Modern methods of contraception for women. Chemical contraception (creams, suppositories, tampons). Types of female contraceptives

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 several years unwanted pregnancy, 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 when installing. 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 Oh. Accordingly, the risk of infertility in the future increases. Therefore, spirals are usually recommended for women who have given birth.

4. Probability of occurrence 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 Probability heavy menstruation. Therefore, non-hormonal intrauterine systems it is not advised to put women who have strong 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 appear 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 influence 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. Often happens if you try to apply on it various substances in the form of a lubricant that is 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.

Incidentally, as emergency contraception you can use an intrauterine device. It should be installed a maximum of 5 days after unprotected intercourse. Naturally, this way 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. chemical method 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 correct reception 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. Render positive influence 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, you can not take some medicines, for example, antibiotics, 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. Occasional reception hormonal contraception provokes a set excess weight.

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's always been that way, but modern facilities contraception appeared relatively recently. That is why in ancient times people tried with all their might to come up with at least some reliable way fight against unwanted conception.

Undoubtedly, some folk remedies contraception worked, but most of them were real obscurantism. Unfortunately, despite modern development contraception, some people still try to use the old methods. And this is bad, because an unplanned pregnancy is a big stress for both partners, and let alone the dangers of abortion for women's health and there is nothing to say. reliable contraception we discussed, 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 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: lemon acid capable of destroying spermatozoa. But first, not all. And secondly, the impact lemon juice can cause severe burns of the vaginal mucosa, head of the penis, 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 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 suitable more for men, moreover, in order to "expel" the infection from urethra, which he could receive 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 hustlers will enter 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 conditionally pathogenic microorganisms i.e. inflammation.

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

Appeared relatively recently on the domestic pharmacy market, chemical contraceptives are a unique combination of contraceptive, antimicrobial and antiviral agents. These drugs are an antiseptic that equally kills spermatozoa, and almost all bacterial and viral pathogens, including even AIDS and hepatitis viruses.

Chemical contraceptive preparations

They are convenient and easy to use, but unfortunately they do not have a sufficiently reliable contraceptive effect. With regular sexual activity, it is necessary to combine the use of chemical contraceptives with condoms. Such a "duet" perfectly compensates for the shortcomings of both methods of contraception and reliably protects against pregnancy and genital infections.

But it's important to remember correct use of these drugs: they are all acids, and when in contact with an alkaline environment (for example, soap) lose activity. Therefore, if you use one of the chemical contraceptives, then soap should not be used for genital hygiene before and after intercourse. Better to just rinse with warm water.

ATTENTION!!!
The time of action of chemical contraceptives indicated on the packaging and in advertising is somewhat overestimated (4-10 hours). The real effect of these drugs is limited to 35-40 minutes. That is, with repeated sexual intercourse, it is required to introduce a new candle or apply a new portion of the cream. This has nothing to do with tampons, since their activity lasts for 12-16 hours.

Chemical contraception suitable for women after childbirth (during lactation), as well as women with contraindications to other methods. I would recommend its use to couples who rarely live sexually. Still, the reliability of this method is not high enough, so it is not suitable for long-term, systematic use.

ATTENTION!!!
At frequent use means of chemical contraception, there is a change in the natural microflora of the vagina. Under the influence of an antiseptic, beneficial bacteria die along with sperm, which can lead to vaginal dysbacteriosis or other disorders. Therefore, this method cannot be used for regular contraception.

But for casual sex (in combination with a condom), this is the most ideal option - reliable protection from infections and protection from pregnancy. The preparations have the effect of artificial lubrication, have no taste and smell, and are easy to use.

Photo from wusf.usf.edu

At least 16.7 million unwanted pregnancies occur worldwide each year. 15 million of them (that is, almost 90%!) could be prevented if women used modern methods of contraception correctly. Surprisingly, inIn the 21st century, millions of people ignore them or misuse them. As shown recently, women are afraid of side effects, have different prejudices, or they simply do not have enough information. MedNews figured out how (and whether) the most popular methods of contraception work.

"Barrier" contraception

Barrier contraception is a male and female condom, a vaginal diaphragm and a uterine cap. All of these devices physically block the way for sperm to enter the uterus. The sperm cannot meet the egg and fertilization does not occur.

condoms

male condom known to all, but female much less popular. This is a small pouch, usually made of polyurethane, that is inserted into the vagina and held in place by elastic rings. The advantage of both types of condoms is that they not only prevent unwanted pregnancy, but also protect against sexually transmitted diseases.

