What contraceptives. Contraception: types and action. Mechanism of action of hormonal contraceptives

2 Sterilization

Female sterilization is also called tubal occlusion or “tubal ligation.” As a result of the operation, an artificial obstruction of the fallopian tubes is created: the female egg is isolated from sperm and fertilization becomes impossible. In Russia, this method of contraception is legally permitted only for women over 35 years of age who have at least one child.

BEHIND Almost 100% protection against unwanted pregnancy; the operation does not entail changes in health, hormonal levels, does not affect sexual desire, and sometimes even increases it; the risk of ovarian cancer is reduced.

AGAINST Sterilization is almost irreversible, surgery to restore fertility is very expensive and there is no guarantee of a successful outcome; the operation is performed under anesthesia, and these are associated risks; does not protect against sexually transmitted diseases and HIV infection.

PEARL INDEX 0.15 (in an extremely small percentage of women, pregnancy occurred in the first year after surgery).

3 Vasectomy

Type of male sterilization. During the operation, part of the man's vas deferens is ligated or removed so that sperm do not enter the ejaculate.

BEHIND Relatively simple operation; local anesthesia; libido, erection, ejaculation, sexual desire, orgasm do not undergo changes.

AGAINST You must carefully consider your decision as reconstructive surgery is much more complex, expensive and success is not guaranteed. Does not protect against sexually transmitted infections.

PEARL INDEX 0.4 pregnancies per 100 women.

4 Intrauterine device

The spiral is a fairly common method of contraception in women 25-30 years old. This is a small device that is inserted into the uterus to prevent conception. Today there are about 50 types of spirals: round, spiral, T-shaped, copper or silver, hormonal, etc. The IUD prevents the implantation of the egg into the uterine wall, has a detrimental effect on sperm (copper-containing coils), and affects their ability to pass through the cervix (hormonal). The average period of use is 2-5 years.

BEHIND High protection against unwanted pregnancy. Using an IUD, you can forget about other methods of birth control for several years. The spiral does not affect lactation, is easily removed by a doctor and is inexpensive.

AGAINST May cause heavy menstruation in some women. Prolonged stay of a foreign body in the body reduces immunity and can also cause inflammatory processes. The IUD is not recommended for nulliparous girls.

PEARL INDEX 1 pregnancy per 100 women.

Hormonal contraception

5 Hormonal implants and capsules

This type of contraception is a small plastic stick (the size of a match) or a thin capsule filled with hormonal drugs and injected subcutaneously, usually into the inner side of the left forearm. After installation, implants regularly release a hormone that interferes with and also changes the cervical mucosa, making it difficult for sperm to pass through. In 2018, a new progressive product is expected on the American market - a hormonal contraceptive chip, which will be implanted under the patient’s skin and controlled using a smartphone and a special application.

BEHIND There is no need to frequently replace the implant. The effect lasts approximately 5 years. The operation is quite simple and painless.

AGAINST Side effects: nausea, headaches and possible allergic reactions. Implants are not widely represented on the Russian market, hence the high cost. In addition, gynecologists do not recommend installing implants for girls who have not yet given birth.

PEARL INDEX 0.3 pregnancies per year per 100 women.

6 Combined oral contraceptives

AGAINST There is a risk of developing thrombosis if there is a predisposition. It takes discipline and regular application. In addition, COCs can reduce libido, cause allergies, nausea, increased breast sensitivity, pigmentation and mood swings.

PEARL INDEX About 0.5 pregnancies per year per 100 women for combination oral medications.

7 Hormonal injections

BEHIND Availability and ease of use, wide choice. Condoms provide the best protection against sexually transmitted diseases.

AGAINST Protection against pregnancy is only 82% for male and 79% for female condoms. Many women complain that female condoms feel a bit awkward and that they can make inappropriate noises during sex. Allergy to latex is a contraindication.

PEARL INDEX From 5 to 12 pregnancies per 100 women.

11 Contraceptive caps, vaginal diaphragms and sponges

A contraceptive cap is a reusable contraceptive, which is a silicone cup with a loop that is placed on the cervix. The caps are recommended for use in conjunction with spermicides. The contraceptive is inserted immediately before sexual intercourse and can be worn for about 48 hours.

