The rhythm method contraception: The request could not be satisfied
Fertility Awareness Methods | Natural Birth Control
What are Fertility Awareness Methods?
Fertility awareness methods (FAMs) are ways to track your ovulation so you can prevent pregnancy. FAMs are also called “natural family planning” and “the rhythm method.”
What are the different kinds of FAMs?
Fertility awareness methods help you track your menstrual cycle so you’ll know when your ovaries release an egg every month (this is called ovulation).
The days near ovulation are your fertile days — when you’re most likely to get pregnant. So people use FAMs to prevent pregnancy by avoiding sex or using another birth control method (like condoms) on those “unsafe,” fertile days.
There are a few different FAMs that help you track your fertility signs. You can use 1 or more of these methods to predict when you’ll ovulate:
It’s most effective to combine all 3 of these methods. When used together, they’re called the symptothermal method.
The Standard Days Method is a variation on the calendar method. You track your menstrual cycle for several months to figure out if your cycle is always between 26 and 32 days long — you can’t use this method if it’s longer or shorter. Once you’ve established that your cycle is in the right range, you use another form of birth control (or don’t have vaginal sex) on days 8-19, which is when you’re fertile.
How effective are fertility awareness methods?
FAMs are about 76-88% effective: that means 12-24 out of 100 couples who use FAMs will get pregnant each year, depending on which method(s) are used. If you use multiple FAMs together, they work even better.
The better you are about using FAMs the right way — tracking your fertility signs daily and avoiding sex or using birth control on “unsafe” days — the more effective they’ll be. But there’s a chance that you’ll still get pregnant, even if you always use them perfectly.
Fertility awareness methods don’t work as well as other types of birth control because they can be difficult to use. Want a more effective way to prevent pregnancy? Check out IUDs and implants, or take this quiz to find the birth control method that’s best for you.
How can I make FAMs more effective?
Like all birth control methods, FAMs are more effective when you use them as perfectly as possible. How well FAMs work also depends on both partners, so it’s important that each of you is supportive and learns how to use the methods.
FAMs are most effective when:
you work with a nurse, doctor, or counselor who knows FAMs well to learn how to use them correctly
you have the time and discipline to check your fertility signs and chart your cycle every day
you and your partner don’t mind avoiding vaginal sex or using another kind of birth control around your fertile days
The best way to use FAMs is to combine the temperature, cervical mucus, and calendar methods. Each of these methods relies on different signs to predict your fertile days, so using them together gives you the best picture of your fertility and makes FAMs more accurate. For example, keeping track of your cervical mucus pattern can be useful if your temperature chart gets messed up because you’re sick or stressed. And using more than 1 method may help you narrow down your fertile days, so you will have more safe days each month.
You can keep track of your mucus, days, and temperatures on a fertility awareness method chart like this one.
What do I need to know about my menstrual cycle and fertility?
In order to use FAMs, you’ve got to learn a lot about your menstrual cycle. You have to know when you’re ovulating and fertile, and when it’s safe for you to have sex without risking pregnancy.
In order for pregnancy to happen, a sperm cell must join with your egg (this is called fertilization). During your menstrual cycle, there are certain days when it’s possible for sperm to fertilize an egg and cause a pregnancy — these are your fertile days.
Each month, your ovary releases an egg into your fallopian tube (this is called ovulation). Your egg is in your fallopian tube for about 12-24 hours. Sperm can hang out in your uterus and fallopian tube for up to 6 days after sex. If a sperm cell does join up with your egg in the tube, the fertilized egg travels from your fallopian tube to your uterus (womb) and can attach to the uterine wall, which starts a pregnancy. If your egg doesn’t get fertilized, it dissolves and you eventually get your period.
Since an egg lives about a day after ovulation and sperm live about 6 days after sex, you’re basically fertile for around 7 days of every menstrual cycle: the 5 days before you ovulate, and the day you ovulate. You can also get pregnant a day or 2 after ovulation, but it’s less likely.
More questions from patients:
What is natural family planning or natural contraception? How do natural birth control methods work?
“Natural” family planning is when you track your menstrual cycle and ovulation to estimate what days you’re fertile, and then avoid unprotected penis-in-vagina sex on those days to prevent pregnancy.
There are a few ways to monitor your fertility for birth control — they’re called Fertility Awareness Methods (FAMs for short). Every day you take your temperature, monitor your cervical mucus, and/or chart your menstrual cycle to track your fertility signs. Using all 3 methods together works best, and it’s important to make sure you’re doing them every day.
FAMs are a great way to learn about your body, and they can be really effective if you have regular cycles and stay on top of tracking your fertility signs perfectly. Many people who use FAMs also like that there aren’t any side effects. But FAMs can also be difficult to use correctly, and won’t work well if you have an irregular menstrual cycle.
Sometimes when people talk about “natural” birth control, they mean a birth control method that doesn’t have hormones. If FAMs aren’t your thing but you want a super effective birth control method without hormones, check out the copper IUD. Condoms are another way to prevent pregnancy without hormones, with a great perk of also protecting against STDs. (Some people who use FAMs also use condoms on their fertile days.)
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Does the Rhythm Method Actually Work?
Call it the rhythm method, natural family planning, or fertility awareness-based birth control. It’s a birth control method that uses a woman’s monthly fertility cycle to help prevent pregnancy. The question is, does it work?
How the Rhythm Method Should Work
Here’s how the rhythm method is supposed to prevent pregnancy: You track your menstrual cycle on a calendar. Then, you do not have sex on the days when you are likely fertile. Or, you use another type of birth control on those days.
Each month, you release an egg in a process called ovulation. That’s when you are fertile. Pregnancy only occurs when a man’s sperm fertilizes the egg. If there is no sex during ovulation or no sperm to fertilize the egg, you should not become pregnant.
However, it’s not always quite so simple.
The rhythm method fails about a fourth of the time — 24%. That means 24 of every 100 women using this method of birth control still get pregnant. When done exactly right, the rhythm method fails just 3 to 5% of the time. But, that’s sometimes easier said than done.
Tracking Your Fertility Cycle
You can usually tell when you’re ovulating. The discharge (cervical mucus) that occurs around ovulation is different. When you’re fertile, the mucus is slippery, thick, clear in color and stretchy. You can also measure your body temperature to tell when you’re fertile. When you’re ovulating, your temperature will be almost 1 degree Fahrenheit higher than normal.
You’ll then need to track your fertility cycles and ovulation times on a calendar. There are about seven days each month when a woman can get pregnant. They are about five days before you ovulate, the day of ovulation, and for another day or two afterward. An egg lives for about a day after it’s released. Sperm can live in the uterus for as long as six days.
For the rhythm method to be effective:
- You must accurately identify your fertile days
You cannot have sex during those days. Or, if you do, you must use another type of birth control. This could be a condom, diaphragm or sponge, for instance.
The problem is a woman’s menstrual cycle can change a bit from month to month. If your cycle is a bit shorter or longer than normal, then the days you are fertile change. You may be off when you try to figure out your fertile days. You’re more likely to get pregnant when this happens.
There are many ways to prevent pregnancy. Talk with your doctor about the most effective, safest method that meets your needs.
[Risks associated with the rhythm method of contraception]
Contracept Fertil Sex (Paris)
. 1979 Jul;7(7):505-9.
Item in Clipboard
Contracept Fertil Sex (Paris).
Contracept Fertil Sex (Paris)
. 1979 Jul;7(7):505-9.
Item in Clipboard
It has been known for a long time that ovulation takes place generally in the middle of the cycle, and consequently that one may avoid impregnation by observing sexual abstinence during this time. Studies have revealed however that impregnation can occur practically any day of the cycle, which suggests that emotional factors such as sexual intercourse may to a certain extent influence the time of ovulation. It has been demonstrated that impregnation in the middle of the cycle is rarely followed by spontaneous abortion or extra-uterine implantation. Subsequently the hypothesis was made, that accidental impregnation in women observing sexual abstinence in the middle of the cycle as a method of birth control, may lead to reproduction abnormalities such as congenital malformations. The rhythm method of contraception was improved with the method of the body temperature and other techniques destined to detect the ovulation so as to considerably diminish the rate of failure due to this method. Experiments involving a delay in the ovulation have proved that when the ovum is too ripe, it can provoke abnormalities in the fetus. This leads to the conclusion that failures of the rhythm method of contraception carry a great risk of fetal malformation. Ideally this method should be combined with other behavioral contraceptive methods, particularly for women who have decided to bring to term an unwanted pregnancy.
[The risks of the natural family planning methods].
Ther Umsch. 1986 May;43(5):417-24.
Ther Umsch. 1986.
[Contraceptive failure in the United States: the impact of social economic and demographic factors (author’s transl)].
Schirm AL, Trussell J, Menken J, Grady WR.
Schirm AL, et al.
Contracept Fertil Sex (Paris). 1983 Apr;11(4):659-73.
Contracept Fertil Sex (Paris). 1983.
A second look at natural family planning.
Initiatives Popul. 1983;7(1):2-12.
Initiatives Popul. 1983.