The effectiveness of condoms is relatively high: according to WHO, when used correctly, the male one prevents unwanted pregnancy in 98% of cases, but the female one only 90%. In addition, you need to take into account that the condom can break.

caps

Uterine cap and vaginal diaphragm are latex caps different shapes that are placed on the cervix. They will no longer protect partners from gonorrhea or syphilis, but they do not allow sperm into the uterus. Their main disadvantages are the complexity of use (not every woman will be able to put on the cap on her own) and allergies, which can occur due to the tight and prolonged contact of the mucosa with latex.

"Natural" contraception

"Natural" refers to methods of protection that do not require mechanical or medical intervention.

Coitus interruptus

One of the most popular and at the same time the least reliable "natural" methods. When used, the partner removes the penis from the woman's vagina moments before ejaculation. The unreliability of this method is determined by two factors. Firstly, a man may not have time to remove the penis in time (it all depends on his ability to self-control). Secondly, during frictions, a small amount of pre-seminal fluid, which may contain a certain amount of sperm - and disease-causing agents. The effectiveness of the method, according to WHO, ranges from 73 to 96%, depending on the correct use.

calendar method

Another popular and not always effective method. A woman keeps track of favorable and unfavorable days for conception of her menstrual cycle. Fertilization of the egg can occur only within 48 hours after ovulation, and the life expectancy of the sperm in the cervix is ​​up to a week, but often less. Therefore, a few days before ovulation are considered dangerous for conception (the sperm can remain in the woman's genitals and wait for the mature egg) and a couple of days after ovulation. Adepts calendar method argue that it is during this period that a woman should refrain from sexual intercourse if she does not want to become pregnant. The disadvantage of the method is that it is not always possible to accurately calculate exactly when ovulation occurs, especially in women with irregular menstrual cycles.

temperature method

This method just allows you to specify the moment of ovulation. It is not for the lazy: every day, immediately after waking up, you need to measure the basal temperature (inserting the thermometer into anus). Before ovulation basal body temperature drops a little, and immediately after ovulation it rises by 0.3-0.5 degrees and stays at this mark until the end of the cycle. By monitoring the temperature daily, you can determine quite accurately when ovulation occurs, and in accordance with this, refrain from sexual intercourse on fertile days.

cervical method

Another method to help determine the onset of ovulation is cervical method, or the Billings method. This Australian doctor noticed that shortly before ovulation, the mucus secreted from the vagina becomes more viscous. In this way, "dangerous" days can be tracked. True, due to fluctuations in hormones, mucus can become viscous even in the absence of ovulation, so the method is inaccurate.

Lactational amenorrhea method

The bottom line is simple: in the first months breastfeeding ovulation does not occur, so you can not use protection. But there is a condition: a woman must breastfeed her baby very actively (at least every three hours during the day and every six hours at night), otherwise the production of prolactin and oxytocin hormones decreases, and their “protective” effect disappears. However, frequent feeding is also not a 100% guarantee.

Spiral

The intrauterine device is a common and fairly simple method of contraception. This device, usually made of copper or silver with plastic, is placed in the uterus by a doctor for several years. Copper or silver has a detrimental effect on spermatozoa, and the spiral itself, if fertilization does occur, prevents the egg from attaching to the wall of the uterus (the embryo is thus unable to develop). The method is convenient in that it requires almost no effort on the part of the woman, but has its drawbacks - for example, it increases the risk of developing infections and inflammations.

Hormonal contraception

There are a huge variety of hormonal contraceptives, and they work in different ways. In general, they can be divided into two types: containing estrogen hormones (or rather, their analogues) and not containing them.

COCs

The most common method of hormonal contraception. When used correctly, it is considered one of the most reliable. Pills contain two types of hormones: estrogens and progestins. They suppress ovulation, and pregnancy becomes impossible.

It is a paradox, but it is with these means that the most fears are associated. Women are afraid of side effects, for example, blood clots: estrogens contribute to thrombosis and increase the risk of thrombosis. In fact, this danger is much higher, say, with smoking or even pregnancy. So if a woman does not have serious contraindications (a history of thrombosis and among family members, a greatly increased blood pressure etc.), the use of COCs is considered safe. However, women are much more afraid of being overweight than thrombosis: the belief that you can get better from pills is one of the most persistent. In fact, this has not been the case for a long time: modern oral contraceptives contain minimal doses of hormones, which, although they can slightly exacerbate the feeling of hunger (and even then not for everyone), do not in themselves increase weight gain.

vaginal ring

This is another method of hormonal contraception using estrogens. It is similar in composition and principle of action to COCs, but radically differs in the method of application. A flexible ring is inserted directly into the vagina, where it releases hormones in the right doses that help suppress ovulation. The advantage over COCs is that the ring has almost no effect on the liver, the disadvantages are the relative inconvenience of use: it can fall out of the vagina or interfere with the woman.

