What is better: a condom, birth control pills or a calendar? This question is asked by every young couple who wants to delay having children. People have long been looking for methods of contraception - preventing unwanted pregnancy. The secrets of family planning have been passed down from generation to generation.

However, at present there is no remedy that would guarantee one hundred percent protection against unplanned pregnancy, except for radical surgery– abortion.

Choosing the right contraception for you

When choosing the contraceptive method that's best for you, it's important to know accurate information about all of your options. You need to consider how well each method works, possible side effects, how easy it is to use each method, and how much it costs.

The choice of method will depend on a number of factors, such as general condition health, lifestyle and relationships, the risk of getting sexually transmitted infections, and how important it is to you not to get pregnant.

Some methods require more motivation, time and effort than others. For example, if you choose oral contraception, then you need to remember that you need to take the pill every day, while if you choose contraceptive implants, protection can last up to several years.

When choosing contraception, it is important to weigh the pros and cons, determine for yourself all the pros and cons, and settle on the method that best meets your current and future needs. It is also very important to discuss your choice of contraceptive method with your partner.

The most popular methods of contraception are:

• Barrier methods.
• Hormonal methods.
• System methods.
• Natural methods.
• Sterilization.

Hormonal methods

Hormonal methods of contraception imitate the role of natural female hormones estrogen and progesterone. These hormones prevent pregnancy by blocking the message to the ovary to release an egg and also thicken cervical mucus, creating a barrier for sperm.

Birth control pills

Female contraceptive pills based on artificially synthesized sex hormones guarantee 97–99% protection. Manufacturers do not risk guaranteeing 100%, because the likelihood of pregnancy while taking medications, although negligible, exists - the human body is unpredictable, there is always a risk of an error, for example, skipping a dose. But we must remember that without harm to women’s health, birth control pills can be taken for no more than ten years. But is this method the safest? No unfortunately. First, birth control pills do not protect against sexually transmitted infections. Secondly, they can provoke side effects – sometimes very serious ones. By the way, this is written in the instructions for most birth control pills. Manufacturers warn, in particular, that venous thromboembolism may occur when using any of the combined oral contraceptives. There are many contraindications for taking oral contraceptives. Among them, for example, liver disease is a fairly common medical problem.

In addition, it is not advisable to constantly take birth control pills. Without harm to health, they can be taken for no more than ten years, and then under the supervision of a doctor. In addition, a woman must have a blood test twice a year while taking medications. The need for such caution exists because contraceptives can cause blood to thicken. Doctors also advise periodically doing liver tests. Three years after starting to take oral contraceptives, a break of at least two to three months is necessary. This is necessary so that the body “rests” from artificial hormones.

Is it true that after stopping taking oral contraceptives it is difficult to get pregnant and they make you fat and “hairy”? Oral contraceptives are prescribed for hormonal disorders in a woman’s body and for infertility. Although if a woman has been taking these drugs for a certain period (to prevent pregnancy), she may become pregnant immediately after stopping the use. Often in such situations, women become pregnant with twins or even triplets. The reason is that at first the eggs are suppressed and then activated.

It is true that a woman who uses oral contraceptives may begin to gain weight, but this is usually temporary. But excess hair growth is a reason to think about replacing the drug.

Emergency contraception

Emergency contraception, also known as morning after sex, is a hormonal birth control method that can stop ovulation. This method can be used after unprotected sex, or if a condom slips or breaks during sex, or if birth control pills are missed. Emergency contraception prevents 85 percent of pregnancies that would otherwise occur.

There are different types of emergency contraception. The most commonly used type is a pill containing the hormone progestin. This method can be prescribed by a doctor or chosen independently, since such tablets can be purchased at most pharmacies without a doctor's prescription. But you should always remember that emergency contraception is effective if used as soon as possible after unprotected intercourse (ideally within 24 hours after sex). And in general method can be used within 96 hours after sexual intercourse, but its effectiveness decreases every day.

You should not get carried away with emergency contraception, since such drugs are very aggressive, with them the woman’s body receives a heavy dose of hormones. The reaction to this method is different women varies and only specialists can predict it.

Bquarry methods

These are the most popular and most used methods of contraception. Barrier methods of contraception are based on stopping sperm from entering the uterus. There are the following types of barrier methods of contraception:

• male condoms
• female condoms
• contraceptive intravaginal devices

Male and female condoms also reduce the risk of contracting sexually transmitted diseases and HIV/AIDS. Barrier techniques can be very effective if they are used correctly every time you have sex.

Mmale condoms

A male condom is a latex (or polyurethane) coating that is placed over the erect penis, stopping sperm from entering the vagina. The method is 98 percent effective if used correctly. Male condoms are not expensive like other methods and are available in all pharmacies without a doctor's prescription, as well as in supermarkets, kiosks and other places.

ANDenskyecondoms

The female condom is a loose-fitting polyurethane pouch with a flexible ring at each end that fits into the vagina, stopping sperm from entering the uterus. It can be placed several hours before sexual intercourse and is considered stronger than the male latex condom, but this method may require some practice. If the female condom is used correctly every time you have sex, it is 95 percent effective against unwanted pregnancy. Female condoms are available in pharmacies and some retail outlets.

Intravaginal contraceptives

Intravaginal contraceptives are one of the barrier methods - an alternative to condoms. However, they are not suitable for everyone. For example, they are prescribed with caution to women with allergies. They can cause discomfort in men - and this is unnecessary at the moment of intimacy.

Natural Methodspreventing pregnancy

Natural methods are oldest form birth control and do not require medications, chemicals or foreign objects. These methods are the least effective and include:

• fast withdrawal method;
• calendar method,
• method of abstaining from sex.

Quick withdrawal method

This is a purely male method of contraception, it consists in the fact that during sexual intercourse, the partner must control the process of ejaculation (sperm release) and pull the penis out of the vagina right before ejaculation, so that sperm does not enter the vagina.

Advantages of the method:

• inexpensive
• no medical side effects.

Disadvantages of the method:

• very ineffective
• man has no control over ejaculation
• sperm may enter the vagina during a previous ejaculation
• interruptions during sexual intercourse
• there is no protection against STIs and HIV infections.

Calendar method

The calendar method is based on determining the date of ovulation. Such a date can be calculated, but a woman’s body is not a computer that can be programmed. The hormonal sphere is very sensitive, reacts to internal and external factors. The smallest stress, such as anxiety or a cold, can trigger hormonal imbalance.

Therefore, one cannot rely on the calendar method as something absolute. A woman can become pregnant even while on her period, although this is theoretically impossible. One reason is that sperm are very durable and can maintain their functions for up to 72 hours after entering the female body. After the end of menstruation, they can, accordingly, fertilize the egg.

The calendar method is determined by calculating the time of ovulation, which is approximately 2 weeks before your period.

The basal body temperature method involves taking your temperature every morning. A slight increase in temperature occurs after the egg leaves the follicle

The cervical mucus method can be used if there are no inflammatory processes in the genitals. Using this method, a woman determines the so-called fertile phase by observing mucous discharge from the vagina. If clear, sticky mucus is released, sexual intercourse should be avoided.

Advantages:

• inexpensive
• woman getting to know her body

Flaws:

• ineffective if body signs are interpreted incorrectly
• inconvenient and time-consuming
• does not protect against STIs and HIV

This is a refusal to have sex during a woman's fertile period or a complete refusal to have sex at all.

Traditional methods of contraception

Among the “homemade” contraceptives, there is a recipe: after unprotected sex, a woman should rinse her genitals with a stream of water or put a slice of lemon there to destroy sperm. Experts assure: water can only push sperm deeper into the cervix, which, accordingly, will increase your chances of pregnancy. Regarding lemon, there is a certain logic in this: sperm do not tolerate an acidic environment and will most likely die from such a liquid. However, no one has yet managed to treat the vagina thoroughly and deeply on their own.

Video version:

At first glance it may seem strange that, despite the fact that throughout recent years Mortality in Russia prevails over birth rate; the problem of contraception remains one of the most important problems in gynecology. But this situation can only be strange for those who consider contraception only from the standpoint of preventing pregnancy.

An obvious fact is that preventing unwanted pregnancy and, as a consequence, abortion is a factor in preserving reproductive health women.

Modern hormonal contraception has gone beyond its original properties. The therapeutic and preventive effect of these drugs, in fact, can dramatically change the structure of gynecological morbidity as a whole, since it has been shown that taking hormonal contraceptives reduces the risk of most gynecological and general diseases. Contraception “preserves” a woman’s reproductive system, providing her with a comfortable personal life, preventing diseases and the consequences of abortion. Thus, effectively reducing the number of unwanted pregnancies is the leading driving force for increasing the reproductive potential of women.

I don’t presume to say for sure, but most likely it is in our country that women live who have set a kind of record for the number of abortions they have undergone. The most depressing fact is that the most common “method of contraception” in Russia was and remains to this day – abortion.

Of course, in lately There has been a positive trend, and more and more, mainly young women, are starting to use oral contraceptives. Oddly enough, this is largely facilitated by fashionable women's magazines, which with a sufficient degree of competence talk about all sorts of aspects healthy image life and hygiene, paying great attention to the problems of contraception. Apparently, it is to these printed publications that we owe the debunking of the prevailing myth about the harmfulness of “hormonal pills.” But at the same time, even a quick glance at the advertising spreads of popular magazines and newspapers in the “medicine” section shows that the prevailing service offered to the population remains: “Abortion on the day of treatment. Any terms,” and, as you know: demand creates supply.

