Family planning: the natural method. Basic methods of contraception
Family planning is a concept that actively enters our lives. For many years, this term meant birth control. However, it is more likely to ensure the woman’s health for the birth of desired and healthy children. The right to family planning, or freedom and responsible parenthood, is an internationally recognized right of every person.
Principles of sensible family planning
Sooner or later, every person, every family faces questions about when and how many children to have, how to avoid unwanted pregnancy, which contraceptives are best to use and how to use them. Family planning helps people consciously choose the number of children in the family and the timing of their birth, plan their lives, and avoid unnecessary worries and worries.
The optimal age for conceiving and having children is 20–35 years. The intervals between births should be at least 2–2.5 years. If pregnancy occurs earlier or much later, it occurs with a large number complications.
Teaching teenagers the basics of family planning
Sex education and sexuality education for children and adolescents will help maintain their health and prepare them for the future. family life and instill a sense of responsibility. Today, there are many modern methods of contraception that can reliably prevent unwanted pregnancy. Their use is many times safer for health than abortion.
Sexually transmitted diseases are often the cause of infertility in men and women. Only a condom will help avoid infection and at the same time protect against unwanted pregnancy.
Contraceptive methods for family planning
Properly selected contraception when planning a family makes intimate life more harmonious and eliminates possible worries and worries among spouses.
Currently existing contraceptive methods are usually classified in the following way:
barrier (or mechanical);
spermicides (or chemical);
rhythmic (or biological);
interrupted sexual intercourse;
intrauterine devices (intrauterine device);
hormonal contraception;
voluntary surgical sterilization.
Currently, the range of contraceptives has increased significantly, contraceptives have become more reliable and are selected individually for each woman. A gynecologist at a family planning center (office) or at a clinic helps a woman understand this issue.
Methods of postpartum contraception for family planning
Return of fertility, i.e. fertility, and therefore the chance of becoming pregnant again, usually occurs six weeks after birth (this depends on the length of breastfeeding). The female body rest is necessary after pregnancy and childbirth. The interval between pregnancies should be at least 2.5–3 years (the so-called “intergenetic interval”), so after childbirth it is important to strictly follow the rules for using a particular method of contraception (contraception).
Women who exclusively breastfeed their babies are usually protected from pregnancy for the first 4 to 6 months after giving birth. In women whose children receive artificial nutrition, the ability to conceive is restored earlier. The use of breastfeeding as a means of contraception is called the lactational amenorrhea method (LAM). But, unfortunately, the effectiveness of this method is about 70% and therefore, when using it, a monthly examination by a gynecologist is necessary for timely diagnosis possible pregnancy. A woman can resume sex life with a partner as soon as she feels inclined to do so and provided that she does not have any health complications.
The method of lactational contraception is based on the physiological effect of suppressing ovulation by irritating the mother's nipples during breastfeeding.
To use this method for family planning, the following factors must be absent:
child's age 6 months;
presence of menstruation;
feeding food other than breast milk;
an interval of more than three or four hours between feedings in the afternoon and evening;
an interval of more than 6 hours between feedings at night.
If after giving birth a woman has not yet chosen a specific method of postpartum contraception, then the best way for her - the use of condoms and/or spermicides, until the moment when she is ready to use another method of protection.
Contraception with spermicides during family planning
Spermicides are chemical contraceptives. Let's take a closer look at the method of contraception with spermicides. Contraception with spermicides is based on the ability of the active ingredient in their composition to destroy sperm within a few seconds. Various substances that are potent on sperm are used as active ingredients.
These contraceptives are available in the form
- creams,
- jelly,
- candles,
- tablets,
- films,
- foam.
Contraception with spermicides - foaming tablets are inserted into the vagina 10 minutes before sexual intercourse. 8–10 minutes after insertion into the vagina, they dissolve in the mucus present in it, forming a thick viscous foam. Foam fills the lumen of the vagina, and since it contains substances harmful to sperm, sperm, once in such an environment, are immobilized and die very soon without penetrating the uterus. The meeting of sperm with an egg in the vaginal cavity cannot lead to conception, since their interaction with each other to form an embryo must occur in fallopian tubes ah, or at least inside the uterus.