Hormonal patch

The hormonal patch also contains estrogens, but is glued to the skin and delivers hormones to the body through the blood.

mini pili

Other group hormonal contraceptives They do not contain estrogens, only progestogens. Because of this, they do not have estrogen-related side effects and are considered safer, although less effective. This group includes the so-called mini-pills: these are tablets containing minimum dose hormone.

The principle of their action differs from estrogen-containing contraceptives: they do not prevent ovulation, but cause thickening cervical mucus(mucus in the cervix), which prevents sperm from entering the uterus itself. In addition, progestogens do not allow the inner lining of the uterus, or the endometrium, to swell (without the use of hormones, this naturally occurs in the second half of the menstrual cycle). Because of this, the embryo cannot attach to the wall of the uterus and continue its development.

Subdermal implants

Particularly desperate women may decide to sew a contraceptive hormonal implant under their skin, which also does not contain estrogen. It is installed for several years and dosed releases the required amount of the hormone progestogen into the body. Like mini-pills, the implant increases the viscosity of the cervical mucus and does not allow the endometrium to swell.

Hormonal intrauterine device

Her principle of operation is mixed. It immobilizes spermatozoa and mechanically prevents the embryo from attaching to the wall of the uterus, like a conventional spiral. In addition, just like implants, she secretes daily minimal amount the hormone progestogen, which prevents the growth of the endometrium and thus prevents the embryo from gaining a foothold.

Chemical contraception

Vaginal suppositories, creams, foams, sponges and tablets that have a spermicidal effect, that is, destroy spermatozoa. Usually, all these funds should be used 10-15 minutes before sexual intercourse. Their advantage is that they also protect against sexually transmitted diseases - but not from all and not completely. The disadvantage is much lower efficiency than other methods. Therefore, they are recommended to be used in combination with other means.

Emergency (aka "morning") contraception

If unprotected intercourse has already occurred, but the woman is not planning a child, then not everything is lost: for some time, conception can still be prevented. There are a variety of methods for this - from folk to hormonal.

Folk methods

A slice of lemon, an aspirin tablet, laundry soap and a solution of potassium permanganate - this is far from full list funds that ethnoscience ready to offer careless lovers. It is understood that citric acid, components laundry soap, potassium permanganate and acetylsalicylic acid(aspirin) acidify the environment, and this kills spermatozoa.

Doctors categorically do not recommend using folk remedies for two reasons. The first is their low efficiency: spermatozoa can penetrate the cervical canal within a few seconds after ejaculation, and before that it is hardly possible to introduce a lemon into the vagina. And the second - side effects: aggressive acid or improperly diluted potassium permanganate can “burn out” the mucous membrane and disrupt the vaginal microflora.

Hormonal pills

There is also a more reliable method of postcoital (that is, used after sexual intercourse) contraception. Designed specifically for this hormonal pills. At the core different drugs lie different substances, but their mechanism of action is similar: they suppress ovulation, and if conception has already occurred, they prevent the fertilized egg from attaching to the wall of the uterus. Tablets usually need to be taken in the first few days after unprotected intercourse (the sooner the better), but with each day of delay, their effectiveness will decrease.

It is widely believed that the use of such drugs is extremely harmful, but WHO has repeatedly emphasized that they are safe. This, of course, does not mean that such remedies should be used regularly: they are simply not designed for this.

Emergency coil installation

The same copper or silver coil, which has already been mentioned above, can also be installed urgently - within five days after unprotected intercourse. The principle of its operation is the same: copper or silver has a detrimental effect on spermatozoa and the egg, and the spiral itself prevents the embryo from attaching to the wall of the uterus. After an emergency installation, the coil can be left as permanent remedy contraception.

Karina Nazaretyan

Spermicides- creams, gels, aerosol foams, as well as foam and non-foam suppositories containing an active ingredient that inactivates spermatozoa within a few seconds (maximum 2 minutes). It is usually used in conjunction with other contraceptives such as diaphragms, contraceptive sponges, and condoms. 3% of women use only spermicides.

2 types of substances are used as an active ingredient

Surfactants (eg nonoxynol-9)

Active enzyme inhibitors.

