What contraceptives exist? Absolute contraindications for the intrauterine device. The best birth control pills

Contraceptives are divided into several types:

• barrier,
• chemical,
• hormonal (including mechanical hormone releasers),
• intrauterine devices,
• sterilization.

Reliability of contraception- this is the probability of not getting pregnant within a year if you constantly (and correctly) use this contraceptive. This Not the likelihood of becoming pregnant after one sexual intercourse.

For example, 98% reliability for male condoms means that if 100 women protect themselves using (correctly worn) male condoms at every sexual intercourse for a year, then no more than 2 of them will have a chance of getting pregnant in that year, of which -for various failures. Of course, all such reliability calculations are only approximate.

All contraceptive methods except sterilization have limited reliability, since each method has failures. How to achieve greater security? Firstly, when using two methods of contraception at the same time, reliability increases dramatically, because it is extremely unlikely that two methods at the same time will fail. Secondly, if there is an obvious contraceptive failure such as a broken condom, you can use emergency contraception, otherwise called post-coital pills.

Barrier contraceptives

Barrier contraceptives prevent live sperm from entering the uterus. They do not have long-term effects on the body of a woman or man. These include:

• male and female condoms,
• vaginal diaphragms and
• cervical (cervical) caps.

The condom is the most important means of contraception at the moment, because when used correctly, it reliably prevents not only pregnancy, but also the transmission of infections, including HIV and hepatitis.

Disadvantages: requires a stable erection; may tear.

The use of a condom is under the control of the man, while the negative consequences of improper use - unwanted pregnancy - mainly fall on the woman. Both partners are at risk of contracting sexually transmitted diseases (STDs).

Many men refuse to use condoms, believing that they reduce the intensity of sensations, obviously without comparing them with the intensity of sensations a woman experiences during an abortion. In fact, there are condoms with special surfaces that improve the sensation of both partners, which are recommended even for men who have difficulty achieving orgasm.

Condoms are also used to protect against the transmission of infections during oral and anal sex.

Reliability: 98%

Female condom – a polyurethane tube with a diameter of 8 cm and a length of 15 cm. Placed in the vagina and protects the mucous membranes of partners from direct contact.

Like the male condom, it prevents pregnancy and the transmission of infections. Can be used for weak erections. May remain in the vagina for several hours.

Disadvantages: currently not sold in Russia.
Reliability: 95%

Vaginal diaphragms and cervical caps.

Caps and softer elastic diaphragms made of various materials(silicone, latex) are used together with spermicidal ointments. They are placed in the vagina so as to prevent sperm from entering the uterus, and are removed no earlier than 6 hours after the last ejaculation. Reduce the risk of transmission of certain infections. Does not prevent HIV infection. Can be used repeatedly (usually for 1-2 years). To choose the appropriate cap or diaphragm size, you need to consult a gynecologist.

Disadvantages of caps: Less effective for women who have given birth. You need to re-size after giving birth. May cause inconvenience to partners.

Disadvantages of diaphragms: You need to reselect the size after childbirth and with a significant (from 5 kg) change in weight. May increase the risk of certain infections and inflammation of the cervix.

Reliability: 85-95%.

Chemical contraceptives

These include vaginal creams, suppositories, tampons.

One of the easiest to use means, which also have not only contraceptive properties, but also protect against bacteria and viruses, in particular against chlamydia, staphylococci, herpes type 2. However, this type of contraception is more suitable for people who have irregular sex life , since the antiseptic not only destroys sperm and kills some viruses, but also disrupts the microflora, which can cause vaginal dysbiosis. It is best to use these products in combination with a condom, because their duration of action is short (with the exception of tampons) and repeated intercourse requires reintroduction of the contraceptive. It is also important to remember that upon contact with soap (with any alkaline medium), the active substance of the drugs is destroyed, so all washing before and after sexual intercourse is possible only with clean water.

Chemical contraceptives: Pharmatex ( vaginal suppositories, cream, tampons); "Patentex-Oval" (candles); "Nonoxynol" or "Conceptrol"; "Sterilin" (candles).

Reliability: 75-80%

Hormonal contraceptives

Currently, only female hormonal birth control medications are widely available. Male hormonal contraceptives exist, but are still in the research stage and are not widely used.

The principle of action of women's hormonal contraceptives is that they prevent ovulation.

Modern hormonal contraceptives come in many forms: pills (combined containing two hormones, progesterone and estrogen, as well as purely progestogenic, or mini-pill), implants(there are none in Russia) and injectable drugs. IN different means contain different doses of hormones. To choose the most suitable hormonal contraceptive, you need to contact a gynecologist and do a blood test for hormones.

Hormonal contraceptives have some contraindications and side effects. But if first-generation contraceptives could cause serious complications, then correctly selected modern means quite harmless. Contrary to popular belief, not all hormonal contraceptives cause weight gain.

Combined oral contraceptives taken every day for 21 days menstrual cycle; mini-pill– every day throughout the entire cycle, and it is important to take them at the same time of day.

Injections hormonal contraceptives are taken every 2-3 months. They are indicated only for women over 35 who have given birth, as they can disrupt the menstrual cycle. Injections do not protect against STDs.
Drugs: Depo-Provera, Net-En (Noristerat).

Reliability: 96.5-97%

To hormonal means of prevention unwanted pregnancy include postcoital pills , or emergency contraception. They are taken after unprotected sexual intercourse and prevent the egg from maturing (and then it cannot be fertilized), or, if it is already mature and fertilized, they prevent it from attaching to the wall of the uterus. Emergency contraception is effective in the first five days after intercourse, and it is best to take it the next day. In any case, you should carefully read the instructions before using.

There are often misconceptions about the mechanism of action of postcoital pills. For example, people sometimes believe that they are "scraping out the lining of the uterus." To be frank, this is complete nonsense.

In Russia, the most widely known of these drugs is Postinor. It quite strongly destabilizes hormonal levels, so its frequent use can cause very serious complications. There are newer and safe drugs(for example, “Ginepriston”), in which the dose of the hormone is much lower. However, it is important to remember that all postcoital medications are emergency contraception and should not be used regularly. At the same time, emergency contraception is much more gentle on the body than even the safest one. medical abortion. Therefore you should not use emergency contraception How the only way protection, but if for some reason unprotected sexual intercourse occurs, and the pregnancy, if it happens, will still be terminated, then it is much better to use emergency contraception.

Reliability: 97%

Mechanical contraceptives that release hormones

This is the NuvaRing vaginal ring and contraceptive patch"Eura".

NuvaRing ring It is made of elastic material and, when inserted into the vagina, adapts to the contours of the woman’s body. The ring does not reduce the sensitivity of partners, does not prevent a woman from playing sports, does not affect blood clotting (varicose veins of the lower extremities, which to one degree or another happens from birth control pills), but it does not protect against STDs.

One ring is designed for one cycle; on the 22nd day it is removed, and a week later a new one is inserted.