Risks of rhythm method of birth control.
Iffy L, Wingate MB.
Iffy L, et al.
J Reprod Med. 1970 Sep;5(3):96-102.
J Reprod Med. 1970.
No abstract available.
[Prognosis of ovulation based on contraceptive methods].
- Congenital Abnormalities*
- Congenital, Hereditary, and Neonatal Diseases and Abnormalities
- Evaluation Studies as Topic*
- Natural Family Planning Methods*
The rhythm method and embryonic death
Some proponents of the pro‐life movement argue against morning after pills, IUDs, and contraceptive pills on grounds of a concern for causing embryonic death. What has gone unnoticed, however, is that the pro‐life line of argumentation can be extended to the rhythm method of contraception as well. Given certain plausible empirical assumptions, the rhythm method may well be responsible for a much higher number of embryonic deaths than some other contraceptive techniques.
Keywords: abortion, contraception, moral status of embryos, rhythm method, intrauterine device, IUD
It has not gone unnoticed by advocates of the pro‐life movement that if one is concerned about abortion because of the moral turpitude of killing embryos (and fetuses) then one should also be concerned about various contraceptive techniques. Certainly, they say, one should be concerned about the morning after pill and intrauterine devices (IUDs), since these techniques block the implantation of a conceived ovum. This argument has been extended to the contraceptive pill as well. The contraceptive pill (i) changes the cervical mucus so that the passage of the sperm is blocked, (ii) inhibits ovulation, and (iii) affects the endometrium so that the uterus is not a hospitable environment for implantation. Of course this third route is only operational in preventing pregnancy if the first and second routes fail. It is not known in what percentage of cases the pill fails to block the sperm and fails to inhibit ovulation and is effective only because it manages to block implantation. It is argued, however, that even if this is rarely the case, a great number of embryonic deaths are caused due to this aspect of pill usage. Randy Alcorn calculates that “even an infinitesimally low portion (say one hundredth of one per cent) of 780 million pill cycles per year globally could represent tens of thousands of unborn children lost to this form of chemical abortion annually”.1
A concern for consistency has pushed advocates of the pro‐life position into opposing all contraceptive techniques that cause embryonic deaths. Catholics might welcome this, since the official position of the church is that, aside from the rhythm method, no contraceptive techniques are permissible. This benefit is questionable. What has gone unnoticed is that, if one is willing to make a few relatively innocent assumptions, then the rhythm method may well be responsible for massive embryonic death and the same logic that turned pro‐lifers away from morning after pills, IUDs and pill usage, should also make them nervous about the rhythm method.
The first assumption is that there are a great number of conceptions that never result in missed menses. There are estimates that only 50% of conceptions actually lead to pregnancies. The second assumption is that, even in clinical trials, the rhythm method can fail due to the fact that a pregnancy results from sexual intercourse on the last days before and the first days after the prescribed abstinence period. Estimates of the effectiveness of the rhythm method vary in the literature, but let us set its effectiveness for clinical trials at 90%—that is, conscientious rhythm method users can expect one pregnancy in ten woman years. The third assumption is that there is a greater chance that a conception will lead to a viable embryo if it occurs in the centre interval of the fertile period than if it occurs on the tail ends of the fertile period. This assumption is not backed up by empirical evidence, but does have a certain plausibility. From assumption one, we know that there is a high embryonic death rate. It seems reasonable to assume that an embryo that results from an “old” ovum (that is waiting at the end of the fertile period) or an “old” sperm (that is still lingering on from before ovulation), and that is trying to implant in a uterine wall that is not at its peak of receptivity, is less viable than an embryo that comes about in the centre interval of the fertile period. Let us make a conservative guess that the chance that an embryo conceived in the centre interval of the fertile period, which coincides with the abstinence period in the rhythm method—let us call this “the heightened fertility (HF) period”—is twice as likely to be viable as an embryo conceived at the tail ends of the fertile period.
So now let us run the argument. We know that even conscientious rhythm method users get pregnant. Conception may occur due to intercourse during the tail ends of the fertile period and the conceived ovum may turn out to be viable. Rhythm method users try to avoid pregnancy by aiming at the period in which conception is less likely to occur and in which viability is lower. So their success rate is due not only to the fact that they manage to avoid conception, but also to the fact that conceived ova have reduced survival chances. Just like in the earlier case of pill usage, we do not know in what percentage of cases the success of the rhythm method is due to the strictly contraceptive workings of the technique and in what percentage of cases it is due to the reduced survival chances for the conceived ovum. None the less, along with Alcorn, one could argue that even if the latter mechanism has only limited effectiveness, it remains the case that millions of rhythm method cycles per year globally depend for their success on massive embryonic death.
Let us try to make the argument more vivid. Pro‐lifers oppose IUDs because their main mode of operation is to make embryonic death likely. Now suppose that we were to learn that the success of the rhythm method is actually due, not to the fact that conception does not happen—sperm and ova are much more long lived than we previously thought—but rather because the viability of conceived ova outside the HF period is minimal due to the limited resilience of the embryo and the limited receptivity of the uterine wall. If this were the case, then one should oppose the rhythm method for the same reasons as one opposes IUDs. If it is callous to use a technique that makes embryonic death likely by making the uterine wall inhospitable to implantation, then clearly it is callous to use a technique that makes embryonic death likely by organising one’s sex life so that conceived ova lack resilience and will face a uterine wall that is inhospitable to implantation. Furthermore, if one is opposed to IUDs because their main mode of operation is to secure embryonic death, then, on the assumption that one of the modes of operation of the pill is to make embryonic death likely, one should be equally opposed to pill usage. This is essentially Alcorn’s argument and assuming that the empirical details hold, consistency does indeed drive IUD opponents in this direction. If, however, our empirical assumptions about the rhythm method hold, then one of its modes of operation is also that it makes embryonic death likely. And if embryos are unborn children, is it not callous indeed to organise one’s sex life on the basis of a technique whose success is partly dependent on the fact that unborn children will starve because they are brought to life in a hostile environment?
What is the expectation of embryonic death for rhythm method users? Our first assumption was that only half of the embryos are viable. I take it that this value holds for populations using no contraception and not distinguishing between HF and non‐HF periods (or using contraceptive techniques that do not distinguish between HF and non‐HF periods). What is not known is what proportion of embryos are conceived during the HF period as opposed to outside the HF period. Since it is reasonable to assume that only a minority of embryos are conceived outside the HF period, let us make a broad estimate that between 1/10 and 1/3 are so conceived. Then, by our third assumption—that is, that the chance of the viability is twice as high for an embryo conceived during the HF period as for an embryo conceived outside of the HF period, we can calculate that the chance of viability outside the HF period ranges roughly from one in four to one in three. So, on average, for every pregnancy that results from a conception outside the HF period, there are two to three embryonic deaths. And hence, by our second assumption—that is, that rhythm users may expect one pregnancy in ten woman years, it follows that we can expect two to three embryonic deaths in ten woman years. If all of Alcorn’s 780 million pill users were to switch to the rhythm method, then these converts would be causing, in his own words, the deaths not of tens of thousands, but of millions of unborn children.
So what is the alternative? If one is concerned about minimising embryonic death, then one should avoid types of contraception whereby each unintended pregnancy (due to its failure) comes at the expense of a high embryonic death rate. Given our first assumption, a condom user (who makes no distinction between HF and non‐HF periods) can count on one embryonic death for each unintended pregnancy. A rhythm method user, however, should count on two to three embryonic deaths for each unintended pregnancy. Assuming a success rate of 95% for condom usage, we can count on an expectation of .5 pregnancies in 10 years. Hence, the expectation of embryonic death is .5 per ten years for a condom user, which is substantially lower than the expectation of two to three embryonic deaths per ten years on the rhythm method. Even a policy of practising condom usage and having an abortion in case of failure would cause less embryonic deaths than the rhythm method.
So how can this argument be blocked? First, one could say that the empirical data are questionable. However, the result really depends on the simple assumption that embryos conceived outside the HF period are less viable than embryos conceived during the HF period. If this is the case, then the success of the rhythm method is contingent on a higher embryonic death rate and so every pregnancy due to a failure of the technique will come at the expense of a higher embryonic death rate—and this is all that is needed to get the argument off the ground. Second, one could be concerned about the death of an embryo due to an abortion but not due to IUD usage, because not providing the right environment for embryonic growth is less of a direct action than performing an abortion. This would bring in the intricacies of the action/omission doctrine. I am dubious that enough can be gleaned from the action/omission doctrine to support this distinction, but this is not the place to turn to this discussion. Third, one might draw a moral distinction between techniques that cause embryonic death (such as abortion and IUDs) and techniques that employ a mixed approach of preventing conception and increasing the likelihood of embryonic death in case conception occurs (such as the contraceptive pill and the rhythm method). There may indeed be a psychological distinction, similar to the comfort a person in a firing squad receives from not knowing that it was his bullet that killed the victim, but I do not think that this distinction has any normative force. Fourth, one might try to make a distinction between causing an inhospitable environment for embryonic survival (as in IUD and pill usage) and restricting the possibility of conception to a time when the environment is inhospitable for embryonic survival (as in the rhythm method). Again, the former may be considered to be more of a direct action than the latter, but once again, I think that this would be asking more from the action/omission doctrine than it can deliver.