Instead of pills when planning a family, you can just as successfully use paste, ointment or suppositories with foaming and spermaticidal (anti-sperm) components. Their use and contraceptive effect are similar to the pill. But in the case of using ointment or paste, you will need a special syringe for administration and dosage: 5–6 g of ointment or paste corresponds to the full volume of such a syringe. In addition, foam-forming contraceptives are produced by our industry in cans with the ability to be released under slight pressure. With the help of such a spray, a foam-forming aerosol is introduced into the vagina. It can be administered not 10 minutes before, but immediately before sexual intercourse. If these medications are not available, the pharmacy can produce vaginal balls according to a prescription prescribed by your gynecologist.
Foaming contraceptives are completely safe when used for contraception with spermicides, except in cases of individual intolerance. However, their frequent and regular use is undesirable, since in this case they can lead to irritation of the vaginal mucosa and sometimes inflammatory processes in the vagina.
Foam-forming contraceptives during family planning should be used by women who cannot tolerate hormonal contraceptives and do not want to have an intrauterine device. In addition, these medications can be used in between taking hormonal medications. contraception, as well as in all other cases when a prognosis is possible 5–10 minutes before sexual intercourse.
Handy methods of contraception
However, despite the variety of contraceptive methods, the means used by women in everyday life as contraceptives have been preserved to this day.
To protect against unwanted conception, you can use any chemicals, damaging sperm, but not damaging the vagina and uterus, and also does not have a dangerous effect on the body as a whole.
Firstly, various acids can act as improvised contraceptive methods for women:
- lemon,
- vinegar,
- dairy,
- boric,
- salicylic,
- ascorbic acid
- or medications that have a detrimental effect on microorganisms of the protozoan clan (such as the causative agents of malaria or trichomonas).
It is also possible to use products of plant origin: freshly squeezed lemon juice, red or white currants; tuber aquatic plant- yellow egg pods.
These substances need to be introduced into the vagina, preferably before sexual intercourse with a man or immediately after sexual intercourse, in the form of a liquid solution by douching or using a tampon moistened with them.
Douching must be done before and after sexual intercourse. In this case, the tip of the syringe should be rotated in different directions, washing the entire inner surface of the vagina. The douching procedure should last 3–5 minutes. After this, the vagina should be rinsed with water to avoid possible irritation. When using acids and drugs, you should beware of their irritating effect on the mucous membrane of the genital organs. This complication is possible when using highly concentrated solutions. Do not use acid solutions in concentrations exceeding 0.5–1%.
And finally, in the absence of any means of contraception, copious douching can protect you from unwanted pregnancy plain water, although this method is far from one hundred percent.
All of the above methods of contraception for women do not completely protect against pregnancy; in addition, complications are possible, such as an allergic reaction, burns due to improper dilution of drugs and acids, etc. Therefore, it is most advisable to consult a gynecologist and choose the most suitable contraception for you.
Abortion as a method of family planning
Abortion is not the best method of birth control. If an unwanted pregnancy does occur, you need to consult a doctor as early as possible, which will reduce the risk possible complications. After childbirth and abortion, you can get pregnant again before the arrival of your first menstruation, so you should choose reliable method contraception before resuming sexual activity.
Undoubtedly, there is no ideal method of contraception for family planning: traditional methods of contraception for women have relatively low contraceptive effectiveness, and the use of modern ones is limited by a number of contraindications and side effects. There is also no universal method for all women, 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.
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 of the IPO Tyumeneva L.P.
1. Family planning and reproductive health
2. History of contraception
3. Modern methods contraception
4. Hormonal contraception
5. Postcoital contraception
6. Intrauterine contraception.
7. Traditional methods of contraception.
8. Natural contraception.
9. Surgical methods 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 actively enters our lives. What is it and why is family planning so important for each of us, for every 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 necessary for:
¨ 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 parenting to be responsible, so that desirable and healthy children are born, everyone modern man should know how to maintain your reproductive health:
Reproductive health- 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 stability family relations, general well-being of a person. One of the factors influencing the state of reproductive function is the prevention of unwanted pregnancy. Often a woman is faced with a difficult choice - to give birth to a child 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), jeopardizing further studies and acquiring a profession. Each such situation must be considered individually, carefully and with greater understanding of the problem.