The active ingredients destroy spermatozoa, reduce their motility or inactivate the enzymes necessary for the penetration of the spermatozoon into the egg. Part of the sperm that penetrate the cervical mucus after exposure to spermicide has a reduced fertility.

Must be combined with barrier methods of contraception.

Spermicide should be re-introduced with each sexual intercourse.

After sexual intercourse with the use of spermicide, douching should not be done for 6-8 hours.

After use, the applicator should be rinsed with water.

Indications: contraception in women with a reduced risk of pregnancy (rare sex or late reproductive age); combination with a rhythmic method of contraception; temporary interruption in the use of IUDs or oral contraceptives.

Flaws: relatively low contraceptive effect (pregnancy rate is 25-30 cases per 100 women per year), the possibility of teratogenic effects on the fetus during pregnancy.

Advantages. Protects against sexually transmitted diseases, inflammation of the pelvic organs, especially when combined with barrier methods of contraception. It has been established that nonoxynol-9 also inactivates gonococci, genital herpes virus, Trichomonas, pale treponema and even HIV.

INTERRUPTION (coitus break)

Ordinary sexual intercourse ends with ejaculation outside the woman's genital tract.

The method has many disadvantages:

Low contraceptive effect (15-30 pregnancies per 100 woman year) 60% of women do not experience orgasm

With prolonged use, congestion in the pelvis, frigidity, ovarian dysfunction may develop.

In men, long-term use can cause neurasthenia, reduced potency, hypertrophy prostate.

Intrauterine devices

Advantages:

High efficiency - the pregnancy rate when using intrauterine devices (IUD) is 2-3 cases per 100 women per year.

No concomitant systemic action for metabolism.

For long-term use, a single procedure (IUD insertion) is sufficient.

No teratogenic effect.

Reversibility of the contraceptive effect.

Elimination of psychological discomfort associated with the need to take care of preventing unwanted pregnancy before each sexual intercourse.

Disadvantages: A large number of contraindications:

High risk of developing inflammatory processes of the uterus and its appendages

Increased blood loss during menstruation

High risk of uterine perforation.

Mechanism of action:

Inert ( non-drug ) IUD - the action is associated with a local aseptic inflammatory reaction caused by the presence of a foreign body in the uterus.

Contractions of the myometrium, increased peristalsis of the fallopian tubes - a fertilized egg passes faster through fallopian tubes and enters the uterine cavity before the conditions for its implantation arise.

Inflammation of the endometrium (not always), also preventing implantation. The addition of copper enhances the inflammatory response.

After removal of both copper-coated and non-copper-coated IUDs inflammatory response quickly disappears, after which the ability to fertilize is restored.

Spermatotoxic and ovotoxic effects of copper ions.

Medical IUDs with progesterone show their contraceptive effect locally in the endometrium and cervix - the endometrium does not undergo changes necessary for implantation, changes in cervical mucus make it difficult for sperm to penetrate.

Types:

TSi-380A: application period - 5 years

TCu-220, TCu-220B - 3 years

TCu-200Ag - 3 years

TCu-380Ag - 4 years

Multiload C 375 - 5 years

CONTRACEPTIONS, methods (contraceptiva) - means and methods used to prevent pregnancy.

Story

Contraceptives have been known since Ancient Greece, India and Arab countries. In the writings of Aristotle and Soranus of Ephesus in Ibn Sina's "Canon of Medicine", some recommendations are given on the use of herbal and animal products for the purpose of contraception. However, these recommendations were of an empirical nature, since at that time there was still no clear idea about the process of fertilization. Only after the male and female germ cells were discovered did the scientific development of issues of preventing pregnancy (contraception) begin. Due to the increase in the frequency of artificial termination of pregnancy, the search for highly effective P. s. is highly relevant.

P. s. divided into two groups: used by women and used by men. According to the nature of their action, they are classified into mechanical contraceptives(vaginal diaphragms, cervical caps, male condom); chemical contraceptives (creams, pastes, tablets, balls, suppositories, powders, solutions, aerosols introduced into the vagina); physiological method of preventing pregnancy (by periodic abstinence); operational methods (sterilization of men and women); combined methods (eg, mechanical with chemical, etc.). Modern methods of preventing pregnancy are intrauterine contraceptives (intrauterine contraception) and hormonal contraceptives.

