The best contraceptive methods for women. Voluntary surgical sterilization. The advantages of the intrauterine device are

In the clinic " New life"You can get advice from highly qualified gynecologists-endocrinologists on the most suitable method of contraception for you.

Many women are interested in the question: which method of contraception should they prefer? To make a choice, many listen to the advice of friends or simply use “folk” methods familiar to them. But no one can choose the right contraceptive for you the way a competent specialist can.

Pros and cons of different contraceptive methods

The female body was created by nature in order to reproduce and feed offspring. But today, few women are ready to give birth from the moment of puberty until old age, practically without interruptions. Therefore, the issue of contraception is quite acute.

Today there are many different methods contraception. All of them can be divided into two groups: reliable and unreliable. The first group includes only four methods: application birth control pills, usage intrauterine contraceptives, surgical sterilization and refusal of sexual activity. Other methods are unreliable.

Naturally, the woman herself must decide which method to choose; the doctor can only give advice and choose for you the optimal method of protection against unwanted pregnancy.

Modern contraception

. Hormonal pills

These are oral contraceptives, which come in two types: combined estrogen-progestogen drugs and mini-pills containing only progestogen. We will touch on the latter later. But dignity combination drugs is their almost 100% effectiveness.

Hormonal pills are the most reliable contraceptives that exist today, with the only exception being voluntary surgical sterilization. Hormonal pills provide a contraceptive guarantee if you start taking them from the first day of your cycle. They are easy to use, and the only thing you need to do is not miss taking them and try to take them at the same time. In addition, many drugs have a cosmetic effect - they can improve the condition of the skin.

It should be noted that such drugs differ greatly from each other in composition, clinical properties and dose of hormones. Therefore, the question of choosing a drug should definitely be entrusted to a doctor.

. Mini-pill

These pills contain only microdoses of progestogens, approximately 15-30% of what is contained in combination pills. The contraceptive effect of the mini-pill is significantly lower than that of the tablets. But due to their lesser impact on the blood coagulation system, they can be used smoking women over 35 years of age, as well as those who suffer diabetes mellitus and other diseases for which it is unacceptable to take combined oral contraceptives.

. Intrauterine device

Method intrauterine contraception is based on the introduction into the uterus of a device that prevents pregnancy - a spiral. It is only suitable for women who have given birth. Administration procedure intrauterine device It is carried out by a doctor in the clinic quite quickly and almost painlessly.

Despite the reliability of such a contraceptive, recently many patients refuse to use it, since the spiral can cause an increase in the number of menstrual flow and painful menstruation.

Our clinic specialists will be able to select for you best view intrauterine contraception and correctly install the device, which is very important for its effective functioning and your comfort.

. Hormonal ring NuvaRing

NuvaRing is a flexible ring made of hypoallergenic EVA material used for the manufacture of implants. It is inserted into the vagina for 21 days and releases hormones, thereby ensuring high contraceptive effectiveness. The convenience of the ring is that it needs to be inserted once a month, whereas tablets need to be taken daily. It allows you to conduct active image life, but some patients note that the ring interfered with them during sex.

. Barrier contraceptives

. Hormonal implant

A special capsule with hormones, which is administered through surgical manipulation on the inner side forearms for a period of 5 years. Good decision for women who are contraindicated hormonal pills.

. Hormonal injections

Hormone injections are high effective method contraception. After injection into the buttock, the contraceptive effect lasts 3 months.

. Coitus interruptus

A very common method that has many disadvantages. First of all, sperm can be released before complete ejaculation, in addition, some men find it very difficult to stop, and finally, this method is harmful for men, as it is fraught with the development

“Conscious pregnancy” is a popular term today, which 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: to suit everyone’s taste and budget - monophasic contraceptives, implants, condoms, rings, IUDs and much more. But any method of preventing unwanted pregnancy has both advantages and disadvantages. Let's figure out how to choose from this variety suitable look contraception and how to avoid misfires.

1. Sterilization

This is the most effective method of contraception with 99.9% reliability. Women are sterilized by bandaging fallopian tubes, men - by vasectomy.