And finally, one person’s modus ponens is another person’s modus tollens. One could simply conceive of this whole argument as a reductio ad absurdum of the cornerstone of the argument of the pro‐life movement, namely that deaths of early embryos are a matter of grave concern.
Fertility Awareness (for Parents) – Nemours Kidshealth
What Is Fertility Awareness?
Fertility awareness is a way to try to prevent pregnancy by not having sex around the time of
ovulation(the release of an egg during a woman’s monthly cycle). Couples who want to have a baby can also use this method to plan sex during the time the woman is most likely to conceive. Fertility awareness is sometimes called natural family planning, periodic abstinence, or the rhythm method.
How Does Fertility Awareness Work?
If a couple doesn’t have sex around the time of ovulation, the girl is less likely to get pregnant. The trick is knowing when ovulation happens. Couples use a calendar, a thermometer to measure body temperature, the thickness of cervical mucus, or a kit that tests for ovulation. The ovulation kits are more useful for couples who are trying to get pregnant. The fertile period around ovulation lasts 6 to 8 days. During this time, a couple using only fertility awareness for birth control should not have sex.
How Well Does Fertility Awareness Work?
Fertility awareness is not a reliable way to prevent pregnancy for most people. Over the course of a year, as many as 24 out of 100 typical couples who use fertility awareness alone will have an accidental pregnancy.
It is often very hard to tell when a girl is ovulating. She can conceive for up to 5 or 6 days before she ovulates and 1 or 2 days after. Because teens often have irregular periods, it makes predicting ovulation much harder. Even girls who usually have regular cycles can have irregular timing of ovulation from things like stress or illness. Fertility awareness requires a commitment to monitoring body changes, keeping daily records, and not having sex during the fertile period.
Does Fertility Awareness Help Prevent STDs?
No. Fertility awareness does not protect against STDs. Couples having sex must always use condoms to protect against STDs, even when using another method of birth control.
When Should I Call the Doctor?
Someone who uses fertility awareness should call the doctor if she:
- might be pregnant
- has a change in the smell or color of vaginal discharge
- has unexplained fever or chills
- has belly or pelvic pain
- has pain during sex
Natural Family Planning: Methods to Control Pregnancy
Natural family planning is a form of birth control that doesn’t involve pills or devices. As a result, it doesn’t have side effects.
With these methods, you track your fertility, which is when you are most likely to get pregnant.
How It Works
Usually, the ovaries release an egg at about the same time each month. That’s called ovulation. The egg moves through the fallopian tubes toward the uterus. An unfertilized egg can live up to 24 hours.
Fertility happens for about 6 days each month: 5 before ovulation and the day of ovulation. Natural family planning uses different methods to pinpoint those fertility days.
You can use natural family planning to control pregnancy in several ways:
Rhythm method. One of the oldest ways of natural family planning, this is based simply on the calendar. A normal menstrual cycle lasts between 28 and 32 days. Ovulation usually happens around day 14. So you would avoid unprotected sex on days 8 through 19, since that’s when you’re most fertile. Ask your doctor how best to use the rhythm method.
The rhythm method doesn’t work for all couples. People who have regular menstrual cycles and who are very careful about when they have sex usually find it effective. If that’s not you, this isn’t going to be the best approach to birth control.
Cervical mucus or ovulation method. Here, you track the mucus your cervix makes. When you’re ovulating, your mucus is clear, stretchy, and wet, like raw egg whites. You write down what your mucus is like each day so you know when you’re ovulating.
Basal body temperature (BBT) method. Your temperature can rise between 0.5 and 1 degree when you ovulate and stay there until your next period. With this method, you take your temperature before you get out of bed each morning, before you have anything to eat or drink.
BBT by itself isn’t a good way to prevent pregnancy, because charting your temperature tells you when ovulation has already happened.
Symptothermal method. With this, you combine several methods, usually BBT and cervical mucus. Using more than one method can give you a better idea of what’s going on in your body.
How Effective Is It?
Natural family planning isn’t as effective as other methods of birth control. According to the CDC, the failure rate is 24%. That means about 1 in 4 people who use natural family planning will get pregnant.
You need to be careful, be diligent, and have plenty of self-control to practice natural family planning. You have to follow instructions completely to be successful.
Natural family planning is free. There are no side effects. You can stop anytime, and it won’t have an impact on your body. It also meets most religious guidelines.
Apps can help you track your fertility, which can make things easier.
Once you’ve learned a method, you don’t have to keep going to a doctor for refills or follow-up appointments.
Natural family planning requires you to keep track of your body and stick to a schedule. It may not be for you if you have irregular periods or if you’re breastfeeding.
Talk to your doctor or gynecologist if you have questions about these methods or to see if natural family planning might work for you.
In addition, the rhythm method and other forms of natural family planning don’t protect you from sexually transmitted diseases (STDs). The male condom provides the best protection from most STDs.
FDA: Rhythm Method App Can Be Marketed for Contraception
WASHINGTON — Want to prevent pregnancy? There’s an FDA-approved app for that.
The rhythm method got a 21st century makeover when the FDA announced on Friday that they were permitting marketing of Natural Cycles, the first direct-to-consumer mobile medical application that can be used as “a method of contraception to prevent pregnancy” in premenopausal women ages ≥18.
Natural Cycles involves a woman inputting the reading of her waking basal body temperature, as well as her menstrual cycle information in the app, and the app then calculates days of the month where a woman is likely to be fertile, the agency said. Women who want to use the app “as a method of contraception” then avoid intercourse or use protection when “fertile day” is displayed on the app.
Clinical studies to evaluate the efficacy of Natural Cycles for “use in contraception” had 15,570 women use the app for an average of 8 months, and the agency cited a “perfect use” failure rate of 1.8%, meaning 1.8 in 100 women who used the app for 1 year would become pregnant because their protection failed on a fertile day or they had unprotected intercourse when the app “predicted they would not be fertile.” The app had a “typical use” failure rate of 6.5%, which accounted for “incorrect use,” such as having intercourse on fertile days.
Interestingly, a CDC fact sheet puts the failure rate of “fertility-based awareness” family planning methods at 24% (one assumes no data was available yet for fertility-based awareness method apps, however).
The agency said the application was approved under a de novo review pathway, and said they are establishing “special controls,” where the app meets criteria to assure “accuracy, reliability, and effectiveness” in preventing pregnancy. They added that this action also creates a new regulatory classification, with Natural Cycles serving as a so-called predicate device. That means similar apps putting the rhythm method into their own algorithms can reach market through the 510(k) process with no trials required, as long as they demonstrate “substantial equivalence” to Natural Cycles.
The FDA dutifully noted that the app does not provide protection against sexually transmitted infections.
Last Updated August 10, 2018
90,000 Contraception – Nikamed Clinic
If you plan to use contraception, you have a variety of options, from natural family planning and OTC contraception to prescription contraceptives or sterilization. If you have any questions about the birth control methods available, please make an appointment. At the consultation, you will receive comprehensive information about hormonal and non-hormonal methods of contraception and will be able to choose the option most suitable for you, as well as receive detailed information on the specifics of conception and pregnancy management.
Contraceptives include oral contraceptives, natural family planning and barrier methods. If you plan to use birth control (contraceptives), you should work with your doctor to find the right birth control method for you and your partner.
Barrier methods. This group includes male and female condoms, as well as diaphragms, cervical caps and contraceptive sponges.
Hormonal methods. A large set of contraceptive pills, a vaginal ring (NuvaRing), an intrauterine device (Mirena), contraceptive injections (Depo-Provera) and a contraceptive patch (Evra).
Intrauterine devices (IUDs). For example, the copper IUD (Multilood) and the hormonal IUD (Mirena).
Sterilization. Options include laparoscopic tubal ligation for women and vasectomy for men.
Natural family planning.Methods for controlling rhythm, basal body temperature and cervical mucus can be cited as examples.
It is also important to know about methods of emergency contraception, such as pills, which are used to prevent unwanted pregnancies after 3-5 days of unprotected sex.
Mechanisms of work of various contraceptives
Different contraceptives work in different ways. Basic mechanisms of action:
- Sperm-egg contact prevention
- Inactivation or destruction of spermatozoa
- Absence of cyclical changes in the ovaries (anovulation)
- Changes in the lining of the uterus, preventing the implantation of a fertilized egg
- Thickening of cervical mucus to prevent penetration of semen
To be effective, any method of contraception must be used consistently and correctly.Contraceptive methods that require special manipulation and involvement of a physician, such as IUDs, contraceptive implants, and sterilization, are associated with a lower chance of getting pregnant. In contrast, methods that require fertility monitoring (the ability to reproduce offspring) or periodic abstinence are associated with higher pregnancy rates. The correct method is the one that you can use and which is the most convenient for you.
