Contraceptives. Contraceptive methods: understand the types and choose the most effective

“Conscious pregnancy” is a popular term today that denotes the right of every couple to consciously choose the time for such an important step as the birth of a baby. There are many methods of contraception: monophasic contraceptives, implants, condoms, rings, spirals and much more, according to the taste and wallet of everyone. But any method of protection against unwanted pregnancy has both advantages and disadvantages. Let's figure out how to choose the right type of contraception from this set and how to avoid "misfires".

1. Sterilization

It is the most effective contraceptive method with 99.9% reliability. Women are sterilized by tubal ligation, men by vasectomy.

BUT! The main disadvantage of sterilization is radicalism. Conclusion: if after a certain number of years you want to leave offspring after yourself, you will not succeed.

2. Oral contraceptives

The leader of non-invasive methods of contraception is combined oral contraceptives (COCs) in tablets. Their reliability is estimated at up to 99.7%. Comprehensively affecting the female reproductive system with the help of hormones, oral contraceptives suppress ovulation, thicken the mucus in the cervical canal and provoke a thinning of the endometrial layer in the uterus. This triple action provides a temporary "rest" for the ovaries, reduces the risk of infectious diseases through the mucus barrier function (however, it does not completely protect against sexually transmitted infections), and reduces the amount of blood loss in a woman during menstruation.

Combined oral contraceptives compare favorably with other hormonal contraceptives in that different pills contain different dosages and combinations of hormones. In European countries, this method is the most popular among women of different ages and different lifestyles. After all, in a wide range of these products, including those presented on the Ukrainian market, there are even tablets with innovative intake regimens 24 + 4 and 26 + 2. They reduce the non-hormonal period, which minimizes negative symptoms, and, importantly, simplifies the regimen for taking such pills.

Additional non-contraceptive actions: COCs of the latest generation, also already available to Ukrainian women, contain, in addition to hormones, an additional substance - calcium levomefolate (an active form of folic acid). Thanks to this substance, modern contraceptives have a pronounced additional non-contraceptive effect: they eliminate the negative manifestations of PMS, improve the condition of the skin and hair, fight acne, prevent photoaging (the negative effect of the sun on the skin), and even have an antidepressant effect. In addition, folate-containing contraceptives significantly reduce the risk of developing defects in the child's nervous system during pregnancy in the future.

BUT! Oral contraceptives have some contraindications, are selected and prescribed exclusively by a gynecologist individually for each woman, and also require a woman to be organized and attentive when taking.

3. Intrauterine contraception

We are talking about the intrauterine device and the intrauterine hormonal system, which differ both in reliability and in the mechanism of action. The spiral performs a barrier function and prevents the implantation of a fertilized egg into the uterine cavity. The intrauterine hormonal system releases a certain amount of a hormone that increases the viscosity of mucus in the cervical canal, thins the endometrial layer and inhibits sperm motility. The reliability of intrauterine contraception ranges from 99.2 to 99.8%.

BUT! The intrauterine device increases the risk of developing inflammation of a different nature, often causes heavy, long, painful menstruation and creates a risk of ectopic pregnancy. And the hormonal system is put, as a rule, for a long time - 5 years. Therefore, it is not suitable for women who do not plan to delay conception for such a long time. In addition, this method of contraception sometimes causes intermenstrual bleeding and pain.

4. Hormonal implants and injections

8. Coitus interruptus

This most ancient method of contraception is that the partner removes the penis from the vagina before ejaculation.

BUT! A small amount of seminal fluid will be released during intercourse, so the reliability of the method does not exceed 80%. In addition, the method is very inconvenient for a man who is not only forced to closely follow the process, but also risks getting problems with potency, ejaculation, and even prostatitis. In addition, when using this method, the woman also experiences more psychological discomfort.

9. Spermicides

These are chemicals in the form of vaginal suppositories, creams, tablets and capsules that are inserted into the vagina and have a devastating effect on sperm. Their efficiency is not more than 70%.

BUT! Chemical contraceptives require constant administration before sexual intercourse and often cause irritation and inflammation of the vaginal mucosa, as well as vaginal candidiasis.

There are also emergency contraceptive preparations containing levonorgestrel, which affects ovulation and reduces the risk of a woman's egg being fertilized in the pre-ovulatory period. These drugs include escapelle and others.

Today, every couple can control their sex life and plan their pregnancy consciously. The existence of such a life of freedom is a great merit of scientists and pharmacists, who regularly invent more and more advanced methods of contraception. Of course, even the most reliable method sometimes has misfires. In addition, there are many myths that make it difficult to understand the true reliability of a particular method.

Let's try to figure out which methods of contraception are the most reliable.

Sterilization - 99.9%

The most effective method of contraception is sterilization. In men, this is a vasectomy; in women, it is tubal ligation. These procedures require surgical intervention and exclude the possibility of having a child in the future, therefore, naturally, they are not particularly popular with young men and women. In terms of reliability, sterilization is surpassed only by complete abstinence.

Features: Recommended only for women who already have several children and in case of medical contraindications to pregnancy, because the ability to become pregnant is not restored. There is also a risk of ectopic pregnancy.

Oral contraceptives - 99.7%

Hormonal pills are one of the most reliable methods of contraception.

Their main feature is the mechanism of action on the woman's body. They have a complex effect on the female reproductive system: ovulation is suppressed, mucus thickens in the cervical canal, and the endometrial layer in the uterus becomes thinner. While taking the pills, the woman's ovaries "rest", and the necessary dose of the hormone is provided by the drug. The thickening of cervical mucus in the cervix prevents not only sperm, but also bacteria from entering the uterus, thereby reducing the risk of infectious diseases. However, it should be understood that oral contraceptives do not protect against sexually transmitted infections. Also, when using this method of contraception, the blood loss of a woman during menstruation is reduced, by reducing the inner layer of the uterus. This effect has a positive effect on overall health, especially for women suffering from iron deficiency anemia.

