Family planning and modern methods of contraception planning. Family planning and contraceptive methods

VOLUNTARY STERILIZATION

At the present stage, voluntary surgical contraception, or sterilization, is the most common method of family planning in both developed and developing countries.

Voluntary Surgical Sterilization for Women (VCS) The most common is the method of tubal occlusion - surgical blocking of the patency of the fallopian tubes, as a result of which the fertilization process becomes impossible.

Sterilization methods:

- laparotomy;

- laparoscopy.

To block the fallopian tubes, they are ligated, cut, stapled, rings, or electrocoagulated.
The consultant is obliged to explain in detail all the stages of surgical sterilization and indicate its possible side effects and complications. The patient must voluntarily agree in writing to undergo DHS.

Voluntary surgical sterilization for men

Vasectomy - this is male voluntary sterilization (DS), carried out by the standard method (one or two small incisions) or with the help of a no-kalpel technique. After blocking the vas deferens, there are no spermatozoa in the ejaculate. A vasectomy does not provide protection against pregnancy during the first 3 months after surgery, or if sperm are present when the seminal fluid is examined under a microscope.

Form of voluntary consent to sterilization.

I, the undersigned, ______________________________________

(Last and first name of the patient)

I ask you to perform a surgical sterilization operation on me.

I am making this request of my own free will, without coercion or influence from anyone. I am aware that:

1. Me and my partner can use available temporary methods of contraception.

2. The procedure I am undergoing is a surgical operation, the details of which have been explained to me in detail.

3. Like any surgical operation, this procedure, in addition to positive results, carries a certain risk, which was explained to me.

4. If the operation is successful, then I will no longer be able to have children.

5. The procedure is irreversible.

6. I can decide to cancel the operation at any time before the operation.

___________________ ____________________

(Patient's signature) (date)

(Signature of attending physician (date)

or designated employee)

EMERGENCY CONTRACEPTION

Emergency (postcoital) contraception is used after unprotected intercourse when pregnancy is not planned or desired. It should be noted that a sufficiently high efficiency of the method of emergency contraception is achieved by introducing doses of hormones that significantly exceed the dose available in conventional contraceptive preparations. Postcoital contraception includes: Postinor, mifepristone, excluton.

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

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

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

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

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

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

Contraceptive methods are divided into:

Biological (calendar);

barrier;

Intrauterine;

Hormonal;

Surgical (sterilization).

BIOLOGICAL (CALENDAR) METHOD

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

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

BARRIER METHODS

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

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

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

The effectiveness of a condom is reduced if it is used incorrectly: repeated use of a condom, intense and prolonged sexual intercourse, leading to macro- and micro-defects of the condom, improper storage, etc. Condoms are a good protection against sexually transmitted infections, but infection with viral diseases, syphilis is still possible when the damaged skin of the patient and a healthy partner come into contact. Side effects include an allergy to latex. The Pearl Index for this type of contraception ranges from 2 to 20.

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

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

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

The diaphragm should be removed with the finger of the right hand, pulling it by the front edge. After removal, the diaphragm should be washed in warm soapy water and dried. The diaphragm can be used repeatedly.

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

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

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

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

The Pearl Index is higher than when using aperture.

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

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

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

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

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

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

HORMONAL CONTRACEPTION

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

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

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

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

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

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

Combined oral contraceptives (COCs);

Gestagen contraceptives:

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

b) injection;

c) implants;

d) vaginal rings containing hormones;

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Contraindications to the use of combined oral contraceptives are:

Acute deep vein thrombosis, thromboembolism;

Severe violations of the liver and kidneys;

Liver disease;

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

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

Migraines with focal neurological symptoms;

Lactation (estrogens pass into breast milk).

Conditions requiring immediate withdrawal of hormonal contraceptives:

sudden severe headache;

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

Acute chest pain, unexplained shortness of breath, hemoptysis;

Acute pain in the abdomen, especially prolonged;

sudden pain in the legs;

Significant increase in blood pressure;

Itching, jaundice;

Skin rash.

The effectiveness of hormonal contraceptives is extremely high -

the Pearl index is 0.05-0.5.

