Pros, cons, and how to

The rhythm or calendar method is a natural approach to birth control. It requires a person to monitor their menstrual cycle and signals from the body to estimate when sex is least likely to result in pregnancy.

The rhythm method is a type of natural family planning or fertility awareness. It is not the most reliable way of preventing pregnancy.

With typical use, the traditional rhythm method, which only involves counting days on a calendar, has a failure rate of 8–25%. With perfect use, the failure rate is less than 5%. Forms of natural family planning that require a person to monitor body signals, such as those that use basal body temperature, tend to be more effective.

In this article, we will look at what the rhythm method is, how effective it is, its advantages and disadvantages, and how to use it.

This article talks about perfect and typical use of birth control. Perfect use describes how effective a form of birth control is if everyone uses it exactly as instructed every time they have sex. Typical use describes how effective a form of birth control is if a person sometimes uses it as instructed but may also use it irregularly or imperfectly.

Even with perfect use, contraception is not 100% effective. People should discuss birth control options with a healthcare professional to find the right option for them.

Was this helpful?

The rhythm method is a natural form of birth control. It relies on a person tracking their fertility throughout the menstrual cycle, ensuring they do not have sex on days when they are most fertile. Alternatively, people may use backup forms of contraception on these days.

The rhythm method requires a person to know when they are ovulating. Ovulation is the point in the menstrual cycle when the ovaries release an egg. Tracking this is essential to the rhythm method, as sperm can fertilize an egg at any time during the fertile window. This is the period shortly before, during, and after ovulation.

Dr. Leo J. Latz first popularized the rhythm method in the early 20th century in the United States. His approach assumed that all or most menstrual cycles were 28 days in duration, with ovulation occurring around day 14.

This is not accurate. A 2020 study found that just 12.4% of respondents had a 28-day menstrual cycle, while 87% had cycles ranging from 23–35 days. Even among people with a 28-day cycle, the typical ovulation range varied by up to 10 days.

For this reason, newer forms of the rhythm method have emerged, such as natural family planning or fertility awareness. Often, these newer techniques involve monitoring a range of fertility signs to predict the fertile window rather than counting days on a calendar.

Some signs a person might track include:

• their average date of ovulation
• ovulation tests, which measure luteinizing hormone
• cervical fluid, which changes consistency when a person approaches ovulation
• cervical position and texture
• basal body temperature, which is a person’s body temperature as soon as they wake up, and which goes up after ovulation

The effectiveness of the rhythm method depends on several factors, such as:

• how regular a person’s cycle is
• how reliably they can predict ovulation
• the tools they use to predict it

The traditional rhythm method has a high failure rate, at 8–25% with typical use. This means that, in everyday circumstances, 8–25 people in every 100 who use this method will become pregnant.

The failure rate with perfect use is better, at 5%. But this still means that 5 in every 100 people who use it will become pregnant. By comparison, intrauterine devices have a failure rate of 0.1 to 0.4%.

Other forms of natural family planning have the following levels of effectiveness:

• Billings ovulation method: This method involves monitoring the cervical mucus for signs of ovulation. The failure rate with perfect use is 3%, but 3–22% with typical use.
• 2-day method: This is a variation on the Billings ovulation method and requires a person to monitor their cervical mucus twice per day. The failure rate with perfect use is 4%, and up to 14% with typical use.
• Sympto-thermal method: This method combines measuring basal body temperature every day with tracking cervical mucus. The failure rate is only 0. 4% with perfect use, but 2–33% with typical use.
• Sympto-hormonal method: This method combines body temperature, cervical mucus, and hormone monitoring. The failure rate is 1–2% with perfect use and 11–14% with typical use.

The rhythm method and other types of fertility awareness have several advantages compared with other types of birth control. They:

• cause no side effects
• do not involve taking medications
• require no doctor appointments or prescriptions
• can be inexpensive and accessible

The rhythm method may also:

• increase awareness of one’s menstrual cycle
• become a useful tool for getting pregnant, if a person does decide to become a parent
• help identify a lack of ovulation, which can be a sign of underdiagnosed conditions, such as polycystic ovary syndrome

These methods are also suitable for people who have religious objections to birth control.

The main disadvantage of the rhythm method is that it is not always reliable, especially for people who have variable menstrual cycles or ovulation days.

This may not be a significant drawback for people who would not necessarily mind if they became pregnant or who would prefer to avoid beginning new medications because they want to get pregnant in the near future.