Features: Combined oral contraceptives are qualitatively different from other hormonal contraceptives, as different pills contain different dosages and combinations of hormones. This makes it possible for an individual approach and the choice of exactly those pills that can solve the problems of a particular woman. Naturally, a gynecologist should select them. Hormonal pills of the latest generation, in addition to the contraceptive effect, have a pronounced non-contraceptive effect: they positively affect the condition of the skin and hair, eliminate PMS, shorten the duration of menstruation and reduce pain during this period. Of the many oral contraceptives presented in pharmacies, one can single out tablets with innovative 24 + 4 and 26 + 2 regimens. They shorten the non-hormonal period, which minimizes negative symptoms. Also, special attention should be paid to oral contraceptives of the latest generation, which contain the active form of folic acid. This component allows a woman to take care not only of her health, but also of the future generation. As soon as a woman decides that she is ready for the birth of a child, she can stop taking the pills, being sure that her body is already prepared for pregnancy.

Intrauterine contraception - 99.2- 99.8%

This type of contraception includes an intrauterine device and an intrauterine hormonal system. Both in reliability and in the mechanism of action, they differ from each other. The spiral is installed in the uterine cavity and prevents the implantation (attachment) of a fertilized egg.

The intrauterine hormonal system is administered in the same way, but acts differently - it regularly releases a certain amount of the hormone, which, acting locally, has several effects: increases the viscosity of mucus in the cervical canal, inhibits sperm motility, thins the inner layer of the uterine cavity (endometrium).

Features: The intrauterine hormonal system is suitable for women who are not going to get pregnant for a long time, as well as nursing mothers. It is set for 5 years, however, if necessary, it is possible to extract it earlier. Unlike the spiral, the hormonal system is not an abortive method of contraception.

Hormonal implants and injections - 90-99%

These methods of contraception work on the principle of hormonal pills, only the hormone is introduced into the body in other ways: an intramuscular injection is carried out every three months (or monthly), a hormonal implant is inserted into the upper arm and provides contraception for 5 years.

Features: It is difficult to choose individually, based on the state of health of the woman and her individual needs. There are a number of side effects: irregular bleeding, discharge, headache, weight gain and acne.

Hormone patch and ring - 92%

The same level of reliability for these two methods does not at all indicate the similarity of their application: the hormonal patch is glued to the skin, and the hormonal ring must be inserted into the vagina on its own.

Features: The hormonal patch must be applied every 7 days, starting from the first day of the cycle. The use of a hormonal ring is designed for one cycle. It must be installed from the 1st to the 5th day of the cycle, and after three weeks (on day 22) it must be removed. On the 8th day of the break, a new one is introduced. It is the adherence to clear patterns that allows these methods to be effective, so they are only suitable for very organized women.

Barrier methods: condom, diaphragm, cap, sponge - 84-85%

A condom is the only one among all the above contraceptives that protects not only from pregnancy, but also from any infections and bacteria. But its low reliability suggests that this product often fails (it simply breaks).

The diaphragm, cap and sponge are also barrier methods of contraception, these devices are installed in the vagina just before intercourse.

Features: These methods of contraception require preparation for sexual intercourse - and, therefore, can significantly reduce sexual desire, cause discomfort and reduce sensitivity.

Calendar method - 80%

It involves mathematical calculations of the days on which fertilization can take place, according to the woman's menstrual cycle. Thus, during the "dangerous" period, you must either refrain from sexual contact or use other methods of contraception.

Features: Suitable only for women with a regular menstrual cycle, who are not embarrassed by "love on schedule".

Coitus interruptus 73%

The bottom line is that a man must have time to remove the penis from the vagina before ejaculation. This is one of the most ancient methods of contraception, but far from the most reliable. Keep in mind that a small amount of seminal fluid can also be released during intercourse.

Features: When resorting to PPA, a man is forced to deliberately control ejaculation, and this not only distracts from the process itself, depriving him of the opportunity to experience the full range of sensations for which, in fact, sexual contact takes place, but is also wrong from a medical point of view. So, volitional obstruction of reflex ejaculation leads to problems with potency and ejaculation (for example, among men with prostatitis, half regularly practiced coitus interruptus).

The lack of reliability of the PPA negatively affects the sexual life of a woman. She also experiences psychological stress, which does not allow her to relax and get maximum satisfaction during intercourse. According to statistics, among women who have never experienced an orgasm -50% were protected by PPA.

Spermicides 71%

Features: If pregnancy occurs with this method of contraception, this can have a bad effect on the fetus, most often doctors recommend an abortion. In addition, chemical contraceptives often cause irritation and inflammation of the vaginal mucosa, vaginal candidiasis.

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In many developing countries, including, unfortunately, ours, abortion continues to be one of the most widely used ways to prevent unwanted pregnancies. But why is this happening? Either this is a lack of elementary sexual education, or an absolutely disregard for one’s health, or echoes of old Soviet statements such as “there is no sex in our country”, which prevent parents from telling their children about the rules of safe sexual behavior correctly and without shame. But still, most likely there is an influence of all the factors listed above in the complex.

According to statistics, in every fifth woman, abortion leads to infertility. Even if you do not take into account the enormous number of other complications that occur after and during the abortion, the risk of infertility should be enough to make you wonder if the game is worth the candle.

Modern medicine offers a grandiose arsenal of ways to prevent unwanted pregnancy. In order not to regret what you have done in the future (we mean abortion), you just need to decide on the method of contraception that suits you personally.

Let's start with the reliability of existing methods.