POSTCOITAL CONTRACEPTION

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

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

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

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

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

After using emergency contraception, it is advisable to conduct a pregnancy test, if the result is negative, choose one of the methods of planned contraception. If pregnancy does occur, then it should be interrupted, since a teratogenic effect of large doses of hormones is possible.

INTRAUTERINE CONTRACEPTION

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

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

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

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

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

The benefits of intrauterine contraception include:

High efficiency;

Possibility of long-term use;

Immediate contraceptive action;

Rapid establishment of fertility after removal of the IUD;

Low cost;

Possibility of use during lactation.

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

Contraindications:

Pregnancy;

Inflammatory diseases of the female genital organs;

Violation of the menstrual cycle;

Tumor diseases of the genital organs;

Allergy to VMC.

SURGICAL CONTRACEPTIVE METHODS

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

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

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

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

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

Lecture No. 3 Words 846.

Family planning. Abortion and its complications. Methods of contraception.

Family planning- one of the main ways to solve the global demographic problem of stabilizing the population of the Earth.

According to the WHO definition, family planning is the control of the reproductive (childbearing) function of a woman for the birth of only desired children.

Women's consultation- a medical and preventive institution of a dispensary type, providing all types of outpatient obstetric and gynecological care to the population.

For example, a women's clinic provides:

work on the formation healthy lifestyle life;

abortion prevention;

Women use contraceptives.

Unfortunately, abortion remains one of the main methods of birth control in Russia. In 2010 1236400 abortions were performed. If at the end of the 80s of the last century in the USSR about a third of all abortions in the world were performed, then since the beginning of the 90s, thanks to the development of family planning services, the frequency of abortions has been gradually decreasing. Nevertheless, abortion in more than 40% of cases remains the cause of secondary infertility.

induced abortion- This is an abortion up to 12 weeks at the request of a woman.

Methods of artificial termination of pregnancy.

1. Surgical, or instrumental. The surgical method involves the extraction of the fetus using special tools.
2. medical method. Medical or pharmaceutical abortion is the termination of pregnancy using pills.

Abortion is performed with the assistance of a qualified specialist - an obstetrician-gynecologist, using approved and recommended methods and in a medical institution that is suitable for this. Abortion is always a risk of developing various complications that can occur both during the operation itself and in the near future after it.

Complications of abortion.

Early complications (during surgery):

1. Bleeding.
2. Remains of the ovum.
3. perforation of the uterus.
4. The death of a woman.

Late complications:

1. Infertility.
2. Violation of the menstrual cycle.
3. Cervical (isthmic-cervical) insufficiency.
4. Bleeding during subsequent births.
5. Anomalies of attachment of the placenta.
6. Weakness of labor activity.

The main prevention of abortion is to prevent unwanted pregnancy -

it's contraception.

Methods of contraception.

There are: 1) non-hormonal methods;

2) hormonal methods.

Non-hormonal methods of contraception.

1. barrier method . Efficiency 80%.

Mechanism of action: preventing the meeting of the sperm with the egg (the sperm does not enter the uterus).

A male condom, a female condom, a vaginal diaphragm and uterine caps are used.

Currently, condoms are the only way to protect against sexually transmitted diseases.

There are no contraindications.

2. chemical method(Spermicides). Efficiency 70-75%.

Mechanism of action: chemicals introduced into the vagina reduce the activity or kill some of the spermatozoa.

The drugs are available in the form of balls, pastes, ointments and tablets that are inserted into the vagina. For example, Pharmatex.

Contraindications: allergic reaction to the drug.

3. Intrauterine contraception (IUD)). Efficiency 85%.

Mechanism of action: increased peristalsis of the fallopian tubes, as a result of which the fertilized egg enters the uterus ahead of time and cannot be implanted.

An IUD is inserted into the uterus for 5 years.

Contraindications to the introduction of the IUD:

A) painful menstruation

B) heavy menstruation

C) inflammatory diseases of the female genital organs.

d) tumors of the female genital organs.