Several points about contraception

• Doesn't exist ideal method contraception. All currently available contraceptives are safer than the consequences that may result from terminating an unwanted pregnancy due to non-use of contraception. At the same time, it is impossible to create a contraceptive that would be 100% effective, easy to use, and provide full return reproductive function and had no side effects. For every woman, any method of contraception has its advantages and disadvantages, as well as both absolute and relative contraindications. An acceptable method of contraception means that its benefits substantially outweigh the risks of its use.
• Women using contraception should visit a gynecologist at least once a year. Problems associated with the use of contraception can be direct and indirect. Increased frequency of sexual intercourse or more frequent changes of sexual partners may necessitate a change in contraceptive method.
• The effectiveness of most contraceptive methods depends on the motivation of the person using the method. For some women, a more adequate method of contraception may be a spiral, ring or patch, since they, for example, do not have the desire to take pills every day, which can lead to incorrect use and a decrease in the contraceptive properties of the method. The contraceptive effect of the so-called calendar method, in addition to other factors, largely depends on the attitude of the couple to calculate and observe days of abstinence from sexual intercourse.
• Most women wonder about the need for contraception after having already had one or more abortions. It often happens that the onset of sexual activity, apparently as a result of some strong emotional experience, is not accompanied by proper care for contraception. In our country, there is a practice of “voluntary-compulsory” prescription of contraception to women coming for an abortion, instead of an “explanatory and recommendatory” approach to all women who are or are just planning to begin sexual activity.

Oral hormonal contraception

Oral contraceptives (OCs) belong to the most studied class medicines. More than 150 million women worldwide take oral contraceptives every day, and most experience no serious side effects. In 1939, gynecologist Pearl proposed an index for numerical expression of fertility:

Pearl Index = number of conceptions * 1200 / number of months of observation

This indicator reflects the number of pregnancies in 100 women during the year without the use of contraceptives. In Russia, this figure is on average 67-82. The Pearl index is widely used to assess the reliability of a contraceptive method - the lower this indicator, the more reliable this method is.

Pearl index for different types of contraception

Sterilization for men and women 0.03-0.5
Combined oral contraceptives 0.05-0.4
Pure progestins 0.5-1.2
IUD (spiral) 0.5-1.2
Barrier methods (condom) 3-19 (3-5)
Spermicides (local preparations) 5-27 (5-10)
Coitus interruptus 12-38 (15-20)
Calendar method 14-38.5

The Pearl index for OK ranges from 0.03 to 0.5. Thus, OCs are an effective and reversible method of contraception; in addition, OCs have a number of positive non-contraceptive effects, some of which continue for several years after stopping taking the drugs.

Modern OCs are divided into combined (COC) and pure progestins. Combined OCs are divided into monophasic, biphasic and triphasic. At the moment, biphasic drugs are practically not used.

How to understand the variety of drugs?

Included combination drug includes two components - two hormones: estrogen and progesterone (more precisely, their synthetic analogues). Ethinyl estradiol is usually used as estrogen, it is designated as “EE”. Progesterone analogues have been around for several generations and are called “progestins.” There are now drugs on the market that contain 3rd and 4th generation progestins.

The drugs differ from each other in the following respects:

• Estrogen content (15,20,30 and 35 mcg)
• Type of progestin (different generations)
• To the manufacturer (the same drug composition may have different names)

Oral Contraceptives are:

• High- (35 µg), low- (30 µg) and micro- (15-20 µg) dosed (depending on estrogen content) - now low- and micro-dosed drugs are mainly prescribed.
• Monophasic and triphasic - in the vast majority of cases, monophasic is prescribed, since the level of hormones in these tablets is the same and they provide the necessary “hormonal monotony” in the woman’s body
• Containing only progestins (analogues of progesterone), there are no estrogens in such preparations. Such tablets are used for nursing mothers and for those who are contraindicated in taking estrogen.

How contraception is actually chosen

If a woman is generally healthy and needs to choose a drug for contraception, then it is enough just gynecological examination with ultrasound and eliminating all contraindications. Hormonal tests in a healthy woman do not indicate in any way which drug to choose.

If there are no contraindications, it is clarified which type of contraception is preferable: tablets, patch, ring or Mirena system.

You can start taking any of the drugs, but it’s easiest to start with the “classic” Marvelon - since this drug is the most studied, and is used in all comparative studies of new drugs, as a standard with which the new product is compared. The patch and the ring come in one version, so there is no choice.

The woman is further warned that normal period adaptation to the drug is considered to be 2 months. During this period, various unpleasant sensations may occur: chest pain, spotting, changes in weight and mood, decreased libido, nausea, headache etc. These phenomena should not be strongly expressed. As a rule, if the drug is suitable, all these side effects quickly disappear. If they persist, then the drug must be changed - reduce or increase the dose of estrogen or change the progestin component. This is chosen depending on the type of side effect. That's all!

If a woman has concomitant gynecological diseases, then initially you can choose a drug that has a more pronounced therapeutic effect on the existing disease.

Other forms of hormone administration for contraception

Currently, there are two new options for administering hormones for contraception - the patch and the vaginal ring.

Evra contraceptive patch

“Evra” is a thin beige patch with a skin contact area of ​​20 cm2. Each patch contains 600 mcg ethinyl estradiol (EE) and 6 mg norelgestromin (NG).

During one menstrual cycle, a woman uses 3 patches, each of which is applied for 7 days. The patch should be replaced on the same day of the week. This is followed by a 7-day break, during which a menstrual-like reaction occurs.

The mechanism of contraceptive action of Evra is similar to the contraceptive effect of COCs and consists of suppressing ovulation and increasing the viscosity of cervical mucus. Therefore, the contraceptive effectiveness of the Evra patch is similar to that when using oral contraception.

The therapeutic and protective effects of Evra are the same as those of the combined oral contraception method.

The effectiveness of the Evra patch does not depend on the location of application (stomach, buttocks, upper arm or torso). The exception is the mammary glands. The properties of the patch are practically not affected elevated temperature environment, air humidity, physical activity, immersion in cold water.

Vaginal ring Novo-Ring

A fundamentally new, revolutionary solution was the use of the vaginal route for administering contraceptive hormones. Thanks to the abundant blood supply to the vagina, the absorption of hormones occurs quickly and constantly, which allows them to be distributed evenly into the blood throughout the day, avoiding daily fluctuations, as when using COCs.

The size and shape of the vagina, its innervation, rich blood supply and large epithelial surface area make it ideal place for administering medications.

Vaginal administration has significant advantages over other methods of administering contraceptive hormones, including oral and subcutaneous methods.

The anatomical features of the vagina ensure successful use of the ring, ensuring its comfortable location and reliable fixation inside.

Since the vagina is located in the pelvis, it passes through the urogenital diaphragm muscle and the pubococcygeus muscle of the pelvic diaphragm. These muscle layers form functional sphincters that narrow the entrance to the vagina. In addition to the muscular sphincters, the vagina consists of two sections: a narrow lower third, which passes into a wider upper part. If a woman is standing, the upper region is almost horizontal, as it lies on the horizontal muscular structure formed by the pelvic diaphragm and the levator anus muscle.

The size and position of the upper part of the vagina, the muscular sphincters at the entrance, make the vagina a convenient place for inserting a contraceptive ring
The innervation of the vaginal system comes from two sources. The lower quarter of the vagina is innervated mainly by peripheral nerves, which are highly sensitive to tactile influences and temperature. The upper three-quarters of the vagina are mainly innervated by autonomic nerve fibers, which are relatively insensitive to tactile stimulation and temperature. This lack of sensation in the upper vagina explains why a woman cannot feel foreign objects, such as tampons or a contraceptive ring.

The vagina is abundantly supplied with blood from the uterine, internal genital and hemorrhoidal arteries. Abundant blood supply ensures that vaginally administered drugs quickly enter the bloodstream, bypassing the first-pass effect through the liver.

NuvaRing is a very flexible and elastic ring, which, when inserted into the vagina, “adjusts” as much as possible to the contours of the body, taking the shape that is necessary. At the same time, it is securely fixed in the vagina. There is no right or wrong position of the ring - the position that NuvaRing takes will be optimal

The starting point for the ring to start working is a change in the concentration gradient when it is inserted into the vagina. Complex system membranes allows the release of a strictly defined amount of hormones throughout the entire time the ring is used. The active ingredients are evenly distributed inside the ring in such a way that they do not form a reservoir inside it.

Besides, a necessary condition The work of the ring is body temperature. At the same time, changes in body temperature during inflammatory diseases do not affect the contraceptive effectiveness of the ring.

NuvaRing is easily inserted and removed by the woman herself.

The ring is squeezed between the large and index fingers and inserted into the vagina. The position of NuvaRing in the vagina should be comfortable. If a woman feels it, then she must carefully move the ring forward. Unlike a diaphragm, the ring does not need to be placed around the cervix, as the position of the ring in the vagina does not affect effectiveness. The round shape and elasticity of the ring ensure good fixation in the vagina. Remove the NuvaRing by grasping the rim of the ring with your index finger or middle and index fingers and gently pulling the ring out.

Each ring is designed for one cycle of use; one cycle consists of 3 weeks of using the ring and a week off. After insertion, the ring should remain in place for three weeks, then removed on the same day of the week on which it was inserted. For example, if NuvaRing was introduced on Wednesday at 10:00 p.m., then the ring must be removed after 3 weeks on Wednesday at about 10:00 p.m. A new ring needs to be inserted next Wednesday.

Most women never or very rarely feel the ring during intercourse. The opinion of partners is also very important; Although 32% of women noted that their partners sometimes felt the ring during intercourse, the majority of partners in both groups did not object to women using NuvaRing.