Mechanical contraceptives

The mechanism of their action is based on the creation of a mechanical obstacle to the fusion of the sperm with the egg. The most common remedy is the male condom (see). The essential advantage of a condom is that it not only prevents the onset of pregnancy, but also protects against sexually transmitted diseases; disadvantage - dullness of sexual feeling. Prior to the introduction of modern methods of preventing pregnancy (intrauterine and oral contraceptives), the use of a condom was the most common method of contraception.

Women use vaginal diaphragms and cervical caps to prevent pregnancy (Fig. 1). Vaginal diaphragms are selected by a doctor; the woman herself introduces them before sexual intercourse and removes them no later than 8-10 hours after it. Cervical caps are selected and put on the cervix by a doctor no earlier than 2-3 days after the end of menstruation; you can leave them on the cervix for no more than 7 days. Contraindications for use vaginal diaphragms and cervical caps: inflammatory processes of the genital organs, especially the cervix, suspicion of pregnancy, a period of 3-4 months. after childbirth and 1 - 2 months. after an abortion. More effective is the use of vaginal diaphragms and cervical caps in combination with chem. contraceptives.

Chemical contraceptives

The mechanism of action of the chem. contraceptives is based on their spermotoxic effect. They are available in the form of creams, pastes, tablets, balls, suppositories, powders, solutions, aerosols. Gramicidin paste (see Gramicidin), produced in tubes with a special plastic syringe-tip, is injected into the vagina before sexual intercourse (5-6 g of paste). Contraceptin T - vaginal suppositories, contain boric acid(0.3 g), tannin (0.06 g), chinosol (0.03 g) and a fat or lanolin base (up to a suppository weight of not more than 1.9 g); injected into the vagina 5-6 minutes before sexual intercourse. Galascorbin (tablets of 0.5 and 1 g), which include a complex compound of potassium salts of ascorbic and gallic acids, is injected into the vagina 5-10 minutes before sexual intercourse. Luten Urin (tablets and boluses), contain the substance plant origin(an alkaloid from the rhizomes of the yellow capsule); they are administered 5-10 minutes before sexual intercourse. Vaginal balls are also used, which include quinazole (0.03 g), quinine hydrochloride (0.3 g), boric acid (0.1-0.3 g), lactic acid (0.15 g) as spermatotoxic components per gelatin or fat base; they are inserted into the vagina 5-10 minutes before sexual intercourse.

intrauterine contraception

Attempts to use intrauterine contraceptives (intrauterine contraceptives) date back to the late 19th and early 20th centuries, but even in the era of Hippocrates, there were intrauterine devices to prevent pregnancy. The beginning of scientific development of intrauterine P. of page. associated with the work of Grefenberg (1929); they were offered intrauterine contraceptives made of silk threads and silver wire, and then spiral rings made of silver or gold wire. In the 60s. experimental and clinical researches, which showed the effectiveness of this method and allowed to justify its widespread use.

For the manufacture of intrauterine contraceptives, polyethylene is mainly used, to a lesser extent - nylon. Intrauterine contraceptives are very variable in form (Fig. 2). The most common type is the "loop" (first-generation intrauterine contraceptives). However, in subsequent years, viutriuterine contraceptives began to be used more and more often. T-shape or in the form of the number "7", vertical axis which is wrapped with copper wire. Proposed also intrauterine contraceptives containing progestogens (progesterone, levonorgestrol, norethisterone). Such improved copper- and hormone-containing viutri-uterine contraceptives are considered as second- and third-generation viutri-uterine contraceptives.

In our country, polyethylene "loops" are produced. There are several sizes of viutriuterine contraceptives. The size of the "loop" is determined by the width of its largest part (No. 1 - 25 mm, No. 2 - 27.5 mm, No. 3 - 30 mm). Intrauterine contraceptives must meet the following requirements: ease of insertion, low percentage of spontaneous expulsions (expulsions), availability of detection in the uterus, minimal possibility of complications, ease of removal (if necessary).

The mechanism of action of intrauterine contraceptives is due to a number of factors: stimulation of the peristalsis of the fallopian tubes and, as a result, the accelerated entry of a fertilized egg into the uterine cavity; implantation disorder gestational sac in the decidua of the uterus, ch. arr. due to changes in chem. environment properties; a mechanical obstacle to the penetration of spermatozoa into the uterus and fallopian tubes; mobilization of neutrophils and macrophages in the endometrium, the object of which is the fertilized egg and spermatozoa that have entered the uterus. The mechanism of action of copper-containing intrauterine contraceptives is associated with a local contraceptive effect of copper ions on the endometrium (a significant increase in the activity of acid phosphatase in the proliferative phase and a decrease in the activity alkaline phosphatase during the secretory phase of the menstrual cycle). The contraceptive effect of intrauterine contraceptives containing gestagens is due to a change in the properties of the epithelium of the fallopian tubes and some other factors.