Reliability: 99%

"Evra" patch Small in size, it can be glued to almost any part of the body. The patch is changed every week and is not used during the fourth week of the cycle.

Disadvantages: Contraindicated for women who smoke 10 or more cigarettes per day. Safe and effective only for women between 18 and 45 years of age. Does not protect against STDs.

Reliability: 99.4%

Intrauterine devices (IUD)

Spirals can be like hormonal, so non-hormonal. But both are inserted into the uterine cavity for a maximum of 5 years, after which the IUD must be removed and a new one inserted during the next menstruation. Only a gynecologist can install the IUD.

Regular IUD prevents the fertilized egg from attaching to the wall of the uterus and, therefore, developing into an embryo; it reduces the vital activity of sperm and eggs.

Hormonal IUD Constantly releases the hormone levonorgestrel (a synthetic analogue of progestogen), which even more reliably protects against unwanted pregnancy.

Despite its popularity and ease of use, this type of contraception is quite dangerous due to the risk of ectopic pregnancy. He has long list contraindications and does not protect against STDs.

Reliability: 75-80%

Sterilization – one of the methods of contraception (not to be confused with castration). Sterilization involves creating an artificial obstruction of the fallopian tubes in women and the vas deferens in men. In this case, neither the ovaries nor the testicles are removed, continuing to function fully. Sterilization does not have a negative impact on a person's sex life.

In Russia, sterilization surgery is permitted only upon written application from citizens who are at least 35 years old or have two or more children.

Reliability: 100%(for men it reaches 100% one and a half years after surgery).

Disadvantages: performed in a hospital; the probability of restoration of fertility is not one hundred percent and is low in women; Women who regain fertility are at risk of ectopic pregnancy.

Male sterilization called a vasectomy.
A vasectomy is performed only with the voluntary, informed consent of the man. The wife's consent is not required. The operation is always carried out for a fee.

Currently practiced in the Russian Federation surgical And no-scalpel vasectomy methods.

The surgery is performed under local anesthesia. If there are no complications, the man remains in the hospital for one day. After three to five days he can resume sexual activity. After a vasectomy, men need to use other methods of contraception for about three months, since during this time the semen may contain active sperm. Within 17 months after surgery, the patency of the vas deferens may spontaneously recover, so it is necessary to do a semen analysis for the presence of live sperm.

Currently, microsurgery methods make it possible, with a reasonable degree of probability, to restore reproductive function in men by restoring the vas deferens.

Scientists are also developing a method of ultrasonic vasectomy, which leads to temporary sterilization (for several months).

Female sterilization called tubal occlusion. It is carried out in a hospital and can be carried out in three ways.

Laparotomy – abdominal surgery, the abdominal incision reaches 20 cm. This method has many complications and leads to the formation of scars and scars. By medical indications is carried out free of charge.

Minilaparotomy It is performed through a 2-5 cm long incision under local anesthesia.

Laparoscopy– an operation during which the surgeon makes 3-4 incisions 1 cm long and carries out all the necessary procedures using special equipment and a video camera. In the absence of complications after laparotomy, women are discharged from the hospital on days 7-10, after laparoscopy - on days 2-3. Rehabilitation period ranges from a week to a month.

Minilaparotomy and laparoscopy are included in the list paid services. Tubal occlusion is performed only with the voluntary informed consent of the patient. Spousal consent is not required.

Restoring fertility (the ability to bear children) is possible using microsurgery methods, but the success rate of these operations is still low. When artificially restoring fertility in women, there is a risk of ectopic pregnancy.

Maria Sokolova

Reading time: 12 minutes

A A

Most of modern methods contraception does not provide a 100% guarantee, especially since more than a third of women become pregnant using one method or another.

What methods for preventing pregnancy are considered the least reliable?

Calendar method and calculation of safe days - does it make sense?

Basis of the method– calculation of safe days. How to determine these safe days? The viability of sperm is about three days, fertilization of the egg occurs within two days after ovulation . Thus, two days should be added to the day of ovulation (in both directions): for a cycle of thirty days it will be the fifteenth day, for a cycle of twenty-eight days it will be the thirteenth. It is believed that it is on these days that there is a risk of getting pregnant, but on the rest you can “not worry.”

Flaw:

The main disadvantage is that the method good only for ideal cycle . But are there many women who can boast of this? After all, the time of ovulation is influenced by many factors:

• Weather
• Chronic diseases
• Stress
• Other factors

Not to mention the fact that there are women who become pregnant during what seems to be a safe period. Therefore, before using this method, you must at least study your cycle for a whole year . According to statistics, every fourth woman becomes pregnant after using calendar method.

Does the temperature method of protection work?

The basis of the temperature method of contraception
A woman’s temperature (measured rectally) changes according to the stage of egg maturation: below 37 degrees – before ovulation, above 37 – after . Safe days are determined as follows: the temperature is measured every morning for six months to a year (right in bed, for at least five to ten minutes). Next, the results obtained are compared, the day of ovulation is identified, and the period dangerous for pregnancy is calculated. It usually starts 4 days before ovulation and ends four days after.

Flaw:

Just like the calendar, this method applicable only if the menstrual cycle is ideal . In addition, it is very complex in its calculations.

Coitus interruptus

Basis of the method known to everyone - interruption of sexual intercourse before ejaculation.

Disadvantage of the method:

The unreliability of this method occurs even with the man’s complete self-control. Why? A separate amount of sperm may be released from the very beginning of sexual intercourse . Moreover, it remains unnoticed by both partners.

Also, the low effectiveness of the method can be explained by the presence of sperm in the urethra, preserved from the previous ejaculation. Out of one hundred women using this method, thirty become pregnant.

Douching after intercourse

Basis of the method– douching of the vagina with potassium permanganate, your own urine, herbal decoctions and other liquids.

Disadvantage of the method:

This method is dangerous not only due to pregnancy, which you did not plan at all, but also with such consequences as:

• Violation of the vaginal microflora.
• Infection in the vagina.
• Vaginitis.

There was no evidence of the effectiveness of the douching method, and no. It does not protect against pregnancy.

Spermicidal lubricants - how reliable is the method?

Basis of the method– use of creams, suppositories, jellies and foams with spermicides. These products have a double effect:

• Filler creates mechanical boundary .
• Special component eliminates sperm .

Flaw:

Of one hundred percent of women who use spermicides, one in three becomes pregnant. That is, the method is not 100% effective. The following disadvantages of the method should also be noted:

• Certain types of spermicides lose effectiveness with regular use due to the habituation of the organisms of both partners to them.
• Spermicides considered hazardous due to nonoxynol-9 content which causes destruction skin. And cracks in the genitals are a direct path for infection.
• Violation of instructions for the use of spermicides multiplies the risk of pregnancy .

When do oral contraceptives fail?

Basis of the method– regular intake hormonal drugs (tablets). Typically, out of one hundred percent of women who practice this method of protection against pregnancy, five percent become pregnant.