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

2. Oral contraceptives

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

Combined oral contraceptives compare favorably with others hormonal drugs contraception because different tablets contain different dosages and combinations of hormones. In European countries, this method is the most popular among women. different ages and different lifestyles. Indeed, in a wide range of these products, including those presented on the Ukrainian market, there are even tablets with innovative dosage regimens 24+4 and 26+2. They shorten the non-hormonal period, which allows you to minimize negative symptoms, and, importantly, simplifies the regimen for taking such pills.

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

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

3. Intrauterine contraception

We are talking about an intrauterine device and an intrauterine hormonal system, which differ both in reliability and mechanism of action. The spiral performs a barrier function and prevents the implantation of a fertilized egg into the uterine cavity. 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 suppresses 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 various types, often causing profuse, long, painful menstruation and creates a risk ectopic pregnancy. And the hormonal system is usually placed on long time- 5 years. Therefore, it is not suitable for women who do not plan to delay conception for so long. In addition, this method of contraception sometimes causes intermenstrual bleeding and pain.

4. Hormonal implants and injections

8. Coitus interruptus

This oldest method of contraception involves the partner removing the penis from the vagina before ejaculation.

BUT! A small amount of seminal fluid is also released during sexual 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 monitor the process, but also risks problems with potency, ejaculation, and even prostatitis. In addition, when using this method, the woman also experiences greater psychological discomfort.

9. Spermicides

This chemical substances as vaginal suppositories, creams, tablets and capsules that are inserted into the vagina and have a destructive effect on sperm. Their effectiveness is no 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 drugs emergency contraception containing levonorgestrel, which affects ovulation and reduces the risk of fertilization of a woman’s egg in the preovulation period. These drugs include escapelle and others.

Contraceptives can be divided into traditional And modern facilities. The degree of effectiveness of any contraceptive method is assessed using the Pearl index, cat. equal to the number of unwanted pregnancies in 100 women who used 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 sperm into the cervix. The edges, inner surface, its outer surface should be lubricated with spermicides. The diaphragm is inserted before sexual intercourse and removed 8-12 hours after it. There are several sizes of the vaginal diaphragm. Pearl index when using a vaginal diaphragm – 12;

- condom (condom) ) is a contraceptive used by men and is a sac-like formation of thin elastic rubber less than 1 mm thick. Condoms are made of rubber, latex, and plastic. A condom prevents sperm from entering the vagina. Pearl index – 20.

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

- spermicidal agents used as douches – vinegar solution, boric acid or lactic acid solution, K permanganate solution, 20% sodium chloride solution, lemon juice solution;

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

- gramicidin paste .

3.Rhythmic methods:

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

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

Modern means of contraception:

1. Intrauterine contraception:

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

2). Medication IUDs – contain copper, gestagens. Mechanism of action of medicated IUDs:

Copper has a bactericidal and spermicidal effect;

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

The Pearl index when using medicated 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 and 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 endometrial leukoplakia;

Polyposis and endometrial hyperplasia;

Tuberculosis of the genital organs;

Malformations of the uterus;

Intrauterine synechiae;

Menstrual irregularities such as menorrhagia or metrorrhagia;

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

The IUD is inserted by the doctor, observing the rules of asepsis, on the 5th-7th day of the menstrual cycle, after an induced abortion - immediately (or after the next menstruation), after childbirth - 3 months later. Necessary conditions are: normal blood picture, 1-2 degree vaginal frequency. After inserting the IUD, the doctor should examine the woman a week after the first menstruation, then after 3 months, subsequent examinations are carried out once every 6 months. The duration of stay of the IUD in the uterine cavity is 3-5 years.

Complications of intrauterine contraception:

Lower abdominal pain;

Uterine bleeding;

Ectopic pregnancy;

Intrauterine pregnancy, often ending in spontaneous abortion;

Perforation of the uterus (partial - when the IUD is inserted into the muscle of the uterus in the area of ​​the fundus 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.

Prevention of abortion is key point in preserving reproductive health girls. According to experts, artificial termination of pregnancy quite often leads to infertility. Today, approximately every fifth pregnant woman resorts to abortion. Despite the high effectiveness of contraceptives, many young ladies unreasonably neglect this opportunity. We should not forget that the main objectives of contraception are not only to ensure the prevention of medical abortions, but also to prevent infection with sexually transmitted diseases.