The vaginal diaphragm has the shape of a cup with a metal spring along the edge; it is inserted before sexual intercourse so that the rim is in the walls of the vagina and the dome covers the cervix. The spring presses lightly on the walls of the vagina and urethra. The size of the diaphragm is selected by a gynecologist; you can wear the contraceptive for no more than 24 hours.

A sponge soaked in spermicidal solution looks like a small donut with an indentation that should fit snugly against the cervix. The sponge combines both mechanical and chemical protection. The sponge is a universal size, and in the USA you can buy it in a regular supermarket.

BEHIND The caps and Co. are reusable, they do not change hormonal levels, and are suitable for breastfeeding women and for those for whom hormonal medications are contraindicated.

AGAINST If administered incorrectly, the effect is extremely weak. They do not protect against infections, and the quality of sex sometimes decreases. In addition, there are a number of contraindications.

PEARL INDEX From 6 to 20 pregnancies per 100 women.

12 Spermicides

Spermicides are chemicals that destroy sperm within a short period of time (up to 1 minute). They contain special creams, jellies, suppositories, vaginal tablets, foams and films - all of this is sold freely in pharmacies. Spermicides themselves have a low contraceptive effect, so gynecologists advise combining them with barrier methods of protection.

BEHIND Ease of use, protection against certain infections.

AGAINST Low contraceptive effect. Spermicides can negatively affect vaginal flora. And one more thing: make sure that you are not already pregnant, since in this case there is a high risk to the fetus.

PEARL INDEX 25-30 pregnancies per 100 women per year.

Natural methods of contraception

13 Interrupted coitus and others

Coitus interruptus, the calendar method, a method that involves tracking basal temperature, monitoring the consistency of discharge and other methods that we inherited from our grandmothers and mothers are all natural methods of contraception. Even modern methods of contraception do not provide a 100% guarantee, and the reliability of “folk” methods is even more out of the question: out of 100 women who use interrupted coitus as protection, on average, 19-20 become pregnant within a year. Additionally, none of the natural methods protect against sexually transmitted infections.

In conclusion, an important disclaimer: before choosing a method of contraception, be sure to consult with your gynecologist.

Text: Yulia Oleynikova.

Today, there is a huge selection of contraceptive methods for women that will help prevent unwanted pregnancy and maintain women's health for the possibility of having healthy children.

According to statistics, about half of girls lose their virginity before reaching the age of twenty. Moreover, in most cases the girls are not married. Two thirds have their first pregnancy terminated before the age of seventeen. The statistics are, of course, depressing. You can blame freedom of morals for everything, introduce all sorts of prohibitions, etc. However, nothing can be more effective than basic knowledge about contraceptive methods, which every girl must have. Only knowledge will help reduce the number of abortions among girls and young women who have not yet experienced the joys of motherhood, which carry with them various gynecological diseases, infertility and subsequent inability to bear a pregnancy. According to research by American experts in the field of oncology, it is the first abortion that provokes the development of cancer of the mammary glands and uterus.

The issue of contraception should be a top priority for sexually active young girls and women who are at least a little concerned about their future. So what do you need to know about contraception, and what methods exist?

Contraception means preventing the occurrence of unplanned pregnancy during casual relationships or regular sexual activity. Each woman can choose the most optimal method for herself. In this case, some nuances should be taken into account, among which should be the absence of pathological effects on the body, high contraceptive reliability and safety of the method, reversibility of the process (that is, after the end of their action there are no obstacles to pregnancy), being accessible and easy to use. The effectiveness of any contraceptive is expressed by the Pearl index, which is determined by the number of pregnancies in 100 women who used this method of contraception during the year.

Contraceptive methods for women are divided into groups:
Group 1 – provides for complete abstinence from sexual activity. This method is absolutely effective.

Group 2 - includes methods of contraception with low effectiveness, but which do not have either beneficial or harmful effects on the female body (rhythmic method (abstinence from sexual intercourse during the period of ovulation or the use of additional contraceptives during this period), intermittent sex, lactation method amenorrhea, temperature method, calendar method).

Group 3 – contraceptive methods with low effectiveness that do not have harmful effects, but at the same time exhibit some protective properties for the woman’s body (condom, vaginal diaphragm). Their advantage is that they prevent the possibility of infection with sexually transmitted diseases, STDs, and AIDS.

Group 4 – highly effective methods of contraception (hormonal contraceptives).