Disadvantage of the method:

• Poor memory often causes pregnancy: you forgot to take a pill, and the concentration in the body of a substance necessary for protection decreases. And by the way, you need to drink them constantly and for a very long time .
• It is also impossible not to note the main disadvantage of such tablets. Namely - consequences for the body , even if these are fourth generation hormones. Possible consequences - metabolic disorders, weight gain,...
• In parallel.
• Many medicines reduce or even completely eliminate efficiency this protection against pregnancy.
• This method of contraception does not protect against sexually transmitted diseases .

Our people have always been cunning in their invention, as a result of which, since ancient times, the people have had many of their own “home” methods of contraception, which, of course, are absolutely useless.

The most unreliable and dangerous contraception - traditional methods

• A tampon in the vagina during sexual intercourse. Ineffective and dangerous: disruption of the vaginal microflora, risk of injury, and there is no question of dubious pleasure for both partners. As for the effect, a tampon will not protect against pregnancy.
• Lactation. It is believed that it is impossible to get pregnant during this period. Of course, given that the menstrual cycle does not improve immediately after childbirth, the risk of becoming pregnant is reduced, but it is certainly not excluded. And it’s impossible to guess whether your reproductive system has already woken up. Many nursing mothers, naively believing that they were “protected by lactation,” became pregnant within a couple of months after giving birth. Therefore, hoping that you will be “carried away” is, at a minimum, imprudent.
• Gynecological diseases. This is another mythical “protection” against pregnancy. In fact, there is only one female disease eliminates the risk of getting pregnant - this.
• Vaginal douche. Another fairy tale that the strong pressure of water, which is used to wash the vagina after sexual intercourse, can “wash away” sperm. Don't believe it. While you were running from the bed to the bathroom, the sperm could already have “jumped” to the treasured egg.
• Lemon inside. The myth is that creating an acidic environment in the vagina ensures the death of sperm. What naive women don’t use – lemon peels and citric acid in powder, and boric acid, and even ascorbic acid! The only effect of this procedure is an internal burn of the mucous membrane due to an overdose of acid.
• Herbal decoctions.“And my grandmother (friend...) advised me...” This folk method is not even worth commenting on. Can you imagine how much you need to drink this (any) decoction, and what concentration it must be in order to “drown” all the sperm in it? This also includes an infusion of bay leaves after sex and beetroot juice - gastronomic, but useless.
• Soap laundry soap inserted into the vagina. Likewise. No effect, except for microflora disruption, bacterial vaginosis and other “joys”.
• Douching. As a rule, this method is used by young inventors, using Pepsi-Cola, urine, potassium permanganate, etc. as a protective agent. The use of Pepsi-Cola (which, by the way, can descale a kettle) leads to vaginal diseases. This is a very strong chemical that does not prevent pregnancy. Urine also has no contraceptive properties. But there is a possibility of introducing an infection along with urine. As for potassium permanganate - it contraceptive effect so small that such douching will not help against pregnancy. A strong concentration of potassium permanganate will cause a very serious burn to the mucous membrane.
• An aspirin tablet inserted into the vagina after sex. Extremely low efficiency of the method. Equivalent to the method with potassium permanganate.
• Jumping after sex. You might as well drink a cup of coffee and smoke after sex. Sperm are not dice and cannot be shaken out of the vagina. And their speed of movement, by the way, is three millimeters per minute.
• Steam the legs in mustard. An absolutely pointless procedure. And it’s hard to imagine how a girl, after an act of love, rushes for a basin to soak her feet.
• Rubbing the head of the penis with cologne before sexual intercourse. Ineffective. In addition, you should remember about those “unforgettable” sensations that await a man after this procedure.
• “You can’t get pregnant on your period!” Absolutely untrue. No, for many women, menstruation is indeed a period during which it is impossible to get pregnant. But there are so many exceptions that considering menstruation a protection, according to at least, unreasonable. Moreover, taking into account the fact that the survival rate of sperm in the uterine mucosa is up to three days. These “tailed ones” are very, very tenacious.

In such a matter as protection against unwanted pregnancy, trust dubious traditional methods not worth it.

We do not live in ancient times, and today every woman has the opportunity go for a consultation with a specialist and choose the ideal contraception option for yourself .

There are more than 20 methods of protection against unwanted pregnancy, which differ in degree of effectiveness. What methods of contraception are the most reliable?

1. Hormonal implant: 99.95% reliability

Contraceptive implants are small ampoules implanted under the skin under local anesthesia. Every day, the implant releases a small dose of a hormone into the bloodstream that suppresses the work of the ovaries and high degree reliably protects against unwanted pregnancy. Validity period is from 3 to 5 years. The most famous hormonal contraceptive implants: Implanon, Norplant.

2. Male sterilization (vasectomy): 99.85% reliability

A vasectomy is a short-term surgical procedure general anesthesia, during which the doctor disrupts the patency of the vas deferens. Vasectomy should not be confused with castration: after vasectomy, the production of male sex hormones and a man’s ability to have a full erection are not impaired in any way. At the end of sexual intercourse, a man will also release ejaculate, which, however, will not contain sperm. This means that even with unprotected intercourse and sperm entering the vagina, a woman will not be able to get pregnant. Duration: After a vasectomy, a man will never be able to conceive a child again.

3. Hormonal intrauterine device: 99.8% reliability

The intrauterine device (IUD) is a very reliable method of contraception, which is installed in the uterine cavity and causes processes in it that prevent pregnancy. Hormonal IUDs, in addition to mechanical impact on the uterus, they release small doses of hormones into its cavity, which significantly enhance the contraceptive effect. Validity period: from 3 to 5 years. The most famous hormonal intrauterine devices: Levonov. Non-hormonal intrauterine devices have lower reliability (about 99.2%).

4. Hormonal injection: 99.7% reliability

After the drug is injected into the muscle, every day it releases a small dose of a hormone into the blood that suppresses the functioning of the ovaries. The contraceptive injection provides reliable protection from pregnancy for 2-3 months, after which the injection must be repeated. Despite the high effectiveness of hormonal injections in preventing pregnancy, this method of contraception is associated with possible side effects such as spotting, cessation of menstruation, decreased sexual desire and with some other symptoms resembling menopause. Most famous drug: Depo-provera.

5. Tubal ligation: 99.5% reliable

The fallopian tubes are the channels through which the egg enters the uterus. It is in the fallopian tubes that fertilization of an egg with a sperm most often occurs. Tubal ligation is an operation during which the surgeon disrupts the patency of the fallopian tubes, and therefore makes it impossible to fertilize the egg. After such an operation, a woman will no longer be able to become pregnant naturally.