According to the results of the All-Russian research project NuvaRing provides positive influence on women's sex life:

• 78.5% of women believe that NuvaRing has a positive effect on their sex life
• 13.3% believe that NuvaRing provides additional positive sexual sensations
• Almost 60% of women have never felt NuvaRing during sexual intercourse. Women who felt NuvaRing said it was a neutral (54.3%) or even pleasant sensation (37.4%)
• There was an increase in the frequency of sexual activity and the frequency of achieving orgasm.

Mirena

Mirena is a polyethylene T-shaped system (similar to a regular intrauterine device) containing a container that contains levonorgestrel (progestin). This container is coated with a special membrane that provides a continuous, controlled release of 20 mcg of levonorgestrel per day. The contraceptive reliability of Mirena is much higher than that of other intrauterine contraceptives and is comparable to sterilization.

Due to the local action of levonorgestrel in the uterus, Mirena prevents fertilization. Unlike Mirena, the main mechanism of the contraceptive effect of conventional intrauterine devices is an obstacle to the implantation of a fertilized egg, that is, fertilization occurs, but the fertilized egg does not attach to the uterus. In other words, when using Mirena, pregnancy does not occur, but with conventional IUDs, pregnancy occurs but is immediately terminated.

Studies have shown that the contraceptive reliability of Mirena is comparable to that of sterilization, however, unlike sterilization, Mirena provides reversible contraception.

Mirena provides a contraceptive effect for 5 years, although the real contraceptive resource of Mirena reaches 7 years. After the expiration of the period, the system is removed, and if a woman wants to continue using Mirena, simultaneously with the removal of the old system, a new one can be introduced. The ability to become pregnant after Mirena removal is restored in 50% after 6 months and in 96% after 12 months.

Another important advantage of Mirena is the ability to quickly regain the ability to become pregnant. So, in particular, Mirena can be removed at any time at the woman’s request; pregnancy can occur already in the first cycle after its removal. As statistical studies have shown, from 76 to 96% of women become pregnant within the first year after Mirena removal, which generally corresponds to the fertility level in the population. Also noteworthy is the fact that all pregnancies in women who used Mirena before their onset proceeded and ended normally. In women who are breastfeeding, Mirena, introduced 6 weeks after birth, does not have a negative effect on the development of the child.

For most women, after installing the Mirena, the following changes are noted in the menstrual cycle: in the first 3 months, irregular spotting between menstrual bleeding appears; in the next 3 months, menstruation becomes shorter, weaker and less painful. A year after Mirena installation, 20% of women may not have menstruation at all.

Similar changes menstrual cycle, if the woman is not informed about them in advance, may cause the woman anxiety and even a desire to stop using the Mirena; therefore, detailed counseling of the woman is recommended before installing the Mirena.

Non-contraceptive effects of Mirena

Unlike other intrauterine contraceptives, Mirena has a number of non-contraceptive effects. The use of Mirena leads to a decrease in the volume and duration of menstruation and, in some cases, to their complete cessation. It was this effect that became the basis for the use of Mirena in patients with heavy menstruation caused by uterine fibroids and adenomyosis.

Using Mirena leads to significant relief pain syndrome in women with painful menstruation, especially due to endometriosis. In other words, Mirena is effective means therapy for pain caused by endometriosis and, in addition, leads to the reverse development of endometrial formations or, at least, has a stabilizing effect on them. Mirena has also proven itself as a component of hormone replacement therapy in the treatment of menopausal symptoms.

New regimens for hormonal contraception

As a result of many years of research into hormonal contraception, it has become possible change patterns of use of these drugs, which reduced the incidence of side effects and relatively increased their contraceptive effect.

The fact that with the help of hormonal contraception you can prolong your menstrual cycle and delay menstruation has been known for a long time. Some women successfully used this method in cases where they needed it, for example, on vacation or sports competitions. However, there was an opinion that this method should not be abused.

Relatively recently, a new regimen for taking hormonal contraception was proposed - a prolonged regimen. With this regimen, hormonal contraception is taken continuously for several cycles, after which a 7-day break is taken and the regimen is repeated again. The most common regimen is 63+7, that is, hormonal contraceptives are taken continuously for 63 days and only after that there is a break. Along with the 63+7 mode, the 126+7 scheme is proposed, which in its portability does not differ from the 63+7 mode.

What is the advantage of a prolonged regimen of hormonal contraception? According to one study, in more than 47% of women, during a 7-day break, the follicle matures to a perovulatory size, the further growth of which is suppressed by the start of taking the next pack of the drug. On the one hand, it is good that the system does not turn off completely and the function of the ovaries is not impaired. On the other hand, a break in taking hormonal contraceptives leads to a disruption of the monotony established against the background of their use, which ensures “preservation” reproductive system. Thus, with the classic dosage regimen, we “tug” the system, actually turning it on and off, not allowing the body to completely get used to the new monotonous hormonal model of functioning. This model can be compared to operating a car, in which the driver would turn off the engine every time he stopped on the road and then start it again. The prolonged mode allows you to turn off the system and start it less often - once every three months or once every six months. In general, the duration of continuous use of hormonal contraception is largely determined by psychological factors.

The presence of menstruation in a woman is important factor her self-perception as a woman guarantees that she is not pregnant and that her reproductive system is healthy. Various sociological research confirmed the fact that most women, in general, would like to have the same menstrual rhythm that they have. Those women for whom the period of menstruation is associated with severe physiological experiences - severe pain, heavy bleeding, and generally severe discomfort - wanted to menstruate less often. In addition, the preference for one or another rhythm of menstruation varies between residents different countries and is highly dependent on social status and race. Such data are quite understandable.

Women's attitude towards menstruation has evolved over centuries, and only a small part of women can correctly imagine what this physiological phenomenon is and what it is needed for. There are many myths that attribute cleansing functions to menstruation (it’s funny, most of our compatriots use the term “cleaning” when referring to curettage of the uterine cavity; they often say “I was cleaned”). In such a situation, it is quite difficult to offer a woman long-term contraception, while the benefits of prolonged use are greater and this regimen is better tolerated.

In 2000 Sulak et al. showed that almost all side effects encountered when using COCs are more pronounced during a 7-day break in use. The authors called these “withdrawal symptoms.” Women were asked to increase their COC intake to 12 weeks and shorten the interval to 4-5 days. Increasing the duration of use and shortening the interval between taking tablets reduces the frequency and severity of “withdrawal symptoms” by 4 times. Although the study lasted 7 years, only 26 of 318 women (8%) were lost to follow-up.

According to other studies, with prolonged use, women practically cease to encounter such common problems as headache, dysmenorrhea, tension in the mammary glands, and swelling.

When there is no break in taking hormonal contraceptives, a stable suppression of gonadotropic hormones occurs, follicles do not mature in the ovaries and a monotonous pattern is established in the body hormonal levels. This is what explains the reduction or complete disappearance of menstrual symptoms and better tolerability of contraception in general.

One of the most striking side effects of a prolonged hormonal contraceptive regimen is intermenstrual spotting. Their frequency increases in the first months of taking the drugs, but by the third cycle their frequency decreases and, as a rule, they disappear completely. In addition, the total duration of spotting against the background of the prolonged regimen is less than the sum of all days of bleeding with the classical dosage regimen.

About the prescription of contraceptives

Quite a lot important has a drug that the patient is taking. As noted above, the drug should suit the woman and this can actually be assessed in the first cycles of use. It happens that a woman already has prolonged spotting during the first cycle or she generally does not tolerate the drug well. In such a situation, we must replace it with another: either with a different dose of estrogen or change the progestogen component. Therefore, in practice, there is no need to immediately advise a woman to buy three packs of hormonal contraceptives. She should start with the drug you suggested and then evaluate how she tolerates it. If the frequency of side effects is adequate to the period of starting to take hormonal contraceptives, then she can continue to take them in a prolonged mode; if not, then she should take the drug to the end, and after a 7-day break, start taking another one. As a rule, in most cases it is possible to select a drug on which a woman feels comfortable, even though she has experienced many side effects with other drugs.

It is very important to properly prepare a woman who has never taken hormonal contraceptives, or who has taken them according to the classical regimen, for starting to take hormonal contraceptives in a prolonged mode. It is important to correctly and clearly convey to her the principle of functioning of the reproductive system, explain why menstruation occurs and what its true meaning is. Many fears in patients arise from a banal ignorance of anatomy and physiology, and ignorance actually gives rise to the mythologization of consciousness. Objectively speaking, not only in relation to contraception, but also in relation to other situations - educating patients significantly increases their adherence to treatment, taking medications and preventing subsequent diseases.

The most common question that women ask when talking about hormonal contraception, and especially about its long-term use, is the question of the safety and reversibility of this method of birth control. In this situation, a lot depends on the doctor, his knowledge and ability to clearly explain what happens in the body when taking hormonal contraception. The most important thing in this conversation is the emphasis on the non-contraceptive effect of hormonal contraception and negative influence abortion on a woman's body. Negative experience Women's use of contraceptives in the past, as a rule, was due to an incorrect approach to their prescription. Quite often negative experience associated with situations where a woman was prescribed the drug only with therapeutic purpose and only of a certain composition for a short period. It was clearly not suitable for the woman; she experienced many side effects, but continued to take it, stoically putting up with difficulties for the sake of cure. In such a situation, an actual change in the drug (and their variety allows this to be done) would neutralize the side effects and would not create a negative attitude in the woman’s mind. This is also important to convey.

On the reversibility of contraception

A very pressing issue among gynecologists is the problem of reversibility of hormonal contraception, and it became especially acute when long-term drug regimens were proposed.