Some parents, teachers, community and religious leaders express concerns that introducing youth 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 indicates the opposite. Where sexuality 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, the age of onset of sexual activity increases, which helps boys and girls 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 great place is devoted 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 decisions about abortion under the influence of temporary emotional experiences or life failures.
Abortion is one of the main problems of modern healthcare. It is well known that the health of children depends on the health of their parents, the course and outcome of pregnancy and childbirth.
There are 78.1 million women in Russia
Among them, the majority (38.6 million) are of childbearing age.
Only 25% of them use modern methods of contraception.
Seven out of ten pregnancies in Russia end in abortion.
Doctors agree: modern contraception is the only alternative to abortion. To solve the problem of abortion, 70-75% of women must use modern contraceptives.
2. History of contraception
People have been using contraceptive methods to prevent pregnancy for a very long time. Some methods of contraception that were used in primitive society still exist today. Below are the most interesting methods of contraception that were 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 Europeans, used vaginal rinsing with a decoction of mahogany bark and lemon. They also believed that after chewing parsley, a woman would bleed for 4 days. In Australia, for example, contraceptive lumps were prepared from fucus extract. In Sumatra and neighboring islands, opium was also used. The issue of preventing pregnancy came to the fore in the Greco-Roman Empire, in connection with the orgies that became widespread at that time. To prevent pregnancy, various substances of plant and animal origin or their decoctions were used with some success. The attitude towards these methods, for example, towards 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. Although this makes us smile today, the recommendation is not without common sense, given the acidifying effect of lemon on the contents of the vagina.
Application of various intrauterine devices, in order to prevent pregnancy, especially various balls, it was also known on Far East, in China and Japan. The insertion of a loop into the uterine cavity was first used to prevent pregnancy at the beginning of the 20th century. The first such remedy was proposed in 1909 by the German gynecologist Richter: a ring made from the intestines of a silkworm, fastened with metal wire. Then a gold or silver ring with an internal disk (Ott ring) was proposed, but since 1935 the use of intrauterine contraceptives has been prohibited due to the high risk of developing inflammatory diseases of the internal genitalia. Only in the 60s of the 20th century was 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 in which 180 different spermicidal substances were described. Subsequent research led to the development of certain spermicidal contraceptives that could be used as powders, tablets, or vaginal pellets. Male condoms from animal skin were used back in ancient world, but became widespread mainly in the first half of the 20th century. Somewhat later, rubber condoms appeared, the improvement of their reliability 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 different shapes, became widespread only in the late 50s and early 60s. Great importance had the creation of more effective intrauterine devices containing copper.
The creation of hormonal contraception was a new milestone in pregnancy prevention. The idea of hormonal contraception arose at the beginning of the 20th century, when the Austrian physician Haberland discovered that the administration of ovarian extract causes temporary sterilization. After the discovery of 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 considered to be June 1, 1961, when the drug 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. From that time on, the history of the development of combined pills began. contraceptives Hormonal contraception developed by reducing the dose of steroids (estrogens) and by creating selective (selective action) gestagens.
Conversation with a gynecologist about family planning
In Russia, intrafamily birth control has long become a widespread practice, but the transition to modern planning the family is not completed - half of the pregnancies are terminated by abortion, therefore, they were not desired or planned. This is why the obstetrician-gynecologist at the Municipal Budgetary Healthcare Institution City Clinical Hospital No. 9 Alina AlekseevnaFedorovskikh spoke about modern and good known methods contraception
There is a myth in the minds of many that intra-family birth control is synonymous with its limitation and wide access to contraception supposedly leads to a decrease in the birth rate. In fact the main objective family planning consists in the birth of desired children at the optimal time for the couple, and in the case of Russia, also in the rapid displacement of abortion as a way of regulating the birth rate by more humane methods. Essentially, family planning means “responsible parenthood.”
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, DHS surgery can be performed by women over 35 years of age and having 2 children. Performing DHS is possible during a cesarean section with voluntary informed consent for this manipulation completed in advance. This method is also available to men. Vasectomy in men does not affect erectile function and does not in any way disrupt the physiological and emotional components of sexual intercourse.