Group 5 – highly effective methods of contraception, but with the risk of developing a number of complications (intrauterine contraception, surgical sterilization of women or men).

Contraceptive methods are divided into:

• hormonal;
• intrauterine;
• barrier;
• surgical;
• postcoital.

Hormonal method of contraception.
This method includes: combined (estrogen-gestagen) oral contraceptives (COCs), which are divided into monophasic oral agents with a constant dose of estrogen and gestagen, two-phase (the first 10 tablets contain estrogen, and the remaining eleven are combined), three-phase (include three type of tablets, their intake recreates the secretion of estrogens and gestagen during the menstrual cycle), vaginal rings and transdermal contraceptive system (Evra contraceptive patch), progestin oral contraceptives (mili-pili), long-acting injection contraceptives, implantation contraceptives (hormonal implant).

Oral contraceptives are the most common and popular methods of contraception today. This group of contraceptives is selected for each woman individually, taking into account her physiological characteristics, hormonal levels, and existing diseases. Third-generation birth control pills recreate a woman's normal menstrual cycle and have virtually no side effects. Their action is aimed at inhibiting the production of hormones that promote ovulation. Under their influence, some changes occur in the endometrium, due to which the fertilized egg is not able to implant. In addition, this group of contraceptives reduces the duration of menstruation, the amount of blood loss during the same period, reduces pain, and also reduces the risk of inflammatory diseases.

Combined oral contraceptives have their disadvantages. Basically, when taking them, nausea, dizziness, headaches, irritability and mood swings may occur.

The main advantages of this method of contraception include high efficiency, positive effects on the woman’s body, including reproductive function, ease of use, and reversibility of the process. It has been proven that among women who regularly take this method of contraception for two years, the incidence of cancer of the reproductive system and mastopathy is reduced.

COCs have some contraindications, including thrombophlebitis, pregnancy, vascular hypertension, strokes, liver disease or dysfunction, hormone-dependent tumors, obesity, oncology, bleeding of unknown etiology. In addition, COCs should not be used by women over 35 who smoke.

Progestin oral contraceptives contain only progestins. These contraceptives are best used by mature women. As a rule, their use is prescribed to women with heavy and painful menstruation, mastalgia, PMS (premenstrual syndrome). Contraceptives of this group can be used even during breastfeeding, and they do not in any way affect the quality and quantity of milk.

Sufficiently long-term protection from unwanted pregnancy is provided by injectable contraceptives or implants inserted subcutaneously. These drugs constantly release special hormones in doses that prevent pregnancy. When using this group of contraceptives, there are the same side effects as when using oral contraceptives.

Intrauterine contraception (IUC).
Among intrauterine contraceptives, the most common is the IUD. Made from plastic or copper, the IUD is quickly and painlessly inserted into a woman’s uterus for two or 5 years. Modern intrauterine devices release doses of hormones that prevent the fertilization of the egg. Its action is aimed at reducing the viability of sperm, enhancing the spermicidal properties of the endometrium, reducing the viability of the egg, and also creates obstruction of the fallopian tubes and enhances the contractile function of the uterus, due to which pregnancy will not occur even as a result of fertilization.

This method of contraception also has its contraindications. The main ones are pregnancy, oncology of the uterus or its cervix, uterine bleeding, infections of the reproductive system.

Barrier methods of contraception and spermicides.
These include: male condoms, vaginal diaphragms, cervical caps and spermicides.

This method of contraception creates mechanical obstacles to the path of sperm into the vagina (condom), cervix (caps, diaphragms), and also blocks sperm activity (spermicides). The effectiveness of this method of contraception directly depends on correct use.

Surgical method of contraception.
This method of contraception is widespread throughout the world. Its effectiveness is absolute, since fertilization does not occur. Surgical contraception or sterilization is resorted to if a married couple has decided that they should no longer have children. This method does not affect sexual function in any way. Female sterilization is carried out through occlusion of the fallopian tubes using laparoscopic surgery, male sterilization through ligation of the vas deferens. After sterilization, it is impossible to restore the ability to bear children.