Contraindications to the use of intrauterine contraceptives are acute (or subacute) inflammatory diseases, benign and malignant neoplasms female genital organs, uterine malformations, isthmic-cervical insufficiency, menstrual disorders. The use of intrauterine contraceptives in women who have undergone uterine surgery ( C-section, myomectomy) is dangerous, other methods of contraception are recommended.

The introduction of intrauterine contraceptives into the uterine cavity is carried out after careful gynecological examination and probing the uterus to decide on the selection of the type and size of the contraceptive. For the introduction of intrauterine devices, special polyethylene syringes-conductors are used (Fig. 3). Pre intrauterine device and the guide syringe are sterilized by placing them in disinfectant solution. It is more advisable to use sterile intrauterine contraceptives and syringe guides in individual packaging. Before the introduction of an intrauterine contraceptive, the vagina and cervix are treated with a disinfectant solution, and if necessary, expanded cervical canal(at nulliparous women). For visual control, most intrauterine contraceptives have a polyethylene thread at the end, which, after insertion into the uterus, is cut at a distance of approx. 2 cm below the external uterine os. On fig. 4 shows the steps for inserting an intrauterine contraceptive into the uterine cavity. Optimal time for the introduction of an intrauterine contraceptive - immediately after the end of menstruation (on the 4-7th day of the cycle); women who have undergone an induced abortion - after next menstruation; after childbirth - not earlier than 3 months. It is also possible to introduce an intrauterine contraceptive immediately after an artificial abortion in the first trimester of pregnancy.

Copper-containing intrauterine contraceptives are most effective. The number of cases of pregnancy per 100 women who used them in the first year of observation does not exceed 1.5%; for other intrauterine contraceptives, this percentage ranges from 3 to 5.

In many women, within a few months after the introduction of intrauterine contraceptives, there is a nek-swarm lengthening of the menstrual cycle and an increase in blood loss during menstruation; further menstrual function usually normalized. Sometimes bloody issues are observed in the intermenstrual period due to the traumatic effect of an intrauterine contraceptive on the uterine mucosa. Frequency of acute inflammatory diseases female genital organs (endometritis, adnexitis, etc.) as a result of wearing an intrauterine contraceptive is up to 5%. The incidence of endometrial cancer is not increasing. In 10-20% of women, after the introduction of an intrauterine contraceptive, cramping pains in the lower abdomen may occur, which last from several hours to several days. Most formidable complication when using an intrauterine contraceptive (mainly at the time of its introduction) - perforation of the uterus (see), edges is observed in one case for several thousand injections. Very rarely, intrauterine contraceptives can spontaneously perforate the uterine wall and enter the abdominal cavity. To prevent side effects and complications, it is necessary to take into account contraindications, follow the rules for the introduction of intrauterine contraceptives and dynamic monitoring of women. In order to determine the location of the intrauterine contraceptive, an ultrasound or rentgenol, study is used; to make the latter feasible, polyethylene intrauterine contraceptives are impregnated with barium or a thin metal thread is inserted into them. Adverse effects intrauterine contraceptives on the subsequent childbearing function of a woman has not been established; in 90% of women, conception usually occurs within the first year after its removal.

Previously, when pregnancy occurred in women wearing intrauterine contraceptives, its further development was allowed in the presence of a contraceptive in the uterus (outside the amniotic cavity). In connection with the revealed increased frequency of acute inflammatory diseases of the genital organs in women with intrauterine contraceptives, as soon as pregnancy is diagnosed, it is recommended to remove them.

The duration of the use of intrauterine contraceptives should not exceed

2-3 years, after which they are removed and in the absence of contraindications after 2-3 months. enter a new one. With the improvement of intrauterine contraceptives, the duration of their use increases.

indications for more early removal intrauterine contraceptives are not amenable to conservative therapy menorrhagia and metrorrhagia, the development of an acute inflammatory process, intense pain in the pelvic organs.

The intrauterine contraceptive is removed by pulling on the thread located in the vagina (Fig. 5). If the thread is torn off, the cervical canal is dilated and instrumental removal contraceptive.

