the “dangerous” period with a constant menstrual cycle of 28 days. Beginning of the “dangerous” period: 28 - 18 = 10th day of the cycle. End of the “dangerous” period: 28 - 11 = 17th day of the cycle inclusive. The duration of the “dangerous” period is 8 days. It begins on the 10th day of the menstrual cycle and ends on the 17th day. Attention! This method can be used only with strict accounting of all menstrual cycles in the calendar and with a small spread of the menstrual cycle throughout the year. If you have not marked the duration of the menstrual cycle on the calendar for 6-12 months and cannot say with certainty about the stability of the cycle, then this method is not suitable for contraception, as well as for calculating the most favorable periods. conception days. Temperature method is based on determining the time of rise in temperature in the rectum (basal temperature). It is known that at the moment of ovulation the temperature in the rectum decreases, and the very next day it increases. By measuring basal temperature daily for several (at least three) months and abstaining from sexual intercourse in the first phase of the menstrual cycle, including the first three days of temperature rise after ovulation, a woman will be able to determine when she ovulates. The effectiveness of the method depends on the accuracy of determining the date of ovulation. Therefore, it is necessary to measure the temperature, observing the following rules: always in the morning, within 10 minutes, immediately after waking up, without getting out of bed, using the same thermometer and eyes closed, since bright light can provoke the release of certain hormones and contribute to changes in basal temperature. The thermometer is inserted into the rectum to a depth of 4-6 cm. The temperature value is noted on the graph. Basal temperature chart(see chart 1): normally, from the very beginning of the menstrual cycle (its duration is calculated from the first day of the previous menstruation to the first day of the next one) and before the onset of ovulation, the basal temperature is below 37 degrees C and can fluctuate within small limits, for example, from 36 .6 degrees C to 36.8 degrees C. At the time of ovulation, the temperature drops slightly (for example, to 36.4 degrees C), the next day the basal temperature rises above 37 degrees C (37.2-37.4). It remains at this level until the start of the next menstruation. A decrease in temperature and the subsequent jump beyond 37 degrees C allows you to determine the date of ovulation. With a 28-day cycle healthy woman Ovulation usually occurs on days 13-14 of the cycle. It should be noted that due to an increase in body temperature in various diseases, basal temperature figures also become high. But can only these two days be considered “dangerous”? Not at all. Even having clearly defined your individual ovulation date, you cannot protect yourself from accidents. If you are nervous, overtired, the climate has changed dramatically, and sometimes for no apparent reason at all, ovulation may occur 1-2 days earlier or later than usual. In addition, the duration of viability of the egg and sperm must be taken into account. If, on the eve of the expected menstruation and especially during the expected but delayed menstruation, a slightly elevated temperature in the rectum remains, then this allows one to suspect an already existing pregnancy. The temperature method for determining the period of increased fertility presupposes that the woman is sufficiently disciplined and does not rush in the morning. The inconveniences of the method are associated with the need for daily temperature measurement and rather long abstinence. However, when used correctly, its effectiveness is quite high. In women suffering from diseases of the genital organs, the basal temperature schedule may change. In this case, the advisability of using this method should be discussed with your doctor. Cervical mucus method. At different phases of the menstrual cycle, the cervix produces cervical mucus of varying amounts and consistency. Its quantity and consistency are influenced by female sex hormones (estrogens and progesterone). At the beginning of the cycle, immediately after menstruation, when estrogen levels are low, there is little mucus, it is thick and sticky. This thick and sticky mucus forms a fibrous network that “clogs” the cervix and creates a barrier to sperm penetration. In addition, the acidic environment of the vagina quickly destroys sperm. Rising estrogen levels gradually change the cervical mucus, which becomes clearer and thinner. Appears in mucus nutrients to maintain the vital activity of sperm, and its reaction becomes alkaline. This mucus, entering the vagina, neutralizes its acidity and creates an environment favorable for sperm. This mucus is called fertile mucus; its amount increases 24 hours before ovulation. The last day of slippery and wet mucus is called afternoon rush. This means that ovulation is near or has just occurred. After ovulation, under the influence of the hormone progesterone, cervical mucus forms a thick and sticky plug that prevents sperm from moving through. The vaginal environment becomes acidic again, where sperm lose their motility and are destroyed. 3 days after the appearance of sticky, viscous mucus, a phase of absolute sterility begins, during which, until the start of the next menstruation, pregnancy will be impossible. The use of the cervical mucus method for contraception involves keeping records. In this case, a whole range of codes can be used (see graph 1). It is believed that the first day of menstruation is the first day of the cycle, the subsequent days are numbered. Relative infertility phase: red squares with an asterisk indicate days of menstrual bleeding; Green squares indicate a period characterized by vaginal dryness, the so-called “dry days.” Fertility phase (squares) yellow color with the letter M, day 11 of the menstrual cycle) begins with the appearance of mucus in the vagina. Ovulation has not yet occurred, but the sperm that has entered the woman’s genital tract at this time can remain viable and “wait” for the egg. As ovulation approaches, cervical mucus becomes more abundant and elastic. In this case, the tension of the mucus (when it is stretched between the thumb and forefinger) can reach 8-10 centimeters. Next comes rush day(M). This means that ovulation is close or has just occurred. The fertile phase continues for another 3 days and its total duration in our case is 7 days (from 11 to 17 days of the menstrual cycle). The phase of absolute sterility begins on the fourth day after maximum discharge (on our chart from day 18) and continues until the first day of the next menstruation.