Reliability of methods of contraception:

* this degree of reliability is only possible with a regular menstrual cycle.

Coitus interruptus

The correct technique for using this method is as follows: the man must remove the penis from the woman's vagina just before ejaculation (ejaculation). The very same ejaculation can occur anywhere, but not in the woman's vagina.

The popularity of this method of preventing unwanted pregnancy is understandable. It does not require material costs, does not reduce the sensitivity of the sexual organs of partners during the act. However, it has much more negative sides than positive ones. First, the method is very unreliable. This is explained by the fact that the “lubricating” (pre-seminal) fluid that is released from a man during sexual intercourse contains from 10 to 20 million spermatozoa, which is more than enough to fertilize an egg. And even if you are sure that your partner superbly controls the process of ejaculation, then no man can control the release of the “lubricating” fluid (except perhaps for a few yogis in distant India, and even then it is unlikely). Secondly, the long-term use of this method of protection negatively affects the psychological state of partners, since the interruption of sexual intercourse is not physiological. Many studies have shown that a regular lack of natural satisfaction can lead to sexual coldness in women, impotence in men and a sharp decrease in sexual desire in both partners. Thirdly, coitus interruptus will never protect you from sexually transmitted diseases, as well as AIDS and viral hepatitis. Therefore, it is unacceptable to use this method for casual sexual intercourse.

Calendar method ("safe days" method)

The calendar method belongs to the group of natural methods for preventing unwanted pregnancy. The essence of the method lies in the fact that a woman is able to conceive only for a few days after the release of the egg from the ovary (ovulation) - that is, during the life of the egg. Theoretically, ovulation occurs in the middle of the monthly cycle - approximately on its 11-15th day. It is this period of time that is considered favorable for conception, and the rest of the time a woman is not capable of conception. But this is only theoretical. A regular 28-day menstrual cycle with ovulation in its middle occurs in only 30% of women. And this is more the exception than the rule. It is also necessary to take into account that the spermatozoa in the woman's vagina can remain viable for up to 9 days. And if ovulation occurs during this period, then be sure that they will not miss theirs. The calendar method is very “time-consuming”, since in order to correctly calculate safe days, a woman must be aware of any changes in her menstrual cycle, that is, regularly keep records for at least the last year. Agree, not every woman is capable of such a feat.

But let's not talk about sad things, because nothing is impossible in our life. And if you really want to use this method of contraception, then use it. Its effectiveness directly depends on your organization and the availability of elementary mathematical skills.

How do you calculate "safe" days?

First, it must be clearly understood that the first day of the menstrual cycle is considered the day of the onset of menstruation (discharge). The last day is the first day of the next and nothing else.

For clarity and ease of counting the days you are interested in, make a table. In the first column, enter the month, in the second - the date of the beginning of the menstrual cycle, and in the third - its duration.

In this case, the data in the table shows that the shortest cycle is twenty-six days (March), and the longest is thirty days (August). That is, there is no clear regularity in the duration of the menstrual cycle.

In a short (26-day) cycle, ovulation occurs approximately fourteen days before the onset of menstruation - on the 12th day of the cycle. Given the possible deviations of the onset of ovulation within 3 days in one direction or another, we can conclude that the period of possible conception in each cycle of the specified duration is in the range from the 9th to the 15th day.

In a long (30-day) cycle, ovulation also occurs 14 days before menstruation, that is, on the 16th day. Possible three-day deviations do not go away and they must also be taken into account. In this case, the period of probable conception is in the range from the 13th to the 19th day of the menstrual cycle.

Even with such a slight variability of the menstrual cycle (the difference between the length of the longest and shortest cycles is only 4 days), it becomes impossible to predict the length of the next one. Therefore, the woman in the example we have described must assume that ovulation can occur between days 9 and 19 of the cycle. And if we additionally take into account the viability of spermatozoa and the possible re-ovulation with an active sexual life, then there will be practically no “safe” days left.

Therefore, we repeat: the effective use of this method of contraception is possible only with a regular menstrual cycle with a predictable time of ovulation.

Method for measuring basal temperature

This method also applies to natural methods of pregnancy planning. Its essence is as follows. Before ovulation, the basal temperature is kept at a lower level due to the action of estrogen, after ovulation, progesterone raises the temperature to a higher level. A rise in basal temperature means that ovulation has already taken place. When measuring basal temperature, you must adhere to several rules:

1. take your temperature at the same time every morning without getting out of bed
2. temperature should be measured throughout the cycle, including during menstruation
3. the duration of the measurement should be the same each time (for example, when using a conventional glass thermometer - 5 minutes)
4. throughout the cycle you need to use the same thermometer.

The standard type of temperature rise clearly shows a low temperature level, then a sharp rise of at least two tenths of a degree, followed by a high temperature level that remains until the end of the current cycle. The difference between the average temperature of the second and first phases of the menstrual cycle should be at least 0.4-0.5 degrees.

The effectiveness of this method is enhanced by its complex use with the calendar method described above.

disadvantage of all the above methods of natural protection against unwanted pregnancy, in addition to their low efficiency, there is also a high risk of contracting sexually transmitted diseases, AIDS and viral hepatitis.

Vaginal douching

The essence of this method lies in the impact on the spermatozoa already present in the woman's vagina with various chemicals that can kill them. Various antiseptic agents are often used, for example, miramistin, chlorhexidine and others. In fact, these substances are not able to protect you from an unwanted pregnancy due to the fact that, once: spermatozoa are extremely mobile, two: there are an unusually large number of them, three: they can hide in the mucus of the cervical canal, which makes them inaccessible to disinfectants.

It is the above listed reasons that determine the low efficiency of this method.