Navy Disadvantages:

1) painful menstruation;

2) heavy menstruation;

3) exacerbation of chronic inflammation of the female genital organs;

4) Expulsion of the IUD (spontaneous expulsion of the IUD from the uterus).

5) The onset of pregnancy (pregnancy can be saved).

4. Surgical method (sterilization). Efficiency 100%.

Mechanism of action: as a result of cutting the fallopian tubes with a scalpel in women or

The vas deferens in men, the spermatozoa cannot meet with

Ovum.

The disadvantage of the method: the irreversibility of the process.

5 . Physiological method of contraception. Efficiency - 55%.

Mechanism of action: a woman calculates the days of ovulation (middle of the cycle), when the probability of pregnancy is high, because. a mature egg is released from the ovary as a result of ovulation. Therefore, it is not necessary to prevent pregnancy after menstruation and before the next menstruation.

Disadvantage of the method: low efficiency (55%).

Hormonal contraception.Efficiency 99%.

Mechanism of action: suppression of ovulation.

Classification according to the method of administration of the drug:

1 group : in tablets (per os):

A) COCs - combined oral contraceptives, contain 2 hormones (analogues of estrogens and progesterone). Preparations - Marvelon, Jeanine, Minisiston. Taking pills daily.

B) Mini - drank - contain one hormone (progestin), prescribed more often to nursing mothers, because. you can breastfeed. Taking pills daily.

Preparations: Charosetta, Microlut.

C) Urgent contraception (emergency). Efficiency 99%.

Mechanism of action: suppression or delay of ovulation, disruption of the fertilization process, the advancement of the blastocyst through the tube and the impossibility of implanting the blastocyst into the endometrium. This method is used only in exceptional cases, after unprotected intercourse, during the first 24-72 hours, otherwise there will be no effect. This method cannot be considered as a regular method of preventing pregnancy.The disadvantage of the method: violation of the menstrual cycle due to a large dose of the drug.

Therefore, this method is used as a last resort, no more than 2 times a year.

2 group . Intramuscular administration of the drug every 3 months.

Depot - Provera. Efficiency 99%.

The mechanism of action is the suppression of ovulation.

3 group . Subcutaneous administration of the drug - Norplant (introduced under the skin of the shoulder 6 capsules

For 5 years).

4 group . Introduction of the drug through the skin: EVRA - patch. Thin patch

It is applied to the skin for 7 days 3 times a cycle.

5 group . Intrauterine route of administration: the Mirena coil is inserted into the uterus for 5 years.

6 group . Vaginal route of administration: a thin ring is inserted into the vagina,

Impregnated with hormone, for 21 days. The drug Nova-Ring.

Contraindications for hormonal contraceptives.

1) Thrombophlebitis now or in the past.

2) Diseases of the cardiovascular system, cerebral vessels, ischemic heart disease,

3) Arterial hypertension.

4) Diseases of the liver.

5) Malignant tumors of the mammary glands and genital organs.

6) Bleeding from the genital tract of unknown cause.

7) Diabetes.

8) Smoking more than 15 cigarettes per day over the age of 35

Disadvantages of COC:

1) They do not protect against sexually transmitted diseases.

2) Taking pills requires great care, because. can't miss any

Pills.

3) Sometimes there are nausea, vomiting, weight gain, headaches.

Teenagers who are not married need the following scheme (the "Gold Standard"):

COC + condom.

Contraception(from Novolat. contraceptio - contraception) - prevention of pregnancy.

Undoubtedly the most frequently asked question asked by women: "Which contraception is right for me?". In each case, the issue is resolved individually, at the appointment of an obstetrician-gynecologist. The choice of contraceptive method depends on many parameters, since not only reliable protection against unwanted pregnancy, abortion and related complications is important, but also the convenience of its use.

The effectiveness of contraceptive methods is assessed using pearl index is the number of unplanned pregnancies that occur in 100 women using this method of contraception for 1 year.

Contraceptive methods with a Pearl index from 0 to 1 are highly effective; 2 to 9 are effective and 10 or more are ineffective.