But those who definitely do not want to become pregnant or need protection from sexually transmitted infections (STIs) may want to use another method of birth control. Alternatively, they could combine the rhythm method with barrier protection, such as condoms.

Other potential disadvantages include:

• Effort: The rhythm method and other fertility awareness techniques require effort and commitment to monitor the body and figure out when ovulation is happening. If a person forgets, they could get pregnant.
• Regularity: People with unpredictable or irregular lifestyles may find it difficult to stick to the rhythm method. For example, people who repeatedly wake up at night or get up at different times in the morning may not be able to get an accurate body temperature measurement.
• Knowledge: Effectively monitoring fertility requires knowledge and practice. While many people can learn how to do it, it is a new skill for many beginners. Using backup contraception can protect against any slipups.
• Responsibility: This approach to birth control places all of the responsibility on a person who menstruates, whereas, with other options, partners who do not menstruate can take on or share responsibility, if applicable.
• Cost: The newest and most effective types of natural family planning often involve equipment to track body temperature, hormones, and ovulation. This can require thermometers, ovulation tests, apps, and more.

The rhythm method may be a good option for a person if they:

• can tolerate the risk of pregnancy, or are willing to use a backup method of contraception
• have regular menstrual cycles
• have the time, knowledge, and commitment to track their cycle
• do not need to use barrier methods to prevent STIs

If both partners have undergone STI screenings, and neither has other sexual partners, STI protection might not be necessary.

The original rhythm method uses a simple but potentially unreliable technique to calculate when it is safest to have sex. It involves counting days on a calendar to figure out when ovulation will happen.

In the past, people thought this would be around day 14 of a person’s menstrual cycle. A person is less likely to get pregnant after ovulation and in the first week of their cycle, which is during their period.

A person who has regular cycles and ovulation days may still be able to use this approach, but generally, it is better to track body signals. Some options for this include:

• Ovulation testing: To determine when it is unsafe to have intercourse, people can test for ovulation daily in the first half of the cycle. When a person gets a positive test, they are more likely to be fertile then and for a few days afterward.
• Basal body temperature: Basal body temperature charting can detect ovulation after it has happened. A person takes their temperature at the same time each morning, then looks for a slight but sustained increase after ovulation. By the time this increase is apparent, a person is no longer fertile.
• Cervical fluid: The cervical fluid method looks for changes in the fluid that comes from the cervix and out of the vagina. Early in the cycle, a person may notice very little fluid or thick fluid. As they become more fertile, the fluid may become very watery or develop the consistency of egg whites. There may also be more of it.

The safest time to have sex is when a person has no signs of fertility and is several days past ovulation.

Many birth control apps use a form of the rhythm method. However, birth control apps have modern technology that can collate and analyze information from a person’s previous cycles. The creators of these apps argue this makes them more effective at calculating safe days than humans.

Birth control apps vary slightly in their approach. Some only gather data using an algorithm or artificial intelligence to predict the fertile window. Some also track current fertility signs, such as body temperature.

The company Natural Cycles submitted data to the Food and Drug Administration (FDA) that suggests that their app may be more effective than natural family planning without an app.

It followed 15,570 app users aged 18–45 from September 1, 2017, to April 30, 2018. According to the data, the failure rate from using the Natural Cycles app was 1% with perfect use and 6.5% with typical use.

Birth control apps may suit people who would prefer not to try and calculate their own fertile window, but it may be useful to speak with a gynecologist about this first to see if it is a good option.

The rhythm method is a form of birth control that relies on a person tracking ovulation to determine which days they will be the least fertile. Originally, the method involved counting days on a calendar to figure out when ovulation would happen, but additional measures now exist.

A person may combine calendar tracking with cervical mucus, body temperature, or ovulation testing. They may also combine these methods with backup contraception, such as condoms, which offer additional protection and can prevent STI transmission.

The rhythm method and natural family planning generally are not completely reliable, even with perfect use. If a person has questions about whether this option is right for them, a sexual health clinic or gynecologist can offer advice.

Pros, cons, and how to

The rhythm or calendar method is a natural approach to birth control. It requires a person to monitor their menstrual cycle and signals from the body to estimate when sex is least likely to result in pregnancy.

The rhythm method is a type of natural family planning or fertility awareness. It is not the most reliable way of preventing pregnancy.

With typical use, the traditional rhythm method, which only involves counting days on a calendar, has a failure rate of 8–25%. With perfect use, the failure rate is less than 5%. Forms of natural family planning that require a person to monitor body signals, such as those that use basal body temperature, tend to be more effective.