• Since mucus may change consistency throughout the day, observe it several times a day. To do this, the thumb and index finger are inserted into the vagina and the existing discharge is removed. Next, the mucus is assessed by consistency and ability to stretch between the fingers. On “dry days” there is no discharge. Every night before you go to bed, determine your fertility level (see below). symbols) and place the corresponding symbol on the card.
• Avoid sexual activity for at least one cycle to identify mucus days.
• After the end of menstruation, during the “dry days” you can safely have sexual intercourse every second night ( rule of alternating dry days). This will prevent the mucus from being confused with sperm.
• When any mucus or a feeling of moisture in the vagina, sexual intercourse should be avoided or barrier contraception should be used at this time.
• Mark the last day of clear, slippery, stringy mucus with an X. It's rush day- the most fertile period.
• After peak day Avoid sexual intercourse for the next 3 “dry days” and nights. These days are not safe (the egg is still viable).
• Starting from the morning of the 4th “dry day” and before the start of menstruation, you can have sexual intercourse without fear of becoming pregnant.

The effectiveness of this method is low: 9-25 pregnancies per 100 women within 1 year of use. Coitus interruptus method consists of removing the penis from the vagina before ejaculation (ejaculation) so that sperm does not enter the vagina and cervix. Its advantage is that it does not require any preparation or special devices, can be applied at any time and does not require any cash outlay. The method requires considerable attention on the part of the man, since some men have sperm in the secretion released even before orgasm. In addition, sperm entering the skin of the genital organs retains fertilizing properties for some time. There is a widespread belief regarding the violation of sexual function of partners who use interrupted coitus. The harmless use of this method is possible with a high sexual culture of partners, with sufficient motivation for choice. It is not recommended for young, inexperienced men and those who have difficulties with erection, potency and premature ejaculation.

Instructions to partners:

• To improve the consistency of their actions and to avoid mutual misunderstanding, partners should discuss their intention to use the interruption method before sexual intercourse.
• Before engaging in sexual intercourse, a man should empty his bladder and wipe the head of the penis to remove any semen that may remain from a previous (less than 24 hours ago) ejaculation.
• When the man feels that ejaculation is about to occur, he should withdraw his penis from the woman's vagina so that the sperm does not fall on her external genitalia. A woman can help him by moving a little back at this time.

Lactational amenorrhea method (LAM) - usage breastfeeding as protection against pregnancy. It is based on the physiological effect that a child’s sucking of the mother’s breast has on suppressing ovulation (physiological infertility develops during lactation).

Who can use MLA

• Women who are exclusively breastfeeding and who are less than 6 months postpartum and have not yet returned to menstruation.

Who should not use MLA

• Women who have resumed menstruation.
• Women who do not exclusively (or almost exclusively) breastfeed.
• Women whose child is already 6 months old.

It is important to know

• Feed your baby from both breasts on demand (about 6-10 times a day).
• Feed your baby at least once at night (the interval between feedings should not exceed 6 hours). Note: Your baby may not want to eat 6-10 times a day or may prefer to sleep through the night. These are normal phenomena, but if any of them occur, the effectiveness of breastfeeding as a method of contraception is reduced.
• Once you start replacing breast milk other food or liquid, the baby will suckle less and breastfeeding will no longer be an effective method of preventing pregnancy.
• The return of menstruation means that your fertility has returned and you should immediately start using other methods of contraception.

