Basic methods of contraception. Family Planning: The Natural Method

Lecture No. 3 Words 846.

Family planning. Abortion and its complications. Methods of contraception.

Family planning- one of the main ways to solve the global demographic problem of stabilizing the population of the Earth.

According to the WHO definition, family planning is the control of a woman's reproductive (childbearing) function for the birth of only desired children.

Women's consultation- a medical and preventive institution of a dispensary type, providing all types of outpatient obstetric and gynecological care to the population.

For example, Women's consultation carries out:

Work on the formation of a healthy lifestyle;

abortion prevention;

Women use contraceptives.

Unfortunately, abortion remains one of the main methods of birth control in Russia. In 2010 1236400 abortions were performed. If at the end of the 80s of the last century about a third of all abortions in the world were performed in the USSR, then since the beginning of the 90s, thanks to the development of family planning services, the frequency of abortions has been gradually decreasing. Nevertheless, abortion in more than 40% of cases remains the cause of secondary infertility.

induced abortion- This is an abortion up to 12 weeks at the request of a woman.

Methods of artificial termination of pregnancy.

1. Surgical, or instrumental. The surgical method involves the extraction of the fetus using special tools.
2. medical method. Medical or pharmaceutical abortion is the termination of pregnancy using pills.

Abortion is performed with the assistance of a qualified specialist - an obstetrician-gynecologist, using approved and recommended methods and in a medical institution suitable for this. Abortion is always a risk of developing various complications that can occur both during the operation itself and in the near future after it.

Complications of abortion.

Early complications (during surgery):

1. Bleeding.
2. Remains of the ovum.
3. perforation of the uterus.
4. The death of a woman.

Late complications:

1. Infertility.
2. Violation of the menstrual cycle.
3. Cervical (isthmic-cervical) insufficiency.
4. Bleeding during subsequent births.
5. Anomalies of attachment of the placenta.
6. Weakness of labor activity.

The main prevention of abortion is to prevent unwanted pregnancy -

it's contraception.

Methods of contraception.

There are: 1) non-hormonal methods;

2) hormonal methods.

Non-hormonal methods of contraception.

1. barrier method . Efficiency 80%.

Mechanism of action: preventing the meeting of the sperm with the egg (the sperm does not enter the uterus).

A male condom, a female condom, a vaginal diaphragm and uterine caps are used.

Currently, condoms are the only way to protect against sexually transmitted diseases.

There are no contraindications.

2. chemical method(Spermicides). Efficiency 70-75%.

Mechanism of action: chemical substances, introduced into the vagina, reduce the activity or kill some of the spermatozoa.

The drugs are available in the form of balls, pastes, ointments and tablets that are inserted into the vagina. For example, Pharmatex.

Contraindications: allergic reaction to the drug.

3. Intrauterine contraception (IUD)). Efficiency 85%.

Mechanism of action: increased peristalsis of the fallopian tubes, as a result of which the fertilized egg enters the uterus ahead of time and cannot be implanted.

An IUD is inserted into the uterus for 5 years.

Contraindications to the introduction of the IUD:

A) painful menstruation

B) heavy menstruation

C) inflammatory diseases of the female genital organs.

d) tumors of the female genital organs.

Navy Disadvantages:

1) painful menstruation;

2) heavy menstruation;

3) exacerbation of chronic inflammation of the female genital organs;

4) Expulsion of the IUD (spontaneous expulsion of the IUD from the uterus).

5) The onset of pregnancy (pregnancy can be saved).

4. Surgical method (sterilization). Efficiency 100%.

Mechanism of action: as a result of cutting the fallopian tubes with a scalpel in women or

The vas deferens in men, the spermatozoa cannot meet with

Ovum.

The disadvantage of the method: the irreversibility of the process.

5 . Physiological method of contraception. Efficiency - 55%.

Mechanism of action: a woman calculates the days of ovulation (middle of the cycle), when the probability of pregnancy is high, because. a mature egg is released from the ovary as a result of ovulation. Therefore, it is not necessary to prevent pregnancy after menstruation and before the next menstruation.

Disadvantage of the method: low efficiency (55%).

Hormonal contraception.Efficiency 99%.

Mechanism of action: suppression of ovulation.

Classification according to the method of administration of the drug:

1 group : in tablets (per os):

A) COCs - combined oral contraceptives, contain 2 hormones (analogues of estrogens and progesterone). Preparations - Marvelon, Jeanine, Minisiston. Taking pills daily.

B) Mini - drank - contain one hormone (progestin), prescribed more often to nursing mothers, because. you can breastfeed. Taking pills daily.

Preparations: Charosetta, Microlut.

C) Urgent contraception (emergency). Efficiency 99%.

Mechanism of action: suppression or delay of ovulation, disruption of the fertilization process, the advancement of the blastocyst through the tube and the impossibility of implantation of the blastocyst into the endometrium. This method is used only in exceptional cases, after unprotected intercourse, during the first 24-72 hours, otherwise there will be no effect. This method cannot be considered as a regular method of preventing pregnancy.The disadvantage of the method: violation of the menstrual cycle due to a large dose of the drug.