Postcoital contraception or emergency method of contraception.
Emergency contraception is a collective concept that combines a variety of methods of contraception, the use of which in the first 1–3 days after unprotected sexual intercourse prevents the onset of an unplanned pregnancy. Emergency contraception is used in cases where sexual intercourse not protected by other means has taken place, as well as in cases where pregnancy may pose a threat to the life of the expectant mother. Emergency or post-coital contraception is recommended for women who have been raped, if the integrity of the condom is broken, if the intrauterine contraceptive device falls out completely or incompletely, if sexual intercourse is interrupted, when ejaculation occurred earlier, as well as for women with irregular sex life. This type of contraception is not intended for permanent use; it cannot be considered as a contraceptive.

This type of contraception includes: the high-dose gestagenic drug Postinor. Taken immediately after sexual intercourse and 12 hours later, 2 tablets, oral contraceptives containing 50 mcg of estrogen (2 tablets 2 times with an interval of 12 hours) - Danazol 400 mg 3 times with intervals of 12 hours, Mifepristone 600 mg once or 200 mg per day for 5 days in the 2nd phase of the menstrual cycle.

Each of the listed methods of contraception entails serious interference in the functional state of a woman’s reproductive system, the violation of which can cause the further development of ovarian dysfunction.

Temperature and calendar methods of contraception.
Temperature and calendar methods can only be used by healthy women with a regular menstrual cycle. However, these methods are not effective and are inferior to modern means. Most often, when using these methods, women make mistakes in calculations.

The temperature method is based on identifying the period during which, for physiological reasons, conception is impossible. During the menstrual cycle, a woman measures her basal temperature every morning immediately after waking up by inserting a thermometer into the rectum. When the temperature rises by 0.4-0.5 degrees, ovulation occurs. After 2-3 days, unfavorable days for conception follow. The possibility of fertilization occurs 4-5 days before the next ovulation.

The calendar method of contraception involves monthly recording of the start and end dates of menstruation in order to identify unfavorable days for conception.

Interrupted sexual intercourse.
The most popular, but not reliable method of contraception is interrupted coitus, in which the man removes the penis from the vagina before ejaculation. During sexual intercourse, a man must constantly control himself, which is difficult psychologically. In addition, during sexual intercourse, men release droplets of sperm, which is completely impossible to control. This drop is enough for fertilization to occur.

The choice of one or another method of contraception must be made together with a gynecologist, who, taking into account physiological characteristics and health status, will suggest the most optimal option for you.

With the beginning of sexual life, reliable and safe contraception in terms of side effects becomes relevant for every representative of the fair sex. It is immediately worth noting that there are no universal remedies. At each age, taking into account the state of health, regularity of sexual relations and other factors, one or another method is more suitable. For a woman after 30 years of age, their choice becomes especially important, since her health is no longer ideal, and some remedies, for example, incorrectly selected hormonal drugs, can further aggravate the situation.

• natural (calendar method, interrupted sexual intercourse, daily measurement of basal temperature to control ovulation and others);
• barrier (condoms, uterine cap, vaginal diaphragm);
• hormonal (tablets for internal use, intramuscular injections, subcutaneous implants, vaginal rings, intrauterine devices and systems, patches, postcoital products);
• chemical (pastes, suppositories, ointments and topical tablets, intrauterine devices containing copper, gold or silver);
• surgical (blocking the patency of the fallopian tubes).

The main criterion by which their effectiveness is assessed is reliability. The first place with a result of 99.9% is occupied by the surgical method, in which a woman undergoes an operation to ligate the fallopian tubes, which eliminates the possibility of becoming pregnant. After 30 years, it can only be recommended for women with absolute contraindications to pregnancy for health reasons or those who clearly no longer want to have children. To restore the patency of the fallopian tubes, a complex operation will again be required, or an expensive IVF procedure will have to be resorted to to give birth to a child.

In second place with a reliability level of 99.7% are hormonal contraceptive pills, followed by the intrauterine device (IUD) and intrauterine systems with a protection level of 99.2% and higher. Relatively new methods of contraception are the hormonal patch and ring, their reliability level is about 92%. Barrier methods of contraception are characterized by reliability at the level of 85–90%, and the lowest rate of protection against unwanted pregnancy (80% or less) have natural methods and topical chemicals or spermicides.

The selection of acceptable contraceptive options for a woman in each specific case should be carried out by a gynecologist after conducting an appropriate examination, this is especially true in the case of choosing hormonal pills.