In this article, we will look at what the rhythm method is, how effective it is, its advantages and disadvantages, and how to use it.

This article talks about perfect and typical use of birth control. Perfect use describes how effective a form of birth control is if everyone uses it exactly as instructed every time they have sex. Typical use describes how effective a form of birth control is if a person sometimes uses it as instructed but may also use it irregularly or imperfectly.

Even with perfect use, contraception is not 100% effective. People should discuss birth control options with a healthcare professional to find the right option for them.

Was this helpful?

The rhythm method is a natural form of birth control. It relies on a person tracking their fertility throughout the menstrual cycle, ensuring they do not have sex on days when they are most fertile. Alternatively, people may use backup forms of contraception on these days.

The rhythm method requires a person to know when they are ovulating. Ovulation is the point in the menstrual cycle when the ovaries release an egg. Tracking this is essential to the rhythm method, as sperm can fertilize an egg at any time during the fertile window. This is the period shortly before, during, and after ovulation.

Dr. Leo J. Latz first popularized the rhythm method in the early 20th century in the United States. His approach assumed that all or most menstrual cycles were 28 days in duration, with ovulation occurring around day 14.

This is not accurate. A 2020 study found that just 12.4% of respondents had a 28-day menstrual cycle, while 87% had cycles ranging from 23–35 days. Even among people with a 28-day cycle, the typical ovulation range varied by up to 10 days.

For this reason, newer forms of the rhythm method have emerged, such as natural family planning or fertility awareness. Often, these newer techniques involve monitoring a range of fertility signs to predict the fertile window rather than counting days on a calendar.

Some signs a person might track include:

• their average date of ovulation
• ovulation tests, which measure luteinizing hormone
• cervical fluid, which changes consistency when a person approaches ovulation
• cervical position and texture
• basal body temperature, which is a person’s body temperature as soon as they wake up, and which goes up after ovulation

The effectiveness of the rhythm method depends on several factors, such as:

• how regular a person’s cycle is
• how reliably they can predict ovulation
• the tools they use to predict it

The traditional rhythm method has a high failure rate, at 8–25% with typical use. This means that, in everyday circumstances, 8–25 people in every 100 who use this method will become pregnant.

The failure rate with perfect use is better, at 5%. But this still means that 5 in every 100 people who use it will become pregnant. By comparison, intrauterine devices have a failure rate of 0.1 to 0.4%.

Other forms of natural family planning have the following levels of effectiveness:

• Billings ovulation method: This method involves monitoring the cervical mucus for signs of ovulation. The failure rate with perfect use is 3%, but 3–22% with typical use.
• 2-day method: This is a variation on the Billings ovulation method and requires a person to monitor their cervical mucus twice per day. The failure rate with perfect use is 4%, and up to 14% with typical use.
• Sympto-thermal method: This method combines measuring basal body temperature every day with tracking cervical mucus. The failure rate is only 0.4% with perfect use, but 2–33% with typical use.
• Sympto-hormonal method: This method combines body temperature, cervical mucus, and hormone monitoring. The failure rate is 1–2% with perfect use and 11–14% with typical use.

The rhythm method and other types of fertility awareness have several advantages compared with other types of birth control. They:

• cause no side effects
• do not involve taking medications
• require no doctor appointments or prescriptions
• can be inexpensive and accessible

The rhythm method may also:

• increase awareness of one’s menstrual cycle
• become a useful tool for getting pregnant, if a person does decide to become a parent
• help identify a lack of ovulation, which can be a sign of underdiagnosed conditions, such as polycystic ovary syndrome

These methods are also suitable for people who have religious objections to birth control.

The main disadvantage of the rhythm method is that it is not always reliable, especially for people who have variable menstrual cycles or ovulation days.

This may not be a significant drawback for people who would not necessarily mind if they became pregnant or who would prefer to avoid beginning new medications because they want to get pregnant in the near future.

But those who definitely do not want to become pregnant or need protection from sexually transmitted infections (STIs) may want to use another method of birth control. Alternatively, they could combine the rhythm method with barrier protection, such as condoms.