There are many reversible methods of contraception. All of them have been sufficiently studied, are safe and, after discontinuation of the method, lead to the rapid restoration of fertility, that is, the ability to conceive. Reversible methods of contraception can be divided into planned 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 that are most favorable for conception and abstaining from sexual intercourse on these days. The method can only be used by women whose menstrual cycle is regular and lasts 28-32 days. The method is good because there are no material costs and side effects, as well as knowledge of their fertile days allows the couple to plan further desired pregnancy. The method does not protect against STIs and HIV.
Lactational amenorrhea method.
Can be used by a woman after childbirth subject to strict adherence to the following conditions:
No more than 6 months have passed since birth;
The child is only on breastfeeding, 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 returned to menstruation.
If all conditions are strictly met, the effectiveness 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 have virtually 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 use 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 sexual intercourse and destroy sperm. Efficiency at correct use up to 88%. Some of them (not containing a fat 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 effect is only local. We will not dwell in detail on vaginal diaphragms, cervical caps and female condoms, since their prevalence in Russia is low and they are rarely sold, 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 effectiveness 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 contraception consultation. The method does not protect against STIs and HIV. Also, in some cases, side effects may occur in the form of heavier and longer periods, 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 influence of hormones contained in the drug that the woman uses. None of the types of hormonal contraception protect against STIs and HIV. There are several groups of drugs for hormonal contraception:
Combined hormonal contraceptives. Presented by 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%. They require compliance with the dosage regimen and dosage regimen from the woman. Cannot be used by nursing mothers. Modern combined hormonal contraceptives have virtually no side effects, but have a number of medical contraindications, which the doctor will identify when consulting on contraception. Prescribing contraceptive drugs does not require extensive preliminary examination. The method also has positive additional properties - regular menstrual cycle, reduction in the volume and duration of menstrual bleeding, 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 compliance with the dosage and administration regimen, are the same as for combination drugs. The difference from the latter is that PPTs do not contain estrogens and can be used by women for whom estrogens are contraindicated for a number of reasons, as well as by nursing mothers, since they do not affect the quantity and composition of breast milk. Their disadvantage is that they do not always provide such good control of the menstrual cycle as with the use of combination drugs.
Progestin-only injectables, implants and hormone-releasing intrauterine systems.
Efficiency is up to 99%. They combine the advantages of hormonal contraception and the IUD, since 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 some gynecological diseases. Can be used by nursing mothers.
Emergency contraception (EC).
Used after unprotected sexual intercourse to prevent unwanted pregnancy. Efficiency ranges from 56 to 93%, depending on timely application. The most common regimens for using the drug are “Escapelle” once or “Postinor” twice with an interval of 12 hours. The drugs can be taken no later than 120 hours (5 days) after unprotected sexual 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 consult a doctor to select a planned effective method. EC is contraindicated during breastfeeding.
In the antenatal clinic of Municipal Budgetary Institution City Clinical Hospital No. 9, specialized appointments are 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 a contraceptive method that is right for you, will be safe and easy to use.
We hope that you will not have to resort to a dangerous artificial abortion operation that cripples your soul and body, and that you will be able to enjoy harmony in your life. intimate life, and when the time comes, the desired happy motherhood.
Modern methods of contraception are very diverse and are selected individually by the gynecologist for each woman. (More details...) At the doctor’s appointment, after a conversation, examination, if necessary, after additional research methods, an appropriate health status and life situation method.
It is surprising that today, with such an abundance of information, many women do not use any contraceptive methods at all. And the most common way to prevent pregnancy is interrupted sexual intercourse. This is not the most best method. It keeps both partners in constant tension, which does not lead to strengthening the relationship between the spouses. There are much more effective and useful methods.
Contraception can be planned or emergency. For planned contraception, intrauterine, tablet, barrier and other methods of birth control are used. Emergency contraception is a method of contraception used to prevent unwanted pregnancy when, for some reason, other methods of contraception have not been used. Emergency contraception is carried out with medications that contain a large number of hormones and cannot be used regularly. It is advisable to recommend emergency contraception as an emergency measure to prevent pregnancy to women after rape, when there is doubt about the integrity of the condom, and in cases where other methods of contraception cannot be used. Women who are rarely sexually active, as well as adolescents, need emergency contraception. Emergency contraception is used only after unprotected intercourse if pregnancy is not planned or desired. Emergency contraception should not be a regular method of contraception.