Hormonal contraception

For hormonal contraception, combined estrogen-gestagen preparations are most often used (not large doses estrogens and gestagens). Of the estrogens, ethinyl estradiol or mestranol are most commonly used, of the gestagens, norethinodrel or norethisterone (see Norsteroids). They are produced mainly in the form of tablets for oral administration and are therefore called oral contraceptives; created by Rock (J. Rock) and G. Pinkus. Started in 1960 mass application oral contraceptives. In our country, the most widely used are bisekurin, non-ovlon, etc.

The contraceptive effect of oral contraceptives is associated with their action on the hypothalamic-pituitary system, ovaries, fallopian tubes, endometrium. Occurs inhibition (suppression) of the ovulation process due to inhibition of cyclic secretion of luteinizing hormone at the hypothalamic level. In women using oral contraceptives, in the middle of the menstrual cycle, there is no pre-ovulatory peak of estrogen excretion, and in the second phase of the cycle - an increase in progesterone secretion, basal (rectal) temperature is monophasic. In the endometrium, after a rapid regression of the proliferative phase, the development of secretory changes is noted earlier. At long-term use oral contraceptives, the endometrium becomes thin and hypoplastic, after discontinuation of the drug, the normalization of its structure is completed within a few months. Oral contraceptives affect the processes of egg migration in the fallopian tubes, implantation of a fertilized egg. In 2-10% of women, despite taking oral contraceptives, ovulation occurs, but pregnancy does not occur. The contraceptive effect in similar cases is explained by change fiz.-chem. properties of the mucus of the cervical canal, a decrease motor activity fallopian tubes.

The use of oral contraceptives is contraindicated in thrombophlebitis and a tendency to thrombosis, varicose veins veins, liver diseases, benign and malignant tumors reproductive organs and mammary glands, hypertension, heavy cardiovascular diseases, migraines, obesity, diabetes, rheumatism, kidney disease, chorea, allergies, depression, bronchial asthma, hematopoiesis disorders, otosclerosis. Oral contraceptives should not be used during lactation.

Usually they are started on the 5th day of the menstrual cycle, 1 tablet per day for 21 days (one package contains 21 tablets). At the end of taking the drug after 1-3 days, as a rule, a menstrual-like reaction occurs, which lasts an average of 4-5 days. Sometimes after taking 21 tablets, a menstrual-like reaction is not observed. In these cases, 7 days after the end of taking the tablets of the first package, you need to start taking the tablets of the next package.

The effectiveness of oral contraceptives when used correctly is high (up to 98%). The risk of conception increases with non-systematic pills.

When using oral contraceptives, side effects and complications may occur: weight gain, pain in the mammary glands headache(in the intervals between doses of the drug), depression, hypertrophic gingivitis, vaginal discharge(whites), nausea (especially at the beginning of the drug), uterine bleeding or spotting (mainly in the intermenstrual period), decreased libido. The most severe complications include thrombosis and thromboembolism. They are caused by changes that occur in the hemostasis system with prolonged use of oral contraceptives (decrease in blood clotting time with unchanged bleeding time, decrease in prothrombin time, increase in fibrinogen concentration, fibrinolytic activity of blood, content of factors Blood VII and VIII). These changes are mainly related to the action of the estrogens contained in the preparation.

Factors that increase the risk of side effects and complications when using oral contraceptives are smoking, alcoholism and obesity. Possibility of developing uterine or breast cancer as a result of long-term use oral contraceptives cannot be considered proven.

To reduce the frequency (or prevention) of complications and side effects, it is necessary: ​​strictly consider contraindications when prescribing oral contraceptives; if possible, recommend a drug with the lowest content of estrogens and gestagens; before starting the use of drugs, take a detailed history and conduct general analysis blood and urine, research of system of a hemostasis, tsitol. composition of the contents of the vagina to identify atypical cells, liver function (if there is a history of indications of past illnesses liver); carry out dynamic monitoring of women taking oral contraceptives at least 2 times a year (they determine body weight, gynecological examination examination and palpation of the mammary glands, the study of the hemostasis system, according to indications - liver function). With persistent side effects the drug should either be changed or another method of contraception should be recommended to the woman.

To prevent pregnancy, drugs containing only microdoses of progestogen (norgestrel, etc.) without an estrogen component have also been proposed. Such drugs (femulen, continuin, etc.) are called "minipills". These oral contraceptives are safer than combined estrogen-progestogen preparations, but less effective.

After stopping the use of oral contraceptives, the childbearing function in women, as a rule, is not impaired; 80-90% have pregnancy in the first 6 months.