Reversibility of the effect of contraceptives
The method of contraception you choose depends on your reproductive plans.If you are planning a pregnancy in the near future, a method that makes it easy to stop the contraceptive, such as oral contraceptives or a barrier method, may be appropriate. If you want to get pregnant, but not in the near future, it is worth considering an IUD. The method of using the IUD provides a quick recovery of fertility, but it is not economical if you intend to use it only for a short period of time.If you are confident that you will never want to have children in the future, a permanent method such as sterilization is preferred. Thus, different contraceptives are optimal at different stages of life.
Convenience and accessibility
For some people, convenience means ease of use, no side effects, or no effect on sex. For others, convenience is the lack of a recipe. When choosing a contraceptive method, ask yourself the question: are you willing to plan ahead or, if necessary, stick to a rigid schedule? It is very important to choose the type of contraceptive that suits your lifestyle and health condition.
Your tolerance for possible side effects associated with certain methods of contraception should be assessed. Some treatments for preventing unwanted pregnancies, especially those containing estrogen and progesterone, have more side effects than others, such as barrier methods and natural family planning methods. The doctor should assess your state of health, analyze all indications and contraindications for the appointment of a particular drug and, taking into account your preferences, recommend a birth control device.
Protection against sexually transmitted infections
Male and female condoms are the only contraceptive methods that provide reliable protection against sexually transmitted infections.
Other benefits of contraception
In addition to preventing unwanted pregnancy, some contraceptives have a number of therapeutic and cosmetic effects – for example, a regular menstrual cycle without pain, prevention of endometrial, ovarian and rectal cancer, effective fight against manifestations of hyperandrogenism (problem skin, hair loss).
Many factors should be considered when choosing a contraceptive method, including your age, health status, emotional maturity, marital status, and religious beliefs. Knowing the contraceptive methods available is an important part of the decision-making process. To make the best decision, it is advisable to discuss your healthcare provider’s options with your partner.
Presentation on the topic: Candidate of Medical Sciences, Revako P.P.
(from lat.contraceptio, lit. – contraception) prevention of pregnancy by mechanical and other contraceptives and methods.
• Calendar method of contraception
• Barrier method
– Men’s protection
– Women’s Protection
• Chemical method
– Vaginal spermicides
– Douching with acidic solutions
• Intrauterine methods of contraception
• Surgical methods
• Hormonal contraceptives
4 RHYTHM METHOD OPTIONS:
-Calendar (Pearl index 0.3 – 5.5)
-Temperature (Pearl Index 0.3 – 6.6)
– Cervical (Pearl index 6 – 39.7)
-Symptothermal – multicomplex (Pearl index 2-16)
Advantages of the method:
– No side effects
Limitations of the method:
– Low contraceptive effect
– Data Interpretation Difficulties
– Long period of abstinence
-Does not relieve fear of unwanted pregnancy
• It is based on determining the time of ovulation, which occurs on the 14 (+/- 2) day of the cycle, and limiting the number of intercourse during the periovulatory period.Given the viability of the egg (48 hours) and sperm (48 hours), sexual intercourse should be avoided from 10 to 18 days of the cycle.
• Male protection – condom. Protects not only from unwanted pregnancy, but also from sexually transmitted infections (gonorrhea, syphilis, chlamydial, mycoplasma infection, etc.).
• Women’s protection – a diaphragm, a rubber ring with a cap.
• The diaphragm is inserted so as to cover the cervix and create a mechanical obstruction to the passage of sperm.
BARRIER CONTRACEPTION METHODS
Indication for using the method:
– medical contraindications to other reversible methods of contraception
– Persons with rare sex
-As a temporary method of contraception (breastfeeding, while awaiting sterilization, etc.)
-Additional method for oral contraception, with IUD
BARRIER CONTRACEPTION METHODS
Benefits of a condom:
– Male participation in family planning
-Easy to use (do not forget the main thing – to teach how to use the method)
– Convenience of use with irregular contacts
– Prevention of premature ejaculation
-Protection against STIs, incl.h. AIDS
– Prevention of cervical cancer
90,000 Contraception – Clinic “Narvskaya” (St. Petersburg)
Pregnancy is the most wonderful time for both partners if this pregnancy is planned and desired. Today, for the prevention of abortion and pregnancy planning, there are many modern methods of contraception. The task of the specialists of the Narvskaya Clinic is to help your couple choose an acceptable method of contraception, taking into account the health status and rhythm of life of both partners.
Reception of a gynecologist, ultrasound, price
|Reception of the chief physician of the gynecologist||1500₽|
|Consultation with a gynecologist-endocrinologist||1500₽|
|Gynecologist’s appointment for contraception||1300₽|
|Installation of IUD without spiral cost||2000RUB|
|IUD installation with spiral cost||3500₽|
|Installing the Implanon contraceptive without the cost of the implant||2500RUB|
|Ultrasound of the pelvic organs||1200RUB|
All prices Promotions Ask a gynecologist
Modern methods of contraception
- Emergency contraception – used after unprotected intercourse within 72 hours, you can resort to it no more than 3 times a year.
- Hormonal contraception is an effective method with regular intake of micro-doses of hormones for long-term contraception.
- Intrauterine coil is a reliable method for long-term contraception in women giving birth, it requires a single introduction into the uterine cavity of a special medical device – a coil.
- Barrier contraception – for those who rarely have sexual intercourse or who have contraindications for using the above more effective methods.
Selection of contraception in the Narvskaya Clinic
Today there is no universal method that would be reliable and suitable for anyone. Each has its own pros and cons, indications and contraindications. Only a doctor can choose the best way to prevent unwanted pregnancy, taking into account all the characteristics of your body. When choosing a method of contraception, the specialist takes into account:
- You have children and your immediate reproductive plans;
- Your characteristics of sex life, frequency of sexual intercourse;
- You have gynecological diseases and diseases of other organs and systems;
- Your age
Sign up for the selection of contraception
90,000 Hormone therapy in the transition period of a woman’s life uMEDp
During the menopausal transition, the restructuring of hormonal homeostasis causes a number of changes in the female body, which negatively affect the quality of life and can lead to the formation of chronic diseases.Maintaining the health of women and preventing possible negative consequences of hormonal imbalance are among the most important tasks facing the gynecologist at this time. The main resource for these tasks is hormone therapy, prescribed according to the indications in three options. Hormonal contraception (combined and purely gestagenic) makes it possible to prevent pregnancy while simultaneously regulating the menstrual cycle and preventing a number of oncological diseases.Cyclic progestogens are indispensable for controlling uterine bleeding, regulating the menstrual cycle and preventing endometrial hyperplasia. Menopausal hormone therapy is aimed at relieving symptoms associated with estrogen deficiency and preventing certain chronic diseases. Dynamic changes in hormonal homeostasis in the transition period require not only a meaningful appointment of one or another type of therapy, but also the ability to make the transition between them without disrupting the quality of life of women.
The natural transition to the infertile status of the reproductive system in women is often associated with a deterioration in the quality of life and the onset of the formation of chronic diseases that can shorten life expectancy [1–4]. Reproductive aging – an integral part of the overall aging of the body – in women manifests itself brighter and more clearly than other manifestations of this process, while simultaneously reflecting health problems in general.The concept of healthy aging, which implies survival to old age with a delay in the development of cardiovascular diseases, cancer, osteoporosis and dementia, as well as the maintenance of daily and social activity , is impracticable without healthy reproductive aging. Hormone therapy is one of the main resources that ensures the protection of the health of women entering the transition period.
Three fundamentally different tasks are faced by a practicing gynecologist in the observation of women of mature age: prevention of unwanted pregnancy, control of an irregular menstrual cycle, and improvement of the quality of life, which is reduced as a result of menopausal vasomotor and psychosomatic symptoms.Three different groups of drugs can solve these problems and get additional benefits for long-term health preservation: hormonal contraceptives, progestogens, drugs for menopausal hormone therapy (MHT).
Hormonal contraception and prevention of unwanted pregnancy
Hormonal contraception (combined and purely gestagenic) is widely used in gynecological practice, and the need for its appointment in order to prevent pregnancy persists until menopause .Hormonal contraceptives are based on progestins – derivatives of nortestosterone, 17-hydroxyprogesterone or spironolactone . They are used as monopreparations or in combination with estrogens (ethinyl estradiol, estradiol, etc.), the main purpose of which is to level the side effects of gestagens.
Hormonal contraceptives have many positive non-contraceptive properties . Reducing the risk of developing ovarian cancer directly depends on the duration of the use of combined oral contraception, and this effect persists up to 20 years after the termination of the use of the method .The same is true for the reduction in the risk of endometrial cancer, which correlates with the duration of the use of combined oral contraceptives and is observed for more than 20 years after their withdrawal . Combined oral contraceptives also reduce the risk of colorectal cancer  and, without significantly affecting the risks of other malignant neoplasms , generally reduce cancer risk . In addition, there is evidence of proven therapeutic or prophylactic effects of combined hormonal contraception (CHC) in relation to a number of gynecological and extragenital diseases and conditions [13–15].But even if there are additional indications in the instructions for use of the contraceptive drug, hormonal contraception remains primarily a method of preventing pregnancy. Ignoring this circumstance, recommending a contraceptive to a patient who is not sexually active, or is absolutely incapable of conceiving, or who wants to become pregnant, is possible only in cases where there is no alternative way to resolve a clinically significant problem. However, it is during the menopausal transition, against the background of a decrease in sexual activity and the ability to conceive, that complaints of menstrual irregularities often appear, requiring the appointment of therapy, rather than contraception.