In our country, the most common drug, proven over the years and by women's destinies, contains 2 tablets of 0.75 mg of levonorgestrel. Levonorgestrel is a synthetic analogue of the already known progesterone. It changes the contraction of the fallopian tubes and the endometrium (the “inner lining” of the uterus). Therefore, the implantation of a fertilized egg becomes impossible. She is simply “not allowed” into the place designated by nature. During the first 48 hours after “unexpected” sexual intercourse, you run to the pharmacy or your own first aid kit (please do this so as not to make a harsher decision against your body later) and take one tablet of the drug. And after 12 hours, supplement the dose with another tablet. This method, although drastic, is quite effective.
There is also a more modern drug, produced using a different technology and allowing you to achieve the same effect by taking just one tablet containing 1.5 mg of levonorgestrel - Escapelle. This method is widely used not only in Russia and Eastern Europe, but also all over the world. The World Health Organization and the World Family Planning Association recommend it as the most appropriate method for emergency contraception.
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 of the IPO Tyumeneva L.P.
Ufa 2010
History of contraception
Modern methods of contraception
Postcoital contraception
Intrauterine contraception.
Traditional methods of contraception.
Natural contraception.
Surgical methods of contraception.
Teenage contraception.
Postpartum contraception.
Contraception in perimenopausal age.
Conclusion.
Analysis of a clinical case.
Bibliography.
Family planning- a concept that actively enters our lives. What is it and why is family planning so important for each of us, for every 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 necessary for:
the birth of desired healthy children;
regulation of intervals between pregnancies;
establishing the number of children;
controlling the choice of time of birth of the child depending on the age of the parents;
maintaining women's health;
achieving harmony in psychosexual relationships in the family;
implementation of life plans.
Reproductive health - 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 of family relationships and the general well-being of a person. One of the factors influencing the state of reproductive function is the prevention of unwanted pregnancy. Often a woman is faced with a difficult choice - to give birth to a child 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 problems. At the same time, the decision to give birth means for her a separation from her peers, leaving school (as a rule), jeopardizing further studies and acquiring a profession. Each such situation must be considered individually, carefully and with greater understanding of the problem.
Some parents, teachers, community and religious leaders express concerns that introducing youth 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 indicates the opposite. Where sexuality 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, the age of onset of sexual activity increases, which helps boys and girls 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 healthcare. It is well known that the health of children depends on the health of their parents, the course and outcome of pregnancy and childbirth.
There are 78.1 million women in Russia
Among them, the majority (38.6 million) are of childbearing age.
Only 25% of them use modern methods of contraception.
Seven out of ten pregnancies in Russia end in abortion.
2. History of contraception
People have been using contraceptive methods to prevent pregnancy for a very long time. Some methods of contraception that were used in primitive society still exist today. Below are the most interesting methods of contraception that were 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 Europeans, used vaginal rinsing with a decoction of mahogany bark and lemon. They also believed that after chewing parsley, a woman would bleed for 4 days. In Australia, for example, contraceptive lumps were prepared from fucus extract. In Sumatra and neighboring islands, opium was also used. The issue of preventing pregnancy came to the fore in the Greco-Roman Empire, in connection with the orgies that became widespread at that time. To prevent pregnancy, various substances of plant and animal origin or their decoctions were used with some success. The attitude towards these methods, for example, towards 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. Although today this brings a smile, nevertheless, the recommendation is not without common sense, given the acidifying effect of lemon on the contents of the vagina.
The use of various intrauterine devices to prevent pregnancy, primarily various beads, was also known in the Far East, China and Japan. The insertion of a loop into the uterine cavity was first used to prevent pregnancy at the beginning of the 20th century. The first such remedy was proposed in 1909 by the German gynecologist Richter: a ring made from the intestines of a silkworm, fastened with metal wire. Then a gold or silver ring with an internal disk (Ott ring) was proposed, but since 1935 the use of intrauterine contraceptives has been prohibited due to the high risk of developing inflammatory diseases of the internal genitalia. Only in the 60s of the 20th century was 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 in which 180 different spermicidal substances were described. During Subsequent research developed specific spermicidal contraceptives that could be used in the form of powders, tablets or vaginal pellets. Male condoms made from animal skin 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 their reliability continued until the end of the last century. Of particular note is an 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 in the late 50s and early 60s. The creation of more effective intrauterine devices containing copper was of great importance.