6. Birth control pills: reliability up to 97%

Combined oral contraceptives (COCs) are perhaps one of the most well-known and popular methods of protection against unwanted pregnancy. The effectiveness of birth control pills greatly depends on how responsibly the woman approaches their use. Provided that everyone is followed, their effectiveness is very high. However, even a small mistake (being late or missing a pill, taking certain medications, alcohol abuse, etc.) can lead to an unwanted pregnancy. Read about all the advantages and disadvantages of hormonal contraceptives in the article:. The most famous drugs:, etc.

7. Hormonal patch: 92% reliability

The contraceptive patch is a sticker on the skin that releases a small dose of a hormone into the blood each day that suppresses the ovaries. The hormonal patch has high efficiency and greater ease of use than birth control pills. The fact is that the patch only needs to be changed once a week (unlike tablets, which need to be taken every day). The most famous drug: .

8. Hormonal ring: 92% reliability

Hormonal ring is a small flexible device that is inserted deep into the vagina. After insertion, the ring releases a small dose of hormones into the blood every day, suppressing the work of the ovaries. The ring is not felt in any way by either the woman or her sexual partner. The ring needs to be changed every three weeks. The most famous drug: .

Today there are the following types of contraception: barrier, chemical and hormonal.

Contraceptive reliability refers to the chance of getting pregnant within a year when using a specific type of protection. Simply put, if the reliability is 99%, then only 1 girl out of 100 can become pregnant using this product for a year.

This type of protection is aimed at preventing sperm from entering the uterus. These include:

1. . It has a significant advantage - it prevents the transmission of infections. The disadvantages include the possibility of tearing at any time. The condom protects 98%.
2. Diaphragms and caps. They can be used several times over a period of 2 years. This option also has disadvantages: it does not protect against HIV and various infections. Protects in 85-95% of cases.

Types of hormonal contraception

They are aimed at preventing ovulation. The reliability of such funds is about 97%. You can purchase them in completely different forms:

1. Pills. They must be consumed every day at the same time for 21 days (combined) or throughout the entire cycle (mini-pill).
2. Injections. The injection is given no more than 3 times monthly. This type of contraception can only be used by women who have given birth and are over 35 years old.

Their action is aimed at preventing the egg from maturing and attaching to the wall of the uterus. Apply after unprotected sex. They are effective for 5 days after sex, but to be sure of their effect, it is recommended to use them as quickly as possible. It is better to use this protection option once every six months. The protection works in 97% of cases.

Modern types of contraception

These include mechanical contraceptives that release hormones:

1. Vaginal ring. This option is valid for one cycle. The reliability of the ring is 99%.
2. Patch. It can be glued to any part of the body and changed weekly. Reliability – 99.4%.
3. Other options:
4. Intrauterine devices. Injected into the uterine cavity for 5 years. Disadvantage - opportunity intrauterine pregnancy. Protects in 80% of cases.
5. Sterilization. Involves creating obstruction of the fallopian tubes. Reliability 100%.

The modern rhythm of life dictates its own rules to us. It gives people many possibilities and restrictions. He gives us, perhaps, the most important thing - the right to choose. Modern couples in everyone special case They themselves decide the important issue of their offspring, and when choosing contraception, couples are often lost in the multifaceted abundance of contraceptive methods offered. In this article we will tell you what type of contraception is preferable and in what situations, reviews of contraception and some secrets.

Contraception from novolat. contraceptio - literally - contraception.

Natural method of contraception

Natural methods of contraception differ from others in that when they are used, no other methods of contraception, such as barrier methods, are used during sexual intercourse.

Calendar method of contraception

This method is based on the fact that, ideally, if a woman’s cycle is 28 days, then ovulation usually occurs on the 14th day. Considering the viability of sperm and eggs, a woman, in order to avoid an unwanted pregnancy, should not have unprotected sex two days before and two days after ovulation.

How to use the calendar method of contraception correctly

• For the use of the calendar method to be most accurate, a woman needs to keep menstrual calendar, noting the duration of each menstrual cycle for at least 8 months;
• A woman should identify her shortest and longest menstrual cycles;
• Using the method for calculating the interval of possibility of conception, it is necessary to find the first “fertile day” (the day when pregnancy is possible) according to the shortest menstrual cycle, and the last “fertile day” according to the longest menstrual cycle;
• Considering the duration of the current menstrual cycle, determine the interval of opportunity to become pregnant;
• During this period, you can either completely abstain from sexual activity, or use barrier methods and spermicides.

Temperature method of contraception

The temperature method of contraception is based on determining the time of rise in basal temperature by measuring it daily. The period from the beginning of the menstrual cycle until her basal temperature is increased for three consecutive days is considered favorable for conception.

How to use the temperature method of contraception correctly

• The most important rule for using the temperature method of contraception is to measure your basal temperature at the same time in the morning, without getting out of bed;
• In the evening, prepare everything you need to measure your basal temperature and place it in close proximity to your bed.

Cervical method of contraception

This method is based on observations of change vaginal discharge during the menstrual cycle. Known as the method of natural family planning (Billing method). After menstruation and in the period before ovulation cervical mucus absent or observed in small quantities with a white or yellowish tint. In the days immediately before ovulation, the mucus becomes more abundant, light and elastic, the stretching of the mucus between the thumb and forefinger reaches 8-10 cm. Ovulation is observed a day after the disappearance of the characteristic mucus (in this case, the fertile period will continue for an additional 4 days after the disappearance of light, elastic secretions).

Symptothermal method of contraception

The symptothermal method of contraception is a method that combines elements of the calendar, cervical and temperature, taking into account such signs as the appearance of pain in the lower abdomen and scanty bleeding during ovulation.

Coitus interruptus as a method of contraception

The principle of the coitus interruptus method is that the man removes the penis from the vagina before he ejaculates. In this method, the most important thing is the man’s control and reaction J

Lactational amenorrhea method (LAM) as a type of contraception

Contraceptive effect breastfeeding within 6 months after the birth of the child. You can count on its effectiveness only if all feeding conditions are met. Its effectiveness is gradually decreasing.

Barrier methods of contraception

Today, one of the most popular types of contraception is the barrier method of contraception. Barrier methods are traditional and the most ancient. In the first half of our century various shapes barrier methods were the only contraceptives. The appearance of more effective ways contraception over the past 20 years has significantly reduced the popularity of barrier methods. However, complications that may arise when using more modern methods contraception, contraindications to use, as well as the significant prevalence of sexually transmitted diseases, force the improvement of barrier methods of contraception.

Barrier methods of contraception are divided into:

• Women's: non-medicinal barrier and medicinal agents;
• Men's barrier products.

The principles of action of barrier contraceptives are to block the penetration of sperm into the cervical mucus.

Advantages of barrier methods of contraception:

• are applied and act only locally, without causing systemic changes;
• have a small number side effects;
• significantly protect against sexually transmitted diseases;
• have virtually no contraindications for use;
• do not require consultation with qualified medical personnel.