Abstinence - abstaining from sexual intercourse. This method of contraception does not affect breastfeeding. With abstinence, the effectiveness of protection against pregnancy is 100%. But for some couples, long periods of postpartum abstinence are difficult to bear. Therefore, abstinence is convenient to use as an intermediate method.

Natural methods of contraception (NMC) involve the use of methods based on monitoring the physiological characteristics of the fertile and infertile phases of the menstrual cycle.

A woman must have certain knowledge of calculating the possible occurrence of ovulation and the certainty of becoming pregnant on dangerous days, which allows planning or preventing the onset of pregnancy. PMCs involve consistent daily observation and analysis of physiological changes occurring in the body during the menstrual cycle: changes in basal body temperature (BBT), the amount and properties of cervical mucus, and the duration of the menstrual cycle. PMCs have both advantages and disadvantages.

Indications for the use of PMC:

• regular menstrual cycle;
• reluctance or inability to use other methods of contraception;
• couples who have a strong motivation to use MVP and can correctly interpret the presence of signs of fertility;
• inaccessibility modern methods contraception.

Advantages of using PMK:

• no side effects;
• no material costs;
• participation of the sexual partner in the implementation of PMC and the like.

Disadvantages of using PMK:

The need for daily observation for 3-4 cycles;

Difficulty in determining fertile days during the first months;

Lack of protection against STDs (sexually transmitted diseases.

Natural methods of contraception, which are based on fertility tracking, involve determining fertile days during the menstrual cycle by monitoring signs of fertility: cervical secretion, BBT, determining ovulation (mostly occurs on the 12-14th day of the menstrual cycle). Sexual contact for the purpose of contraception should be avoided from 8 to 20 days of the menstrual cycle, since the viability of the egg is 24 hours, the viability of the sperm is from 48 hours to 5-7 days.

Calendar method

To determine the fertile period (beginning and end) using the calendar method (synonym - Ogino-Knaus method), a woman needs to measure her BBT for 3-6 months, since its duration depends on the duration of the menstrual cycle. It is recommended to abstain from sexual intercourse from the first to last day fertile period.

schematic representation of the menstrual cycle indicating “dangerous” and “safe” days

Basal body temperature method

The BTT method is based on the body’s ability to increase temperature under the influence of progesterone; temperature measurements are carried out either orally, rectally, or vaginally.

Basal temperature chart

By assessing the basal temperature chart, you can determine fertile days. It is necessary to measure BBT at the same time every morning, without getting out of bed. During the menstrual cycle, it is necessary to chart your basal temperature. The main goal plotting is to determine the time of ovulation in each specific cycle, as evidenced by a rise in temperature above 37 ° C. Standard type temperature rise clearly shows the level low temperatures, then a sharp rise of at least 0.2 ° C and the next level high temperatures, which remains until the end of this cycle. The difference between the average BBT of the second phase and BBT of the first phase should be at least 0.4-0.5 °C. The fertile period begins on the 1st day of the menstrual cycle and ends with an increase in temperature on the 3rd day. It is recommended to abstain from sexual intercourse to reduce BBT after 3 days of high temperatures.

Contraceptive effect: with regular and correct use The Pearl index is 3.5.

Cervical mucus method

The basis of the cervical mucus method (synonym - Billing method) is the peculiarity of cervical mucus to respond to the estrogen saturation of the body. Observations occur daily immediately after the end of menstruation. As estrogen levels increase, thick, sticky mucus appears in the vagina. With a subsequent increase in estrogen levels before ovulation, the mucus becomes transparent, elastic and slippery, and the feeling of dryness in the vagina disappears. After ovulation, the mucus becomes thick again. The beginning of the fertile period coincides with the appearance of mucous discharge, and the end is determined in the evening of the 4th day after the “peak day” ( high humidity). It is recommended to abstain from sexual intercourse during the fertile period.

Contraceptive effect: 85%, with proper and regular use – 98%.

Symptomothermal method

The basis of the method is a combination of cervical mucus and BTT methods. The fertile period is determined by measuring BTT (end of the fertile period), monitoring cervical mucus (beginning and end of the fertile period). The results obtained are combined into a combined method on a calendar data sheet.

Contraceptive effect: approximately 91-95%.

Method of abstinence from sexual intercourse (abstinence)

It is one of the traditional methods of pregnancy planning.