Birth control pills

On pharmacy shelves you can find a wide range of oral contraceptives. Despite the fact that they are available without a prescription, prescribing them independently on the advice of friends or advertising is unacceptable. Hormonal pills are indicated for the prevention of pregnancy during regular sexual activity in women who are married or have a regular sexual partner. Their high efficiency is due to the fact that the contraceptive effect is realized through several mechanisms in parallel. They suppress ovulation, change the structure of the endometrium so that the egg cannot attach to the wall of the uterus if it is fertilized, and increase the density of cervical mucus, making it difficult for sperm to move through.

Kinds

The active ingredients of hormonal contraceptive pills are synthetic analogues of the female sex hormones estrogen and progestogen. They are:

• monophasic, with the same constant dose of estrogen and progestogen;
• biphasic, with a constant content of estrogen and variable content of pogestagen;
• triphasic, with variable doses of estrogen and progestogen;
• mini-pills contain only progestogen in a minimal dosage.

Based on the quantitative content of hormones, combined oral contraceptives (COCs), that is, drugs based on both estrogen and progestogen, are divided into micro-, low- and high-dose.

Indications

To choose the right hormonal pills to prevent unplanned pregnancy, you need to consult a gynecologist. The specialist will assess the patient’s general health, her constitution, perform an examination in a gynecological chair, take smears for flora and oncocytology, and find out whether she has had previous pregnancies. If necessary, he will prescribe additional studies: ultrasound of the pelvic organs, general and biochemical blood tests, blood tests for hormones to determine the state of hormonal levels in case of an irregular menstrual cycle.

Low-dose contraceptive pills (Yarina, Zhanin, Marvelon, Regulon, Diane-35, Silhouette) are prescribed to the categories of patients listed above in case microdosed drugs are ineffective for them and to women who have given birth.

High-dose COCs (tri-regol, triziston, ovidone, non-ovlon, triquilar) are usually prescribed only for therapeutic purposes for the treatment of hormonal diseases of the female reproductive system. In the absence of such pathologies, they are not used only for contraception.

Mini-pills have a slightly less contraceptive effect compared to COCs, but are characterized by a smaller list of contraindications and side effects. They can be recommended to nursing mothers, women over thirty years of age, who smoke and have contraindications for prescribing COCs. Drugs in this group include microlut, charosetta, ovret, exluton, laktinet and others.

Advantages

The advantages of birth control pills are:

• the presence of not only a contraceptive, but a preventive and therapeutic effect for certain gynecological diseases (fibroids, endometrial hyperplasia, breast cancer);
• mitigation or elimination of unpleasant symptoms of premenstrual syndrome;
• normalization of the menstrual cycle;
• later onset of menopause;
• reducing oily skin and hair, and the tendency to acne.

Tablet hormonal contraceptives are easy to use, they do not require special preparation for sexual intercourse (unlike local remedies) and do not reduce the level of pleasant sensations during it.

Flaws

The disadvantages of this method include the need for a woman to take the drug at the same time every day in accordance with the instructions and prescriptions of the doctor. If the package contains 28 tablets, then drink them continuously, and if 21, then take a break for 7 days, during which menstruation occurs, and then start a new pack. Oral contraceptives do not protect against sexually transmitted infections.

Among the disadvantages of COCs, one can note the high risks of complications from the cardiovascular system; for mini-pills they are much lower. COCs are contraindicated for women over thirty if they have bad habits (smoking, alcohol abuse) and the following problems in the body have been identified:

• increased blood clotting and tendency to form blood clots;
• cardiovascular diseases;
• cerebrovascular accidents;
• severe pathologies of the kidneys and liver;
• diabetes;
• hormonally dependent neoplasms.

Side effects

Possible side effects while taking them are:

• spotting and spotting between periods;
• decreased sexual desire;
• the appearance of pigment spots;
• pain in the gastrointestinal tract;
• increased body hair growth;
• headache.

Mood changes and depression are also possible.

Video: What you need to know about using birth control pills

Other hormonal contraceptives

In addition to oral contraceptives, other hormonal contraceptives are also used to prevent unplanned pregnancy. These include:

• vaginal ring;
• subcutaneous implant;
• contraceptive patch;
• postcoital remedies.

Vaginal ring

This is a thin silicone ring with a diameter of about 4 cm, containing estrogen and progestogen, which enter the systemic circulation through the vaginal mucosa and have an effect similar to oral contraceptives. Their concentration in blood plasma is maintained at a constant level for 3 weeks and then gradually decreases.