Progestogens and menstrual cycle control
The period of menopausal transition is manifested by the variability of the menstrual cycle, going beyond seven to nine days . An interesting endocrine event of this initial phase is the increase in estrogen secretion in the luteal phase of the cycle, observed in 20–37% of women . This anomaly can be explained by an increase in the level of follicle-stimulating hormone as a result of a decrease in the secretion of inhibin B.Under the influence of follicle-stimulating hormone, folliculogenesis is accelerated and the second (immediately after ovulation) and third (towards the end of the luteal phase) waves of recruitment of immature follicles, incapable of full ovulation, but secreting estradiol, appear. High levels of estradiol after ovulation excessively decrease the amplitude of pulse luteinizing hormone secretion, leading to dysfunction of the corpus luteum associated with insufficient production of progesterone . From a clinical point of view, an excess of estrogen is a risk factor for abnormal uterine bleeding and endometrial hyperplasia already at this stage of ovulatory dysfunction, and subsequent anovulation only exacerbates the problem.
The main way to correct menstrual irregularities in the early phase of the menopausal transition is the use of drugs that restore the lost hormonal balance, namely progestogens. They are prescribed in such doses and regimen so as not to suppress ovulation and the secretion of endogenous progesterone, but to effectively control the endometrium. Among them, the optimal pharmacological profile is demonstrated by dydrogesterone – retroprogesterone, a stereoisomer of natural progesterone. Dydrogesterone is distinguished from synthetic progestins by such an important property as the absence of a significant effect on fat and carbohydrate metabolism.This is especially true during the menopausal transition, when a regular age-related weight gain  can lead to the accumulation of visceral fat and the development of metabolic syndrome, and estrogen deficiency can increase the risk of type 2 diabetes mellitus .
Abnormal uterine bleeding due to ovarian or endometrial dysfunction is considered the main indication for the appointment of progestogens during the menopausal transition. Their frequency increases with age , and with it the incidence of benign endometrial hyperplasia increases, which is also recognized as an indication for the use of progestogens .Given the inevitable increase in the risk of these disorders, the range of use of progestogens during the menopausal transition can be expanded. It seems appropriate to recommend them to women who have complained of rhythm disturbance (delay) of menstruation and risk factors for the development of abnormal uterine bleeding  and / or endometrial hyperplasia / cancer .
Menopausal hormone therapy and correction of climacteric disorders
The late phase of the menopausal transition begins with lengthening the delays of menstruation up to 60 days and the appearance of episodes of amenorrhea, characterized by an increase in the frequency of anovulatory cycles.The duration of this stage of reproductive aging is usually one to three years before menopause . There is an opinion that the secretion of estradiol at this time is steadily decreasing, and the level of follicle-stimulating hormone increases. However, monitoring of hormonal parameters demonstrates their significant variability and the possibility of periodic return to the premenopausal range. Given such significant fluctuations in the secretion of follicle-stimulating hormone, it is not recommended to use the determination of its concentration in the blood to clarify the status of the reproductive system.Like the early phase of the menopausal transition, the late phase is established clinically by the appearance of periods between menstrual periods, the duration of which exceeds 60 days.
Of course, the clinical criteria for entering the menopausal transition are valid only with an initially regular rhythm of menstruation and the non-use of hormonal drugs that simulate the menstrual rhythm . If it is impossible to clinically establish the status of the reproductive system, the average population characteristics should be used, according to which most women enter perimenopause after 45 years.Starting from this age, complaints of hot flashes and other vasomotor and psychosomatic symptoms signal the onset of the late phase of the menopausal transition associated with estrogen deficiency, and require MHT . A reasonable objection may arise: according to the instructions for the use of MHT drugs, they are recommended to be prescribed to women during the menopausal transition with a delay in menstruation for more than six months. Why do the guidelines and clinical guidelines of the international and expert communities contradict each other?
The history of MGT, unfortunately, is rich in negative events [25, 26].If we consider each of them separately, it becomes clear that the reason for the undesirable outcomes each time was the experimental appointment of MHT, either in deliberate attempts to expand the scope of this group of drugs, or from the best intentions (the desire to provide the patient with an optimal quality of future life, youth and beauty). Restricting such impulses was absolutely necessary, which was the reason for reminding doctors about the advisability of prescribing MHT not earlier than the late phase of the menopausal transition, which is most often characterized by prolonged delays in menstruation.However, “most often” does not mean “always”. Hot flashes may occur when menstruation is delayed for a shorter duration and even against the background of regular menstrual cycles . In fairness, we note that the phenomenon of vasomotor symptoms with a regular cycle is rare, and this demonstrates the independent significance of menstrual irregularities as a stress factor in the pathogenesis of disorders leading to the development of climacteric syndrome. Nevertheless, any options for the course of the menopausal transition may be accompanied by hot flashes, other vasomotor and psychosomatic disorders.For women using hormonal contraception or progestogen therapy and having regular withdrawal bleeding, the six-month missed period criterion does not apply. But even these women can go to a doctor with complaints of a deterioration in well-being associated with the extinction of endogenous estrogen production.
Thus, the main starting point in deciding whether to conduct MHT are vasomotor and psychosomatic symptoms caused by estrogen deficiency, not only negatively affecting the quality of life, but also reflecting delayed health problems [28, 29].Waiting for six months of amenorrhea for the initiation of MHT is advisable when the woman’s complaints are insignificant, do not violate the quality of life and, accordingly, call into question the very need for treatment.
Agreeing with the generally accepted thesis in medicine that the appointment of therapy is determined by the diagnosis, one has to ask how not to be mistaken in establishing the diagnosis of “climacteric syndrome”, also called menopausal syndrome, pathological menopause, or described in terms of a symptom complex closely associated with estrogen deficiency.The main symptoms of climacteric syndrome include hot flashes or chills, which has a pathophysiological basis. Hot flushes are associated with impulses of luteinizing hormone , which in turn are regulated by gonadotropin-releasing hormone (GnRH). Consequently, the occurrence of hot flashes is closely related to hypothalamic neuronal regulation. Among the variety of systems for neuronal control of GnRH secretion in the context of menopausal disorders, the group of KNDy neurons expressing transcripts of the kisspeptin and neurokinin B genes deserves attention.In postmenopausal women, this group of neurons undergoes hypertrophy secondary to estrogen deficiency but not aging . Hyperexcitation of KNDy neurons spreads to neighboring centers and, activating GnRH neurons, promotes an increase in luteinizing hormone impulses. At the same time, as a result of aging of the central nervous system and partly due to estrogen deficiency, there is a reduction in serotonin receptors and sensitization of serotonergic structures. Under such conditions, any additional exogenous or endogenous stimulus leads to an inadequate response of the neuronal systems of the brain with the involvement of the thermoregulatory center through serotonin and norepinephrine and a change in peripheral vascular reactivity.This is clinically expressed in hot flashes or chills, on the basis of which it can be concluded about the pathological course of menopause.
Hot flashes are a classic and predominant, although not pathognomonic, symptom of age-related estrogen deficiency . Taking into account the age-related and clinical periodization of reproductive aging, the diagnosis of climacteric syndrome should be made in women experiencing hot flashes over the age of 45, regardless of the nature of the menstrual cycle, or at the age of 40–45 with a violation of the initially regular menstrual cycle.In other cases, additional diagnostics are needed to determine the reproductive status and / or the causes of complaints that worsen the quality of life.
Vasomotor and psychosomatic symptoms that reduce the quality of life of women in the periods of menopausal transition and postmenopause are the main signal for the onset of systemic MHT. Another reason for choosing systemic MHT is the need to prevent osteoporotic fractures in high-risk groups [1, 24, 33].
Establishing the status of the reproductive system is important in connection with the choice of the mode of application of the combined MHT. It is known that in the period of the menopausal transition, a cyclic (biphasic) regime is used, in postmenopause, a monophasic regimen of taking estrogen-progestogen combinations. Menopause is diagnosed by the absence of menstruation for 12 months, but this is only true for women with its timely onset, that is, over the age of 45. Moreover, the occurrence of uterine bleeding after 12 months of amenorrhea in women younger than 50 is often viewed as a resumption of menstruation, rather than as postmenopausal bleeding.Therefore, the diagnosis of menopause by 12-month amenorrhea is acceptable in women over 45-50 years old, and for younger women, it is customary to talk about menopause in the absence of menstruation for 24 months.
In accordance with international and national clinical guidelines, combined MHT is prescribed for women who need protection against estrogen-induced excessive proliferation of the endometrium or endometrial-like tissue [1, 24, 33]. Thus, the progestogenic component is necessary in the composition of MHT for women with a preserved uterus or women who have undergone hysterectomy, but have confirmed external genital endometriosis.