Many gynecologists, summarizing their experience, claim that quite often, while taking hormonal contraceptives, hyperinhibition syndrome of the hypothalamic-pituitary-ovarian system (hypothalamic-pituitary-ovarian system - the system of regulation of the menstrual cycle) occurs, which leads to prolonged amenorrhea (lack of menstruation), which is very difficult to cope with .

This problem, like many other problems of contraception, is largely mythologized. The incidence of amenorrhea after discontinuation of hormonal contraception has been greatly exaggerated. This is a phenomenon of personal analysis of one’s clinical experiences, which quite often breaks down against impartial statistical data. It happens that within a week several patients with the same pathology may come for an appointment, or the same side effect occurs for a long-used drug and you may get the feeling that the incidence of a certain disease has recently increased or that a drug you know has become counterfeit by unscrupulous people. But these are just sensations, a series of coincidences that cannot form a pattern. In statistics, there are rules that describe patterns, determining the degree of their reliability depending on the sample and various errors. Thanks to statistics, it is possible to prove whether this fact is reliable or not, and with an increase in the sample, that is, the number of cases, the reliability may change.

Why do we have to deal with the problem of amenorrhea relatively more often after taking hormonal contraceptives? Among the women to whom we most often recommend using contraception, most are our patients, that is, women who already have gynecological disorders. Much less often, healthy women come to an appointment with the sole purpose of choosing hormonal contraception for her. If a woman has already had menstrual dysfunction, then the likelihood of these disorders continuing after discontinuation of the drug is higher than in a healthy woman. Here it can be argued that hormonal contraception is used to treat dysfunctional conditions of the reproductive system and there is a “withdrawal effect”, when the HPA axis after a “reboot” should begin to work normally, however, disorders in the HPA axis are different and the reason for their development has not yet been clearly established.

For one situation, temporary suppression of the production of gonadotropins is a positive factor that eliminates disruption in their impulse work, and for another, suppression of the function of the hypothalamic-pituitary system can cause disturbances in their production. This is probably due to various subtle functional disorders, in which either only the cyclicity program is disrupted, or the pathology is much more serious. The most interesting thing is that these nuances in dysfunction of the hypothalamic-pituitary system are described quite generally - there is hypofunction, hyperfunction, dysfunction and complete absence of function, although the concept of dysfunction must be deciphered and classified.

As a rule, women whose dysfunction is more serious are in a state of subcompensation and for them any tangible stimulus can become a trigger factor leading to decompensation of this system. Serious illness, stress, pregnancy, abortion and, oddly enough, taking hormonal contraceptives - all of these can be considered effective factors that can cause disturbances in the system.

We can compare two groups of women - those for whom multiple abortions do not affect the reproductive system in any way and those for whom one abortion becomes the cause of persistent infertility and reproductive dysfunction in general. Some women are affected by stress so significantly that amenorrhea develops, while other women in more difficult situations maintain a regular menstrual cycle. Illnesses and childbirth also divide women into two groups. These comparisons can be continued for a long time, but the conclusion suggests itself - the normal operation of the GGJ has a large supply of compensatory capabilities and can adequately adapt to various situations occurring in the body. If the work of compensatory mechanisms is disrupted, sooner or later the system will fail, and it does not matter what leads to this - taking hormonal contraception or an abortion that occurs in its absence. Therefore, the duration of contraception does not play a crucial importance, since the HGYS is completely suppressed already at the end of the first cycle of taking the drugs.

Is it possible to know in advance what the state of the GGJ is and whether taking hormonal drugs can permanently disrupt its work? Not yet. Various hormonal studies are not able to fully reflect the true state of the GGJ, and even less so to predict the likelihood of disorders. Studies of gonadopropin levels are informative in cases of severe disorders (amenorrhea, PCOS, stimulation protocols, etc.). Since pituitary hormones are produced in impulses, their values ​​during a single measurement are generally not informative, since you do not know at what point in the impulse you did the study at the peak of concentration or at the end.

It will be possible in the future to solve the problem of predicting possible disorders while taking hormonal contraception, in the postpartum or post-abortion period. Nowadays, there are tools that allow us to evaluate the features of subtle disorders differently and highlight patterns individual states. At the moment, hormonal contraceptives can be prescribed if there are no established contraindications to their use. The problem of amenorrhea, if it arises, can be solved with the use of drugs to induce ovulation.

Contraception for various medical conditions

One of the most controversial issues regarding contraception is the problem of its use in women with various diseases and in various conditions of the body.

Contraception in the postpartum period

The postpartum period is characterized by hypercoagulable (increased clotting) characteristics of the blood, and therefore the use of drugs containing estrogens is not recommended. Three weeks after birth, when the coagulation properties of the blood return to normal, women who are not breastfeeding can be prescribed combined contraceptives without any restrictions. As for contraceptives containing only progestins, their use is acceptable from any day, since they do not affect the blood coagulation system, however, it is still not advisable to use them in the first 6 weeks after birth - explanation below. Intrauterine devices and the Mirena system can also be installed without time restrictions, but it is preferable to do this in the first 48 hours after birth, since in this case the lowest frequency of their expulsions is observed.

Lactation period (breastfeeding period)

During the lactation period, the choice of contraception is determined by its type and the time elapsed since birth. According to WHO recommendations, the use of combined hormonal contraceptives in the first 6 weeks after birth can have a negative effect on the liver and brain of the newborn, so the use of such drugs is prohibited. From 6 weeks to 6 months, hormonal contraceptives containing estrogens may reduce the amount of milk produced and impair its quality. 6 months after birth, when the baby begins to eat solid food, combined contraceptives can be taken.

Breastfeeding in the first 6 months after childbirth in itself prevents the possibility of pregnancy if a woman does not have menstruation. However, according to updated data, the frequency of pregnancies due to lactational amenorrhea reaches 7.5%. This fact indicates the obvious need for adequate and reliable contraception during this period.

During this period, contraceptives containing only progestins (progesterone analogs) are usually prescribed. The most famous drug is the mini-pill. These tablets are taken every day without a break.

Post-abortion period

In the post-abortion period, regardless of the form in which it was performed, immediately starting to use hormonal contraception is safe and useful. In addition to the fact that a woman in this case does not need to use additional methods of contraception in the first week of taking the drug, hormonal contraception, if we are talking about monophasic combined contraceptives, can neutralize the effects of hypothalamic stress, which can lead to the development metabolic syndrome, this will be discussed in more detail below. Also, immediately after an abortion, an intrauterine device or the Mirena system can be installed.

Migraine

Migraine is a fairly common disease among women of reproductive age. Tension headaches have no effect on the risk of strokes, while migraines can lead to such a severe complication, therefore differential diagnosis headaches is important when deciding whether to take hormonal contraception.

Some women note relief of migraine symptoms while taking COCs and use these drugs in a long-term regimen to avoid menstrual exacerbation during the seven-day break. At the same time, others experience increased symptoms of this disease.

COCs are known to increase the risk of ischemic stroke in women with migraine, while simply having migraine in a woman increases the risk of ischemic stroke by 2-3.5 times compared to women of the same age who do not have this disease.

It is extremely important to distinguish between migraine with aura and regular migraine, since migraine with aura is significantly more likely to lead to ischemic stroke. The risk of ischemic stroke while taking COCs in women with migraine increases by 2-4 times compared with women with migraine but not taking COCs and 8-16 times compared with women without migraine and not taking COCs. Regarding progestin-containing contraceptives, the WHO has concluded that “the benefits of use outweigh the risks” regarding their use in women with migraine.

Therefore, women suffering from migraine should not take COCs. For contraception, it is possible to use intrauterine devices, barrier methods, and possibly progestin-containing contraceptives.

Obesity

Excess body weight can significantly affect the metabolism of steroid hormones due to increased basal metabolic rate, increased liver enzyme activity and/or excess fermentation in adipose tissue.

Some studies indicate that low-dose COCs and progestin-containing contraceptives may be less effective in women with increased weight bodies. The risk of pregnancy has been shown to be 60% higher in women with a BMI (body mass index) > 27.3 and 70% higher in women with a BMI > 32.2 compared to women with normal indicators BMI. Despite this, the effectiveness of COCs is recognized to be better than barrier methods of contraception, while the effectiveness of COCs increases with weight loss and proper medication use.

It is known that overweight women are at risk for developing venous thrombosis.

Taking COCs itself increases the risk of venous thrombosis, and in women with increased body weight this risk increases. At the same time, no reliable evidence has been obtained of the effect of progestin-containing contraceptives on increasing the risk of venous thrombosis. In addition, when using the Mirena system, there were no changes in the metabolism of progestins in women with increased body weight. Thus, given the described risks, obese women should be recommended progestin-containing contraceptives or, preferably, the Mirena system, which in turn will ensure the prevention of endometrial hyperplastic processes, often observed in overweight women.

Diabetes

As a result of comparative studies, the following data were obtained: All types of hormonal contraceptives, with the exception of high-dose COCs, do not have a significant effect on carbohydrate and fat metabolism in patients with type I and type II diabetes. The most preferred method of contraception is the Mirena intrauterine hormonal system. Miro- and low-dose COCs can be used by women with both types of diabetes who do not have nephro- or retinopathy, hypertension or other cardiovascular risk factors such as smoking or age over 35 years.

Non-contraceptive effects of oral contraceptives

Correct use of hormonal birth control pills can provide both contraceptive and non-contraceptive benefits this method. From the list of advantages of this method given below, in addition to the contraceptive effect, some therapeutic effects are also noted.