Types of contraception

There are different methods of contraception. However, regardless of the type of contraception, female contraceptives must be highly effective, safe for health, easy to use and available for purchase.

Modern methods contraception:

• Physiological.
• Barrier or mechanical.
• Chemical.
• Hormone.

Female contraceptives can be purchased at pharmacy chains over the counter.

Physiological

Peculiarity physiological method contraception is that the girl in certain period her menstrual cycle should abstain from intimacy or actively use other contraceptives. As a rule, if the menstrual cycle lasts 28 days, then it is necessary to abstain from vaginal sex in the period from the 11th to the 18th day, when ovulation occurs. The physiological method is based on alternating periods of high and low fertility (ability to bear children). Scientists have found that the egg remains viable for 1–3 days, and the sperm for about 5 days. What methods can be used to clarify the time of ovulation:

1. Calendar. It is necessary to calculate the fertile period, taking into account individual duration menstrual cycle.
2. Temperature. To determine the fertile period, measurements are taken rectal temperature. They should be held at the same time in the morning. While lying down, the woman inserts a special thermometer into the rectum for 5–6 minutes. Ovulation is recognized by analyzing the temperature curve. The defining moment is a temperature drop of 0.2–0.3 °C and a subsequent rise of 0.7–1.0 °C. Such changes are observed only 1–2 days after the completion of the ovulatory phase. Having determined the day of ovulation, the “dangerous period” is calculated.
3. Cervical. By the nature of the changes cervical mucus Due to estrogen during the menstrual cycle, it will be possible to judge what phase the woman is in.
4. Multicomponent. Judging by the name, it is not difficult to guess that this method includes measuring basal temperature, recording changes in the properties of cervical mucus, calendar calculations and some subjective signs (in particular, the appearance of pain in the lower abdomen, discharge, etc.).

The main advantage of the physiological method is considered to be ease of implementation and absolute safety for the female body, since there are no consequences or adverse reactions there is no need to expect. However, it is worth noting that this method of contraception is suitable for women with normal menstrual cycles. But for teenagers and young girls, the physiological method is inappropriate to use for several reasons:

• Irregular ovulatory cycle.
• Young girls quite often experience random or extraordinary ovulation.
• Late ovulation is more common.
• Not high efficiency.
• Girls find it difficult to make correct calculations and perform basic methods of physiological contraception.
• This method is not able to protect against sexually transmitted diseases.

Not all types of contraception can provide 100% protection against unwanted pregnancy.

Barrier or mechanical

Usage special means preventing sperm from moving into the uterine cavity is called barrier or mechanical contraceptive method. It is known that barrier contraceptives are provided for both women and men. The most common types of barrier protection against unplanned pregnancy:

• Condoms (female and male).
• Vaginal diaphragm.
• Cervical caps.

Condoms

Today, the main material for making condoms is latex. It helps not only protect against unplanned pregnancy, but also prevents infection with sexually transmitted diseases. The main disadvantage of the method is the frequent rupture of condoms made of thin elastic rubber. According to statistics, this happens approximately once every 50-300 times we have sex.

If a condom ruptures, it is recommended to inject a spermicidal substance into the vagina and/or use an oral contraceptive for emergency post-coital prevention of unwanted pregnancy. In addition, quite often when using a condom, both sexual partners note a decrease in sexual pleasure. Clinical studies show that many boys and men neglect this method of contraception.

Therefore, a condom for women was invented, which is effective both as a contraceptive and in preventing infection with sexually transmitted diseases. It must be put on a few hours before intimacy and removed after sex. Repeated use is strictly prohibited.

Vaginal diaphragm

To explain in a nutshell, the vaginal diaphragm is a fairly good barrier contraceptive, shaped like a hemisphere and consisting of a rubber cap connected to a ring. To prevent the passage of sperm, it should be inserted into the vagina in such a way as to close the cervical canal. To increase contraceptive effectiveness, the vaginal diaphragm is used together with spermicidal agents, which can be purchased in the form of creams, foams, gels, etc.

Various models and sizes are available, so individual selection is recommended. As a rule, the insertion of the vaginal diaphragm is carried out immediately before intimacy, using a spermicide on both sides. Its removal is carried out 7–10 hours after completion of sexual intercourse. I would like to note that this barrier method of contraception does not help protect against diseases transmitted during sex, although it can protect the internal genital organs from certain types of infections.