However, the value of the progestogen goes beyond the scope of protection of the endometrium allotted to it. The difference in the metabolic effects of progesterone, its analogs and derivatives of other steroids may be a significant factor in determining the positive and negative outcomes of therapy. The risks of MGT are known. These primarily include breast cancer and thrombotic complications . The use of medroxyprogesterone acetate in combination with estrogen in the WHI study participants increased the risk of cardiovascular disease and breast cancer, in contrast to the use of pure estrogens .In contrast, progesterone and dydrogesterone have a favorable safety profile, without increasing the risk of developing breast cancer , venous thromboembolism and arterial thrombosis in combination with estrogens, and without reducing the beneficial effects of estradiol on endothelial function and preventing the development of visceral obesity and sugar type 2 diabetes [24, 35]. The disadvantage of progesterone is its relatively weak protective effect on the endometrium, requiring an increase in the daily dose .This reduces adherence to treatment, as well as the forced separate use of two components of therapy – estradiol and progestogen. Dydrogesterone, which is part of the combined preparations of the “Femoston” line, possessing the positive properties of progesterone, has a higher affinity for progesterone receptors, which provides endometrial protection, similar to that of synthetic progestins.
Principles of prescribing hormone therapy
After studying the characteristics of the three types of hormone therapy and the indications for their appointment, it becomes clear that the choice of one or another of them will depend on the status of the reproductive system, assessed clinically or, if such an approach is impossible, established presumably by the age of the patient.
Contraception will be the first in the priority of the use of hormone therapy methods, based on age. Recommendations on the specifics of the primary prescription of CHC come into force when consulting women over 35, that is, long before the onset of the menopausal transition.
The main concern when using hormonal contraception is the risk of thrombosis due to the action of the estrogenic component . The generalized data indicate a low incidence of thrombotic complications of CHC: the incidence of acute conditions caused by thrombosis is 6–9.9 cases per 10,000 women per year .These conditions are usually represented by venous thromboembolism. The risk of myocardial infarction increases exclusively in women who smoke , and a twofold increase in the risk of ischemic stroke does not seem so threatening due to its rarity in the population of women of fertile age (1 case per 10,000 women per year)  and dependence on other factors, especially migraine.
Nevertheless, the increased risk of thrombotic complications in the older age group imposes a number of restrictions on the use of CHC, including in women who smoke or in patients with migraine .In the absence of contraindications for taking CHC for primary use, only those drugs that contain estradiol or a microdose of ethinylestradiol are suitable. Minimizing the action of the estrogenic component allows not only to reduce thrombotic risks, but also to reduce the likelihood of estrogen-dependent weight gain associated with fluid retention, as well as to increase the level of triglycerides entering the fat depots. Overweight is an additional risk factor for thrombosis in adult women, which deserves attention in the process of individual selection of contraceptives .
In the age group over 45, it is unreasonable to initiate CHC intake, since the likelihood of pregnancy is significantly reduced, and the risk of complications increases, starting to outweigh the possible benefits. The method of contraceptive choice in this situation is “pure” gestagens, the use of which is not associated with the risk of venous thromboembolism , and additional positive properties allow good control of the endometrium, which is prone to excessive proliferation, and prevent episodes of heavy menstrual bleeding.The weak side of progestogen contraception is the lack of control over the rhythm of menstruation, which should be warned about a woman. If this aspect does not cause her concern, the use of progestogens can be continued until menopause or the appearance of signs of estrogen deficiency, which serve as an indication for the appointment of MHT.
The risk of thrombotic events associated with CHC has a clear inverse relationship with the duration of use of the hormonal agent, virtually disappearing after six months of taking the drug .Therefore, women who started taking CHC before the age of 35 may not switch to micro-dosage drugs after reaching this milestone. They are advised to change the method at 45 years old, and at their choice it can be either a microdosed or estradiol-containing CHC, or a purely gestagenic drug. At the age of 50, the question of continuing to receive KGC is raised anew. In case of refusal from CHC, women should be offered barrier contraception, but if they wish to continue taking CHC, this can be done until the expected menopause, but no longer than 55 years old .
Thus, the first key point in making a decision on the use or modification of hormone therapy is the age limit of 45 years, which determines not only the very possibility of prescribing CHC, but also the need to switch to microdose drugs or purely progestogenic contraception. But it is after 45 years that most women enter the period of the menopausal transition, when the variability of the rhythm of menstruation appears and its disturbances only progress in the future.Obviously, at this stage of aging of the reproductive system, the primary goal is not contraception, but the regulation of the menstrual cycle with the simultaneous prevention of diseases associated with ovulation disorders. It can be achieved by progestogen therapy in a cyclic mode of application [21, 43].
Two prescription regimens for dydrogesterone (Duphaston) are acceptable during the menopausal transition. Most often, it is recommended to take 20 mg of the drug from the 11th to the 25th day of the menstrual cycle.This regimen well regulates the rhythm of menstruation and is indicated for women with abnormal uterine bleeding associated with ovulatory dysfunction, especially in situations where menstrual bleeding does not go beyond moderate blood loss. The regimen of prescribing dydrogesterone from the fifth to the 25th day of the cycle in a daily dose of 20 mg or more is advisable if it is necessary to control excess menstrual blood loss in women with abnormal uterine bleeding or benign endometrial hyperplasia.
Tracking the onset of menopause in women using hormonal drugs is difficult . Cyclic administration of progestogens / CHCs simulates menstrual bleeding or the like, and continuous or prolonged use of CHCs / purely progestogenic contraceptives may be accompanied by amenorrhea. Therefore, the reason for switching from contraception or progestogen therapy to MHT is the occurrence of complaints associated with a deficiency of endogenous estrogens, or another clinically significant situation, for example, prevention of osteoporotic fractures in high-risk groups, indicated as an indication for hormone therapy with estrogens .The disappearance or scarcity of withdrawal bleeding serves as an additional factor indicating a possible menopause, but not an indication for MHT in the absence of symptoms of pathological menopause.
The KGK – MGT transition algorithm has been revised many times. Re-assessment of the level of follicle-stimulating hormone with an interval of four to six weeks after the abolition of CHC is now not practiced, since interruptions in taking combined hormonal drugs are fraught not only with the occurrence of an unwanted pregnancy or a deterioration in the quality of life, but also with the development of thrombosis, the likelihood of which already increases with age …A number of experts believe that in order to clarify the status of the reproductive system, it is advisable to assess the levels of gonadotropins at the end of the seven-day hormone-free interval of CHC intake. But the regimen of taking modern CHCs often provides for shorter hormone-free intervals or even their absence . Interpreting the results of hormonal studies in such situations is difficult. In addition, during the menopausal transition, the secretion of gonadotropins is variable, little predictable and reflects exclusively the current status, not allowing to reject the possibility of resumption of menstruation and even ovulation in the future.Therefore, the North American Menopause Society, with which other large communities of experts in the field of contraception and observation of older women have agreed, recommends switching from contraception to MHT without additional testing or any interruption .
It is much easier to make the transition to MHT in women using progestogens during the menopausal transition to regulate the menstrual cycle: the appearance of hot flashes in women receiving progestogen therapy in a cyclic mode becomes a signal for the addition of an estrogenic component.If women over 45 years old, taking progestogens, stop regular menstrual withdrawal bleeding, then the onset of menopause can be ascertained without additional examination. In this case, the question of prescribing MHT is resolved positively if there is a deterioration in the quality of life due to estrogen deficiency, or there is a need to prevent osteoporotic fractures [1, 24, 33].
The choice of MHT regimen when switching to it from contraception or purely progestogen therapy depends on the expected status of reproductive aging.
The cyclic regimen of estrogen-progestogen drugs should be offered to two categories of patients:
90,024 90,025 women under 50;
90,025 women 50–55 years of age with hot flashes or other menopausal symptoms with persistent menstrual or menstrual bleeding withdrawal.
The choice of the dose of estradiol in MHT preparations depends on the severity of the symptoms. With mild to moderate severity of climacteric syndrome, 1 mg of estrogen in the MHT is sufficient (Femoston 1).For severe symptoms, it is more advisable to prescribe 2 mg of estrogen (Femoston 2) for a faster achievement of the effect.
Monophasic mode (Femoston conti) is recommended:
- women 50–55 years old using CHC or cyclic progestogen therapy, in the absence of withdrawal bleeding;
90,025 women over 55.
The duration of MHT is not limited today, since while maintaining a clinically significant situation for which hormone therapy was initiated, its benefits outweigh the risks .Discontinuation of hormonal drugs is often associated with recurrence of symptoms and an increased risk of chronic diseases, which MHT can prevent [26, 47]. The use of MHT with the minimum effective dose of estrogen in women over 65 years of age is allowed subject to persistence (return) of hot flashes, regular medical supervision and informed consent of the patient to continue taking hormonal drugs . A combination of 0.5 mg of micronized estradiol and 5 mg of dydrogesterone (Femoston mini) can be an option for patients of this age group.