The duration of the use of oral contraceptives should not exceed 1 - 1.5 years. After a break lasting 3-4 months, during which the oppressed function of the menstrual cycle regulation system is restored, oral contraceptives can be prescribed again. During this period of time, a woman should be advised to use another method of contraception, since 60-70% of pregnancy occurs precisely at these times.

Oral contraceptives are being developed that can be used once a month; however, with their use, menstrual-like bleeding is irregular; high inefficiency.

Proposed injectable prolonged preparations with a duration of action of 3 months (DAMP - depot-forming acetate of medroxyprogesterone; NET - EN norethisterone-enanthate). The mechanism of their action is due to the suppression of the secretion of gonadotropins (especially the cyclic release of luteinizing hormone), anovulation, an increase in the viscosity of the mucus of the cervical canal, and a change in the secretory transformation of the endometrium. The effectiveness of drugs is high. However, when they are taken, menstrual bleeding is irregular, there is amenorrhea, an increase in body weight.

In order to inhibit the implantation of a fertilized egg, the use of large doses of estrogens after sexual intercourse is recommended; however, possible serious complications(bleeding and thromboembolism) limit the use of this type of hormonal contraception.

Work is underway to find an oral contraceptive for men ( birth control pills), which would interfere with the formation of spermatozoa or inhibit their maturation and (or) the ability to fertilize an egg. In our country, long-acting injections, large doses of estrogen, and oral contraceptives for men are not used.

Other methods of preventing pregnancy

In addition to the above methods, pregnancy prevention can be achieved physiological method, or the "rhythm" method. It is based on abstaining from sexual intercourse during the period when conception usually occurs (in each menstrual cycle). Most auspicious days for conception, the days of the menstrual cycle, close to ovulation, are considered. This takes into account the timing of ovulation, usually occurring on the 12-16th day with a 28-day cycle, the life expectancy of a mature egg (up to 24 hours), as well as the fertilizing ability of spermatozoa (up to 48 hours after sexual intercourse). The method was proposed in the 20s. our century Ogino (K. Ogino) and Knaus (H. Knaus); based on monthly data menstrual calendar women. Subsequently, it was found that the efficiency of the method increases significantly when measured for 3 months. consecutive basal (rectal) body temperature, which allows you to set the time of ovulation.

To facilitate the use of the method, special tables are proposed, however, it must be remembered that ovulation may occur earlier or later than the eric indicated in them.

Sometimes special formulas are used. With a regular menstrual cycle total number days in the cycle subtract 18, get the first day of the "dangerous" period; then subtract 11 from the total number of days in the cycle and get last day"dangerous" period. So, this (“dangerous”) period with a 28-day menstrual cycle lasts from the 10th (28-18) to the 17th (28-11) day of the cycle, inclusive. This method unacceptable with irregular or very short cycle. When used correctly and regular cycle the effectiveness of the "rhythm" method approaches 90%.

Operative methods of contraception in the form of sterilization of men (partial excision or ligation of the vas deferens) and women (dissection, partial excision or ligation of the fallopian tubes) are allowed only on special medical indications(see Sexual sterilization).

Improved methods have also been developed surgical sterilization(diathermocoagulation of the fallopian tubes and the imposition of brackets under the control of a laparoscope; hysteroscopic method of occlusion of the tubes with visual control).

interrupted intercourse, used as a means of preventing pregnancy, is not physiological, harmful to the health of men and women and is associated with a large emotional stress(see. Sexual intercourse). However, the opinion about possible development adverse effects This method, both in women (congestion in the small pelvis, frigidity, development of ovarian dysfunction) and in men (neurasthenia, impotence, prostatic hypertrophy) is not recognized by all researchers.

Bibliography: Manuylova I. A. and Antipova N. B. Effect of intrauterine devices with copper on reproductive system women, Akush. and gynec., No. 10, p. 49, 1978, bibliogr.; New methods of fertility regulation, Report of the WHO scientific group, trans. from English, M., 1975; P e r about in - M and with l and to about in M. A., etc. Modern contraceptives, L., 1973, bibliogr.; Sleptsova S.I. Modern methods of fertility regulation, Akush. and gynec., Co. 10, p. 5, 1980, bibliogr.; Handbook of obstetrics and gynecology, ed. J.I. S. Persianinov and I. V. Ilyin, p. 210, L., 1980; The development of a new triphasic oral contraceptive, ed. by R. B. Greenblatt, Lancaster, 1980; Roland M. Response to contraception, Philadelphia a. o., 1973; Taubert H.D.u. Kuhl H. Kontrazeption mit Hormonen, Stuttgart - N. Y., 1981.

B. L. Gurtova.