Other potential disadvantages include:

• Effort: The rhythm method and other fertility awareness techniques require effort and commitment to monitor the body and figure out when ovulation is happening. If a person forgets, they could get pregnant.
• Regularity: People with unpredictable or irregular lifestyles may find it difficult to stick to the rhythm method. For example, people who repeatedly wake up at night or get up at different times in the morning may not be able to get an accurate body temperature measurement.
• Knowledge: Effectively monitoring fertility requires knowledge and practice. While many people can learn how to do it, it is a new skill for many beginners. Using backup contraception can protect against any slipups.
• Responsibility: This approach to birth control places all of the responsibility on a person who menstruates, whereas, with other options, partners who do not menstruate can take on or share responsibility, if applicable.
• Cost: The newest and most effective types of natural family planning often involve equipment to track body temperature, hormones, and ovulation. This can require thermometers, ovulation tests, apps, and more.

The rhythm method may be a good option for a person if they:

• can tolerate the risk of pregnancy, or are willing to use a backup method of contraception
• have regular menstrual cycles
• have the time, knowledge, and commitment to track their cycle
• do not need to use barrier methods to prevent STIs

If both partners have undergone STI screenings, and neither has other sexual partners, STI protection might not be necessary.

The original rhythm method uses a simple but potentially unreliable technique to calculate when it is safest to have sex. It involves counting days on a calendar to figure out when ovulation will happen.

In the past, people thought this would be around day 14 of a person’s menstrual cycle. A person is less likely to get pregnant after ovulation and in the first week of their cycle, which is during their period.

A person who has regular cycles and ovulation days may still be able to use this approach, but generally, it is better to track body signals. Some options for this include:

• Ovulation testing: To determine when it is unsafe to have intercourse, people can test for ovulation daily in the first half of the cycle. When a person gets a positive test, they are more likely to be fertile then and for a few days afterward.
• Basal body temperature: Basal body temperature charting can detect ovulation after it has happened. A person takes their temperature at the same time each morning, then looks for a slight but sustained increase after ovulation. By the time this increase is apparent, a person is no longer fertile.
• Cervical fluid: The cervical fluid method looks for changes in the fluid that comes from the cervix and out of the vagina. Early in the cycle, a person may notice very little fluid or thick fluid. As they become more fertile, the fluid may become very watery or develop the consistency of egg whites. There may also be more of it.

The safest time to have sex is when a person has no signs of fertility and is several days past ovulation.

Many birth control apps use a form of the rhythm method. However, birth control apps have modern technology that can collate and analyze information from a person’s previous cycles. The creators of these apps argue this makes them more effective at calculating safe days than humans.

Birth control apps vary slightly in their approach. Some only gather data using an algorithm or artificial intelligence to predict the fertile window. Some also track current fertility signs, such as body temperature.

The company Natural Cycles submitted data to the Food and Drug Administration (FDA) that suggests that their app may be more effective than natural family planning without an app.

It followed 15,570 app users aged 18–45 from September 1, 2017, to April 30, 2018. According to the data, the failure rate from using the Natural Cycles app was 1% with perfect use and 6.5% with typical use.

Birth control apps may suit people who would prefer not to try and calculate their own fertile window, but it may be useful to speak with a gynecologist about this first to see if it is a good option.

The rhythm method is a form of birth control that relies on a person tracking ovulation to determine which days they will be the least fertile. Originally, the method involved counting days on a calendar to figure out when ovulation would happen, but additional measures now exist.

A person may combine calendar tracking with cervical mucus, body temperature, or ovulation testing. They may also combine these methods with backup contraception, such as condoms, which offer additional protection and can prevent STI transmission.

The rhythm method and natural family planning generally are not completely reliable, even with perfect use. If a person has questions about whether this option is right for them, a sexual health clinic or gynecologist can offer advice.

Condom, implant, rhythm method: which contraceptive to choose for young people?

Komsomolskaya Pravda

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HEALTH To live healthy!

Anna KUKARTSEVA

November 16, 2021 18:05

Top 10 questions that young people often ask when choosing contraception. And expert answers that will help to understand the variety of methods and not harm reproductive health

Photo: Shutterstock

According to statistics, on average, the onset of sexual activity among adolescents in Russia falls on 16 years. But many girls plan to give birth to children no earlier than 25. That is, for at least 10 years they must be properly protected so as not to harm their health and not catch sexually transmitted diseases.

Unfortunately, the topic of sex and contraception is still considered shameful, and in many families it is simply not discussed. And not every girl (especially in a small town where everyone knows each other) will go to the gynecologist to consult.

Therefore, we have collected the most popular questions in various forums, and also asked young people what questions they are interested in. And we tried to answer as frankly as possible.

Our expert – Stepan Krasnyak, Ph.D. ON THE. Lopatkina, executive secretary of the Profile Commission of the Ministry of Health of Russia on the reproductive health of men.