The creation of hormonal contraception was a new milestone in pregnancy prevention. The idea of hormonal contraception arose at the beginning of the 20th century, when the Austrian physician Haberland discovered that the administration of ovarian extract causes temporary sterilization. After the discovery of 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 considered to be June 1, 1961, when the drug 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. From that time on, the history of the development of combined pills began. contraceptives Hormonal contraception developed by reducing the dose of steroids (estrogens) and by creating selective (selective action) gestagens.
At the first stage, drugs were created with a high content of hormones (Enovid, Infekundin) and many serious side effects. At the second stage, contraceptives with a low content of estrogens (30-35 mcg) and gestagens with selective action appeared, which made it possible to significantly reduce the number of complications when taking them. 3rd generation drugs include products containing low (30-35 mcg) or minimal (20 mcg) doses of estrogens, as well as highly selective gestagens (norgestimate, desogestrel, gestodene, dienogest, drospirenone), which have an even greater advantage over their predecessors.
Now the hormone content in contraceptive pills is regulated by the rule “As much as necessary. As little as possible.” The first drug in “calendar” packaging was released in 1964. One tablet corresponds to each day of the week on the package. This simplifies control over taking the drug.
Modern drugs contain minimal amounts of hormones, so they very rarely cause complications and can be used without interruption for years, of course, with appropriate medical supervision.
Majority modern drugs- monophasic. All tablets in the package are the same, which ensures ease of use and guaranteed contraceptive effect.
3. Modern methods of contraception
Medicines used to prevent pregnancy are called contraceptives. Contraception is integral part family planning system and is aimed at regulating the birth rate, as well as the overall health of women.
An indicator of the effectiveness of any contraceptive method is the Pearl index - the number of pregnancies occurring within 1 year in 100 women who used one or another method of contraception.
Modern methods of contraception are divided into:
intrauterine;
hormonal;
traditional;
surgical (sterilization).
4. Hormonal contraception
Hormonal contraception has become one of the most effective and widespread methods of birth control. Tablets (dragées) are one of the most effective contraceptives today (if used correctly, the effectiveness approaches 100%). Group classification:
combined estrogen-progestogen oral contraceptives;
progestin contraceptives:
(mini-pill);
2) injection;
3) implants;
Vaginal rings with estrogens and gestagens.
Combined oral contraceptives (COCs) are tablets containing estrogen and progestogen components. Synthetic estrogen - ethinyl estradiol - is used as an estrogenic component of COCs, and various synthetic progestogens are used as a progestogen component.
The mechanism of action is diverse. The contraceptive effect is achieved as a result of blockade of the cyclic processes of the hypothalamic-pituitary system in response to the administration of steroids (the principle feedback), as well as due to the direct inhibitory effect on the ovaries. As a result, follicle growth, development and ovulation do not occur. In addition, progestogens, by increasing the viscosity of cervical mucus, make it impenetrable for sperm. Finally, the gestagenic component slows down the peristalsis of the fallopian tubes and the advancement of the egg along them, and in the endometrium causes regressive changes up to atrophy, resulting in implantation ovum, if fertilization does occur, it becomes impossible. This mechanism of action ensures high reliability of COCs. When used correctly, contraceptive effectiveness reaches almost 100%, the Pearl index is 0.05-0.5.
Based on the level of ethinyl estradiol, COCs are divided into:
high-dose (more than 35 mcg, currently not used for contraceptive purposes);
low dose (30-35 mcg)
microdosed (20 mcg)
In addition, COCs are monophasic, when all the tablets included in the package have the same composition, and multiphase (two-phase, three-phase), when the package, designed for a dosage cycle, contains 2 or 3 types of tablets different color, differing in the amount of estrogen and progestogen components. Stepped dosage causes in target organs (uterus, mammary glands) cyclical processes, reminiscent of those during a normal menstrual cycle.
Complications when taking COCs.
Due to the use of new low- and micro-dose COCs containing highly selective gestagens, side effects from the use of hormonal contraceptives are rare.