It is also necessary to remember that frequent exposure to drugs that are aggressive towards microorganisms on the vaginal mucosa leads to a violation of the normal composition of the microflora and the development of a subsequent condition called dysbacteriosis. At the same time, the reproductive system of a woman is inhabited by microorganisms, which are normally either very small or should not exist at all (for example, fungi of the genus Candida).

Condom

The mechanism of action of a condom as a means of contraception is to create a mechanical barrier to the penetration of sperm into the vagina. Therefore, the complete inefficiency of using this means of protection is observed only when it is damaged. It should be borne in mind that the resulting defect can be quite small and it is often almost impossible to notice it.

To reduce the risk of damage to the condom during its use, certain rules must be followed. Firstly, you must not roll out the condom before putting it on the penis, secondly, do not try to check its integrity in any way (for example, by inflating or filling it with water), as this significantly increases the risk of damage, and thirdly, you must not use additional oil-based lubricants at the same time as condoms, as they can reduce the strength of latex - only water-based lubricants are acceptable; fourthly, it is necessary to strictly follow the instructions for using a condom.

Remember that the correct use of a condom will not only protect you from unwanted pregnancy in 90% - 95% of cases, but will also reduce the risk of contracting sexually transmitted diseases by 90%.

Diaphragm (vaginal cap)

The diaphragm is the female version of the condom. It also consists of the finest latex. Before using the vaginal cap, it is necessary to consult a gynecologist, since the effectiveness of the use of the diaphragm directly depends on the correct choice of its size, which must clearly correspond to the size of the vagina and cervix. The vaginal cap, like the condom, creates a mechanical obstacle to spermatozoa, but, unlike the latter, does not protect against sexually transmitted diseases.

The negative aspect of this method of contraception, in addition to its inability to protect against infections, is also the need for a correct insertion of the cap into the vagina. Agree that not every woman and not the first time will be able to do it right.

Intrauterine devices (spirals)

The contraceptive effect of the spiral is due to the following. The leg of the intrauterine device consists of copper, which, released into the uterine cavity, creates an environment impossible for the existence of spermatozoa and the egg. Also, copper provokes the development of a local aseptic (without the participation of pathogens) inflammatory reaction, which, in turn, does not allow the spermatozoa and the egg to function fully. The effectiveness of this method of contraception is on average 80%.

As with any method of contraception, the use of an IUD has its pros and cons.

Let's start with positive sides:

• The IUD begins to act immediately after the introduction and does not require the use of additional methods of contraception;
• The installation of an IUD implies a long-term contraceptive effect (up to 6 years) and the removal of the spiral is performed more often not because of its expiration date, but more often because of the woman's desire to become pregnant;
• The ability to conceive is restored immediately after the removal of the spiral from the uterine cavity.

To negative The parties to the use of the IUD include the following:

• The presence of a foreign body in the uterine cavity is always an open entrance gate for infection;
• When using this method of contraception, a regular (at least once every six months) examination by a gynecologist is necessary;
• The presence of an IUD can cause an increase in the abundance of menstrual flow, as well as provoke their soreness;
• IUDs do not protect against sexually transmitted diseases;
• The use of an IUD is not recommended for nulliparous women.

Also, before using the spiral, it is necessary to consult a gynecologist, who will determine the presence of contraindications to the installation of the spiral (for example, the spiral cannot be installed if the woman has any infection of the genital area).

One of the most unpleasant consequences of using this method of contraception is the increased risk of developing an ectopic pregnancy after the removal of the spiral. Many studies have shown that the risk of an ectopic pregnancy in women who use spirals is 4 times higher.

Hormonal intrauterine devices (spirals)

Hormonal intrauterine devices differ from the usual ones in that, in addition to the copper component, they also contain the hormone levonorgestrel, which prevents pregnancy. That is, the action of the hormone is added to the effect of local inflammation, which determines the higher efficiency of the method compared to the use of conventional spirals.

There are no fundamental differences in contraindications, positive and negative effects of the hormonal spiral in comparison with the use of the usual one. The only thing a woman needs to know is that the ability to conceive after the removal of the hormonal coil can be restored for a longer time. So, 6 months after its removal, pregnancy occurs in 50% of women, and a year later, almost all women are already capable of conception (98%).

Chemical contraception (creams, suppositories, tampons)

Chemical contraception combines several effects: contraceptive, antimicrobial and antiviral. These drugs contain antiseptic substances that actively affect both spermatozoa and pathogens of infectious diseases, including viruses. But, unfortunately, the use of this method in monomode (without the parallel use of other means) is far from always effective.

When using them, it must be remembered that the acid, which is chemical contraceptives, is neutralized when interacting with alkali, which causes a decrease in the effect up to its complete disappearance. That is why before and after sexual intercourse using chemical contraceptives, you can not use soap (soap has an alkaline reaction).

Again, it is known from practice that the duration of action of candles and creams is much shorter than the manufacturer claims on the package. Therefore, before the next sexual intercourse (even if it occurs after a short period of time after the previous one), it is recommended to introduce a new suppository or portion of cream. This nuance does not apply to contraceptive tampons. Their action lasts from 12 to 16 hours.

This method is convenient for women who are breastfeeding, since the substance contained in the contraceptive has only a local effect and does not enter the bloodstream, and, accordingly, into breast milk.

A negative consequence of the frequent use of chemical contraception (as well as with douching) is a violation of the normal composition of the vaginal microflora with the formation of dysbacteriosis.

Hormonal pills

This method of contraception was discovered not so long ago, but its appearance opened a new era in solving the problem of preventing unwanted pregnancy. The essence of hormonal contraception is to prevent ovulation - the release of a mature egg from the ovary. And if the egg does not appear in the field of view of the sperm, then they sit idle, unable to fertilize it.