Cervical cap

The mechanism of action and contraceptive effectiveness of cervical caps are almost the same as that of vaginal diaphragms. In shape they resemble a hemisphere with thickened edges. The negative pressure created helps the cap not to slip off the cervix. It should be administered 30–10 minutes before sexual intercourse. It can remain in the vagina for 6–9 hours (maximum period – 1.5 days). Unlike a condom, the vaginal diaphragm and cervical cap can be used more than once. Before using any method of barrier or mechanical contraception, it is recommended that you carefully read the instructions.

Modern contraceptives for women (contraceptives) must be available with a prescription.

Chemical (spermicidal)

The chemical or spermicidal method of contraception is based on the use of special agents that can inactivate sperm. This effect is realized due to active component, which destroys the cell membrane of male germ cells in a few seconds. Spermicidal agents are available in the form of gel, cream, suppositories, foam, tablets, etc. Efficacy chemical method contraception directly depends on the correct use of it. Features of application:

1. Spermicidal preparations are administered no later than 30–60 days before sexual intercourse.
2. Spermicides must come into contact with the cervix.
3. If you do not know how to use chemical contraception correctly, consult your gynecologist.

The active substances included in spermicides can not only destroy sperm, but also have a bactericidal and virusicidal effect. For example, the active component nonoxynol or benzalkonium chloride inhibits the growth and reproduction of such pathogenic microorganisms, such as chlamydia, mycoplasma, trichomonas, ureaplasma, etc. To increase contraceptive effectiveness, many experts advise combining the use of chemical and barrier contraceptive methods.

Pharmatex

One of the most popular spermicidal agents for chemical contraception is Pharmatex. To completely destroy sperm, 20 seconds of male germ cells being in an environment with Pharmatex is enough. Repeated sexual intercourse requires a new administration of the drug. In addition, it has antimicrobial activity against a number of sexually transmitted diseases (for example, gonorrhea, chlamydia, trichomoniasis, etc.). At the same time, Pharmatex does not affect normal microflora vagina and does not lead to menstrual irregularities.

It can be combined with intrauterine devices (IUD), condoms, vaginal diaphragm, cervical caps. Pharmatex is available in the following forms for vaginal use:

• Pills.
• Pills.
• Candles.
• Tampons.
• Cream.

Each form has its own application features, which you can familiarize yourself with by reading official instructions to the drug. It should be remembered that Pharmatex is contraindicated in hypersensitivity to its active components and inflammatory diseases genitals. To avoid a decrease in spermicidal effect, simultaneous vaginal use of several drugs is not recommended.

Contraceptive sponge

A product that combines mechanical and chemical protection against unwanted pregnancy is called a contraceptive sponge. It acts as a barrier, preventing the movement of male germ cells in the cervical canal, and also secretes a spermicidal component that helps destroy sperm. The shape is a round pad with a small depression on one side, which should be adjacent to the cervix. However, due to its low contraceptive effectiveness, it is usually not recommended for use by adolescents and young girls. More experienced and older women are quite capable of installing this type of contraceptives and do not have special problems using.

The best method of contraception is the combined use of contraceptives (for example, hormonal drugs and a condom).

Hormone

Statistics show that almost 150 million girls and women around the world take oral contraceptives every day. At the same time, at present, the newest hormonal drugs are taken either orally or can be introduced into the body in other ways (injection, transdermal, intravaginal, etc.). Mechanism hormonal contraception is as follows:

• Slow down the production of gonadotropic hormones.
• Suppress the ovulation process.
• Increase the viscosity and density of cervical mucus, which is produced by the cervix.
• By changing the properties of cervical mucus, the motility of sperm in the direction of the uterine cavity is inhibited.

Reception oral contraception stops ovulation and prevents fertilization of the egg. Also, due to the effect on the endometrium, there is a prevention of egg implantation in the uterine cavity.

Oral contraceptives

There are many types of hormonal contraceptives. Let's focus on the most clinically significant ones. Depending on the composition, oral contraception is divided into the following main groups:

1. Combined hormonal drugs containing progestogen and estrogen (Mersilon, Ovidon, Regulon, Rigevidon, Silest, Triziston, Triquilar, Belara).
2. Hormonal drugs whose active component is progestogen (Exluton, Ovret, Microlut, Charozetta). They are also called Mini-pills.