In a small percentage of women taking COCs, in the first 3 months. administration, unpleasant sensations associated with the metabolic effect of sex steroids are possible. Estrogen-dependent effects include nausea, vomiting, swelling, dizziness, heavy menstrual-like bleeding, and gestagen-dependent effects include irritability, depression, increased fatigue, decreased libido. Headache, migraine, engorgement of the mammary glands, bleeding may be due to the action of both components of the COC. Currently, these signs are considered as symptoms of adaptation to COCs; they usually do not require the prescription of corrective drugs and disappear on their own by the end of the 3rd month of regular use.
The most serious complication when taking COCs is the effect on the hemostatic system. It has been proven that the estrogen component of COCs activates the blood coagulation system, which increases the risk of thrombosis, primarily coronary and cerebral, as well as thromboembolism. The possibility of thrombotic complications depends on the dose of ethinyl estradiol included in the COC and risk factors, which include age over 35 years, smoking, arterial hypertension, hyperlipidemia, obesity, etc. It is generally accepted that the use of low- or micro-dose COCs does not have a significant effect on the system hemostasis in healthy women.
When taking COCs, the arterial pressure, which is due to the influence of the estrogenic component on the renin-angiotensin-aldosterone system. However, this phenomenon was noted only in women with an unfavorable history (hereditary predisposition, obesity, arterial hypertension in the present, OPG-gestosis in the past). No clinically significant changes in blood pressure were detected in healthy women taking COCs.
When using COCs, a number of metabolic disorders are possible:
decreased glucose tolerance and increased blood levels
(estrogenic influence), which provokes the manifestation of latent forms
diabetes mellitus;
unfavorable effect of gestagens on lipid metabolism (according to
an increase in total cholesterol and its atherogenic fractions), which increases the risk of developing atherosclerosis and vascular complications.
Increased body weight due to the anabolic effect of gestagens, fluid retention due to the influence of estrogens, and increased appetite. Modern COCs with low estrogen content and selective gestagens have virtually no effect on body weight.
Estrogens can have a slight toxic effect on the liver, manifested in a transient increase in transaminases, and cause intrahepatic cholestasis with the development of cholestatic hepatitis and jaundice. Progestins, increasing the concentration of cholesterol in bile, contribute to the formation of stones in the bile ducts and bladder.
Acne, seborrhea, hirsutism are possible when using gestagens with a pronounced androgenic effect. The highly selective gestagens currently used, on the contrary, exhibit an antiandrogenic effect and provide not only a contraceptive, but also a therapeutic effect.
A sharp deterioration in vision when using COCs is a consequence of acute retinal thrombosis and requires immediate discontinuation of the drug. It should be taken into account that COCs cause corneal edema with discomfort when using contact lenses.
A rare but concerning complication is amenorrhea that occurs after discontinuation of COCs. There is an opinion that COCs do not cause amenorrhea, but only hide hormonal disorders regular menstrual-like bleeding. Such patients must be examined for a pituitary tumor.
Long-term use of COCs changes the microecology of the vagina, contributing to the occurrence of bacterial vaginosis and vaginal candidiasis. In addition, the use of COCs is considered a risk factor for the transition of existing cervical dysplasia to carcinoma. Women taking COCs should undergo regular cytological examinations of cervical smears. Any component of the COC may cause an allergic reaction. One of the most common side effects is uterine bleeding when using COCs (from spotting to breakthrough). The causes of bleeding are a lack of hormones for a particular patient (estrogens - when bleeding appears in the first half of the cycle, gestagens - in the second half), impaired absorption of the drug (vomiting, diarrhea), missed pills, the competitive effect of other COCs taken together medicines(some antibiotics, anticonvulsants, beta blockers, etc.). In most cases, however, intermenstrual bleeding disappears on its own within the first 3 months. taking COCs and do not require discontinuation of contraceptives.
COCs do not have a negative effect on fertility in the future (it is restored in most cases within the first 3 months after discontinuation of the drug), and do not increase the risk of fetal defects. Accidental use of modern hormonal contraceptives in early dates pregnancy does not produce a mutagenic or teratogenic effect and does not require termination of pregnancy.