The effectiveness of hormonal contraception, when used correctly, approaches 100%, but it must be remembered that the use of hormonal pills does not protect you from sexually transmitted diseases.

Rules for choosing a hormonal contraceptive

The most correct method of choosing an oral contraceptive is a visit to a gynecologist. He will be able to comprehensively assess the state of your health, take into account all possible contraindications, and then advise a hormonal contraceptive that will best suit you.

To date, there are the following groups of oral contraceptives:

1. Combined oral contraceptives (COCs)- these drugs contain both gestagens and estrogens. Depending on the dose of hormones, drugs are divided into groups:
   • Microdosed COCs. They contain the smallest dose of hormones and are therefore indicated for young nulliparous women who have a regular sex life.
   • Low-dose COCs. The dose of hormones is slightly higher than in the preparations of the previous group. Shown to the same group of women in case of ineffectiveness (ovulation did occur) of microdosed COCs
   • Medium dose COCs. This group of drugs contains an average dose of hormones. Shown to women giving birth, leading a regular sex life.
   • High-dose COCs. These drugs have found application not so much as contraceptives, as a means for the treatment of hormonal diseases. Their use in order to prevent unwanted pregnancy is recommended for women who have given birth in case of ineffectiveness of all groups of drugs listed above.
2. Gestagen oral contraceptives
   These contraceptives can be used by women after childbirth during lactation, as well as in case of contraindications to taking COCs. Also, this group of drugs is successfully used to treat gynecological diseases (uterine fibroids, endometriosis).

The effectiveness of the contraceptive effect of hormonal drugs directly depends on the correctness of their use. Tablets should be drunk strictly according to the scheme indicated in the instructions, at the same time of the day.

It must be remembered that in the first month of taking the drug, the contraceptive effect is incomplete, since at this time the body "gets used" to the new conditions of functioning. Accordingly, in the first month it is recommended to additionally use any other means of protection.

Some drugs (painkillers, antibiotics, etc.) can reduce the effectiveness of hormonal contraception, so in this case it is also necessary to use additional protection.

Even if you have chosen the right contraceptive drug on your own and you do not experience any disturbances in well-being and side effects, a visit to the gynecologist is still unavoidable, since it is necessary to determine how effectively the drug you have chosen blocks ovulation. And only a specialist can evaluate this by conducting an ultrasound examination on the 11-13th day of the menstrual cycle.

Frequently Asked Questions

How to behave in case of missing the next pill from the package?

The tablet must be taken as soon as possible. If less than 12 hours have passed since the due time of taking, then just take another pill and don’t worry about anything else. In this case, the contraceptive effect of the drug is not reduced. Take the next pill as soon as possible (the sooner the better). If more than 12, and even more than 24 hours have passed, then it is necessary to use additional protective equipment before starting a new package, since the risk of pregnancy is increased.

What to do if side effects are observed and their intensity greatly affects your well-being?

If you experience pronounced side effects while taking the drug (intense headache, increased pressure, depressed mood, sudden weight gain), then most likely the drug is not suitable for you and you need to change it to another, lower-dose one.

What to do if spotting occurs between periods?

This also means that the drug is not suitable for you and you need to change it to another, higher dose.

What to do if menstruation does not start during a week-long break from taking hormonal contraceptives?

This means that the dose of hormones that the selected drug contains is too high for you. It is necessary to change the contraceptive to a drug containing a lower dose of hormones.

How long can hormone pills be taken?

Since hormonal contraception to some extent still disrupts the activity of the ovaries, it is recommended to take drugs without interruption for no more than 2-3 years. After that, you need to take a break for at least six months. During this time, the ovaries fully restore their function.

Once again, a reminder: only a specialist gynecologist can choose the most correct drug. But if you decide to do it yourself, then read the instructions for use very carefully. Only strict adherence to it will provide a reliable contraceptive effect and minimize the risk of side effects. If you feel unwell while taking this medicine, contact your doctor immediately.

Hormonal injections

The essence of the method is as follows. The drugs used for this type of contraception contain the hormone levonorgestrel, which, after administration, is gradually released, as a result of which its constant concentration in the blood is maintained for 2-3 months. This is a method of long-term contraception.

As well as when taking pills, for 20-30 days after the first injection, the contraceptive effect is incomplete and during this period the use of additional protective equipment is recommended.

The negative effect of this method of preventing unwanted pregnancy is the effect of "inhibition" of ovarian function. It is because of this that hormonal injections can only be used by women who have given birth. As with the choice of hormonal pills, it is first necessary to visit a gynecologist to assess the state of health, identify concomitant diseases and determine contraindications to the use of the method.

Hormonal implants

Implantation of hormonal capsules refers to long-term methods of contraception. The mechanism of action is the same as that of hormonal injections: the gradual release of hormones while maintaining their constant concentration in the blood. A feature of this method is that it provides a full-fledged contraceptive effect for 5 years.

Implants can only be used by women who have given birth, since the “inhibition” of ovarian function when using this method is quite intense, and in nulliparous young girls there is a high risk of not restoring childbearing function after the end of the drug. The capsule is injected subcutaneously into the upper arm, forearm, inner thigh or lower abdomen (optional).

Hormonal ring NovaRing (NovaRing)

A hormone ring is a contraceptive that is inserted into a woman's vagina. The action of NuvaRing is the daily release of microdoses of hormones that prevent the onset of ovulation. Unlike hormonal pills, injections, and implants, hormones released from the ring act predominantly locally. This reduces the risk of side effects that can occur with the systemic effect of hormones on the body. In addition, the concentration of hormones released from the ring is much less than in the most low-dose COCs.