The ethinyl estradiol content plays a significant role when choosing the optimal combined oral contraceptive. Considering the amount of estrogens, hormonal drugs are divided into three large groups: high-, low- and micro-dose. Popular representatives of each of these groups:

• The first is Anteovin, Silest, Non-ovlon. They contain more than 35 mcg of ethinyl estradiol.
• The second is Regulon, Belara, Microgynon, Femoden (30 mcg each).
• Third - Mercilon, Mirrel, Miniziston (20 mcg each).

Main advantages and disadvantages

Among all hormonal oral contraceptives, priority is given to monophasic drugs containing a stable amount of both female hormones(for example, Mercilon). Two- and three-phase drugs have different amounts of estrogens and gestagens, which helps them act on different periods menstrual cycle. The main advantages of monophasic oral contraceptives:

• They are more effective than other types of non-invasive contraceptives.
• Available for most girls and women.
• They do not provide severe consequences for the body.
• After stopping use, fertility is restored fairly quickly.
• It is considered a highly safe method.
• Long-term use possible.

A distinctive feature of most new combined oral contraceptives is their high efficiency and safety. Moreover, according to clinical studies, contraceptive effect– this is not their only property. What else is characteristic of contraceptives? hormonal drugs:

• Able to regulate the menstrual cycle, especially in young girls.
• Helps get rid of algodismenorrhea (painful menstruation).
• If you choose the right contraceptive, you don't have to worry about weight gain.
• They do not affect the main types of exchange.
• Eliminate deficiency of female hormones.
• Reduce the likelihood of a number of gynecological and somatic diseases.

The appearance of side effects is possible in the first 3 months of taking combined hormonal drugs. In most cases, they gradually disappear over time. Long-term use usually does not provoke such adverse reactions as headache, dyspeptic disorders, swelling of the mammary glands, painful menstruation, etc.

Unlike combined oral contraceptives, Mini-pills containing only progestogens have less pronounced contraceptive effectiveness. However, they do not apply serious harm young body. In addition, they are recommended for girls and women who have contraindications to the use of other oral contraceptives.

Use latest methods Contraception for women is recommended after consultation with a specialist.

Contraindications

Hormonal contraceptives can boast quite long list various kinds of contraindications. Most attention those that have a high lethal risk deserve it. Diseases related to absolute contraindications on the use of hormonal oral contraceptives:

• Heart and vascular diseases (uncontrolled high pressure, myocardial infarction, atherosclerotic lesion bloodstream).
• Severe pathologies of the blood coagulation system and other diseases that provoke the formation of blood clots ( venous thrombosis, thromboembolism).
• Tumors reproductive system and mammary glands.
• Severe pathology of the liver and kidneys with the development of functional failure.

How to take oral contraceptives?

To reduce the development of side effects and increase contraceptive properties, new schemes for the use of hormonal drugs have been developed. contraceptive drugs. One of the latest innovations was the introduction into clinical practice prolonged use of combined oral contraceptives. Continuous use of the drug was proposed for 3–5 menstrual cycles, after which a 7-day break was taken and use was resumed.

Passed successfully clinical trial mode called “63+7”. Its essence is that the contraceptive is taken for 63 days, then there is a pause in taking it for exactly a week. In certain cases, the prolonged regimen can be extended to 126+7. With prolonged use of oral contraceptives with minimal interruption, a decrease in the occurrence of “withdrawal symptoms” is observed. The prolonged dosage regimen made it possible for girls and women to experience fewer headaches, menstrual irregularities of various types, breast pathologies and other side effects.

In addition, another one is actively being developed innovative approach to taking hormonal contraceptives, which is called fast start. What are its features:

1. It is allowed to start taking combined oral contraceptives at absolutely any period of the menstrual cycle.
2. Lack of significant negative influence on pregnancy and fetal development from the newest contraceptive drugs allowed scientists to come to such conclusions.
3. If pregnancy is diagnosed while using oral contraception, the medication must be stopped. It has been established that short-term use of hormonal contraceptives during pregnancy does not affect the risk of miscarriage.