Seven questions from girls

1. Should a girl carry a condom in her bag?

“I am 17 years old. And my boyfriend and I have been together for two months, he hints at sex, but I don’t know if he will have a condom. How can I prepare myself?

– First of all, it is worth preparing mentally: are you sure you are ready for intimacy or are you just following the guy who threatens to leave you? It is not in vain that intimacy is called so – it is a continuation of a trusting relationship, a continuation of your love. If in doubt, maybe it’s worth the wait?

Secondly, the responsibility for your health is only your responsibility. And if you are not sure about your partner, it is better to put a condom in your purse, it will not be superfluous. And by the way, practice using it correctly. An incorrectly worn condom is a common cause of unplanned pregnancy.

2. Do birth control pills make you fat?

“I’m afraid to take pills (oral contraceptives) – my mother told me that they made me fat. And a friend says that she has acne!

– First of all, it is worth understanding that contraception 20 years ago and now are two big differences. Now there are combined oral contraceptives (COCs) for nulliparous girls, which, on the contrary, help fight acne and even reduce weight. In addition, modern contraceptives containing synthetic analogues of female sex hormones work with the body more carefully than before: they simply “turn off” ovulation, that is, the egg does not mature. And a woman retains her reproductive potential longer than without taking COCs.

But it is very important to choose the right oral contraceptives. And this can be done only together with a gynecologist. It is the doctor who will be able to collect an anamnesis, ask the right questions to determine possible risks. For example, some pills are not suitable for girls at risk of developing thrombosis or smokers.

In addition, when taking COCs, stability and accuracy are very important. And if you are not sure of yourself, it is better to consult a doctor about what other methods of protection will suit you.

3. What other methods of protection are there besides pills?

“I’m 19 years old, I don’t want to take pills (I’m afraid to forget about them), but the spiral, my mother says, is only suitable for women who have given birth. What are the alternatives?

– If you list all the methods of contraception, then there are several of them, and each has its own characteristics:

Coitus interruptus. Requires a lot of endurance from a man.

Calendar method (or rhythm method) based on the female cycle: excludes sex on dangerous days. As a rule, this is the 14th calendar day. But from that day, you should immediately subtract 72 hours (so many sperm can live inside the female body after intercourse) and add another 48 hours (the life time of the egg). That is almost a week without sex. For a young hot couple is often an impossible task.

Condoms. Not always a convenient way for young, inexperienced people, but still the most optimal barrier method for protecting against genital infections.

Spermicides (an agent inserted into the vagina before intercourse). With some degree of probability protects against infections and pregnancy.

Oral contraceptives (COCs), i.e. birth control pills to be taken 21 days a month.

Intrauterine devices (or colloquially, spirals). In the last 10 years, doctors have also recommended them to young girls who have a regular partner. IUDs prevent the fertilized cell from attaching to the wall of the uterus, that is, pregnancy does not occur. They are advised if there are contraindications or intolerance to COCs.

Subdermal implants – refers to hormonal contraception.

Emergency contraception is the only way to prevent pregnancy immediately after intercourse.

The most effective means of contraception is premarital chastity. Its Pearl Index* is 0.0. For all other means of protection, including sterilization, the index is still higher, says our expert Stepan Krasnyak. Among the popular methods of contraception, the combination of contraceptives and a condom is most effective.

* Pearl Index – an indicator of the ineffectiveness of a contraceptive (the number of unplanned conceptions during the year in 100 women). The lower the index, the more reliable the tool.

4. The calendar method works great, why do we need to protect ourselves with something else?

“My period is right on time, my boyfriend and I know all about the dangerous days and trust each other. So far, there hasn’t been a single failure, so no condoms or pills are needed.”

– The human body is not a machine. And many factors can affect the female hormonal background – from a cold to stress at work. Therefore, being confident in your menstrual cycle is, of course, good, but this does not mean that tomorrow this method will work just as effectively.

5. Will the subcutaneous implant disturb the hormonal background?

“We are a young couple, and my husband and I are not planning children yet. I’m tired of remembering pills, reading about subcutaneous implants, but I’m afraid of a large dose of hormones.”

– This is one of the most reliable methods of contraception when you have a regular partner. A capsule (implant) inserted under the skin releases hormones precisely at a given time, their amount does not exceed what is in the COC. The effect of the implant is about three years. The only negative: if you want children or some unforeseen health problems happen when hormone therapy is contraindicated, you will have to cut out the implant…

6. Will emergency contraception help?

“Even if you have unprotected sex, there is always emergency contraception: you take a pill and you don’t have to worry.”