NuvaRing is inserted into the woman's vagina from the 1st to the 5th day of the menstrual cycle. Due to its elasticity, it occupies the most comfortable position, adapting to the individual characteristics of the woman's vagina. The term of the contraceptive effect of the ring is 21 days, that is, in the next menstrual cycle, the introduction of a new ring is necessary.

The disadvantage of the method is that the ring does not protect against sexually transmitted diseases.

Contraceptive hormonal patch Evra (Evra)

The contraceptive patch Evra (Evra) is a method of long-term hormonal contraception. The patch is glued to the skin once a week, after this period it must be changed. The effect of the patch, as well as other methods of long-term contraception, is the gradual release of hormones into the blood that prevent ovulation.

One of the main positive effects of the Evra patch is its convenience. It is firmly attached to the skin, does not peel off under the influence of water, does not lose its properties when exposed to sunlight. A patch is glued to choose from on the buttocks, abdomen, shoulder blade or shoulder.

The side effects of the Evra patch are the same as those of microdosed COCs. If you opted for this method of contraception, you must also first visit a gynecologist to assess the presence of possible contraindications.

Medical sterilization

This is a radical method of contraception that can only be used by women who are 100% sure that they will never want to get pregnant again. The essence of the method is the intersection of both fallopian tubes. This makes it impossible for the egg and sperm to meet.

Restoration of natural reproductive function after medical sterilization is impossible.

Medical sterilization can be carried out in several ways:

• routine surgery with a cut in the abdomen. It is for the purpose of sterilization that it is rarely used due to the long recovery period and the subsequent presence of a scar at the incision site.
• laparoscopic method. The operation is carried out not through an incision, but through a puncture of the anterior abdominal wall under the control of optical instruments. Less traumatic operation, the recovery period is short, the scars at the puncture sites are almost invisible
• culdoscopic method. The operation is performed through a puncture in the posterior wall of the vagina. This is the most progressive method, since the number of complications is minimal, and there are no scars at all.

Men can also use the method of medical sterilization. To achieve a contraceptive effect, the vas deferens are simply tied up, as a result of which spermatozoa cannot leave the testicles. The operation is performed under local anesthesia on an outpatient basis.

Emergency contraception (after intercourse)

Emergency (postcoital, emergency contraception), unlike planned, is used immediately after intercourse or during the first 1-3 days after it. The essence of this method of contraception is to prevent the processes of fertilization of the egg and / or implantation of the fetal egg by inhibiting ovulation, disrupting egg transport and / or changing the structure of the endometrium (uterine mucosa).

The most reliable and popular method of emergency contraception in our time is a single (or divided into two doses) administration of a drug containing 1.5 mg of levonorgestrel. This method of contraception can be used after unprotected intercourse (including after rape), in violation of the integrity of the condom, missing three or more tablets of combined oral contraceptives, prolapse of the intrauterine device and in other similar circumstances, accompanied by an increased risk of unwanted pregnancy.

The greatest effectiveness of emergency contraceptives is noted if they are taken within the first 24 hours after unprotected intercourse, the effectiveness remains acceptable up to 72 hours after intercourse and decreases sharply at a later period. It is important to understand that levonorgestrel-based emergency contraceptives are not abortion drugs and can only work until the egg has implanted into the wall of the uterine cavity. Therefore, the use of emergency contraception in women with a confirmed pregnancy is meaningless.

Levonorgestrel, which is part of emergency contraceptives, does not pose a danger to an embryo that has passed the implantation stage, therefore, it is not necessary to terminate a pregnancy that occurred while taking an emergency contraceptive, for fear of developing malformations in the fetus.

Preparations for emergency contraception are intended only for use in an "emergency" situation and are not suitable for regular use as planned contraception, since, firstly, their effectiveness with constant use is much lower than the effectiveness of modern planned contraceptives, and secondly, regular use of emergency contraceptives can cause menstrual irregularities.

Conclusion

Childbirth is an exclusive function of the female body, and in no case should it be treated negligently. In order for your pregnancy to be desirable and timely, choose the method of contraception that suits you. It is not recommended to use methods whose efficiency is below 50-60%.
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Modern means of contraception: barrier, chemical, biological, hormonal, intrauterine contraception, surgical - there are a lot of them, but often a woman cannot decide what to choose. And in the end, unexpectedly, she becomes pregnant. We will briefly describe the different contraceptives for women, their advantages and disadvantages.

Intrauterine systems

These are those that are installed in the uterine cavity for a long time. Usually recommended exclusively for women who have given birth due to possible side effects. But we'll start with the benefits.

1. You can not worry about unwanted pregnancy for several years, it has a positive effect on sexual relations.

2. High reliability. Slightly less than 100%.

3. Availability. The most inexpensive intrauterine device costs about 200-300 rubles. Purchased once.

And these are shortcomings.

1. Unpleasant sensations during installation. Some women require local anesthesia.

2. The possibility of falling out and displacement of the spiral, which provokes a decrease or termination of its contraceptive action.

3. Inflammatory diseases. The installation of the system can provoke the penetration of pathogens into the uterine cavity, which sometimes causes endometritis, the occurrence of adhesions in the intestines, fallopian tubes. Accordingly, the risk of infertility in the future increases. Therefore, spirals are usually recommended for women who have given birth.

4. The likelihood of an ectopic pregnancy. A fertilized egg cannot be fixed in the uterine cavity due to the spiral and can return back to the fallopian tube and implant there.

5. Increasing the likelihood of heavy periods. Therefore, non-hormonal intrauterine systems are not recommended for women who have severe cyclic and acyclic uterine bleeding.

condoms

Barrier contraceptives have a number of advantages and can be used without consulting a doctor. Always welcome.