Lactational amenorrhea method

MLA is based on the suppression of ovulation in a woman who breastfeeds her child due to an increase in prolactin in the blood. With lactogenic hyperprolactinemia, the biorhythm of pulsating secretion of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) is suppressed, while the sensitivity of the pituitary gland to gonadotropin-releasing hormones (GnRH) is reduced, and estrogen positive feedback from the periphery to the center does not work. A key factor in maintaining rhythmic ovulatory cycles in women is the pulsatile release of GnRH into the portal capillaries, which is suppressed by prolactin during lactation. As the baby continues to suckle at the breast, the paradoxical mechanism comes into play. feedback– with an increase in the level of estrogen, there is an increased suppression of the secretion of LH and FSH, as opposed to an increase in the concentration and acceleration of the pulse secretion of LH and FSH, which occurs in women who do not have lactation. In women with intensive lactation, conditions are created that contribute to an increase in the period of restoration of menstruation or the appearance of menstruation, but without ovulation.

Advantages of MLA:

• high efficiency for up to 6 months, subject to conditions of exclusive breastfeeding and absence of menstruation (amenorrhea). Breastfeeding should begin immediately after birth, and it is important correct technique feeding the baby (Fig. 6);
• significant benefits for both the health of mother and child;
• availability of time to select and prepare for use in the next contraceptive method.

Criteria for using MLA:

• period after birth -<6 месяцев;
• presence of lactational amenorrhea;
• a woman exclusively breastfeeds on demand (at least 6 times a day, including night feedings, the interval between feedings is<4:00 днем ​​и <6:00 ночью), и ребенок не получает другой пищи, кроме материнского молока.

Indications for use of MLA:

• breast-feeding;
• period after birth -<6 месяцев;
• lack of renewal of menstruation after childbirth.

Only exclusive, almost exclusive and complete or almost complete breastfeeding has a significant effect on fertility, when the intervals between feedings do not exceed 4 hours during the day and 6 hours at night. The return of menstruation in women who are breastfeeding is a sign of restoration of fertility. The resumption of menstruation means that reproductive function has been restored and it is necessary to immediately begin using other methods of FP.

Contraindications for the use of MLA:

• restoration of menstruation;
• lack of exclusive (or almost exclusive) breastfeeding;
• child's age => 6 months.

Conditions that require caution when using MLA, since the likelihood of pregnancy increases:

• introduction of regular complementary feeding to the child (instead of breastfeeding);
• restoration of menstruation after childbirth;
• interval between feedings -> 4 hours during the day, > 6 hours at night;
• child aged >6 months.

Contraceptive effect: 98% provided that the child is exclusively breastfed (the interval between feedings is<4 часов днем ​​и <6 часов ночью), отсутствия менструации после родов и срока после родов <6 месяцев.

Algorithm for choosing natural methods of contraception

For the purpose of contraception, PMC can be used:

• women in all periods of reproductive age;
• women with any number of births, including those who have not given birth;
• couples whose religious or philosophical beliefs do not allow the use of other methods of contraception;
• women who cannot use other methods;
• couples who are able to avoid sexual intercourse for more than 1 week during each cycle;
• couples who are able and willing to observe, record, interpret the signs of the fertile phase on a daily basis.

For the purpose of fertilization, PMC can be used:

• couples who are planning a pregnancy.

PMCs cannot be used:

• women whose age, number of births or health conditions make pregnancy extremely dangerous;
• women without experience of effective use of PS methods;
• women whose partners do not want to abstain from sexual relations on certain days of the cycle;
• women who do not want to use this method for personal reasons;
• women with irregular menstrual cycles.

There are a number of conditions that require caution in the use of MVP. In case of irregular menstruation, constant vaginal discharge and breastfeeding, PMC should be used with caution, since there is a high probability of pregnancy if these methods are used incorrectly.

If the patient wishes to use natural methods of contraception
The technique of each method is explained:

• – Calendar;
• – Cervical mucus;
• – BTT;
• – Symptomothermal.

A patient learns how to record her menstrual cycle observations over a 6-month period.

The use of withdrawal or current abstinence is considered.

Repeat visit – after 6 months.
Fertile days in the menstrual cycle are counted according to the chosen method.

Provide information about emergency contraception methods.

Return visits are encouraged to clarify instructions.

Literature: Modern methods of pregnancy planning / G.I. Reznichenko, A.B. Gordeychuk, N.Yu. Reznichenko. – Kyiv: RVH Queen