The use of barrier methods of contraception is better in the following cases:

• contraindications to the use of oral contraceptives and IUDs ( intrauterine device);
• during lactation, since they do not affect either the quantity or quality of milk;
• in the first cycle of taking oral contraceptives from the 5th day of the cycle, when the own activity of the ovaries is not yet completely suppressed;
• if necessary, take medications that are not compatible with OK or reduce their effectiveness;
• after spontaneous abortion until a period favorable for a new pregnancy arrives;
• as a temporary remedy before sterilization of a man or woman.

Disadvantages of barrier methods:

• are less effective compared to most oral contraceptives and intrauterine devices;
• in some patients, use is not possible due to an allergy to rubber, latex or polyurethane;
• their successful application requires constant attention;
• use requires certain manipulations on the genitals;
• Most barrier contraceptives should be used during or immediately before sexual intercourse.

Barrier contraception for women

Vaginal diaphragm (vaginal pessary)

The vaginal diaphragm is used for contraception alone or in combination with spermicides. The vaginal diaphragm prevents sperm from entering the uterus. It is a dome-shaped rubber cap with a flexible rim, which is inserted into the vagina before sexual intercourse so that the posterior rim is in the posterior vaginal fornix, the anterior one touches pubic bone, and the dome would cover the cervix. There are diaphragms different sizes: from 50 to 150 mm. For nulliparous women Usually a vaginal diaphragm measuring 60-65 mm is suitable, and women who have given birth use a vaginal diaphragm measuring 70-75 mm. After childbirth or loss of weight, the size must be selected again.

How to use a vaginal diaphragm

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

Procedure for installing a vaginal diaphragm:

1. The gynecologist examines the woman and selects the diaphragm according to size and type.
2. Diaphragm insertion: two fingers right hand a woman, squatting or lying on her back, inserts the diaphragm into the vagina (with her left hand, the woman spreads the labia) in a compressed form from above and moves it along the posterior wall of the vagina until she reaches the posterior vaginal fornix. Then the part of the edge that passed last is pushed upward until it contacts the lower edge of the pubic bone.
3. After insertion of the diaphragm, the woman should check the position of the diaphragm covering the cervix.
4. The health care provider rechecks to determine whether the woman inserted the diaphragm correctly.
5. The vaginal diaphragm should be removed index finger by pulling down by the leading edge. If difficulties arise, the woman should push. After removing the diaphragm, it should be washed with hot water and soap, dried and placed in a 50-70% alcohol solution for 20 minutes.

Benefits of the vaginal diaphragm:

• ease of use;
• reusability;
• harmless and largely protect against sexually transmitted infections.

Contraindications to the use of a vaginal diaphragm:

• endocervicitis;
• colpitis;
• cervical erosion;
• allergy to rubber and spermicides;
• abnormalities of genital development;
• prolapse of the walls of the vagina and uterus.

Side effects of vaginal diaphragm:

• possible infection urinary tract due to pressure of the diaphragm on the urethra;
• Inflammatory processes may occur at the points of contact of the diaphragm with the walls of the vagina.

Cervical caps

A latex or silicone cap that covers the cervix; more reliable when used simultaneously with spermicides. There are currently three types of cervical caps made from latex rubber.

Prentif's cervical cap is deep, soft, rubber, with a hard rim and a recess to enhance suction. With its rim it fits tightly near the junction of the cervix and vaginal vaults. Prentif cap dimensions: 22, 25, 28, 31 mm (outer rim diameter).

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

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

When placed, the cap covers the cervix, fornix, and upper part of the vagina and is held in place by the vaginal walls rather than by adhesion to the cervix.

Instructions for use of the uterine cap

The appropriate type and size of cervical cap is determined during an examination by a gynecologist based on the shape and size of the cervix. Insertion through the vaginal opening is facilitated by compressing the edges, and placement over the cervix is ​​facilitated by tilting the cap into the vagina. Before inserting the cap, place it on inner surface you need to apply a spermicidal drug. After a medical professional has installed a cap on a woman, he must explain to her how to check that the product is installed correctly and whether it covers the cervix. The woman then removes the cap and reinserts it, while the health care provider checks that she is doing it correctly. It is not recommended to leave the cap in the vagina for more than 4 hours.

Female condom

The female condom is a tube made of polyurethane or latex inserted into the vagina.

Barrier contraception methods for men

Condom

Condom is the only thing contraceptive used by men. The condom is a sac-shaped formation made of thick elastic rubber, about 1 mm thick, which makes it possible to increase the condom depending on the size of the penis. Condom length 10 cm, width 2.5 cm.

How to use a condom

A rolled condom is placed on the erect penis when the head is not covered by the foreskin.

Disadvantages and side effects of a condom (both male and female):

• there may be a decrease in sexual sensation in one or both partners;
• the need to use a condom at a certain stage of sexual intercourse;
• you may be allergic to latex rubber or the lubricant used in the condom;
• The condom may break.

Advantages of a condom (both male and female):

• the condom is easy to use;
• a condom is used immediately before sexual intercourse;
• A condom protects against sexually transmitted diseases and HIV infection.

At the moment, the condom and femid (female condom) are the only means of contraception that protect against sexually transmitted diseases, including HIV infection, so they can also be used in addition to other (hormonal, chemical) contraceptive methods (“safe sex”) "). At the same time, along with protection against infections, the contraceptive effect increases.

Chemical contraceptives (spermicides)

The mechanism of action of spermicides is to inactivate sperm and prevent its penetration into the uterus. The main requirement for spermicides is the ability to destroy sperm in a few seconds.

Spermicides are available in various forms, namely:

• cream;
• jelly;
• foam aerosols;
• melting candles;
• foaming suppositories and tablets.

Some women use douching after sexual intercourse for contraception with solutions that have a spermicidal effect, acetic, boric or lactic acid, lemon juice. Considering the data that 90 seconds after sexual intercourse, sperm are detected in the fallopian tubes, douching with a spermicidal drug cannot be considered a reliable method of contraception.

Modern spermicides consist of a sperm-killing substance and a carrier. Both components play the same important role in providing a contraceptive effect. The carrier ensures distribution chemical substance into the vagina, enveloping the cervix and supporting it so that no sperm can escape contact with the spermicidal ingredient.

How to use spermicides

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

Benefits of spermicides:

• ease of use;
• providing a certain degree of protection against certain sexually transmitted diseases;
• they are simple backup agents in the first cycle of oral contraceptives.

Disadvantages of spermicides:

• limited period of effectiveness and the need for some manipulation of the genitals.

Hormonal types of contraception

Hormonal drugs act differently, depending on their composition.

Combined oral contraceptives (COCs)

These drugs are the most common form in the world hormonal contraception. Contains estrogen and progestin.

Depending on the dose of estrogen and the type of progestogen components, OCs may have a predominantly estrogenic, androgenic or anabolic effect.

Mechanism of action of oral contraceptives

The mechanism of action of OK is based on the blockade of ovulation, implantation, changes in gamete transport and the function of the corpus luteum.