Therefore, this method is used as a last resort, no more than 2 times a year.

2 group . Intramuscular administration of the drug every 3 months.

Depot - Provera. Efficiency 99%.

The mechanism of action is the suppression of ovulation.

3 group . Subcutaneous administration of the drug - Norplant (introduced under the skin of the shoulder 6 capsules

For 5 years).

4 group . Introduction of the drug through the skin: EVRA - patch. Thin patch

It is applied to the skin for 7 days 3 times a cycle.

5 group . Intrauterine route of administration: the Mirena coil is inserted into the uterus for 5 years.

6 group . Vaginal route of administration: a thin ring is inserted into the vagina,

Impregnated with hormone, for 21 days. The drug Nova-Ring.

Contraindications for hormonal contraceptives.

1) Thrombophlebitis now or in the past.

2) Diseases of the cardiovascular system, cerebral vessels, ischemic heart disease,

3) Arterial hypertension.

4) Diseases of the liver.

5) Malignant tumors of the mammary glands and genital organs.

6) Bleeding from the genital tract of unknown cause.

7) Diabetes.

8) Smoking more than 15 cigarettes per day over the age of 35

Disadvantages of COC:

1) They do not protect against sexually transmitted diseases.

2) Taking pills requires great care, because. can't miss any

Tablets.

3) Sometimes there are nausea, vomiting, weight gain, headaches.

Teenagers who are not married need the following scheme (the "Gold Standard"):

COC + condom.

Contraception(from Novolat. contraceptio - contraception) - prevention of pregnancy.

Undoubtedly, the most common question women ask is: "Which contraception is right for me?". In each case, the issue is resolved individually, at the appointment of an obstetrician-gynecologist. The choice of contraceptive method depends on many parameters, since not only reliable protection from unwanted pregnancy, abortion and related complications, but also the convenience of its use.

The effectiveness of contraceptive methods is assessed using pearl index is the number of unplanned pregnancies that occur in 100 women using this method of contraception for 1 year.

Contraceptive methods with a Pearl index from 0 to 1 are highly effective; 2 to 9 are effective and 10 or more are ineffective.

High performance and effective methods contraception:

• Hormonal contraception.
• Intrauterine contraception.
• Voluntary Surgical Sterilization (VCS).
• Method of lactational amenorrhea.

Low effective methods of contraception:

• Barrier - diaphragm, cervical caps, sponges, condom.
• Spermicides (chemicals that neutralize sperm).
• Biological (calendar, temperature).
• Interrupted intercourse.

Hormonal method of contraception more than 120 million women in the world use it. It includes COOK And ( combined oral contraceptives- mono- and multi-phase), characterized by reliability, complete reversibility (quick recovery of the ability to conceive), regulation of the menstrual cycle, prevention of uterine fibroids, endometriosis, inflammatory diseases of the genital organs, as well as functional cysts and ovarian cancer, therapeutic effect in premenstrual syndrome.

Progestogenic oral contraceptives- a reliable method of contraception only in breastfeeding women. Used when more reliable methods cannot be used.

parenteral methods of contraception:
a) Subcutaneous implants, placed subcutaneously, duration of action up to 5 years.
b) Injectable contraception.

transdermal contraceptive patch- "Evra" - microdosed percutaneous contraceptive, securely attached to the skin of the buttocks, abdomen, outer surface of the upper half of the body, does not peel off during water procedures.

Modern intrauterine contraceptives contain: progesterone, copper, gold or a number of other drugs that are gradually released into the body (they are recognized as the most reliable and safe for a woman's health); there are also inert ones, but they have less efficiency and are now used less and less.

For example, "Mirena" - combines high contraceptive efficacy and medicinal properties with the convenience and long-term action of the IUD (5 years).

Advantages of intrauterine contraception- this high efficiency and reliability, which approach 100%, the onset of action immediately after the introduction, so that the woman does not need to use additional contraceptives, installation once for a long period (up to 5 years).

Disadvantages of intrauterine contraception include lack of protection against sexually transmitted diseases, and infectious disease a spiral can aggravate the situation; a possible increase in the duration of menstruation and their profusion. This phenomenon is associated with minor injuries of the uterine mucosa, which are caused by a foreign object. A similar disadvantage is typical only for products that do not contain progesterone, since the latter has a neutralizing effect; as well as the possibility of expulsion of the IUD (if you suspect it is necessary to contact a gynecologist).

Vaginal contraceptive ring "NovaRing"- a fundamentally new method of contraception, using the vaginal route of hormone administration. High contraceptive effect and minimal impact on the woman's body.

Voluntary Surgical Sterilization (VCS) is given a special place in the family planning program, since, firstly, this method is associated with surgical intervention and, secondly, it is irreversible. female sterilization is based on the creation of artificial obstruction of the fallopian tubes surgically during laparoscopy, mini-laparotomy or traditional abdominal surgery (for example, during caesarean section).