– Yes, alas, young girls who are characterized by, let’s say, spontaneity in relationships, are frequent users of emergency contraceptives, which protect against unwanted pregnancies after unprotected intercourse. But it is worth remembering that one such pill is not at all harmless. For the hormonal system, this is a serious shake-up, literally an explosion of a hydrogen bomb. If this method is abused, then in the future serious problems with the reproductive system are possible: the formation of cysts, bleeding, possible infertility …

7. Is abortion less traumatic now than it used to be?

“Now, with our level of medicine, abortion is not at all as scary as it was 50 years ago. Even if I heal, then in the early stages it will not hurt me?

– The most dangerous delusion of today’s youth! Yes, of course, today’s methods of early termination of pregnancy are much more gentle than, say, 50 years ago. But it is still interference in the work of the body, even if it is not physical, but medication. And often this does not go unnoticed: any abortion is stressful not only for the body, but also for the psyche. A woman may begin to experience fear of the gynecological chair, stop coming for scheduled examinations, which is fraught with the development of diseases. The more abortions, the lower the woman’s protection against genital infections, the likelihood of adhesions increases many times over, which in the future will prevent her from becoming pregnant or giving birth normally.

And three important clarifications from young people

1. If you believe your girlfriend, do you need a condom?

“Usually I use condoms, but if I’m sure about a girl (I can ask for a certificate, if anything, and show my own), then there is sex without a condom if she takes pills. I don’t see anything wrong with that.”

– Trust in a partner is wonderful. But words are always just words. The girl herself may not suspect that she is infected with an infection (for example, HIV or hepatitis do not manifest themselves for a long time). Again, her claim that she is taking birth control is very difficult to verify. So any unprotected intercourse is always a risk, both for her and for him. But everyone chooses his own destiny. Just remember: the cost of a mistake can be very high!

2. Do spermicides help prevent pregnancy?

“My friend uses spermicides, we are already used to waiting for a while, but it feels better without a condom. She says it’s great pregnancy protection without pills.”

– Spermicides are perhaps the most unreliable method of contraception (its Pearl Index is 18-29, that is, a 30 percent chance of pregnancy). In addition, they affect the mucous membrane of both girls and young people and become a high risk factor for the development of genitourinary infections (urethritis, cystitis).

3. Interrupted sex – not a reason for peace?

“I am sure of myself – I will always be able to interrupt in time, not a single girl has become pregnant from me!”

– Such self-confidence arouses respect and bewilderment at the same time. First, coitus interruptus is unprotected sex, which means that there is an easy possibility of contracting an STI. Secondly, self-control cannot be eternal – and if such a passion is overwhelmed that you will forget about everything? In any case, the responsibility for your health and the health of the girl is always in your hands. We can only warn you that this is not safe.

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Practical aspects of contraception | Lukyanchikov V.S., Korolevskaya L.I.

Among the numerous methods of contraception, hormonal contraception (HC) is the most modern and reliable. It should be noted that GC is not only a very convenient, effective and safe method of reversible prevention of pregnancy. The advent of the GC has significantly advanced the emancipation of women who have received the opportunity to lead a safe sex life in terms of pregnancy without discussing this issue with a partner. At the same time, while giving due to the social significance of GC, including for birth control, it must be recognized that opinions about its impact on women’s health are ambiguous. Undoubtedly, against the background of GC, the menstrual cycle becomes more regular and even manageable, menstrual blood loss decreases, premenstrual syndrome and dysmenorrhea are eliminated. There is evidence that HA reduces the incidence of pelvic inflammatory disease (PID) and mastopathy, reduces the risk of osteoporosis, ovarian retention cysts, cancer of the ovaries, cervix, endometrium and mammary glands, alleviates the course of acne, endometriosis, thrombocytopenic purpura and rheumatoid arthritis [2 ,4,5,6,7]. But there are also opposite statements that HA contributes to the development of breast, endometrial and ovarian cancer, and is also capable of inducing cholestatic hepatitis and venous thrombosis [1,3,8,9,10,11,12].