1. Reliability. Almost 100% protection not only from unwanted pregnancy, but also from sexually transmitted infections.

2. Ease of use and availability. Can be purchased at any pharmacy, supermarket. The abundance of models allows any couple to choose the right contraceptive for themselves.

3. Absence of contraindications. Only sometimes they have allergic reactions. More often than not, it's the lubricant, dye, or flavor that's coated on the condom. In this case, you need to try another, ordinary, without "bells and whistles".

But there are downsides too. They are usually especially frightening for couples who have previously used other types of contraception.

1. Negative effect on erection, sensitivity. Usually in this case, a condom with ultra-thin walls helps.

2. Falling off the condom during intercourse. Again, due to poor erection. It happens when a condom is put on with insufficient sexual arousal.

3. Damage to the condom. It often happens if you try to apply various substances in the form of a lubricant to it, which are not intended for this. But damage can also be the result of a defective product. If the condom breaks, emergency contraception is used to prevent pregnancy.

By the way, an intrauterine device can be used as emergency contraception. It should be installed a maximum of 5 days after unprotected intercourse. Naturally, this method is suitable for those women who already thought about installing an intrauterine system.

Spermicides

They have no contraindications and can be used, if necessary, by women who are breastfeeding. The chemical method of contraception also has pros and cons.

Some benefits.

1. Availability. 10 vaginal tablets (or suppositories), for 10 sexual acts, cost about 300 rubles. Sold in all pharmacies.

2. They do not affect the body, like hormonal contraceptives, that is, they have only a local effect.

3. Have some antimicrobial and antibacterial action.

4. Have no contraindications and can be used in cases where no other contraception is suitable.

And these are the cons.

1. Often cause irritation of the vaginal mucosa and glans penis.

2. With regular use, 2-3 times a week or more, the vaginal microflora is disturbed.

3. Efficiency is significantly lower than stated if sexual intercourse is started earlier than the time specified in the instructions. After the introduction of the drug into the vagina, you need to wait a bit for it to start working.

Hormonal remedies

They are considered one of the most reliable and convenient, but at the same time having many contraindications and side effects. We will talk about oral contraceptives. First about the good.

1. When taken correctly, birth control pills are almost 100% effective.

2. Make the menstrual cycle regular.

3. It is possible sometimes to postpone menstruation, to delay its onset, if necessary. To do this, a break that is taken in taking pills for 7 days every month is transferred.

4. Have a positive effect on the endometrium. Also, hormonal contraception is the prevention of the formation of certain types of ovarian cysts.

5. Can be taken indefinitely, with interruptions only for pregnancy. Reception ends with the onset of menopause.

And cons.

1. Sometimes they provoke the development of varicose veins.

2. Should be taken without gaps, and preferably at the same time, so that the effectiveness does not decrease.

3. In parallel with oral contraceptives, certain medicines, such as antibiotics, should not be taken, as protection against pregnancy is reduced because of this.

4. Diarrhea and diarrhea are also undesirable effects, especially in the first three hours of taking the pill.

5. Sometimes taking hormonal contraception provokes weight gain.

6. Spotting discharge outside of menstruation. A common side effect in the first three cycles of taking the drug. If they persist longer, you need to think about taking a drug with a higher dosage of the hormone estrogen.

7. Decreased libido, vaginal dryness. We'll fix it. A longer prelude and the use of water-based lubricants will solve this problem. In some cases, women switch to triphasic drugs or no estrogen at all. It can also help in the return of sexual desire.

And that's not all. A complete list of side effects can be found in the instructions for the drug. But, of course, it is not at all a fact that any of them will affect you or be pronounced.

Ineffective and unreliable methods of contraception

Sex to conceive children is a much rarer thing than intercourse for pleasure. That is why not every sexual intercourse should end in pregnancy. It has always been so, but modern contraceptives have appeared relatively recently. That is why in ancient times people tried with all their might to come up with at least some reliable way to deal with unwanted conception.

Undoubtedly, some folk contraceptives worked, but most of them were real obscurantism. Unfortunately, despite the modern development of contraception, some people still try to use the old methods. And this is bad, because an unplanned pregnancy is a great stress for both partners, and there is nothing to say about the dangers of abortion for women's health. We discussed reliable contraception, and now let's talk about the most stupid methods of folk contraception, in order to completely get rid of stupid delusions and not use them as a means of contraception after childbirth and in other situations.

1. Sex while standing. There is a myth that standing sex does not allow the male seed to reach the egg, as it simply spills out of the vagina. In fact, this is not at all the case. Spermatozoa are quite able to achieve their goal. Thus, trying to protect yourself from an unplanned pregnancy due to a standing position, and any other one too, is impossible.

2. Coitus interruptus. The most popular method of folk contraception is interrupted intercourse. However, popularity is not the key to success. The fact is that during arousal, a certain amount of lubricant containing sperm can be released from the male genital organ. Therefore, conception can occur even at the very beginning of intercourse.

3. Lemon. There is such a very unusual recipe for a chemical contraceptive. A slice of lemon is inserted into the vagina and remains there until the very end of sexual intercourse. It is believed that lemon juice will easily kill all spermatozoa and conception will not occur. There is still some truth in this myth: citric acid can destroy spermatozoa. But first, not all. And secondly, exposure to lemon juice can cause serious burns of the vaginal mucosa, penis head, etc.

4. Free week or calendar method of contraception. It is believed that after menstruation, a girl has from three days to a week during which she can make love without fear of pregnancy. Purely theoretically, the way it is, because ovulation usually occurs no earlier than the 12th day of the cycle. In practice, things are not so clear cut. Indeed, in so many women, the menstrual cycle does not follow a clear schedule, and in such cases, this method of contraception is completely pointless.