• almost 100% reliability and almost immediate effect;
• reversibility of the method and providing the woman with the opportunity to independently control the onset of pregnancy. Fertility in nulliparous women under 30 years of age who took combined OCs is restored within 1 to 3 months after discontinuation of the drug in 90% of cases, which corresponds to the biological level of fertility. During this time interval, there is a rapid rise in FSH and LH levels. Therefore, it is recommended to stop taking OCs 3 months before the planned pregnancy.
• sufficient knowledge of the method;
• low incidence of side effects;
• comparative ease of use;
• does not affect the sexual partner and the course of sexual intercourse;
• impossibility of poisoning due to overdose;
• reduction in the incidence of ectopic pregnancy by 90%;
• reduction in the incidence of inflammatory diseases of the pelvic organs by 50-70% after 1 year of use due to a decrease in the amount of lost menstrual blood, which is an ideal substrate for the proliferation of pathogenic microorganisms, as well as less expansion of the cervical canal during menstruation due to the indicated reduction in blood loss. Decrease Intensity uterine contractions and peristaltic activity fallopian tubes reduces the likelihood of developing an ascending infection. The progestogen component of OC has a specific effect on the consistency of cervical mucus, making it difficult to pass not only for sperm, but also for pathogenic pathogens;
• preventing the development of benign neoplasms of the ovaries and uterus. Taking OCs is strongly associated with a reduced risk of ovarian cancer. The mechanism of protective action of OCs is probably related to their ability to inhibit ovulation. As is known, there is a theory according to which “continuous ovulation” throughout life, accompanied by trauma to the ovarian epithelium with subsequent repair (restoration), is a significant risk factor for the development of atypia, which, in fact, can be considered as the initial stage of the formation of ovarian cancer. It has been noted that ovarian cancer develops more often in women who have had a normal (ovulatory) menstrual cycle. Physiological factors that “turn off” ovulation are pregnancy and lactation. The social characteristics of modern society determine a situation in which a woman, on average, experiences only 1-2 pregnancies in her life. That is physiological reasons it is not enough to limit ovulatory function. In this situation, taking OCs seems to replace the “lack of physiological factors” limiting ovulation, thus realizing a protective effect against the risk of developing ovarian cancer. Using COCs for about 1 year reduces the risk of developing ovarian cancer by 40% compared with non-users. The purported protection against ovarian cancer associated with OCs continues to exist 10 years or more after stopping their use. For those who have used OCs for more than 10 years, this figure decreases by 80%;
• positive effect on benign diseases mammary gland. Fibrocystic mastopathy decreases by 50-75%. Unsolved problem The question is whether COCs cause an increased risk of developing breast cancer in young women (up to 35-40 years of age). Some studies suggest that COCs may only accelerate the development of clinical cancer breast, but overall the data seems encouraging for most women. It is noted that even in the case of breast cancer development while taking OCs, the disease most often has a localized nature, a more benign course and good prognosis regarding treatment.
• reduction in the incidence of endometrial cancer (uterine lining) with long-term use OK (risk decreases by 20% per year after 2 years of use). Cancer and Steroid Hormone Study conducted by the Centers for Disease Control and National Institute US Health, showed a 50% reduction in the risk of endometrial cancer, which was associated with the use of OCs for at least 12 months. The protective effect lasts up to 15 years after stopping OC use;
• relief of symptoms of dysmenorrhea (painful menstruation). Dysmenorrhea and premenstrual syndrome occur less frequently (40%).
  reduction of premenstrual tension;
• positive effect (up to 50% when taken for 1 year) in iron deficiency anemia by reducing menstrual blood loss;
• positive effect on endometriosis - a positive effect on the course of the disease is associated with pronounced decidual necrosis of the hyperplastic endometrium. The use of OCs in continuous courses can significantly improve the condition of patients suffering from this pathology;
• According to a study that included a large group of women, it was shown that long-term use oral contraceptives reduces the risk of developing uterine fibroids. In particular, with a five-year duration of taking OCs, the risk of developing uterine fibroids is reduced by 17%, and with a ten-year duration - by 31%. A more differentiated statistical study, which included 843 women with uterine fibroids and 1557 women in the control group, found that with increasing duration of continuous OC use, the risk of developing uterine fibroids decreases.
• reduction in the frequency of development of retention formations of the ovaries (functional cysts - read about ovarian cysts in the corresponding section) (up to 90% when using modern hormonal combinations);
• reduced risk of developing rheumatoid arthritis by 78%
• positive effect on the course of idiopathic thrombocytopenic purpura;
• reducing the risk of developing colorectal cancer (colon and rectal cancer) by 40%
• therapeutic effect on the skin for acne (pimples), hirsutism (increased hair growth) and seborrhea (when taking third-generation drugs);
• preservation of higher bone density in those who used OCs in the last decade of childbearing age.
• A large number of studies have been devoted to the relationship between COCs and cervical cancer. The conclusions from these studies cannot be considered unambiguous. It is believed that the risk of developing cervical cancer increases in women who have taken COCs for a long time - more than 10 years. At the same time, the establishment of a direct connection between cervical cancer and human papillomavirus infection partly explains this trend, since it is obvious that women using oral contraceptives rarely use barrier methods of contraception.
• Other types of contraception

Condoms, like other methods of barrier contraception, are unlikely to lose their relevance in the near future, since only these means of preventing pregnancy combine both the contraceptive effect and the possibility of protection against sexually transmitted infections. Combined use of spermicides with condoms or diaphragms is known to improve their reliability. Obviously, this method of birth control is especially indicated for women who do not have a stable monogamous relationship, are prone to promiscuity, and also in cases where, for one reason or another, the contraceptive effect of oral contraceptives is reduced. Routine use of barrier methods or spermicides is essentially only indicated if absolute contraindications to the use of OCs or IUDs, irregular sexual activity, as well as when a woman categorically refuses other methods of contraception.

The calendar method of birth control is known to be one of the least reliable methods, however, this method has a unique advantage: it is the only method of birth control accepted by both the Catholic and Orthodox churches.

Sterilization is an irreversible method of contraception, although if desired, fertility can be restored either through tubal repair or assisted reproductive technologies. The contraceptive effect of sterilization is not absolute; in some cases, pregnancy develops after this procedure, and in most cases such pregnancy is ectopic.

Although there are clear indications for whom this method of birth control is indicated, that is, women who have achieved reproductive function, it is still necessary to take into account the fact that sterilization is abdominal surgical intervention requiring general anesthesia. The question is: does it make sense to achieve a contraceptive effect at such a price? Obviously, for this category of women, Mirena may be the optimal method of contraception. Considering the fact that it is in this age group the most common diseases are uterine fibroids and endometriosis, the use of Mirena will have not only a contraceptive, but also a therapeutic and/or preventive effect. A doctor should never forget that a woman’s choice of a contraceptive method is largely determined by her ability to clearly and convincingly explain the advantages and disadvantages of each type of contraception.

In our opinion, injectable contraceptives occupy a completely separate place and, probably, this is primarily due to a certain degree of inconvenience in their use. In addition to the method of their administration (injections, sewing in capsules), negative emotions in women are caused by frequently observed spotting. In general, it is difficult to precisely identify the group of women who would be most suitable for this method of contraception.

Thus, the problem of contraception at the moment can be successfully solved using oral contraceptives, patches and rings, intrauterine devices or Mirena and barrier methods. All of the listed methods of birth control are quite reliable, extremely safe, reversible and easy to use.

... contraception is not only protection against unwanted pregnancy; this is the preservation of your health and the path to birth healthy child when you want it.

CONTRACEPTION IN MARRIAGE

The most optimal means should be considered a combination of the physiological method with barrier agents. This combination has no contraindications, restrictions, or side effects. A married couple can use this method completely harmlessly throughout the entire period of maintaining the ability to conceive.

Until the 5th day of the cycle, as well as from the 16-17th day of the cycle - free sexual intercourse, from the 6th to the 11th day - use of a condom, interrupted intercourse, spermicides, vaginal diaphragm (alternating them), from 12 1st to 16th day - sexual abstinence or condom, vaginal diaphragm, interrupted sexual intercourse. Intrauterine devices and oral contraceptives are also widely used in marriage.

CONTRACEPTION IN ADOLESCENCE (FROM 14 TO 18 YEARS OLD)

The most adequate means of contraception for this age is a condom, which protects not only from conception, but also from sexually transmitted inflammatory diseases of the genital organs.

Teenagers can use physiologically, interrupted sexual intercourse, as well as all types of spermicides and their combinations. From the age of 16, separate oral contraceptives are allowed for a period of 6 months followed by a break of up to 3 months. In total, no more than 2-3 courses can be used. The intrauterine device is extremely rare for nulliparous young women over 17 years of age. However, all means except a condom do not prevent infection with sexually transmitted and inflammatory diseases.

CONTRACEPTION IN UNMARRIED WOMEN WHO ARE RARELY SEXUAL

Women belonging to this group can widely use the physiological method, but only in those cases if the woman knows about the date in advance and it falls on the expected II phase of menstruation. On the eve of sexual intercourse, you need to measure your basal body temperature within 2-3 days. if it reaches 37 °C and above, free sexual intercourse is allowed.

In case of an unexpected date or in the first phase of menstruation, oral contraceptives, postinor, interrupted coitus, vaginal diaphragm, condom, spermicides are recommended, which must be prepared in advance.

CONTRACEPTION DURING BREASTFEEDING

While breastfeeding, even without menstruation, pregnancy is possible. Means that are harmless not only to the mother, but also to the child are chosen. Oral contraceptives are not recommended. You can most widely use barrier barriers for both men and feminine remedies. 3 months after birth or 6 months after caesarean section you can insert an intrauterine device.