In the presence of appropriate indications and the absence of contraindications, preparations of sex steroid hormones and their combinations can be used in the periods of late reproduction, menopausal transition and postmenopause, providing a high quality of life and prevention of diseases associated with aging. Skillful use of this resource is really capable of providing women with active longevity.
TEENAGE CONTRACEPTION | # 04/02 | The Attending Physician is a professional medical publication for doctors.Science articles.
What methods of contraception are used in adolescents?
Which methods should be preferred in certain circumstances?
As you know, adolescents are characterized by transient hypersexuality. If the parents did not create a psychological barrier before the age of 10-12, which prevents the early onset of sexual activity, then the first sexual intercourse can occur already in adolescence.The average age of sexual debut in Russia is 16.1 years; by the age of 18, 1/3 of girls (23-40%) have a single experience of sexual intercourse . Therefore, already in adolescence, girls and boys should be provided with basic information about contraception, sexually transmitted diseases (STDs), emergency contraception (EC), the dangers and consequences of early abortion.
Adolescents often engage in sexual intercourse in an inappropriate, “non-romantic” environment: in a basement, in a dacha, in a car, in companies, at home next to their parents and often without prior preparation, in a state of alcohol and / or drug intoxication, with elements of violence etc.Therefore, the contraceptives recommended for adolescents must meet modern requirements for contraceptives: high efficiency, acceptability, safety and individual tolerance.
For most adolescents, who usually have an irregular sex life, the most acceptable method of choice is the barrier method, that is, a condom. It prevents conception and protects against infection with sexually transmitted diseases, and under certain parameters (made of nonxilon-coated latex: DUREX, RFSU) – against AIDS.This is especially important if the girl has a relationship with several or one casual partner. But condoms often break, slip off, put on incorrectly, lubricate with ointments and fat-based creams, stored for a long time in a crumpled state or in high humidity, and are exposed to direct sunlight. Therefore, adolescents are advised to use the so-called double Dutch method (simultaneous use of a hormonal oral contraceptive with a condom), when the high efficacy of an oral agent is complemented by the prevention of STDs provided by a condom.
In Russia, the proportion of oral contraception among adolescents and young women reaches 9-15% . However, hormonal contraception is acceptable only for those adolescents who have more or less regular sex and are sufficiently informed about the use of this method. The priorities for adolescents taking oral contraceptives are low-dose combined (COC) (containing 30-35 mcg ethinylestradiol), highly selective progestogens (third generation) with low androgenic activity, monophasic drugs such as Mersilon, Marvelon, Femoden, Logest, Selest.It is undesirable to use pure gestagens (“mini-pills”), injectable and intrauterine contraceptives for adolescents. The same can be said about physiological methods (rhythm method, temperature method), since it is ineffective for adolescents.
Due to a lack of funds and a lack of awareness of the quality of condoms, adolescents often use cheap condoms, which increases their risk of contracting STDs. In such cases, chemical methods of protection (spermicides), used simultaneously with a condom, help.Spermicides include Pharmatex, Pantexoval, Dolphin, Galenic and other drugs produced in the form of suppositories, tablets, creams, sponges, films, aerosols. These drugs have a spermicidal, and some of them bactericidal effect and are inserted into the vagina just before intercourse. Suffice it to mention that the main active ingredient in Pharmatex, benzalkonium chloride, is four times more effective than another surfactant, nonxilon-9, used to coat some condoms.Nonxilon-9 suppresses the causative agents of gonorrhea and syphilis, inhibits the growth of fungi, chlamydia and Trichomonas, is fatal for herpes viruses, cytomegalovirus, Epstein-Barr virus.
Nonxilon-9 is also an active ingredient in the zhinofilm contraceptive film, which has some advantages over other spermicides – it does not increase the volume of vaginal secretions and has a bactericidal effect, in addition, the contraceptive film is invisible .
Emergency (urgent, postcoital) contraception is very important in case of “unprotected” coitus, failure of barrier methods (tearing, slipping of the condom), missed oral contraceptive pills, in cases of rape.
In 1970, the Canadian doctor A. Yuzpe suggested using combined estrogen-progestin drugs in cases of EC. This method, first applied in 1972, was named after him. The Yuzpe method consists of two-fold administration of 200 mcg of ethinyl estradiol and 1 mg of levonorgestrel or 2 mg of norgestrel (each tablet contains 50 mcg of ethinyl estradiol and 0.25 mg of levonorgestrel or 0.5 mg of norgestrel). Within the first 72 hours of unprotected intercourse, 2 tablets are taken, and 12 hours later, 2 more tablets are taken in the United States and Canada, this EC is called ovral; in Germany and Switzerland – tetragion, in Great Britain – Schering PC 4.In our country, rigevidon or microginon-30 is used – 4 tablets in the first dose and 2 tablets in the second (data from the consortium for urgent contraception; 1996). V.N.Serov and S.V. Paukov recommend taking 3 tablets of Marvelon, Microginon, Silest in the same regimen. In addition to the Yuzpe method, there are other EC methods – estrogens, gestagens, danazol, mifepristone, IUD insertion, but due to the many adverse reactions they are not used in adolescents .
Practice shows that uninformed girls willfully interrupt the use of contraceptive pills, having discovered in themselves certain side effects.In addition to the contraceptive effect, hormonal drugs can cause side effects – temporary conditions that, as the body adapts to the drug, disappear without any consequences and usually do not require its cancellation. In adolescence, the lack of sex hormones occurs three times more often than their excess. Some negative side reactions are caused not by excess, but by a lack of estrogen (hot flashes, intermenstrual bleeding at the beginning and middle of the cycle, decreased libido, irritability, vaginal dryness, decrease in the size of the mammary glands) or progesterone deficiency (menorrhagia with clots, intermenstrual bleeding at the end of the cycle, delayed menstrual reaction after taking the drug).With all the variety of negative side reactions, they disappear after 1-3 months or a little later. The positive side effects or non-contraceptive benefits of taking COCs include a decrease in anxiety about a possible pregnancy, a decrease in the risk of ectopic pregnancy, as well as the frequency of inflammatory diseases of the genitals; prevention of the development of benign and malignant tumors of the ovary and uterus, mammary glands; harmonization of metabolic processes; normalization of the menstrual cycle; relief of ovulatory pain and symptoms of premenstrual tension .
In adolescence, the question of contraindications to the appointment of COCs is not as acute as in adults, however, due to the presence of one or another chronic pathology in three out of four adolescents, one has to be careful and think about the safety of taking them. In general, young women tolerate low-dose drugs well, and the use of COCs is limited by known contraindications.
Currently, adolescents independently purchase and take various medications (analgesics, sleeping pills), as well as a number of antibiotics, sulfonamides, antiepileptic drugs, antipsychotics, etc.used as prescribed by a physician, contribute to the weakening of the action of the used COCs. Among adolescent girls taking COCs, factors that weaken their contraceptive effect are also smoking and drug use, weight loss with induction of vomiting or diarrhea after eating.
Girls receiving hormonal contraceptives should be under the dispensary supervision of a teenage gynecologist or family planning specialist and come to an appointment once a month for the first 3 months, and then quarterly.General information about contraceptives can be presented for the first time to adolescents at the age of 13-14, and more detailed information – at 15-16 years. Even if this information does not seem relevant to some adolescents, the first knowledge and skills on contraception should be obtained from the adolescent gynecologist in advance.
Thus, the implementation of the outlined recommendations for the use of modern and reliable methods of contraception among adolescents and young girls, both for the first time starting to take contraceptives and changing the method or drug, will significantly reduce the risk of unwanted pregnancy, the incidence of sexually transmitted infections, the proportion of abortions among adolescents.The opportunity given to a young woman to have only the children she wants, and just when she is ready for this morally and socially, will ultimately have a beneficial effect on future generations.
- Gurkin Yu. A. Reproductive problems of adolescent girls (manual for cadets’ doctors). SPb., 1997. S. 24–28.
- Korkhov V.V., Gurkin Yu.A. Adolescent contraception. Gynecology of adolescents (a guide for doctors). SPb .: Foliant, 1998.S. 463.
- Kostava MN Treatment of diseases of the cervix caused or combined with inflammatory processes of the lower genital tract // Gynecology (journal for practitioners). 2000.Vol. 2.No. 3.P. 90.
- Kulakov V.I., Prilepskaya V.N., Oganezova M.V. Emergency contraception // Gynecology (a journal for practitioners). 2000. T. 2. No. 2. S. 36-42.