Highly effective and effective methods of contraception:

• Hormonal contraception.
• Intrauterine contraception.
• Voluntary Surgical Sterilization (VCS).
• Method of lactational amenorrhea.

Low effective methods of contraception:

• Barrier - diaphragm, cervical caps, sponges, condom.
• Spermicides (chemicals that neutralize sperm).
• Biological (calendar, temperature).
• Interrupted intercourse.

Hormonal method of contraception more than 120 million women in the world use it. It includes COOK And ( combined oral contraceptives- mono- and multi-phase), characterized by reliability, complete reversibility (quick restoration of the ability to conceive), regulation of the menstrual cycle, prevention of uterine fibroids, endometriosis, inflammatory diseases of the genital organs, as well as functional cysts and ovarian cancer, therapeutic effect in premenstrual syndrome.

Progestogenic oral contraceptives- a reliable method of contraception only in breastfeeding women. Used when more reliable methods cannot be used.

parenteral methods of contraception:
a) Subcutaneous implants, placed subcutaneously, duration of action up to 5 years.
b) Injectable contraception.

transdermal contraceptive patch- "Evra" - microdosed percutaneous contraceptive, securely attached to the skin of the buttocks, abdomen, outer surface of the upper half of the body, does not peel off during water procedures.

Modern intrauterine contraceptives contain: progesterone, copper, gold or a number of other drugs that are gradually released into the body (they are recognized as the most reliable and safe for a woman's health); there are also inert ones, but they have less efficiency and are now used less and less.

For example, "Mirena" - combines high contraceptive efficacy and medicinal properties with the convenience and long-term action of the IUD (5 years).

Advantages of intrauterine contraception- this is high efficiency and reliability, which are close to 100%, the onset of action immediately after administration, due to which the woman does not need to use additional contraceptives, installation once for a long period (up to 5 years).

Disadvantages of intrauterine contraception attribute the lack of protection against sexually transmitted diseases, and in case of an infectious disease, the spiral can aggravate the situation; a possible increase in the duration of menstruation and their profusion. This phenomenon is associated with minor injuries of the uterine mucosa, which are caused by a foreign object. A similar disadvantage is typical only for products that do not contain progesterone, since the latter has a neutralizing effect; as well as the possibility of expulsion of the IUD (if you suspect it is necessary to contact a gynecologist).

Vaginal contraceptive ring "NovaRing"- a fundamentally new method of contraception, using the vaginal route of hormone administration. High contraceptive effect and minimal impact on the woman's body.

Voluntary Surgical Sterilization (VCS) is given a special place in the family planning program, since, firstly, this method is associated with surgical intervention and, secondly, it is irreversible. female sterilization is based on the creation of artificial obstruction of the fallopian tubes surgically during laparoscopy, mini-laparotomy or traditional abdominal surgery (for example, during caesarean section).

In accordance with the law Russian Federation, DHS can be performed on the condition that: the woman's age is over 32 years old, if there is one or more children in the family, if there are two or more children in the family.

Choosing this method of contraception married couple should be informed about the irreversibility of sterilization, the features of surgical intervention and possible complications.

Question d Voluntary surgical sterilization and other alternative REVERSIBLE (as opposed to sterilization surgery, which is irreversible) methods of contraception are actively discussed on our FORUM. Express your opinion, ask questions that interest you, write to our!

male sterilization - vasectomy, the operation is performed under local anesthesia, lasts 15-20 minutes, the man can immediately return home.

Lactational amenorrhea method. It can be used by women in the first six months after the birth of a child. The method is absolutely harmless to the health of both mother and child. It is based on the fact that if a woman is breastfeeding, her period does not occur and she is not able to become pregnant. A woman should start breastfeeding immediately after childbirth, the effectiveness is observed only with full breastfeeding and persistent amenorrhea (absence of menstruation).

barrier method of contraception- protection against unwanted pregnancy by preventing sperm from entering the vagina or cervix by mechanical (condoms, vaginal diaphragms and caps) or chemical (spermicides) methods. The combination of these two paths is called combined.

Male contraception is considered a reliable method - use condoms, the effectiveness of which approaches 95%, especially when combined with spermicidal agents (pharmatex, pantetexoxaval, contraceptin). The efficiency of the combined method increases and approaches 100%.