CONTRACEPTION FOR WOMEN WITH MASTOPATHY

In the presence of mastopathy, free sexual intercourse is very important. Therefore, preference should be given to the intrauterine device. But often mastopathy occurs after 40-42 years. In such situations, you can widely use the physiological method in combination with barrier feminine products. It is recommended to use injectable hormonal contraception, as well as oral products containing only progestogens.

CONTRACEPTION IN WOMEN WITH UTERINE FIBROID

For this group of women, a free sexual regime is necessary. At the same time, if pregnancy is unwanted, abortion should not be allowed, since each abortion contributes to the growth of the tumor. The intrauterine device is contraindicated for this category of women. It is best to use the physiological method in combination with female barrier products.

If you have uterine fibroids, you can prescribe some hormonal agents(gestagen-containing), having therapeutic effect. The best would be long-acting injectable contraceptives, tablets containing only progestogens.

CONTRACEPTION IN SICK WOMEN FOR WHOM PREGNANCY IS CONTRAINDICATED FOR HEALTH STATES

EMERGENCY CONTRACEPTION

Emergency contraception is a method used to prevent unwanted pregnancy in cases where, for some reason, other generally accepted methods have not been used and there is a possibility of conception.

Emergency contraception is most effective within the first 24–72 hours after sexual intercourse.

Indications: Emergency contraception should be recommended as an emergency measure to protect against unwanted pregnancy ( 1 ) women who have been raped; ( 2 ) if there are doubts about the integrity of the used condom; ( 3 ) in situations where the diaphragm moves during sexual intercourse; ( 4 ) during expulsion of the intrauterine device; ( 5 ) skipping oral contraceptives or ( 6 ) in cases where the planned methods of contraception cannot be used for some reason.

Patients who are rarely sexually active and young women who may experience an unwanted pregnancy after their first sexual intercourse without the use of contraceptives also need to be prescribed postcoital methods.

There are currently two methods of emergency contraception that are most effective::

(1 ) use of hormonal drugs: estrogens, estrogen-gestagen drugs, gestagens, antigonadotropins, aptiprogestins;

(2 ) insertion of an intrauterine contraceptive: insertion of an intrauterine device is carried out within 5-7 days after unprotected sexual intercourse (there is evidence that the effectiveness of this method is higher than when using the Yuzpe method, which consists of twice taking (with a 12-hour interval) 100 mcg of estradiol and 500 mcg of levonorgestrel no later than 72 hours after unprotected sexual intercourse).

It should be emphasized once again that emergency contraception is ( ! ) one-time contraception. There are no emergency contraception methods yet whose effectiveness and safety over long-term and continuous use would allow them to be recommended for use over many menstrual cycles.

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Contraceptives are drugs used to prevent pregnancy. The purpose of contraception is family planning, preserving the health of a woman, and partly her sexual partner, realizing a woman’s right to free choice: to become pregnant or to refuse it.

Why are all types of contraception necessary:

• any methods of contraception reduce the number of abortions - the causes of gynecological diseases, premature birth, maternal and infant mortality;
• contraception helps plan the birth of a child depending on the family’s living conditions, the health of the parents and many other factors;
• some effective methods contraception also helps fight gynecological diseases, osteoporosis, infertility.

The effectiveness of contraceptives is assessed using the Pearl index. It shows how many women out of a hundred who used the method during the year became pregnant. The smaller it is, the higher the effectiveness of protection. Modern contraceptive methods have a Pearl index close to 0.2-0.5, that is, pregnancy occurs in 2-5 women out of 1000.

Classification of contraceptive methods:

• intrauterine;
• hormonal;
• barrier;
• physiological (natural);
• surgical sterilization

Let's consider listed species contraception, the principle of their action, effectiveness, indications and contraindications.

Intrauterine methods

Foreign objects placed in the uterine cavity are used. Intrauterine contraception is widespread in China, Russia, and Scandinavian countries.

The method was proposed at the beginning of the twentieth century, when it was proposed to insert a ring made of different materials into the uterine cavity to prevent pregnancy. In 1935, intrauterine contraception was banned due to the high number of infectious complications.

In 1962, Lipps proposed the famous device made of curved plastic with an attached nylon thread for removing contraceptives - the Lipps loop. Since then, intrauterine contraception has been constantly evolving.

Intrauterine devices are divided into inert and medicinal. Inert ones are not currently used. Only medicated contraceptives containing metal supplements or hormones are recommended, including:

• MultiloadCu-375 - an F-shaped spiral, coated with copper and designed for 5 years;
• Nova-T - a T-shaped device covered with copper winding;
• CooperT 380A – T-helix, designed for 6 years;
• - the most popular device today, which gradually releases levonorgestrel, a progesterone derivative, into the uterine cavity, which has a contraceptive and therapeutic effect.

Mechanism of action

The intrauterine contraceptive has the following effects:

• death of sperm that have penetrated the uterus due to the toxic effect of the metal;
• increasing the viscosity of cervical mucus due to the hormone, which prevents sperm;
• endometrial atrophy under the influence of levonorgestrel; ovulation and the effect of estrogen on the female body are preserved, and menstruation becomes shorter, less frequent or disappears completely;
• abortive action.

The abortive mechanism includes:

• active movement of the tubes and entry of an immature egg into the uterine cavity;
• local inflammatory process in the endometrium, preventing the attachment of the embryo;
• activation of uterine contractions that release the egg from the genital tract.

The Pearl index for coils containing copper is 1-2, for the Mirena system it is 0.2-0.5. Thus, this hormonal system - best way intrauterine contraception.

Introduction of a contraceptive

An intrauterine device is installed after an abortion or removal of a used one, 1.5-2 months after the birth of a child, or six months after a cesarean section. Before this, the patient is examined, paying attention to signs of infection.

After 7 days, the woman visits the gynecologist. If everything went well, she should visit the doctor at least once every 6 months.

The contraceptive is removed at the request of the patient, if complications develop or at the end of the period of use, by pulling the “antennae”. If the antennae are torn off, removal is carried out in a hospital. It happens that the spiral grows into the thickness of the myometrium. If a woman has no complaints, it is not removed, and the woman is recommended to use other methods of contraception.

Complications and contraindications

Possible complications:

• myometrial perforation (1 case per 5000 injections);
• pain syndrome;
• bloody discharge;
• infectious diseases.

When severe pain in the abdomen, cramping sensations with bleeding, heavy menstruation, fever, heavy discharge, “falling out” of the IUD, you should immediately consult a doctor.

The insertion of the IUD is absolutely contraindicated during pregnancy, infection or tumors of the genital organs. It is better not to use it if the menstrual cycle is disrupted, there is endometrial hyperplasia, anatomical features of the genital organs, blood diseases, large, allergies to metals, severe associated conditions. Women who have not given birth can use intrauterine contraception, but their risk of future pregnancy pathology is higher.

The advantages of this method of contraception are the possibility of use during lactation, the absence of side effects caused by estrogens, and less impact on the body's systems. Disadvantages: less effectiveness and likelihood of metrorrhagia.

Injectable contraceptives and implants

This method is used for long-term protection against unwanted pregnancy. The drug Depo-Provera, containing only a progestogen component, is used; it is injected into the muscle once a quarter. Pearl index 1.2.

Advantages of injection contraception:

• quite high efficiency;
• duration of action;
• good tolerance;
• no need to take daily pills;
• You can take the drug for uterine fibroids and other contraindications for products with an estrogen component.

Disadvantages of the method: the ability to conceive is restored only 6 months - 2 years after the last injection; a tendency to develop uterine bleeding, and subsequently to its complete cessation.

This method is recommended for women who need long-term contraception (which, however, is reversible), during breastfeeding, with contraindications to estrogen drugs, as well as for patients who do not want to take tablet forms every day.

For the same indications, you can install the implantable drug Norplant, which consists of 6 small capsules. They are sutured under the skin of the forearm under local anesthesia, the effect develops during the first day and lasts up to 5 years. The Pearl index is 0.2-1.6.

Barrier methods of contraception

One of the advantages of barrier methods is protection against sexually transmitted diseases. Therefore they are widespread. They are divided into chemical and mechanical methods of contraception.

Chemical methods

Spermicides are substances that kill sperm. Their Pearl index is 6-20. Such drugs are produced in the form of vaginal tablets, suppositories, creams, foam. Solid forms (suppositories, films, vaginal tablets) are inserted into the vagina 20 minutes before sexual intercourse so that they have time to dissolve. Foam, gel, cream act immediately after application. If coitus occurs again, spermicides must be administered again.

The most common products are Pharmatex and Patentex Oval. Spermicides somewhat increase protection from sexually transmitted diseases because they have a bactericidal effect. However, they increase the permeability of the vaginal walls, which increases the likelihood of contracting HIV infection.

The advantages of chemical methods of contraception are their short duration of action and the absence of systemic effects, good tolerability, and protection against sexually transmitted diseases. Disadvantages that significantly limit the use of such products include low efficiency, the risk of allergies (burning, itching in the vagina), as well as the direct connection of use with coitus.

Mechanical methods of contraception

Such methods retain sperm, creating a mechanical obstacle to their path to the uterus.

The most common are condoms. They are available for men and women. Men's should be worn during an erection. Female condoms consist of two rings connected by a latex film, forming a cylinder closed at one end. One ring is put on the neck, and the other is brought out.

The Pearl Index for condoms ranges from 4 to 20. To increase their effectiveness, it is necessary to use these accessories correctly: do not use oil-based lubricants, do not reuse the condom, avoid prolonged intense acts during which the latex can tear, and also pay attention to expiration date and storage conditions of the contraceptive.