- For most adolescents who have a generally irregular sex life, the barrier method is the most acceptable method of choice
- Hormonal contraception is only acceptable for adolescents who have more or less regular sex
- In case of “unprotected” coitus, emergency (urgent, post-coital) contraception is very important
- The side effects of COCs, if the drugs are taken correctly, usually disappear in 1-3 months
- Girls receiving hormonal contraceptives should be under the dispensary supervision of a teenage gynecologist
90,035 90,000 Modern aspects of contraception
The modern rhythm of life dictates its own conditions.By setting goals, we want to achieve them as soon as possible. And to be confident in the future, to know that you are insured against failure is very important. A modern woman is used to planning her life herself, clearly regulating her events. Therefore, to achieve this goal, she needs a lot. Competent contraception is one of the important links in this chain. It is she who helps to plan pregnancy when it is desired. And also to protect the fragile female body from a number of gynecological diseases, such as:
violation of the menstrual cycle
adenomyosis and endometriosis
Restrictions on the use of oral contraceptives
- history of thrombosis and embolism
- diseases accompanied by severe liver dysfunction
- Heart failure and cerebrovascular disorders
Therefore, the selection of the drug should be carried out only by a doctor.But with the correct, systematic use of contraceptive pills, you have almost guaranteed protection against unwanted pregnancy.
Preparations for contraception
A huge selection and variety of modern oral contraceptives is an undoubted “plus” for every woman, tk. it is possible to select hormonal drugs that are individually suitable for each and to minimize side effects and risks.
In our online pharmacy you can find not only time-tested drugs, but also new products such as Jess plus, Yarina plus.A special protection system – the Nova-ring vaginal ring – occupies a special place.
New, low-dose monophasic oral combined estrogen-gestagenic contraceptive preparation, including active tablets (containing drospirenone and ethinyl estradiol) and auxiliary vitamin tablets (containing calcium levomefolate). The homronic components of the drug help to prevent hormone-dependent fluid retention, which can manifest itself in a decrease in body weight and a decrease in the likelihood of peripheral edema, and also help to reduce acne (acne), oily skin and hair.Levomefolate is a biologically active form of folate and is better absorbed than folic acid. The introduction of calcium levomefolate in the composition of the drug reduces the risk of developing a defect in the neural tube of the fetus if a woman becomes pregnant unexpectedly, immediately after stopping contraception.
The second novelty with a similar composition. Taking the drug helps to normalize the menstrual cycle, it becomes more regular, the pain, intensity and duration of menstrual bleeding decrease, as a result of which the risk of iron deficiency anemia decreases.The risk of developing endometrial and ovarian cancer is also reduced. The drug is recommended for women with symptoms of hormone-dependent fluid retention in the body; as a contraceptive for women with folate deficiency, as well as in the complex therapy of moderate forms of acne (acne vulgaris).
A revolutionary form of a contraceptive in the form of a vaginal ring, which causes the absence of systemic effects of hormones on the body. The effect of the drug is exclusively local, which makes its use possible in women who have contraindications to the use of oral contraceptives.Against the background of the use of the drug NovaRing, the cycle becomes more regular, the pain and intensity of menstrual bleeding decreases, which helps to reduce the frequency of development of iron deficiency states. There is also a reduced risk of endometrial and ovarian cancer. In addition, the risk of developing ovarian cysts, inflammatory diseases of the pelvic organs, benign changes in the mammary glands and ectopic pregnancy is reduced, which is not typical for any of the drugs.No medical attention is required to insert the ring into the vagina. The ring should be in the vagina at all times for 3 weeks. It is only advisable for a woman to regularly check whether it remains in the vagina and, if necessary, correct its location. The use of this contraceptive can be limited in severe or chronic constipation, as well as in women leading an overly active lifestyle (intense physical activity, etc.) due to the risk of ring loss.
The use of modern contraceptives will help reduce the risk of unwanted pregnancy to a minimum and will allow you to enjoy life in all its colors.
Please note the following publications:
Modern method of contraception (spiral)
Contraception after childbirth / Maternity.Ru
Having a child is a rather difficult test for a woman’s body. Psychological activity is also added to the physical activity: no matter how happy we are with the baby, his birth greatly changes our rhythm of life. How not to get pregnant right after childbirth? And how not to harm the newborn baby?
Resourceful nature has foreseen all these questions and found a truly wise answer for them: it turns out that while a woman feeds her baby with breast milk, invaluable for him, she will not need additional contraception.This unique mechanism is based on the principle of lactational amenorrhea, or absence of menstruation. Under the action of the hormone prolactin, which is produced in the pituitary gland of a nursing mother and is involved in the synthesis of milk, ovulation is also blocked (this is the process of maturation of the follicle and the release of an egg from it). And if ovulation does not occur, then, accordingly, conception itself becomes impossible.
This natural method is absolutely reliable and safe for the health of a nursing mother. In addition, during feeding, the baby receives vital antibodies-immunoglobulins, which already in the first months of life form his strong immunity and protect him from various infections.Having such a gift from God, it is simply unreasonable to independently and artificially deprive yourself of such happiness – feeding your baby with natural breast milk!
All this must be borne in mind by those women who artificially stop lactation (the process of formation of breast milk), trying to maintain a beautiful breast shape. In this case, the child is deprived of the most important substances for his development, the process of natural contraception, provided by nature itself, is disrupted. It turns out that a woman has to select other hormonal agents immediately after childbirth that will protect against unwanted pregnancy.
What if the natural protection is no longer working?
The breastfeeding method has one essential feature – it is only effective when the baby is fully breastfed. This means that the mother feeds the child exclusively with breast milk, and (which is very important!) Always at the request of the baby. Only in this case there is a regular synthesis of the hormone prolactin, which, as mentioned above, blocks the processes of ovulation and conception.
What about those women who did not have enough milk? In this case, you can advise the old, time-tested ways to increase the volume of breast milk.Firstly, the mother herself needs to include sufficient milk in her diet (and not only milk, you can also drink tea with condensed milk – if there is no allergy to condensed milk), and in general, drinking during feeding should be abundant. Secondly, try to breastfeed your baby a little, but as often as possible. In addition to milk, some other foods contribute to lactation, such as walnuts (which, unfortunately, can often cause allergies).
In addition, there are times when a woman cannot feed her baby due to illness or in accordance with her personal psychological principles (for example, to maintain a beautiful breast shape).
Let’s summarize. In what cases should you not rely on the method of “natural” contraception?
1. If a woman is not breastfeeding, then the normal menstrual cycle, as a rule, is restored after 4-6 weeks. And with the restoration of regular menstruation, pregnancy is already possible.
2. In case of incomplete breastfeeding, when the mother begins to use various complementary foods. The volume of breast milk gradually decreases, the synthesis of prolactin in the pituitary gland decreases, and at the same time the function of the ovaries is gradually restored (ovulation occurs).This is manifested either by normal menstruation or by spotting menstrual flow.
3. With full breastfeeding, menstruation will also begin (and consequently, conception is possible) if the nursing mother reduces the volume of lactation or takes the baby away from the breast.
In all these cases, there is no longer any hope for the effect of prolactin: if you are not planning another child, you will have to use additional methods of contraception. They can be either barrier methods of contraception (condom, caps), or hormonal contraceptives.Barrier contraceptives are simple and have no contraindications, however, they do not guarantee one hundred percent protection against unwanted pregnancy and, due to their specifics, are not suitable for every family.
A brief overview of contraceptives
If the need to use artificial contraceptives nevertheless arises, the doctor may advise the use of those drugs that will be most gentle for the nursing mother and her baby, and also will not adversely affect the lactation process itself.There are special hormonal preparations with a minimum content of hormones that are allowed during breastfeeding. However, before you start taking hormonal contraceptives, you should definitely conduct a study on sex hormones (this is necessary to determine the general hormonal background, which undergoes serious changes during pregnancy and in the postpartum period).
As a rule, nursing mothers are advised to take a drug containing only one progestogenic component: taking combined oral contraceptives (which include both estrogenic and progestogenic components) is contraindicated for breastfeeding, since estrogens have a negative effect on the child, and can also affect on the lactation process, reducing or completely stopping the synthesis of prolactin (and hence the production of milk).
The most common hormonal contraceptive approved for use during lactation is a group of drugs called “mini-pills” (with a minimum content of only progestin). The mechanism of contraceptive action of the drug is approximately the same as that of all hormonal contraceptives: it is an increase in the viscosity of cervical mucus, which makes it difficult for sperm to penetrate into the uterine cavity, as well as a change in the structure of the endometrium (inner layer of the uterus) in such a way that the ovum cannot attach to the wall uterus.If the “mini-drink” is taken by a woman who is not breastfeeding, the contraceptive effect of the drug may not be high enough. But in combination with lactation, the contraceptive effect of each of these methods – natural and protection. Of course, the minimum amount of progestin will in any case enter breast milk, but it is so insignificant that it will not affect either the baby, or the amount of breast milk, or the lactation process itself.
Another question is that while taking “mini-pili” some women may experience side effects in the form of headaches, dizziness, nausea, as well as a decrease in sexual activity. As a rule, all these symptoms disappear within two to three months after the start of taking the drug. If this does not happen, but, on the contrary, the side effects become even more pronounced, then the drug must be canceled.
In addition, one of the most effective and convenient methods of postpartum contraception is the intrauterine device (IUD).The advantage of this method is that the IUD can be safely used during breastfeeding, the spiral does not interfere with the lactation process at all and does not negatively affect the composition and amount of milk.