Female barrier contraception is not as reliable as male. Caps made of aluminum, polymers, plastics are put on the cervix. After 10 days, the cap is removed, while it is necessary to regularly examine the cervix. The method is contraindicated in the presence of inflammation, pseudo-erosion and erosion of the cervix.

The vaginal diaphragm or cap is a rubber plate worn on a rim of springy metal wire. The diaphragm inserted into the vagina forms a barrier that separates the cervix from the vagina itself. It can be left for 10-12 hours, after use, be sure to wash with soap and water and a mild disinfectant solution. Before subsequent use, you can rinse the diaphragm with boiled water. Multiple use. Female barrier contraception must be combined with spermicidal preparations, which increases its effectiveness up to 90%.

Spermicides- this group of drugs, otherwise called chemical vaginal contraceptives, is very diverse - tablets, vaginal suppositories, gels, pastes, foams, tampons, etc. Their action is to create an increased acidity of the vaginal environment, which damages or kills the spermatozoa that enter it and makes conception unlikely.

Calendar (rhythmic) method is a method for determining the fertile phase by observing the menstrual cycle, that is, the period when a woman can become pregnant. If the sperm enters the vagina outside the fertile period, then fertilization does not occur.

Rules for calculating the fertile period ("dangerous days"):

1. Track the duration of at least 6 menstrual cycles, as not all women have a regular cycle.
2. Subtract 11 from the number of days in your longest cycle (for safety net, you can subtract from 8 to 11 days). This will determine the last fertile day of your cycle.
   The number 11 is taken from here: since after ovulation 12-16 days pass (on average 14) before menstruation, then, as is obvious, ovulation will occur 12-16 days before menstruation. It is advisable to add a few days for insurance.
3. From the number of days in the shortest of your cycles, subtract 18 (for safety net, you can subtract 19-21 days). By this you determine that spermatozoa in the genital tract of a woman can exist for up to 4-5 days. That is, we subtract not 14 days, but an additional 5 days of sperm life.

For convenience, we offer you a table: How to calculate " dangerous period"- the most likely days for conception

An example of using a table:

Your cycle is between 27 and 33 days.

In the table, find the shortest cycle - 27 days and determine the first fertile day (in our case, 9 days after the start of menstruation).

Thus, the dangerous period will be from 9 to 22 days.

Avoid sexual intercourse on fertile days or use an additional method of contraception (condom, spermicide, etc.).

Coitus interruptus is an ineffective contraceptive method.

Firstly, not every man is able to feel the onset of ejaculation and control himself at this moment.

Secondly, a certain amount of spermatozoa is released at the very beginning of sexual intercourse, along with the secretion of the Cooper glands. According to some reports, this is the “vanguard”, consisting of the most mobile and viable spermatozoa, which, accordingly, makes the probability of conception very high.

In addition, during repeated sexual intercourse, sperm that remains on the walls of the urethra of a man after the first ejaculation can enter the vagina.

And of course, when using this method, we are not talking about spontaneity, ease or the ability to relax - a man is forced to constantly control himself during intercourse.

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Lecture on gynecology.

TOPIC: FAMILY PLANNING. CONTRACEPTION.

Our country has the lowest birth rate, a high percentage of abortions, and a large number of complications after abortions.

All contraceptives are aimed at protecting yourself from unwanted pregnancy. There are many such means, their effectiveness is different.

Calendar method of contraception. It is based on determining the time of ovulation, which is observed on the 14th (+/- 2) day of the cycle, and limiting the number of sexual intercourse during the periovulatory period. Given the viability of the egg (48 hours) and sperm (48 hours), sexual intercourse should be avoided from the 10th to the 18th day of the cycle.

Barrier method of contraception.