Condoms protect quite well from sexually transmitted diseases, but do not completely protect against infection with syphilis and some viral diseases transmitted through skin-to-skin contact.

This type of contraception is most indicated for women with infrequent or promiscuous sexual intercourse.

Which method of contraception should I choose for the most complete protection against pregnancy and sexually transmitted diseases? In this case, a combined method is recommended - taking hormonal contraceptives and using a condom.

Vaginal diaphragms and caps are not widely used. These devices are placed on the cervix before sexual intercourse and removed 6 hours after it. They are usually used together with spermicides. They are washed, dried, stored in a dry place and reused if necessary. The use of these tools requires training. They are not used for deformation of the cervix, vagina, or inflammatory diseases of the genital organs. The undoubted advantage of such devices is their reusable use and low cost.

Mechanical methods of contraception have the following advantages: safety, protection against sexually transmitted diseases (for condoms). The disadvantages are related to the lack of effect and the connection between use and coitus.

Natural ways

Natural methods involve abstaining from sexual intercourse in the days close to ovulation. The Pearl index reaches 40. To determine the fertile (“dangerous” period), the following methods are used:

• calendar;
• measuring temperature in the rectum;
• examination of cervical mucus;
• symptothermal.

Calendar method of contraception

Used only in women with regular cycle. It is believed that ovulation occurs on days 12-16 of the cycle with a duration of 28 days, the sperm lives 4 days, the egg lives 1 day. Therefore, the “dangerous” period lasts from 8 to 17 days. These days you need to use other methods of protection.

The main method of preventing unwanted pregnancy is the use of effective contraception. The effectiveness of contraceptive methods is assessed using Pearl index, which shows the number of unplanned pregnancies that occur in 100 women using a given method of contraception for 1 year. Contraceptive methods with a Pearl index of 0 to 1 are highly effective, 2 to 9 are effective, and 10 or more are ineffective.

Highly effective and efficient methods of contraception: hormonal contraception, intrauterine contraception, voluntary surgical sterilization and lactational amenorrhea method (under certain conditions: if the woman is exclusively breastfeeding, she is not menstruating and the baby is less than 6 months old).

Low-effective (“traditional”) methods of contraception: mechanical (diaphragm, cervical caps, condom), chemical (using spermicides - chemicals that neutralize sperm), rhythmic (calendar, temperature), interrupted sexual intercourse.

Contraceptive methods differ from each other in effectiveness (reliability), reversibility (restoration of the ability to bear children after stopping the use of the method), health safety, and the presence of additional therapeutic or preventive effects. Let's take a closer look at the main types of modern contraception.

Combined hormonal oral contraceptives

Combined oral contraceptives- these are drugs containing hormones (estrogens and gestagens) that are taken orally, through the gastrointestinal tract in the form of tablets or capsules, in a cyclic manner. They are highly reliable, well tolerated, affordable and easy to use, provide good control of the menstrual cycle, and are safe for most women. The time of taking the pills does not depend on the time of sexual intercourse. After stopping the medication, reproductive function is reversibly restored. The Pearl index is 0.1 – 5 pregnancies per 100 women within 1 year.

Mechanisms of action combined oral contraceptives: suppression of egg maturation and ovulation (there is no direct object of fertilization); increased viscosity of mucus in the cervical canal, preventing sperm from penetrating into the uterus; delayed entry of the fertilized egg into the uterus due to decreased peristalsis of the fallopian tubes; a change in the lining of the uterus that prevents the attachment of a fertilized egg.

Depending on the combination of estrogens and progestogen, combined oral contraceptives are divided into: monophasic(the tablet contains a certain dose of estrogen and gestagen, which does not change throughout the entire administration cycle), two-phase(in all tablets the estrogen content is the same, and the dose of gestagen increases in the second phase of administration) and three-phase(consist of three types of tablets, at first they use tablets with a low content of gestagen, in the middle of the cycle they take tablets with an increased dose of gestagen, in the last third the amount of gestagen increases even more).

When using oral contraceptives, some side effects may occur, which are observed in the first months in 10–40%, then their frequency decreases to 5–10%. Most common side effects are: headache, discomfort in the gastrointestinal tract, nausea, vomiting, tension in the mammary glands, nervousness, irritability, depression, dizziness, weight changes, menstrual irregularities in the form of intermenstrual spotting, heavy bleeding or, conversely, absence of menstruation during during or after taking oral contraceptives. If side effects persist for longer than 3 to 4 months, the contraceptive drug should be replaced or discontinued. Weight gain during the first three months may be due primarily to fluid retention in the body, and should not exceed more than 3 kg. Undoubtedly, there are risk factors in which taking oral contraceptives is impossible, as life-threatening consequences may occur.

After discontinuation of the drug, about 75% of women are able to become pregnant in the first spontaneous menstrual cycle, and in the remaining 25%, ovulation is restored within the next 2-3 menstrual cycles.

Preventive and therapeutic effects hormonal contraceptives: regulation of menstrual function in case of dysfunctional uterine bleeding, polycystic ovary syndrome, etc.; reducing the intensity of premenstrual syndrome; eliminating or reducing pain in the first days of menstruation; reducing the volume of menstrual blood loss and reducing the incidence of anemia; reducing the risk of ectopic pregnancy, ovarian cancer, breast cancer, uterine cancer, uterine fibroids, ovarian cysts, pelvic inflammatory diseases, osteoporosis.

Combined oral contraceptives: deep vein thrombosis, branch thromboembolism pulmonary artery, high risk thrombosis or thromboembolism; ischemic disease heart, stroke; arterial hypertension; diseases associated with damage to the valvular apparatus of the heart; liver diseases (cholelithiasis, cholestasis, viral hepatitis, chronic hepatitis, cirrhosis, tumor); vascular headache or migraine with focal neurological symptoms; diabetes mellitus with angiopathy and disease duration of more than 20 years; confirmed hyperlipidemia; systemic lupus erythematosus or systemic scleroderma; breast cancer or suspicion of it; epilepsy and other conditions requiring the use of anticonvulsants and barbiturates or their analogues; smoking over the age of 35; breast-feeding; pregnancy.

Combined oral contraceptives are usually started in the first five days of the menstrual cycle. Allowable intervals between dosing cycles should be no more than 7 days. If for some reason you missed taking one tablet, you must take this tablet as quickly as possible and continue taking the drug as usual. At the same time, it is advisable to use one of the barrier methods of contraception for insurance purposes due to the possibility of spontaneous ovulation. 3 months after starting to use the combined oral contraceptive, a follow-up examination should be carried out, including an assessment of the condition of the mammary glands and liver, a gynecological examination, blood pressure measurement, a cytological examination of a smear from the cervix, ultrasound examination, determination of blood sugar levels, and assessment of the blood coagulation system.

What to do if side effects occur while taking combined oral contraceptives?

• In case of engorgement of the mammary glands, dizziness, headache, weight gain, nausea, it is recommended to wait about 3 months for the body to adapt to the drug, take tablets before bed or change the drug with a lower dose of estrogen or to another drug that has an antimineralkorticoid effect.
• If there is intermenstrual bleeding, you should take the tablets at the same time, exclude the presence of a urogenital infection, use drugs with a higher dose of estrogen or triphasic drugs.
• In the absence of menstruation, pregnancy should be excluded and switch to taking medications with a higher dose of estrogen or use triphasic medications.

Use of combined oral contraceptives stop immediately: if pregnancy is suspected, with thrombotic or thromboembolic complications, persistent increase blood pressure, when planning any surgical operation, with the development of depression or jaundice.

Despite a number of possible negative effects and contraindications, combined hormonal oral contraceptives are highly effective methods of preventing pregnancy, acceptable for the vast majority of women.

Progestogen-based contraceptives

Progestogen-based contraceptives is a type of hormonal contraceptive that does not contain estrogen. The drugs can be used in the form of tablets, injections, subcutaneous implants or intrauterine gestagen-containing contraceptives.

Oral medications (mini-pills). The actions of these contraceptives are based on increasing the viscosity of mucus in the cervical canal, slowing down the delivery of a fertilized egg to the uterus through the fallopian tubes and disrupting the process of its implantation. The advantages of the mini-pill are the absence of complications and adverse reactions associated with the presence of estrogens, good tolerability, and the possibility of use during breastfeeding. However, it should be noted that the lack of an estrogen component makes mini-pills a less reliable means of contraception compared to combined hormonal oral contraceptives. When using these drugs, you are more likely to experience uterine bleeding or delayed menstruation. It is most advisable to use oral gestagens for the purpose of postpartum contraception in nursing women, as well as in older women and in women who smoke. Mini-pills are taken continuously, without breaks, 1 tablet per day at the same time. It is highly undesirable to skip taking a pill.

Injectable gestagens. When using this type of contraception, the drugs are administered intramuscularly once every three months. That is, the drug acts relatively long time, but its effect cannot be stopped quickly. As a result of prolonged exposure to gestagens on the endometrium, in the first months of drug use, erratic uterine bleeding, which subsequently stop on their own, and there are no further menstruation. This type of contraceptives can be prescribed to patients with endometrial hyperplastic processes. Side effects may include weight gain, acne, headache, swelling, mood disorders. After discontinuation of the drug, restoration of reproductive function occurs within 6 to 18 months.

Implants. Typically, silicone capsules are placed under the skin of the shoulder, which slowly release the hormone into the body. The contraceptive effect appears up to 5 years. This method can be used in women who need long-term contraception. Dynamic observation Patients should be monitored every 6 months.