Blocking ovulation with COCs

The primary mechanism for blocking ovulation is suppression of the secretion of gonadotropin-releasing hormone (GTR) by the hypothalamus. The secretion of pituitary gonadotropic hormones (FSH and L) is inhibited. An indicator of hormonal suppression of ovulation is the absence of an estrogen peak in the middle of the menstrual cycle and inhibition of the normal postovulatory increase in serum progesterone. Throughout the menstrual cycle, estrogen production in the ovaries remains at a low level corresponding to the early follicular phase.

Effect of COCs on cervical mucus

Thickening and thickening of cervical mucus becomes apparent 48 hours after the start of progestin administration. The motility and ability of sperm to penetrate the cervical mucus is impaired due to its compaction and thickening; cervical mucus becomes a mesh-like structure and is characterized by reduced crystallization.

The effect of COCs on implantation

Implantation of a developing pregnancy occurs approximately 6 days after fertilization of the egg. To ensure successful implantation and development of pregnancy, sufficient maturity of the superficial endometrial glands with adequate secretory function and appropriate endometrial structure for invasion is necessary. Changes in levels and disturbances in the ratio of estrogen and progesterone lead to disruption of the functional and morphological properties of the endometrium. All this disrupts the implantation process. Transport of a fertilized egg changes under the influence of hormones on secretion and peristalsis fallopian tubes. These changes disrupt the transport of sperm, eggs or developing embryos.

Efficacy and acceptability of COCs

ok are the only way preventing pregnancy with 100% effectiveness. It is customary to distinguish between theoretical efficiency, which involves using a method without errors and missing tablets, and clinical effectiveness, which is calculated based on the number of pregnancies that occur in real conditions, taking into account the errors made by women.

Thus, COCs meet all the requirements for modern contraceptives:

• highly effective in preventing pregnancy;
• ease of use (coitus-independent);
• reversibility of the impact.

Principles of using oral contraceptives

Although modern contraceptives contain low doses of sex hormones and are well tolerated, they are still medicines, the application of which has various restrictions. The basic therapeutic principle is to prescribe to each woman the smallest dose of steroids that can provide optimal contraceptive reliability. For continuous use in healthy women, OCs containing no more than 35 mcg of ethinyl estradiol and 150 mcg of levonorgestrel or 1.5 mg of norethisterone are recommended. The most important task The doctor's goal is to identify women for whom hormonal contraception is contraindicated, which makes it necessary to carefully collect anamnesis and carefully examine each patient.

Absolute contraindications to the use of COCs are the following diseases that the patient currently has or has a history of:

• cardiovascular diseases;
• history of thromboembolism;
• varicose veins with a history of thrombophlebitis;
• cerebrovascular diseases;
• malignant tumors of the genital organs and mammary glands;
• liver diseases;
• sickle cell anemia;
• history of severe forms of gestosis;
• diabetes;
• blood pressure above 160/95 mmHg;
• gallbladder diseases;
• smoking;
• trophic ulcer of the leg;
• long-term plaster cast;
• prediabetes;
• severe headaches;
• significant headaches;
• significant excess weight;
• age 40 years and above;
• epilepsy;
• hypercholesterolemia;
• kidney diseases.

Systemic changes when taking OK

Taking OCs may have adverse effects on cardiovascular disease; metabolic and biochemical processes; liver diseases; some forms of cancer. It should be emphasized that all of the above complications relate to taking tablets containing 50 mcg estrogen and high content gestagens of the 1st and 2nd generation. Specified negative impact does not appear when using OCs with lower doses of estrogens and 3rd generation gestagens. In addition, there are a number of risk factors that cause complications when taking OCs: smoking; obesity; age over 35 years; history of severe toxicosis.

The most serious complications when taking OCs include thromboembolism. Estrogens increase most blood clotting parameters, while the anticoagulant factor, antithrombin III, decreases. Platelet aggregation tendencies increase. The result may be blood clots. Oral contraceptives with an estrogen content of more than 50 mcg, the frequency of fatal embolism increases 4-8 times. The use of the latest generation of OCs containing small doses of estrogens - 20-35 mcg, only slightly increases mortality from embolism compared to the population not using OCs.

The risk of developing thromboembolism in smoking women increases. Smoking increases mortality from thromboembolism in women taking OCs over the age of 35 years by 5 times and over 40 years by 9 times. It should be noted that the mortality rate from thromboembolism in women who smoke is 2 times higher than in women taking OCs. The combination of several risk factors in women taking OCs increases the likelihood of developing thromboembolism by 5-10 times. When prescribing OCs, you should always remember that the risk of thromboembolism associated with taking OCs is 5-10 times less than the risk associated with normal pregnancy and childbirth.

It should be noted that the increase in the incidence of diabetes in the group of women using OCs compared with the control changes in carbohydrate metabolism in the body healthy woman has a transient nature and disappears after discontinuation of the OC. In addition, these disorders of carbohydrate metabolism are observed only when taking drugs containing high doses steroids. Women with previously established glucose tolerance should be considered a risk group and be under constant medical supervision. Oral contraceptives may be prescribed to young women with established diabetes in the absence of other risk factors. Monopreparations containing only a progestogen component affect carbohydrate metabolism to a much lesser extent than combined ones. They are the drugs of choice for hormonal contraception in patients with diabetes.

Oral contraceptives and fertility

After stopping taking OCs, ovulation quickly recovers and more than 90% of women are able to become pregnant within two years. The term "Post-pill" amenorrhea is used to describe cases of secondary amenorrhea for more than 6 months after stopping OC use. Amenorrhea for more than 6 months occurs in approximately 2% of women and is especially characteristic of the early and late reproductive periods of fertility.

Oral contraceptives and pregnancy

Women who used OCs did not experience an increased incidence of spontaneous miscarriage, ectopic pregnancy, or fetal abnormalities. In those in rare cases When a woman accidentally took OCs during early pregnancy, their damaging effect on the fetus was also not revealed.

Oral contraceptives and age

An important issue is the age at which a woman can start taking OCs to prevent unplanned pregnancy. Previously, there was prejudice towards the appointment oral contraception teenage girls. Currently, such ideas are rejected. In any case, taking birth control pills is best alternative pregnancy and especially abortion in adolescence. OCs have been shown to have no effect on body growth and do not increase the risk of amenorrhea.

Need in effective contraception is also evident in the period preceding menopause. In cases where other methods of contraception are unacceptable for the woman and her partner, when risk factors for cardiovascular and metabolic complications such as hypertension are excluded, diabetes, obesity, hyperlipidemia, it is possible to take OCs before menopause. A woman's age is not so important in the absence of risk factors. The creation of modern OCs with low doses of hormones allows their use by women up to 45 years of age and older. The drug of choice at this age may be drugs containing only gestagens.