The ring is inserted into the vagina on the first day of menstruation and left for 21 days, after which it is removed and replaced with a new one a week later. Its position in the vagina does not affect the pharmacological effect, but may create discomfort during sexual intercourse. The disadvantages of this method are an increased risk of developing an inflammatory process in the vagina and the inability to use tampons during menstruation.

The contraceptive patch works in a similar way. It is glued to the skin in certain places for 21 days, and then a break is taken for 7 days. The advantage of the vaginal ring and the contraceptive patch is the absorption of the active components into the systemic bloodstream, bypassing the gastrointestinal tract, which increases the degree of their absorption and reduces the number of side effects.

Subcutaneous implants

These are capsules about 3.5 cm long and 2.5 mm in diameter, containing a synthetic progestogen, which is gradually released into the systemic circulation over a long period of time. A significant drawback of this method of contraception, despite its high efficiency and duration of action (up to 5 years), is the need for minimally invasive surgery to place and remove implants.

Contraindications for a subdermal implant are the same as for all hormonal contraceptives. Progestin-only contraceptives can also be introduced into the body by injection (depo-provera). To ensure pregnancy prevention, injections are given intramuscularly once every two months.

Postcoital contraceptives

The most popular drug is Postinor, which contains very high doses of hormones. Must be taken no later than 72 hours after unprotected sexual intercourse. The mechanism of action is associated with changing the structure of the endometrium and preventing the attachment of a fertilized egg to the wall of the uterus. This method of contraception is used only in emergency cases, it is not recommended for women of any age, not only after 30 years, as it is fraught with serious side effects. Using it systematically is strictly prohibited.

Spermicides

Local contraceptives used before sexual intercourse after 30 years of age can be recommended for parous and nulliparous women with irregular sex life. These include creams, suppositories, tablets (pharmatex, gynekotex, patentex, benatex), containing chemical compounds as active ingredients that have a destructive and immobilizing effect on sperm.

Women administer such drugs directly into the vagina in a lying position 15 minutes before sexual intercourse. In addition to low efficiency (80%), they also have a number of disadvantages:

• Do not wash with soap immediately after sexual intercourse;
• the need to comply with time intervals;
• a feeling of discomfort in both partners;
• repeated administration before each sexual intercourse.

The advantages include the absence of the need for a doctor's prescription, the presence of antibacterial components in some drugs, which help prevent infection with certain sexually transmitted diseases.

Barrier methods of contraception

The most popular means of barrier contraception are condoms. Their use is especially important during casual sexual intercourse, since only they reliably protect both partners from sexually transmitted infections.

The main disadvantage of condoms is a decrease in sensitivity during sexual intercourse, which can become a significant obstacle for the fair sex after 30 years of age, who are experiencing the blossoming of their sexual life. However, today pharmacies offer a wide selection of condoms with a wide variety of properties, differing in color, smell, material of manufacture, thickness, size, shape, lubricants used, texture, so if desired, each couple will be able to choose the best option for themselves.

Intrauterine device

The IUD is intended as a method of contraception after 30 years only for women who have given birth, if the birth proceeded naturally and without complications. This type of contraception is not recommended for caesarean section.

Currently, two types of IUDs are used, containing metals (copper, silver, gold) or hormones. The IUD is inserted into the uterine cavity on the third or fourth day of the menstrual cycle. It prevents the fertilized egg from attaching to the uterine wall and reduces its lifespan. IUDs with hormones additionally affect the consistency of cervical mucus, increasing its density, and also help normalize the menstrual cycle and prevent the formation of uterine fibroids.

Depending on its type, the IUD is installed for a period of 5 years, maximum 10 years, after which it is removed. If a woman decides to become pregnant, it can be removed at any time. However, before conception, a recovery period will be necessary, since during the presence of the spiral in the uterus, the endometrium is greatly depleted, which greatly complicates the attachment of a fertilized egg. Contraindications for the use of the IUD are:

• endometriosis;
• severe diseases of the cardiovascular system;
• sexually transmitted infections;
• inflammatory diseases of the pelvic organs;
• malignant neoplasms localized in the cervix or body of the uterus;
• fibroids, accompanied by deformation of the uterine cavity.