Male protection - condom. Protects not only from unwanted pregnancy, but also from all sexually transmitted infections (HIV infection, gonorrhea, syphilis, chlamydia, mycoplasma infection, etc.).

female protection - the diaphragm, is a rubber ring with a hemisphere-shaped cap. The diaphragm is inserted in such a way as to cover the cervix to create a mechanical obstacle to the passage of spermatozoa. The doctor must choose the size of the diaphragm and encourage the woman to insert it through the vagina. The diaphragm can be injected with spermicides - chemicals that inhibit the movement of spermatozoa and kill them. One of the spermatocides is zhenol. Spermatocides can be in the form of tablets, psta, cream (now - Pharmatex). Pharmatex is also good because it has a bactericidal effect, chlamydia, mycoplasmas, various viruses, gonococci, ureaplasmas, etc. are sensitive to it.

Chemical method.

Vaginal spermacids. In the form of vaginal balls, tablets, pastes and solutions. When using these agents, a foamy substance is formed, which is active against spermatozoa.

Douching with acidic solutions: a solution of acetic acid (one tablespoon of table vinegar per 1 liter of water); 5% boric acid solution; citric acid solution (1 lemon per 0.5 l of water). Douching should be done immediately after intercourse.

Intrauterine contraception. One of the most common methods of contraception in our country. However, intrauterine contraception is no longer popular abroad. 70-80% of women use oral contraceptives. Intrauterine devices contain copper, gestagens. Mechanisms of action: IUD disrupts the implantation of a fertilized egg, which is associated with accelerated peristalsis of the fallopian tubes and the resulting inferiority of the egg or with the absence of favorable conditions for implantation in the endometrium: copper has a bactericidal and spermicidal effect.

Surgical methods.

Sterilization of women. Women with at least two children over 35 years of age may be exposed.

Sterilization of men.

Oral contraceptives. More than 120 types of hormonal contraceptives. They suppress the formation and secretion of gonadotropins by the anterior pituitary gland, which causes anovulation. One of the most important properties of these drugs is reversibility, that is, after stopping the intake, a normal pregnancy is possible. Hormonal contraceptives are in the form of tablets and in the form of capsules (depot) implanted subcutaneously, providing a prolonged effect (5-7 years), during this time, the gestagen contained in the capsule is gradually, impulsively excreted into the blood and maintains the state of ovulation inhibition. Norplant is injected subcutaneously on the back of the forearm under local anesthesia. To date, the birth rate in the world is very high in countries: India, China. These are countries with overpopulation and the issue of family planning is very acute here. In Russia, there is a low birth rate, and abortions exceeded the birth rate by 2 times. Last year, 34.5 thousand births took place in St. Petersburg, more than 70 thousand abortions per year (about 10 thousand - infected abortions, 2 thousand abortions - for social reasons). 11% of women who have an abortion are nulliparous. In the 60s, American scientists R. Pincus and Garcia isolated a substance from Mexican grapes that had a contraceptive effect. Based on it, oral contraceptives were subsequently manufactured. The main components are estrogens and gestagens in different proportions. The estrogen component is ethinylestradiol. Gestagens - levonorgestrel, desogestrel. The point of application of estrogens and gestagens is the hypothalamus, pituitary gland. Estrogens and gestagens suppress the production of luteinizing hormone, thereby inhibiting ovulation. This mechanism of action is inherent in all oral contraceptives.

Classification.

1. Combined oral contraceptives. They consist of a combination of estrogenic and progestogen components. As a rule, containing them the same amount, or the proportion varies depending on the phase of the menstrual cycle. Therefore, there are: 1. Monophasic preparations (containing gestagens and estrogens in the same way in each tablet). 2. Multiphasic: biphasic and triphasic (the concentration of hormones changes, that is, at the beginning of the cycle, the estrogen component increases, then the concentration of progestogens begins to increase) - they maintain a normal menstrual cycle, as it were, only without ovulation. Monophasic: marvelon, regividon, demolen, femoden. Multiphase: trizistan, triquilor, tririgan.

Preference in young women was given to three-phase drugs, as they restore the regulation of the menstrual cycle. In women with congenital erosion of the cervix, mastopathy, fibroadenomatosis, monophasic drugs (Marvelon) are indicated, as they promote epithelialization, reduce the risk of developing ovarian and breast cancer.