The contraceptive advantages of COCs include:
high efficiency and almost immediate contraceptive effect;
reversibility of the method;
low incidence of side effects;
good fertility control;
lack of connection with sexual intercourse and influence on the sexual partner;
eliminating the fear of unwanted pregnancy;
ease of use.
reduction in the risk of developing ovarian cancer (by 45-50%), endometrial cancer (by 50 – 60%), benign diseases of the mammary glands (50- 757о), uterine fibroids, postmenopausal osteoporosis (increased mineralization of bone tissue);
reduction in the incidence of inflammatory diseases of the pelvic organs (by 50-70%) as a result of increased viscosity of cervical mucus, ectopic pregnancy, retention formations (cysts) of the ovary (up to 90%), iron deficiency anemia due to less blood loss during menstrual-like discharge than during normal menstruation;
weakening of symptoms of premenstrual syndrome and dysmenorrhea;
therapeutic effect for acne, seborrhea, hirsutism (for 3rd generation COCs), for endometriosis, for uncomplicated ectopia of the cervix (for three-phase COCs), for some forms of infertility accompanied by ovulation disorders (rebound effect after discontinuation of COCs);
increasing the acceptability of ICH;
positive effect on the course of gastric and duodenal ulcers, rheumatoid arthritis.
Disadvantages of the method:
the need for daily intake,
possibility of receiving errors,
lack of protection against sexually transmitted infections,
decrease in the effectiveness of COCs with simultaneous
taking other medications.
in the post-abortion period;
in the postpartum period (3 weeks after birth, if the woman is not breastfeeding);
with a history of ectopic pregnancy;
survivors of inflammatory diseases of the pelvic organs; with menometrorrhagia; with iron deficiency anemia;
with endometriosis, fibrocystic mastopathy(for monophasic COCs);
With premenstrual syndrome, dysmenorrhea, ovulatory syndrome;
with retention formations of the ovaries (for monophasic COCs);
with acne, seborrhea, hirsutism (for COCs with 3rd generation gestagens).
Absolute contraindications to the use of COCs:
hormonal dependent malignant tumors(tumors of the genital organs, breast) and liver tumors;
severe dysfunction of the liver and kidneys;
pregnancy;
heavy cardiovascular diseases, vascular diseases of the brain;
bleeding from the genital tract of unknown etiology;
severe arterial hypertension (blood pressure higher than
180/110 mm Hg. Art.);
migraine with focal neurological symptoms;
acute deep vein thrombosis, thromboembolism;
long-term immobilization;
period 4 weeks before and 2 weeks after abdominal surgery (increased risk of thrombotic complications);
smoking in combination with age over 35 years;
diabetes mellitus with vascular complications;
obesity 3-4 degrees;
lactation (estrogens pass into breast milk).
Conditions requiring immediate discontinuation 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 abdominal pain, especially prolonged;
sudden pain in the legs;
significant increase in blood pressure;
itching, jaundice; skin rash.
COCs are started to be taken from the 1st day of the menstrual cycle, 1 tablet daily at the same time of day for 21 days.
It should be remembered that multiphase drugs must be taken in a strictly specified sequence. Then they take a 7-day break, during which a menstrual-like reaction occurs, after which they begin a new cycle of administration. When performing an artificial abortion, you can start taking COCs on the day of the operation. If a woman does not breastfeed, the need for contraception arises 3 weeks after birth.
There is another scheme for using monophasic COCs: a woman takes 3 cycles of pills in a row, then taking a 7-day break.
If the interval between taking pills is more than 36 hours, the reliability of the contraceptive effect is not guaranteed. If a pill is missed in the 1st or 2nd week of the cycle, then the next day you need to take 2 tablets, and take the next pills as usual, using additional contraception for 7 days. If you missed 2 tablets in a row in the 1st or 2nd week, then in the next 2 days you should take 2 tablets, then continue taking the tablets according to the usual scheme using additional methods of contraception until the end of the cycle. If you miss a pill in the last week of your cycle, it is recommended to start taking the next pack without interruption.
At correct selection- COCs are safe. The duration of use does not increase the risk of complications, so you can use COCs for as many years as necessary, until the onset of postmenopause. It has been proven that taking breaks in taking medications is not only unnecessary, but also risky, since during this period the likelihood of unwanted pregnancy increases.