Women with an IUD should visit a gynecologist more often, since such a foreign object can provoke inflammatory processes in the uterus and appendages, which need to be diagnosed and treated in the early stages. For a long time during the adaptation period after insertion of the IUD, women may experience spotting and increased menstrual pain. IUDs also increase the amount of blood loss during menstruation.

Video: Review of the most popular contraceptive methods

Prevention of abortion is a key point in preserving a girl’s reproductive health. 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 of contraception:

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

Female contraceptives can be bought in pharmacy chains without a prescription.

Physiological

The peculiarity of the physiological method of contraception is that a girl must abstain from intimacy or actively use other contraceptives during a certain period of her menstrual cycle. 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 the individual duration of the menstrual cycle.
2. Temperature. To determine the fertile period, rectal temperature measurements are taken. 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 changes in 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 use and absolute safety for the female body, since no consequences or adverse reactions can be expected. 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.
• Low 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

The use of special means that prevent sperm from moving into the uterine cavity is called a 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 the active component, which destroys the cell membrane of male germ cells in a few seconds. Spermicides are available in the form of gel, cream, suppositories, foam, tablets, etc. The effectiveness of the chemical method of contraception directly depends on its correct use. 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 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 the normal microflora of the 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 characteristics of use, which can be found by reading the official instructions for the drug. It should be remembered that Pharmatex is contraindicated in case of hypersensitivity to its active components and inflammatory diseases of the genital organs. 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 any special problems with use.

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.). The mechanism of 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.

Taking oral contraception stops ovulation and prevents the 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 at different periods of the 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 have serious 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. In addition, according to clinical studies, the contraceptive effect is not their only property. What else is typical for contraceptive 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 cause serious harm to the young body. In addition, they are recommended for girls and women who have contraindications to the use of other oral contraceptives.

It is recommended for women to use the latest methods of contraception after consultation with a specialist.

Contraindications

Hormonal contraceptives can boast a fairly long list of various contraindications. Those that have a high lethal risk deserve the most attention. Diseases that are absolute contraindications for the use of hormonal oral contraceptives:

• Diseases of the heart and blood vessels (uncontrolled high blood pressure, myocardial infarction, atherosclerotic lesions of the bloodstream).
• Severe pathologies of the blood coagulation system and other diseases that provoke the formation of blood clots (venous thrombosis, thromboembolism).
• Tumors of the 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 regimens for the use of hormonal contraceptives have been developed. One of the latest innovations has been the introduction into clinical practice of a prolonged regimen 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.

A regimen called “63+7” has successfully passed a clinical trial. 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 innovative approach to taking hormonal contraceptives, called quick start, is being actively developed. What are its features:

1. It is allowed to start taking combined oral contraceptives at absolutely any period of the menstrual cycle.
2. The absence of a significant negative impact on pregnancy and fetal development from the latest 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 familiarized with 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.

Clinical experience shows that 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 are 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 of high doses of 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 global clinical studies, 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 in the 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.
• Disruption of natural changes in the endometrium.

Some scientific studies have found that mifepristone is more effective and better tolerated than levonorgesterel. One of the main advantages of mifepristone over other methods of emergency contraception for women was that there was no decrease in effectiveness when the interval between sex and use of the contraceptive was increased (up to 120 hours).

In the post-Soviet space, the drug Ginepristone, used for emergency contraception, has become widespread. 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 “urgent” 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. If you suspect a sexually transmitted infection after intimacy, you should immediately contact a specialist.

Today there is simply a huge variety of contraceptives, which allows every woman to choose the best option for herself, taking into account her needs and characteristics of the body. Ideally, contraceptives should protect not only from unwanted pregnancy, but also from dangerous infections. Therefore, next we will consider in more detail ways to protect against pregnancy for women.

Navigator by methods

1. Condoms

The most popular and accessible method. Condoms should be purchased from trusted pharmacies. They allow you to protect not only from unwanted pregnancy, but also from deadly diseases. In this case, you need to learn how to use condoms correctly, following the instructions from the manufacturer. Every woman and man is advised to always carry quality condoms with them to protect themselves in any situation.

2. Caps

The caps are made of high-quality latex and are inserted directly into the cervix. The material from which the cap is made helps protect partners from dangerous infections, such as syphilis or gonorrhea. At the same time, you need to learn how to use them. Not every woman will be able to correctly insert the cap into the cervix, which is the main disadvantage of this method. In addition, allergic reactions are also possible.