The lack of clarity on the consequences of long-term GC, especially the risk of oncological and vascular complications (Table 1) is the reason why Russian doctors and patients are generally wary of it.
Methods of contraception
There are 7 groups of modern methods and means of contraception (Table 2). The most natural method of contraception is breastfeeding by the mother. Physiological amenorrhea and infertility of the lactation period are due to anatomical and morphological changes in the uterus, endometrium and adenohypophysis, as well as reflex inhibition of the secretion of hypothalamic-pituitary-ovarian hormones in response to breastfeeding, i.e. on frequent irritation of the nipples and peripapillary areas of the mammary glands. Unfortunately, the duration of lactational infertility is unpredictable. Large individual variations depend on the age, constitution and obstetric history of the mother, social conditions and ethnic characteristics, in particular, infant feeding traditions. It is believed that if a mother breastfeeds her baby without additional feeding, then lactational infertility lasts about 6 months. However, in 40–60% of nursing mothers, ovulation is restored by this time (and often earlier), often before the first postpartum menstruation. This explains the high percentage of failures in lactation contraception.
Withdrawal method of natural contraception, like lactation, is absolutely harmless, economical and perfect from the point of view of Christian and other religions. But even less reliable. The essence of the method is periodic abstinence from sexual activity in the pre- and periovulatory days of the menstrual cycle, which make up the middle of the menstrual cycle. Theoretically, taking into account the viability of the egg and sperm, successful “calendar” contraception requires sexual abstinence for 2-3 days. However, it is almost impossible to accurately calculate the day of ovulation, since its onset varies greatly even with a stable cycle. In addition, the viability of spermatozoa in the genital tract of a woman can reach 8 days. As a result, depending on the duration of the menstrual cycle, the number of “withdrawal” days increases to 7 and even up to 14, while the failure rate reaches 50%.
Constant monitoring of changes in the amount and consistency of cervical mucus is a more reliable way to determine ovulation. About 4-5 days before ovulation, wet days begin – the secret of the vulva and the amount of cervical mucus increase. For 3-5 days just before ovulation, during and after it, cervical mucus is copious, slippery, clear and stringy, resembling raw egg white. This is the most dangerous, or rather, the most optimal period for conception. At the end of the fertile period, cervical mucus again becomes scarce, cloudy and sticky, or disappears altogether. This method of establishing ovulation is more accurate than the calendar one, but it requires skill and a certain psychological warehouse.
Calculation of ovulation according to the basal temperature schedule is the most time-consuming. Every day after a night’s sleep and before getting out of bed, you need to measure the temperature in the mouth or in the vagina, or in the rectum. In most women, in the first half of the menstrual cycle, that is, before ovulation, the basal temperature is 0.2–0.5 ° C lower than in the luteal phase of the cycle. An increase in temperature occurs about a day after ovulation and persists until menstruation.
The calculation of the day of ovulation is facilitated by the so-called fertility indicator – an electronic wrist bracelet that combines calendar and temperature methods. Unfortunately, 10-15% of women in the luteal phase do not have a fever.
Many women physically feel the rupture of a mature follicle, experiencing moderate, sometimes severe pain in the lower abdomen at the time of ovulation. The fixation of these sensations, together with the control of changes in cervical mucus and basal temperature, is called the symptothermal Belling method.
In general, natural contraception is associated with a number of inconveniences, in particular, it strictly regulates sexual life, is ineffective with an unstable menstrual cycle, and most importantly, is not reliable enough.
Coitus interruptus, with or without vaginal douching, is slightly more effective than natural contraception, but the failure rate is still too high. In addition, an interrupted act does not give complete satisfaction, and this is fraught with a decrease in libido and even the development of frustration, and for both partners.
Contrary to popular belief, the reliability of barrier methods of contraception is low, but they compare favorably with natural contraception in their simplicity and availability. Contraindications are associated with rare cases of allergies to latex, rubber and spermicides, or with a psychological inability to perform simple manipulations with the genitals. The main advantage of barrier methods (especially condoms) is that they effectively prevent HIV infection and sexually transmitted diseases (STDs).
Intrauterine contraception (IUD) in our country are used most often. The mechanism of action and the degree of reliability of the IUD depend on the type of device (neutral, copper-containing and progestin-releasing), but the differences are not great. The introduction of the IUD no later than 5 days after unprotected intercourse is an effective method of postcoital contraception. One of the indications for the IUD is the prevention or elimination of scars and synechia of the uterine cavity after childbirth, abortion and miscarriage. Poor tolerability of the IUD – in the form of menstrual irregularities (heavy, irregular menstruation and intermenstrual bleeding) and dysmenorrhea – is noted in about 15% of cases. In 10% spontaneous expulsion of the IUD occurs. Exacerbation of chronic PID is possible, in the presence of which treatment is carried out before the introduction of the IUD.