The combined method is the most reliable way to protect against unwanted pregnancy, involving the simultaneous use of several types of contraceptives.

Modern contraceptives for women may have contraindications and side effects, which should be read before using them.

Emergency contraception

Despite the wide range of contraceptives, the problem of unplanned pregnancy remains very relevant for millions of girls and women. As a rule, the risk of unwanted pregnancy is associated with having sex without using contraception or its ineffectiveness. Oddly enough, many women believe that in such situations the only thing they can do is wait to see whether the next period will come or not.

However, by using emergency contraception methods, you can significantly reduce the likelihood of unexpected conception. It is worth noting that this approach is practically unknown to many girls and women. At the same time, popularizing the basic principles of emergency contraception among the masses would significantly reduce the number of abortions.

When is emergency contraception indicated?

It's no secret that the chance of conceiving a child varies throughout the menstrual cycle. According to some data, the probability of pregnancy after unprotected intercourse is approximately 20%, regardless of the day of the menstrual cycle. At the same time, if sex without contraception occurred during the periovulatory period, then the chances of getting pregnant increase to 30%.

A British study showed that unprotected intercourse during ovulation can result in conception in 50% of cases, even during the first menstrual cycle. It has long been proven that sperm in a woman’s genitals remain viable for 3–7 days, and an unfertilized egg remains viable for 12–24 hours. According to most experts, it is advisable to carry out emergency contraception in the first 1–3 days after intimacy. In what cases is it indicated:

• Any unprotected sexual intercourse. Simply put, vaginal sex occurred without the use of contraceptives (condom, vaginal diaphragm, combined oral contraceptives, etc.).
• During intimacy, the condom broke or fell off.
• Premature removal of the vaginal diaphragm or cervical cap.
• Skipping a dose of oral contraceptives or taking the drug more than 12 hours late.
• A girl or woman was forced to have sex without her consent.

As shown clinical experience, modern contraceptives for women, regardless of the type, method and route of administration, are highly effective in preventing unplanned pregnancy.

Emergency contraception methods

1. Use of combined oral contraceptives (Yuzpe method).
2. Specially developed drugs for emergency protection.
3. Use of intrauterine contraception.

Combined hormonal oral medications It is used quite often as emergency contraception. This method was named after the Canadian scientist Albert Yuzpe, who first used it and widely promoted it. Its essence was reduced to 2 times the use of a large dosage of estrogens and progestogens for 3 days from the moment of completion of sexual intercourse. The break between doses should have been at least 12 hours.

The effectiveness of the method was more than 95% and depended on two factors:

• The duration of the interval between intimacy and the prescription of emergency contraception. The earlier contraceptives are taken, the higher the expected effect.
• The day of the menstrual cycle when there was sex.

Despite the high effectiveness of the Yuzpe method, it requires the use high doses oral contraceptives and is associated with a high risk of adverse reactions. It has been recorded that in 30% of cases quite pronounced side effects are observed, including nausea, vomiting, migraine attacks, pain in the mammary glands, etc.

In addition, specially developed drugs based on levonorgesterel are also successfully used for emergency contraception. They are characterized by a pronounced gestagenic effect and the absence of estrogenic action. Among the female population, the two most popular drugs that contain levonorgesterel are Postinor and Escalep. According to the results of world clinical trials, the effectiveness of these contraceptives is slightly higher than that of the Yuzpe method. Also, the tolerability of Postinor and Escalep is much better.

Properly selected female contraception will help maintain reproductive health.

Non-hormonal drugs for emergency contraception

Most non-hormonal drugs for emergency protection against unplanned pregnancy contain the active component mifepristone, which is a synthetic antiprogestin. It is quite often used as a means for artificial termination of pregnancy. early stages (medical abortion). However, it can also be used for emergency contraception, especially when the patient cannot be prescribed hormonal contraceptive methods. Taking into account the phase of the cycle, the drug realizes its contraceptive effect due to:

• Interfering with the release of luteinizing hormone.
• Blocking or delaying ovulation.
• Violation natural changes in the endometrium.

During some scientific research mifepristone was found to be more effective and better tolerated than levonorgesterel. One of the main advantages of mifepristone over other methods of emergency contraception for women was the absence of a decrease in effectiveness with increasing interval between sex and use. contraceptive(up to 120 hours).