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3. Coitus interruptus

This method is used by all those who want to save on contraceptives. However, this method is not reliable, and most importantly, does not protect against sexually transmitted infections. The effectiveness of the interrupted act will depend on the dexterity of the partner. It is not recommended for anyone who does not want to get pregnant.

4. Calendar method

This method is only suitable for women with regular menstruation. We set up a calendar and track safe days. Regular menstruation allows you to accurately track ovulation days and safe days to conceive. Every modern person should know popular methods of protection against pregnancy.

5. Temperature method

In this case, immediately after sleep in the morning, you need to measure the basal temperature in the anus. This method allows you to determine the period of ovulation, before which the temperature drops slightly by half a degree. All other days when the temperature is stable are safe.

6. Cervical method

In this case, you need to monitor the condition of the mucus that is released from the vagina. Just before ovulation begins, the mucus becomes thicker and more viscous. However, this method is not accurate. After all, the state of mucus can be influenced by hormonal changes in a woman’s body. Therefore, it should not be used by anyone who wants to protect themselves from unwanted pregnancy.

7. Lactational amenorrhea

During breastfeeding, a woman’s body produces a unique hormone that protects against unwanted pregnancy. In other words, ovulation does not occur during this period, which guarantees safe sex.

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8. Spiral

The most modern method of contraception. The spiral is made of silver or copper plates, which prevent unwanted pregnancy. The IUD is inserted directly into a woman’s uterus for a period of five years. This method is characterized by a high level of efficiency if the spiral is inserted correctly. Of course, there are exceptions to the rules, and pregnancy can also occur with the IUD. Therefore, you need to choose only a high-quality and proven spiral.

Every woman should know how to prevent pregnancy.

9. COCs

These are hormonal pills that protect a woman from unwanted pregnancy. However, most women are afraid to use this method because of possible side effects, for example, weight gain or blood thickening. The use of cocci is completely safe and effective if the woman does not have serious contraindications.

10. Vaginal ring

A special ring that contains estrogens is inserted directly into the cervix. Hormones are released and prevent ovulation from occurring. In this case, the ring must be inserted correctly to protect yourself from unwanted pregnancy. In addition, it may also fall out, which is a disadvantage of this method.

11. Hormonal patch

The patch needs to be glued to the skin and estrogen hormones will enter the body through the blood and prevent unwanted pregnancy.

12. Mini-pill

These are special pills that contain the hormone progestogen. Compared to the previous type, this method is characterized by a low level of effectiveness, although there are practically no side effects.

13. Subcutaneous implants

A special implant is sewn under the skin to prevent unwanted pregnancy. The hormone progestogen enters the body, which prevents the egg from developing. This implant is installed for several years.

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14. Hormonal IUD

In addition to the usual one, there is also a hormonal intrauterine device. It secretes a hormone that prevents the embryo from attaching to the walls of the uterus and also paralyzes sperm activity.

15. Chemical contraception

There are also products that simply destroy sperm. These can be tablets, gels, creams or suppositories. Such drugs are used mainly a few minutes before sexual intercourse. Benefits also include protection against infections. However, they are characterized by a low level of effectiveness compared to other methods of contraception.

16. Emergency contraception

There are special pills that need to be taken within one or two days after sexual intercourse. This method is harmful to health, so it should be used only as a last resort.

17. Traditional methods

Folk remedies involve creating an acidic environment in the vagina in which sperm die. Lemon juice or potassium permanganate can be used in this way. You need to know that this method has a low level of effectiveness, and the acid also irritates the delicate mucous membrane of the cervix. Therefore, there may be irritation and even wounds.

18. Hormonal pills

There are pills that prevent the embryo from attaching to the wall of the uterus. Such hormonal drugs should be taken for several days after unprotected intercourse.

19. Emergency installation of a spiral

Today, after unprotected intercourse, you can make an intrauterine device for five days. Silver or copper plates prevent the development of the egg and destroy sperm.

20. Medical sterilization

This method is only suitable for those who are sure that they do not want more children. In other words, after medical sterilization, a woman will never be able to become pregnant. The fallopian tubes are simply tied, preventing the egg from meeting the sperm.

These are all the popular ways to protect yourself from unwanted pregnancy during sex.

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