Oral contraceptives during lactation

Combined contraceptives have an undesirable effect on the quantity and quality of milk and can shorten the duration of lactation, so they should not be prescribed until breastfeeding is stopped. If a woman wishes to use OCs during lactation, then only progestogen contraceptives should be used.

Duration of COC use

With constant medical supervision and the absence of contraindications, women can continue taking OCs for many years. There are no sufficiently justifiable reasons for periodic abstinence from taking oral contraceptives.

Interaction of OK with drugs

If OC is prescribed, it is necessary to take into account the possibility of their drug interactions with a number of drugs, manifested in a weakening of the contraceptive effect, in case of their simultaneous use.

A weakening of the contraceptive effect is possible if a woman takes:

• analgesics;
• antibiotics and sulfonamides;
• antiepileptic drugs;
• sleeping pills and tranquilizers;
• neuroleptics;
• antidiabetic agents;
• hypolepidemic drugs;
• cytostatics;
• muscle relaxants.

Adverse reactions and complications when taking OK

Adverse reactions and complications when taking OCs are mainly associated with disturbances in the estrogen-progesterone balance. They are most often observed in the first 2 months of taking OCs (10-40%), and then are observed only in 5-10% of women.

Adverse reactions when taking OCs due to excess content of the estrogen or progestogen component.

Possible adverse reactions when taking OK:

• headache;
• weight gain;
• hypertension;
• increased fatigue;
• nausea, vomiting;
• depression;
• dizziness;
• decreased libido;
• irritability;
• acne;
• engorgement of the mammary glands;
• baldness;
• thrombophlebitis;
• cholestatic jaundice;
• leukorrhea;
• headache between doses of OK;
• chloasma;
• scanty menstruation;
• leg cramps;
• tides;
• bloating;
• rash;
• vaginal dryness.

Mini - drank

Mini pills contain only progestin and do not have estrogen side effects. Mini-pills are taken continuously, starting from the 1st day of the cycle, daily, for 6-12 months. As a rule, at the beginning of using the mini-pill, intermenstrual bleeding is observed, the frequency of which gradually decreases and completely stops by the 3rd month of use. If intermenstrual bleeding appears while taking the mini-pill, then we can recommend prescribing 1 tablet of OK for 3-5 days, which gives a quick hemostatic effect. Since the mini-pill does not have any other side effects, its use in clinical practice has broad prospects.

How mini-pills work:

• Changes in the quantity and quality of cervical mucus, increasing its viscosity;
• Reduced penetration ability of sperm;
• Changes in the endometrium that exclude implantation;
• Inhibition of fallopian tube mobility.

Mini-pills do not affect the blood coagulation system and do not change glucose tolerance. Unlike combined OCs, mini-pills do not cause changes in the concentrations of key indicators of lipid metabolism. Changes in the liver when taking the mini-pill are extremely minor. Based on the characteristics of the mini-pill, they can be recommended as a method of contraception for women with extragenital diseases (liver diseases, hypertension, thrombophlebitic conditions, obesity).

• women who complain of frequent headaches or increased blood pressure when using combined OCs;
• during lactation 6-8 weeks after birth;
• for diabetes;
• at varicose veins veins;
• for liver diseases;
• women over 35 years old.

Hormonal injections

Intramuscular injections every 3 months; contain progestin. A sterile aqueous suspension of medroxyprogesterone acetate is administered intramuscularly once every 3 months. Thus, contraception for a whole year is provided with only four injections. This type of contraception is especially indicated for women during lactation from the 6th week after birth, at the age of late reproductive period in the absence of an opportunity to resort to surgical sterilization, women for whom other methods of contraception are contraindicated, women with sickle cell anemia, in which OCs are contraindicated for the treatment of estrogen-dependent diseases.

Hormonal implants

Implants inserted under the skin; contain levonorgestrel. Represents 6 cylindrical capsules, which are injected subcutaneously into the forearm of the left hand under local anesthesia. The contraceptive effect is provided for 5 years. The implant can be inserted in the first days of the menstrual cycle, immediately after induced abortion, 6-8 weeks after birth. Random spotting occurs in 2 out of 3 women during the first year of use.

Hormonal ring

Flexible contraceptive ring; contains small doses of estrogen and progestogen. It is inserted by the gynecologist at the beginning of the cycle and removed at the end, attached to the cervix.

Hormonal patch

The thin patch delivers hormones into the body through the bloodstream.

Intrauterine contraception

The history of intrauterine contraception begins in 1909, when the German gynecologist Richter proposed introducing 2-3 silk threads twisted into a ring into the uterine cavity for the purpose of contraception. In 1929, another German gynecologist, Graofenberg, modified this ring by inserting a silver or copper wire into it. However, the design was rigid, caused difficulties during administration, or the Mini-pill does not affect the blood coagulation system and does not change glucose tolerance. Unlike combined OCs, mini-pills do not cause changes in the concentrations of key indicators of lipid metabolism. Changes in the liver when taking the mini-pill are extremely minor. Based on the characteristics of the mini-pill, they can be recommended as a method of contraception for women with extragenital diseases (liver diseases, hypertension, thrombophlebitic conditions, obesity).p extraction, caused pain in the lower abdomen, bleeding and, as a result, was not found wide application. And only in 1960, when, thanks to the use in medical practice Inert and flexible plastics were used to create polyethylene IUDs of the Lipps loop type, intrauterine contraception began to be used quite widely (IUD - intrauterine device).

Theory of the mechanism of action of the IUD

Today, there are several theories about the mechanism of the contraceptive action of the IUD.

The theory of the abortifacient action of the IUD

Under the influence of the IUD, the endometrium is traumatized, prostaglandins are released, and the tone of the uterine muscles increases, which leads to the expulsion of the embryo into early stages implantation

Theory of accelerated peristalsis

The IUD increases contractions of the fallopian tubes and uterus, so the fertilized egg enters the uterus prematurely. The trophoblast is still defective, the endometrium is not prepared to receive a fertilized egg, as a result of which implantation is impossible.

Theory of aseptic inflammation

IUD like foreign body causes leukocyte infiltration endometrium. The resulting inflammatory changes in the endometrium prevent implantation and further development blastocyst.

Theory of sperm toxicity

Leukocyte infiltration is accompanied by an increase in the number of macrophages that carry out phagocytosis of sperm. Adding copper and silver to the IUD enhances the spermotoxic effect.

Theory of enzyme disorders in the endometrium

This theory is based on the fact that IUDs cause changes in the content of enzymes in the endometrium, which has an adverse effect on the implantation process.

Types of intrauterine devices

Currently, more than 50 types of IUDs made of plastic and metal have been created, which differ from each other in rigidity, shape and size.