Sexual intercourse during menstruation is more reliable in this regard, but only if the woman's bleeding is not prolonged. After all, it happens that menstruation continues for 7-8 days. Well, spermatozoa can safely be in an active state in the female genital tract for 3 days. That is, if ovulation occurs on day 11, then the egg may well meet a sperm cell on its way.

But after ovulation, already after 3 days (the egg lives a maximum of 2 days), really “barren days” begin, this convenient period lasts until menstruation, on average 7-10 days. That's just not every woman can accurately determine the day of ovulation.

5. Urination after intercourse. This method is more suitable for men, and in order to "expel" the infection from the urethra, which he could get as a result of sexual intercourse. How is the female urethra connected to the vagina? Science does not know this. The method is absolutely hopeless.

6. Vaginal douching. Often, women choose antiseptics for these purposes, such as chlorhexidine or miramistin. But it's useless. These substances can only protect against infections, and even then not always. Well, they are not terrible for spermatozoa. Within 1-2 minutes after sexual intercourse, many quicks will enter the cervical canal. And you can't get them from there.
Well, the most unpleasant thing is that douching violates the microflora of the vagina and leads to the reproduction of pathogenic and opportunistic microorganisms there, that is, to inflammation.

Nevertheless, many women continue to argue that medically approved methods of protection against unwanted pregnancy are by no means 100% effective. There remains only surgical contraception - tubal ligation, which can be done in some cases. However, doctors consider this approach to be wrong; in any case, alternative contraception loses to the officially recognized one in terms of effectiveness. And yet - often seriously injurious to health. Is it worth the risk?

Contraceptives can be divided into traditional and modern funds. The degree of effectiveness of any of the methods of contraception is assessed using the Pearl index, cat. equals the number of unwanted pregnancies in 100 women using a particular method of contraception for 12 months.

Traditional methods of contraception:

Mechanical Methods :

- vaginal diaphragm – a metal ring with a rubber cap; the diaphragm is inserted in such a way as to cover the cervix and create a mechanical obstacle to the passage of spermatozoa into the cervix. The edges, the inner surface, the outer surface of it should be smeared with spermicides. The diaphragm is inserted before intercourse and removed 8-12 hours after it. There are several sizes of the vaginal diaphragm. Pearl index when using the vaginal diaphragm - 12;

- condom (condom) ) is a contraceptive used by men and is a saccular formation of thin elastic rubber with a thickness of less than 1 mm. Condoms are made of rubber, latex, plastic. A condom prevents sperm from entering the vagina. The Pearl Index is 20.

2. Chemical contraceptives (vaginal spermicides ) - destroy spermatozoa in no more than 1-2 minutes. Pearl index when using chemical contraceptives - 30.

- spermicides used in the form of douches - solution of vinegar, solution of boric acid or lactic acid, solution of permanganate K, 20% solution of sodium chloride, solution of lemon juice;

- vaginal spermicidal balls and tablets (containing boric acid, chinosol and tannin);

- gramicidin paste .

3. Rhythmic methods:

- calendar method - based on determining the time of ovulation and limiting the number of sexual intercourse in the periovulatory period (2-3 days before ovulation and 2-3 days after it). Pearl index - 24.

- temperature method - determination of the time of rise in basal temperature by measuring it daily in the morning for 10 minutes. And abstaining from sexual intercourse on the day of the fall and the first 3 days of the rise in basal temperature. Pearl index - 6.

Modern means of contraception:

1. Intrauterine contraception:

1). Neutral intrauterine devices (IUD) - the most widely used Lips loop (a polyethylene device in the form of a double Latin letter), the IUD in the form of the letter T and the number 7. The mechanism of action of neutral IUDs - disrupt the implantation of a fertilized egg, which is associated with accelerated peristalsis of the fallopian tubes and the resulting oocyte deficiency. Pearl index when using neutral naval forces 4.

2). Medical IUDs - contain copper, gestagens. The mechanism of action of medical IUDs:

Copper has a bactericidal and spermicidal effect;

Gestagens change the properties of cervical mucus, which leads to difficulty in the penetration of spermatozoa into the uterine cavity, and also causes the inability of the endometrium to implant an egg.

The Pearl Index when using medical IUDs is 1-2.

Contraindications to the use of IUDs:

Acute and subacute inflammatory diseases of the genital organs;

Chronic inflammatory processes with frequent exacerbations;

Infectious-septic diseases and fever of any etiology;

Isthmic-cervical insufficiency;

Benign and malignant tumors of the genital organs;

Polyps of the cervical canal;

Erythroplakia and leukoplakia of the endometrium;

Polyposis and endometrial hyperplasia;

Tuberculosis of the genital organs;

Malformations of the uterus;

Intrauterine synechia;

Violations of the menstrual cycle by the type of meno- or metrorrhagia;

Violations of the blood coagulation system, accompanied by increased bleeding.

The IUD is inserted by a doctor in compliance with the rules of asepsis on the 5-7th day of the menstrual cycle, after an artificial abortion - immediately (or after the next menstruation), after childbirth - after 3 months. The necessary conditions are: a normal blood picture, 1-2 degree of frequency of the vagina. After the introduction of the IUD, the doctor should examine the woman in a week, after the first menstruation, then after 3 months, subsequent examinations are carried out 1 time in 6 months. The duration of the IUD in the uterine cavity is 3-5 years.

Complications of intrauterine contraception:

Lower abdominal pain;

Uterine bleeding;

Ectopic pregnancy;

Uterine pregnancy, often ending in spontaneous abortion;

Perforation of the uterus (partial - with the introduction of the IUD into the muscle of the uterus in the area of ​​the bottom or side walls; complete - with the movement of part or all of the IUD into the abdominal cavity).

2. Hormonal contraception. Classification of hormonal contraceptives.