On post-Soviet space wide use received the drug Ginepristone, used for emergency contraception. Its distinctive feature is that it is well tolerated and has a low dosage of the active component, compared to other existing non-hormonal drugs that are used for “quick” protection against unwanted pregnancy. Ginepristone must be taken once for 3 days after intimacy, excluding the period of the menstrual cycle. If there have been repeated coitus after taking the drug, you should use additional contraceptive methods (for example, a condom). Since the contraceptive effect of Ginepristone during subsequent sexual intercourse is somewhat reduced.

Benefits of emergency contraception

I would like to clarify that hormonal and non-hormonal drugs for “emergency” contraception are intended exclusively for emergency cases, and are not used on a regular basis. The main advantages of postcoital protection against unplanned pregnancy:

1. Ability to take contraceptives occasionally. This method will be especially interesting for girls and women who have an irregular sex life.
2. In most cases, there is a high contraceptive effect.
3. There are no significant adverse reactions.
4. Accessibility for many patients.

It should be remembered that emergency contraception drugs do not affect the implanted egg. Most of the recommended methods are safe for the fetus and the course of pregnancy. Therefore, even if conception occurred while using the above drugs, the pregnancy can be maintained. In addition, do not forget that contraceptives, used in emergency situations, do not protect against sexually transmitted diseases. In case of suspected infection venereal infection After intimacy, you should immediately consult a specialist.

Contraception is protection against unwanted pregnancy. Modern methods of contraception are very diverse. Initially, contraceptive methods are divided into male, that is, intended for men, and female. Methods female contraception much more, and which method is preferable is decided by the woman herself together with the doctor, taking into account contraindications and side effects.

Physiological methods of contraception

Lactational amenorrhea method
This method is based on the fact that while a woman is breastfeeding, she has large quantities Prolactin is released, which suppresses the ovaries’ synthesis of their own hormones, and accordingly, ovulation. It is quite effective only in the first six months after birth, provided that all the rules are followed.

Calendar method
This method is based on calculating dangerous and safe days. Not enough reliable way, as it is suitable for women with regular menstrual cycle, especially, the life expectancy of sperm in female body up to 7 days (even if sex was on a safe day, there is no certainty that the sperm will not die before ovulation).

Mechanical methods of contraception

It is a rubber cap that is inserted into the vagina before coitus and covers not only the cervix, but also the vaginal vaults.

Cervical cap
This device is made of latex or silicone, just like a diaphragm, it is inserted before sexual intercourse, but only covers the cervical canal.

Long-acting contraceptives

These include injectable hormones (Depo-Provera), administered once every 3 months, hormonal implants (Norplant) administered subcutaneously in 6 capsules for up to 5 years, hormonal patches (Euro), applied weekly for 3 weeks followed by a seven-day break and hormonal ring, which is administered intravaginally for a period of 3 weeks followed by removal for 7 days.

On to the cons hormonal type contraception can be attributed to the presence of a large number of contraindications, pronounced side effects when not correct selection hormonal method contraception, require discipline and regular use of hormonal pills, do not protect against sexually transmitted infections.

The positive aspects of this method of contraception are its high efficiency; if necessary, it can be used for “fire” contraception (as special tablets for emergency contraception, for example, and COCs), with proper selection are well tolerated and also normalize the cycle.

Chemical contraception

TO this method These include spermicides, which act locally and are available in the form of creams, gels, sponges and aerosol foams. Spermicides cause the death of sperm in the vagina or, if the activity of the latter is preserved, prevent their penetration into the uterine cavity.

The advantages of the chemical method of contraception for women are considered to be certain protection against sexually transmitted infections and ease of use. Negative sides spermicides require use immediately before sexual intercourse and have a limited period of effectiveness. The effectiveness of chemical methods of contraception is 75–80%.

Female sterilization

This method involves occlusion fallopian tubes(ligation and/or crossing of tubes). The advantage of this method is its absolute reliability (100%), although, as nonsense, it is rare that restoration of tubal patency and subsequent pregnancy are observed. The disadvantages include the impossibility of restoring fertility, that is, the irreversibility of the method.