There are three generations of intrauterine devices:

• Inert IUDs. The first generation of IUDs includes the so-called inert IUDs. The most widely used contraceptive is made of polyethylene in the form of the Latin letter S - the Lipps loop. In most countries, the use of inert IUDs is currently prohibited, since their use is associated with lower effectiveness and more high frequency expulsions than when using spirals of later generations;
• Copper-containing IUDs. They belong to the second generation. The basis for the creation of an IUD with copper was experimental data showing that copper has a pronounced contraceptive effect in rabbits. The main advantage of copper-containing IUDs compared to inert ones is a significant increase in efficiency, better tolerability, and ease of insertion and removal. The first copper-containing IUDs were made with copper wire with a diameter of 0.2 mm included in the design. Since copper is released quickly, it has been recommended that the IUD be replaced every 2-3 years. To increase the duration of IUD use to 5 years, they began to use techniques to slow down the fragmentation of copper: increasing the diameter of the wire, including a silver rod. Many types of copper-containing IUDs have been created and evaluated. Of the latter, we should name Sorr-T, having different shapes(for example, T-Cu-380A, T-Cu-380Ag, T-Cu-220C, Nova-T), Multiload Cu-250 and Cu-375, Funcoid;
• Hormone-containing IUDs are the third generation of IUDs. The prerequisite for the creation of a new type of IUD was the desire to combine the advantages of two types of contraception - OK and IUD, reducing the disadvantages of each of them. This type of spiral includes Progestasert and the LNG-20 IUD, which are T-shaped spirals, the stem of which is filled with the hormone progesterone or levonorgestrel. These coils have a direct local effect on the endometrium, the fallopian tubes and the mucous membrane of the cervix. The advantage of this type of coils is the reduction of hyperpolymenorrhea and the incidence of inflammatory diseases of the genitals. The disadvantage is an increase in “intermenstrual spotting”.

Contraindications to the use of an intrauterine device

Absolute contraindications for the intrauterine device:

• acute and subacute inflammatory processes of the genitals;
• confirmed or suspected pregnancy;
• confirmed or malignant process of the genitals.

Relative contraindications for the intrauterine device:

• abnormalities in the development of the reproductive system;
• uterine fibroids;
• hyperplastic processes of the endometrium;
• hyperpolymenorrhea;
• anemia and other blood diseases.

Insertion of an intrauterine device

The intrauterine device is usually inserted on the 4th-6th day of the menstrual cycle. In this period cervical canal slightly open, making the procedure easier. In addition, at this time a woman can be sure that there is no pregnancy. If necessary, the IUD can be inserted in other phases of the cycle. The IUD can be inserted immediately after an abortion, as well as during postpartum period. The main disadvantage of inserting an IUD at this time is the relatively high frequency of expulsions during the first few weeks. Therefore, it is better to insert the IUD after 6 weeks. after childbirth.

How is an intrauterine device inserted?

1. Under aseptic conditions, the cervix is ​​exposed with mirrors, treated with a disinfectant solution and the anterior lip is grabbed with bullet forceps.
2. The length of the uterine cavity is measured using a uterine probe.
3. Using a guide, the IUD is inserted into the uterine cavity.
4. A control examination is done with a uterine probe, making sure that correct position Navy.
5. Trim the IUD threads to a length of 2-3 cm.
6. Remove the bullet forceps and treat the cervix with a disinfectant solution.

How to remove an intrauterine device:

1. The cervix is ​​exposed in the speculum. An IUD that has threads is usually removed with a forceps. If there are no threads, you can use a queen hook with great care.

Observation after insertion of the intrauterine device.

The first medical examination is carried out 3-5 days after administration, after which sexual activity is allowed without the use of any other contraceptive. It is advisable to carry out repeated examinations every 3 months.

Relevance of the intrauterine device

Intrauterine contraceptives are an excellent reversible method of contraception.

The intrauterine device has the following advantages:

• the use of an IUD is not associated with interference in a woman’s normal life;
• After insertion of an IUD, only minimal health care and observation;
• IUDs are possible view contraception for older women and especially in cases where OCs are contraindicated;
• IUDs can be used during breastfeeding;
• possibility of long-term use (from 5 to 10 years);
• Economic factor: In general, the annual costs associated with IUD use are relatively small for both women and family planning programs.

If pregnancy occurs while using an IUD and the woman desires to continue the pregnancy if the threads are present, the IUD should be removed. If there are no threads, extremely careful monitoring of the course of pregnancy is required. It should be noted that in the literature there is no indication of an increase in the incidence of malformations or any damage to the fetus if the pregnancy is carried to term with an IUD. In women using IUDs, the generative function is not impaired. Pregnancy occurs after removal of the IUD within a year in 90%.

Possible complications when using an intrauterine device:

• discomfort in lower parts belly;
• lower back pain;
• cramping pain in the lower abdomen;
• bloody issues.

The pain, as a rule, goes away after taking analgesics; bleeding can last up to 2-3 weeks.

Bleeding when using an intrauterine device

Character disorder uterine bleeding- the most common complication when using an IUD.

There are three types of changes in the nature of bleeding:

1. increased volume of menstrual blood;
2. longer period of menstruation;
3. intermenstrual bleeding. Menstrual blood loss can be reduced by prescribing prostaglandin synthetase inhibitors.

Inflammatory diseases when using an intrauterine device

The question of the relationship between IUDs and inflammatory diseases of the pelvic organs is important. Large-scale research recent years indicate a low incidence of inflammatory diseases of the pelvic organs when using IUDs. The risk increases slightly in the first 20 days after administration. In the subsequent period (up to 8 years), the incidence rate remains at a consistently low level. The risk of disease is higher in women under 24 years of age and is closely correlated with sexual behavior. Active and chaotic sex life significantly increases the risk of these diseases.

Uterine perforation is one of the rarest (1:5000), but serious complications of intrauterine contraception. There are three degrees of uterine perforation:

1st degree- The IUD is partially located in the muscle of the uterus

2nd degree- The IUD is completely located in the uterine muscle

3rd degree- partial or complete release of the IUD into the abdominal cavity.

With the 1st degree of perforation, it is possible to remove the IUD vaginally. For grades 2 and 3 of perforation, the abdominal route of removal is indicated.

In conclusion, it should be emphasized once again that the IUD is the optimal means of contraception for healthy women who have given birth, have a permanent partner and do not suffer from any inflammatory diseases of the genitals.

Postcoital contraception

Contraceptive measures are carried out after unprotected sexual intercourse. Do not confuse this with medical abortion!

The concept of postcoital contraception unites different kinds contraception, the use of which in the first 24 hours after coitus prevents unwanted pregnancy. Postcoital contraception cannot be recommended for continuous use, since each method is an emergency intervention functional state reproductive system with subsequent formation of ovarian dysfunction.

Contraceptive effectiveness

The effectiveness of contraception is determined by the Pearl index. Pearl index (Pearl index), failure rate - an index showing the effectiveness of the chosen method of contraception. The lower this indicator, the more reliable method contraception. A small example: 3 women out of a hundred, who have been protected for 12 months with the same method of contraception, find themselves pregnant, despite the protection. In this case, the Perl index is 3.