Hormonal contraception
and its features
Hormonal contraception (HC) is the most modern method of reversible prevention of pregnancy. Classification of drugs for GC and a comparative analysis of their effectiveness in comparison with other methods of contraception are shown in Table 2. There are two types of drugs for GC: combined oral contraceptives (COCs) and pure progestin contraceptives (POCs). Each of the options is represented by four groups of drugs that differ in pharmacology, side effects, and other characteristics, including the reliability of contraception (Tables 1 and 2).
Assessing the acceptability of a HA and choosing a drug are difficult and demanding tasks. If we are talking about COCs or CHPs, then first of all it is necessary to study the psychosocial characteristics of the patient’s personality, bearing in mind the presence of subjective and objective prerequisites for strict adherence to the rules for the use of the drug, especially the regimen. When using COCs and CHPs, a certain composure, responsibility and self-discipline, a stable and physiological working regime for the time of day, a rational way of life and normal living conditions are required. In the absence of such prerequisites, the appointment of COCs and most PPCs is impractical and even dangerous.
The second step in planning the GC is the study of the patient’s family and personal history, as well as anthropometric, gynecological and medical parameters and characteristics (Table 3). Here it is important to take into account the peculiarities of the interaction of drugs for HA with other drugs and alcohol (Table 4). Analysis of all these data makes it possible to predict possible negative consequences and complications of GC and prevent their development.
The third indispensable condition for prescribing GCs is strict adherence to the principles of “good clinical practice”, which provides not only the most complete assessment of the possible risks of GCs for a particular patient, but also her mandatory informed consent to the use of a particular drug.
In general, COC preparations are more physiological, since they contain both main female sex hormones – estrogen and gestagen. By mimicking the natural rhythm of the secretion of these hormones by the ovaries, COCs suppress the production of GnRH in the hypothalamus and gonadotropic hormones in the pituitary gland. Inhibition of the hypothalamic-pituitary mechanism, which stimulates the maturation of eggs in the ovaries, causes the ovaries to persist in idle mode, due to the fact that their hormone-secreting and gametoproducing functions are temporarily turned off. These functions are fully restored within a year after discontinuation of the drug. However, it is impossible not to notice that in about 1% of cases, irreversible infertility occurs after GC [10,11].
A special group of COCs are preparations in which the progestogen component is represented by substances that have not only progestin, but also antiandrogenic activity. These contraceptives are not only devoid of the side effects of COCs that are associated with the progestogen component (Table 2), but effectively eliminate hirsutism, acne and seborrhea.
Compared to COCs, progestin-only contraceptives (PPCs) have both advantages and disadvantages. The main advantage is the absence of a thrombogenic effect and a protective effect against mastopathy and endometrial cancer. However, gestagens, hence CPC, are not without side effects, although their list is somewhat shorter than that of estrogens, more precisely, COCs (Table 2).
Choosing a method of contraception
In accordance with the main principle of medicine – “do no harm”, when choosing a method of contraception, the patient’s safety must first of all be foreseen. For this purpose, the WHO Committee on Family Planning and Contraception has developed a “contraceptive acceptability rating” [10,11]. With its help, the doctor ranks the chosen method or means of contraception according to safety classes (K1,2,3,4), comparing the risk to the health of a particular woman associated with contraception, with the benefits and positive consequences that this method of contraception provides to this woman.
Contraceptive acceptance rating:
Safety class 1 (K1). The contraceptive method has no restrictions on use (can be prescribed to all women under any circumstances).
2nd security class (K2). For a given woman, the benefits of using this method of contraception outweigh the theoretical and actual risks. The method is allowed.
3rd security class (K3). According to the woman’s condition, the use of this method of contraception is associated with such a theoretical or real risk of side effects that exceeds the benefits received. Nevertheless, the use of the method is permissible, but only in those patients for whom all other methods are not available or absolutely unacceptable.
4th security class (K4). Conditions in which this method of contraception poses an unacceptable risk to the health of a particular woman. This method is contraindicated for her.
The choice of a method of contraception begins with a survey and physical, including gynecological examination. In order to speed up the selection procedure and not to miss significant facts and circumstances, a questionnaire (Table 4) is recommended, which is partially filled out by the patient herself. The algorithm for choosing a method of contraception is presented in Table 5.
In conclusion, we emphasize again that the choice of a contraceptive method cannot be made from the standpoint of paternalism. This choice should be the result of informed consent between physician and patient. The doctor, based on the data of the questionnaire and a special examination, as well as taking into account the wishes of the patient, gives a qualified recommendation. But the right of final choice must be given to the patient.

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