2. Mini-drank. Contain microdoses of gestagen. The drug continuin, fermolen. They are prescribed continuously daily from the first day of the menstrual cycle for 6-12 months.

The contraceptive action is based on inhibition of the contractile activity of the fallopian tubes, an increase in the viscosity of mucus in the cervical canal, and a violation of cyclic processes in the endometrium. These drugs have a pronounced side effect and often lead to menstrual irregularities.

3. Postcoital oral contraceptives. Recommended for women with irregular sex life. This is postinone (0.75 mg of progestogen). Take it 8-10 minutes after sexual intercourse. The contraceptive action is based on preventing the implantation of a fertilized egg, due to changes in the endometrium and its rejection, in response to a decline in hormones after taking the drug. A lot of side effects as a violation of the menstrual cycle. It is not recommended to use more than 4 tablets during 1 cycle.

4. Long-acting contraceptives.

Depo-Provera is used more often in women after childbirth, when the menstrual cycle has not yet returned. Depo Provera is administered once every 3 months. Norplant - a depot of a progestogen, enclosed in a capsule, is implanted subcutaneously.

Indications for the use of oral contraceptives.

Contraception

menstrual irregularity

reduced risk of endometrial cancer

reduce the incidence of ovarian cancer, breast cancer.

Side effects:

dyspeptic disorders (nausea, vomiting, discomfort).

Increase in body weight.

Pastosity of the face, limbs, engorgement of the mammary glands.

An increase in the concentration of lipids, cholesterol.

Changes in blood rheology (increased platelet concentration, increased aggregation leading to thrombus formation).

Intrauterine contraception.

The first studies of the German scientist Rechter date back to 1909. It is introduced into the uterine cavity with silk threads for the purpose of contraception. In 1980, Greferder inserted a platinum plug into the uterine cavity. In 1960 - a boom in intrauterine contraception, due to the appearance of plastic polymer compounds and the manufacture of their intrauterine devices various forms. The IUD contains copper wire, as it has been proven that copper ions delay the progress of spermatozoa.

Theories of the contraceptive effect of the IUD:

1. Theory of abortive action. The endometrium is traumatized by the spiral, the tone of the uterine muscles increases as a result of the release of prostaglandins, and the embryo is aborted.

2. The theory of accelerated peristalsis of the fallopian tubes. The egg enters the uterus prematurely, as the fallopian tubes peristaltize rapidly, and since the trophoblast is incomplete by this time, the egg is not implanted.

3. Theory of aseptic inflammation. An intrauterine contraceptive as a foreign body causes polymorphonuclear leukocyte infiltration, which leads to the release of a large number of macrophages, an increase in the release of lysozyme, and a cytotoxic effect occurs. As a result, the cyclical development of the endometrium is disrupted, which leads to disruption of implantation.

4. Theory of spermatotoxic action. Phagocytosis of spermatozoa by macrophages and the addition of copper ion enhances the spermatotoxic effect. The IUD must be inserted under certain conditions and in the absence of contraindications.

Fully examined woman. The contraceptive is administered on the 4-5th day of menstruation, it is possible to introduce it after an abortion, childbirth. During the first 10 days, observation is required, the prohibition of sexual intercourse. The Navy is installed for 2-2.5 years.

CONTRAINDICATIONS.

Acute inflammatory processes, or exacerbations of chronic processes of any localization.

Infectious-septic diseases (hepatitis, tuberculosis).

Isthmic-cervical insufficiency.

Tumors of the uterus and appendages.

Developmental defects.

Blood coagulation disorders.

COMPLICATIONS.

Pain due to various reasons - incorrect selection of a contraceptive, incorrectly placed contraceptive. There may be cramping or aching pain. This complication occurs in 3-4%.

Spontaneous expulsion (9-15% of cases).

Bleeding (3-9%). Hyperpolymenorrhea or premenstrual bleeding.

Perforation of the uterus (1 per 5 thousand introduced contraceptives): at the time of insertion, while wearing, when removing the contraceptive.

The occurrence of pregnancy (1-8%) - uterine and ectopic.

Inflammatory complications.