Contraindications for use gestagen-based contraceptives: suspicion or presence of pregnancy, migraine with focal neurological symptoms, cerebrovascular accident, liver disease, arterial hypertension, diabetes mellitus, breast cancer, bleeding from the genital tract.

Intrauterine contraceptives

Intrauterine contraceptive device (IUC) is a plastic structure, usually T-shaped, that is placed in the uterine cavity. Such a contraceptive can be copper-containing or hormone-releasing. The contraceptive effect of a copper-containing IUD is based on the fact that in response to the presence in the uterus foreign body a reaction develops on the part of the endometrium, which sharply worsens the conditions for implantation. This reaction is significantly enhanced by the presence of copper in the contraceptive. IUD also reduces sperm motility and fertilizing activity. In addition, due to the increased contractile activity of the fallopian tubes, the fertilized egg enters the uterus earlier than expected, which prevents its full implantation.

The advantages of IUDs are their high efficiency, the absence of a systemic effect on the body, the absence of the need for daily monitoring of use, and the rapid restoration of the ability to fertilize after removal. IUDs are recommended for use by women who have already given birth and who have one regular sexual partner. The Pearl index is 0.6 – 0.8. The use of an IUD in women under 20 years of age and in nulliparous women is not recommended due to the high risk of sexually transmitted infections and spontaneous expulsion of the IUD from the uterine cavity.

Contraindications for use ICH: pregnancy, acute inflammatory diseases or frequent exacerbation of chronic inflammatory diseases of the external and internal genital organs, suspicion of malignant neoplasms of the genital organs, previous ectopic pregnancy, uterine fibroids (deforming its cavity), abnormalities of the uterus, genital infantilism, genital endometriosis, menstrual dysfunction, endometrial hyperplasia, diseases cervix, blood coagulation disorders, anemia, complicated abortion (performed no more than three months ago).

Before inserting an IUD, a thorough examination is necessary to exclude possible contraindications. It is most advisable to introduce an IUD before the 8th day of the menstrual cycle, which reduces the risk of its introduction in the early stages of an unknown pregnancy. During the first week, it is recommended to abstain from sexual activity and intense physical activity. It is advisable to conduct a follow-up examination a week and a month after installation of the IUD. Subsequent examinations are performed at intervals of 6 months. The IUD is removed (if there is no indication) after the period of use has expired or at the request of the patient.

Among possible complications most often observed are inflammatory diseases of the genital organs, pain during menstruation, heavy menstruation, uterine intermenstrual bleeding, spontaneous expulsion of the IUD. When pregnancy occurs, if the patient decides to continue pregnancy, the IUD is not removed.

Hormone-releasing intrauterine contraceptives placed in the uterus for a long time release the hormone into the body. Contraceptive effect such a contraceptive is based, first of all, on the versatile hormonal influence on the endometrium, leading to disruption of egg implantation, along with other contraceptive mechanisms inherent in IUDs in general. Along with the usual contraindications that do not allow the use of IUDs at all, liver diseases and thrombophlebitis, disorders of the blood coagulation system are added for hormone-releasing devices. Reproductive function is restored 6-12 months after removal of the hormone-releasing IUD.

Barrier methods of contraception create a mechanical or chemical obstacle to the movement of sperm to the upper part of the female reproductive system. The advantages of these methods include accessibility, short duration of action, lack of systemic effects, and the protective properties of mechanical methods. Barrier methods of contraception may be recommended if there is an increased risk of sexually transmitted diseases, for breastfeeding women, with irregular sex life, or if there are contraindications to other methods of contraception. The disadvantages of the barrier method are: lower efficiency (compared to hormonal and intrauterine contraception), the possibility of local irritation and local discomfort during sexual intercourse.

Spermicides(included in foam, cream, gel, contraceptive sponge, vaginal tablets or suppositories) - a chemical method of barrier contraception. Spermicides immobilize and neutralize sperm. The Pearl index when using chemical methods is 6 – 26.

Mechanical contraceptives: diaphragm, cervical cap, condom. To increase the contraceptive effect, it is advisable to use it together with spermicides. Diaphragm is a cap made of elastic latex that is placed on the cervix before sexual intercourse. The diaphragm creates additional protection for the cervix from microorganisms and reduces the risk of cervical dysplasia. After sexual intercourse, the diaphragm is removed. Cervical cap performs the same function as a diaphragm, but is less convenient to use compared to a diaphragm. Condom is the most effective means of preventing sexually transmitted diseases. The Pearl index when using mechanical methods of contraception is 3 – 14.

Physiological methods of contraception

Physiological methods contraception is based on the use of alternating periods of decreased and increased possibility of pregnancy, as well as the duration of the ability to fertilize the egg and sperm.

Rhythmic method of contraception is based on calculating the days in each menstrual cycle when conception is most likely to occur. Accordingly, on these days, to prevent pregnancy, it is advisable to abstain from sexual activity. A woman's menstrual cycle (the period from the 1st day of one menstruation to the 1st day of the next menstruation) on average, in most cases, lasts 28-30 days. During the first half of the menstrual cycle, a follicle matures in one of the ovaries, and ovulation occurs on days 14-15. In this case, a mature egg is released from the follicle. Taking into account that a mature egg is capable of fertilization within 2-3 days after ovulation, and sperm have fertilizing activity within 4 days after ejaculation, the total period of the most probable possibility of conception is 6-7 days. To use this method, you must clearly know the duration of the menstrual cycle (from the first day of one menstruation to the first day of another), and be sure that ovulation occurs in the middle of the menstrual cycle. In this case, the beginning of the “dangerous” period, when pregnancy is most likely to occur, can be calculated by subtracting the number 18 from the duration of the menstrual cycle, and the end of this period by subtracting the number 11 from the duration of the cycle. For example, the cycle duration is 30 days. The beginning of the dangerous period is the 12th day of the cycle (30-18=12), the end is the 19th day of the cycle (30-11=19).

Temperature method allows you to more accurately determine the time of ovulation, since after it has occurred, the temperature in the rectum increases by 0.3-0.50 C and remains elevated until menstruation. To detect ovulation using this method, it is necessary to measure the temperature in the rectum every morning without getting out of bed throughout the entire menstrual cycle. It is advisable to use the temperature method in conjunction with the rhythmic method of contraception.

The nature of the crystallization pattern of saliva also allows you to determine the time of ovulation. An increase in estrogen levels, as ovulation approaches, leads to an increase in the amount of sodium and potassium salts in saliva. Their concentration reaches a maximum on the day of ovulation, which leads to saliva crystallization when dried. The reliability of the saliva crystallization test for determining ovulation is between 96% and 99%. To assess the crystallization pattern of saliva and, accordingly, determine the time of ovulation, various mini-microscopes are used, which are compact optical instruments that are convenient for use.

The Pearl index when using the listed methods is 9 – 25.

Interrupted sexual intercourse- this method is based on removing the penis from the vagina before ejaculation. The method has extremely low contraceptive effectiveness. With its use, 15–30 pregnancies per 100 women occur. In addition, emotional discomfort is often noted among sexual partners.

Voluntary surgical sterilization- this method of contraception is highly effective and involves surgical intervention. However, there are certain conditions for the use of sterilization: sterilization is prohibited under the age of 21; the patient should not have any mental illness; from the moment of signing all documents until surgical sterilization, at least 30 days must pass; It is prohibited to obtain consent for sterilization during childbirth or if a woman wants to terminate her pregnancy.

Female sterilization based on the creation of artificial obstruction of the fallopian tubes surgically. Despite the fact that the contraceptive effectiveness of such sterilization is very high, it nevertheless does not reach 100%. It is advisable to plan sterilization for the first days of the menstrual cycle. Restoring the ability to reproduce is possible only in 10-30% of women who have previously undergone sterilization.

Male sterilization consists of crossing the vas deferens. This sterilization is technically simpler than for women and can be performed on an outpatient basis. Restoring reproductive capacity after such an operation is possible. The Pearl index when using surgical sterilization is 0.5.

Postcoital contraception. In a number of cases, the use of contraception is required after unprotected sexual intercourse has completed. However, postcoital contraception cannot be used as the main method of permanent pregnancy protection. It is necessary to select another optimal method of contraception.

For emergency prevention of pregnancy use hormonal drugs, the action of which is based on the suppression or delay of ovulation, disruption of the processes of fertilization and egg implantation. The most popular among such drugs is Postinor, which is taken twice with a 12-hour break for 48-72 hours after sexual intercourse. The contraceptive effectiveness of Postinor is up to 98%. Side effects characteristic of hormonal contraceptives generally occur in up to 1/5 of the total number of patients. For the same purpose, a drug based on Danazol 400 mg two or three times at 12-hour intervals within 72 hours after sexual intercourse. It is also possible to use a drug based on Mifepristone at a dose of 600 mg once within 72 hours after sexual intercourse.

The choice of contraceptive method is strictly individual task, which is decided together with the attending physician. This choice should not be based solely on medical criteria. Characteristics and lifestyle should be taken into account (neatness, motivation to use contraception, presence of one or more sexual partners, regular or occasional sex life etc.), special situations (postpartum period, post-abortion period, situations requiring emergency contraception), age, etc.

About choosing a contraceptive method

• If there are no corresponding contraindications, then the method of choice is low-dose or micro-dose combined hormonal oral contraceptives.
• If long-term reversible contraception is planned, then it is possible to use intrauterine contraceptives.
• If there is a high risk of sexually transmitted diseases, it is advisable to use barrier contraception in combination with the use of combined hormonal oral contraceptives.

The final choice of a contraceptive is best made at a face-to-face consultation with a gynecologist; it is also advisable to remain under the supervision of the attending physician, both to assess the state of health and early detection possible pregnancy.