In accordance with the legislation of the Russian Federation, DHS can be performed on the condition that: the woman's age exceeds 32 years, if there is one or more children in the family, if there are two or more children in the family.

Choosing this method of contraception, a married couple should be informed about the irreversibility of sterilization, features surgical intervention and possible complications.

Question d Voluntary surgical sterilization and other alternative REVERSIBLE (as opposed to sterilization surgery, which is irreversible) methods of contraception are actively discussed on our FORUM. Express your opinion, ask questions that interest you, write to our!

male sterilization - vasectomy, the operation is performed under local anesthesia, lasts 15-20 minutes, the man can immediately return home.

Lactational amenorrhea method. It can be used by women in the first six months after the birth of a child. The method is absolutely harmless to the health of both mother and child. It is based on the fact that if a woman is breastfeeding, her period does not occur and she is not able to become pregnant. A woman should start breastfeeding immediately after childbirth, the effectiveness is observed only with full breastfeeding and persistent amenorrhea (absence of menstruation).

barrier method of contraception- protection against unwanted pregnancy by preventing sperm from entering the vagina or cervix by mechanical (condoms, vaginal diaphragms and caps) or chemical (spermicides) methods. The combination of these two paths is called combined.

Male contraception is considered a reliable method - use condoms, the effectiveness of which approaches 95%, especially when combined with spermicidal agents (pharmatex, pantetexoxaval, contraceptin). The efficiency of the combined method increases and approaches 100%.

Female barrier contraception is not as reliable as male. Caps made of aluminum, polymers, plastics are put on the cervix. After 10 days, the cap is removed, while it is necessary to regularly examine the cervix. The method is contraindicated in the presence of inflammation, pseudo-erosion and erosion of the cervix.

The vaginal diaphragm or cap is a rubber plate worn on a rim of springy metal wire. The diaphragm inserted into the vagina forms a barrier that separates the cervix from the vagina itself. It can be left for 10-12 hours, after use, be sure to wash with soap and water and a mild disinfectant solution. Before subsequent use, you can rinse the diaphragm with boiled water. Multiple use. Female barrier contraception must be combined with spermicidal preparations, which increases its effectiveness up to 90%.

Spermicides- this group of drugs, otherwise called chemical vaginal contraceptives, is very diverse - tablets, vaginal suppositories, gels, pastes, foams, tampons, etc. Their action is to create an increased acidity of the vaginal environment, which damages or kills the spermatozoa that enter it and makes conception unlikely.

Calendar (rhythmic) method is a method for determining the fertile phase by observing the menstrual cycle, that is, the period when a woman can become pregnant. If the sperm enters the vagina outside the fertile period, then fertilization does not occur.

Rules for calculating the fertile period ("dangerous days"):

1. Track the duration of at least 6 menstrual cycles, as not all women have a regular cycle.
2. Subtract 11 from the number of days in your longest cycle (for safety net, you can subtract from 8 to 11 days). This will determine the last fertile day of your cycle.
   The number 11 is taken from here: since 12-16 days pass after ovulation (on average 14) before menstruation, then, as is obvious, ovulation will occur 12-16 days before menstruation. It is advisable to add a few days for insurance.
3. From the number of days in the shortest of your cycles, subtract 18 (for safety net, you can subtract 19-21 days). By this you determine that spermatozoa in the genital tract of a woman can exist for up to 4-5 days. That is, we subtract not 14 days, but an additional 5 days of sperm life.

For convenience, we offer you a table: How to calculate " dangerous period"- the most likely days for conception

An example of using a table:

Your cycle is between 27 and 33 days.

In the table, find the shortest cycle - 27 days and determine the first fertile day (in our case, 9 days after the start of menstruation).

Thus, the dangerous period will be from 9 to 22 days.

Avoid intercourse on fertile days or use additional method contraception (condom, spermicides, etc.).

Coitus interruptus is an ineffective contraceptive method.

Firstly, not every man is able to feel the onset of ejaculation and control himself at this moment.

Secondly, a certain amount of spermatozoa is released at the very beginning of sexual intercourse, along with the secretion of the Cooper glands. According to some reports, this is the “vanguard”, consisting of the most mobile and viable spermatozoa, which, accordingly, makes the probability of conception very high.

In addition, during repeated sexual intercourse, sperm that remains on the walls of the urethra of a man after the first ejaculation can enter the vagina.

And of course, when using this method, we are not talking about spontaneity, ease or the ability to relax - a man is forced to constantly control himself during intercourse.

FAMILY PLANNING. According to WHO experts, these are those activities that are aimed at helping individuals or couples achieve certain results: - avoid unwanted pregnancies, - produce desired children, regulate the interval between pregnancies, - control the timing of childbirth depending on the age of the parents and determine the number of children in the family. This is done through health education and family planning counselling; provision of contraceptives; family and marriage education; organizing services and events such as genetic counseling. Of great importance is the work in preserving the health of adolescents, including the provision of information about the dangers of early onset of sexual activity, the risk of pregnancy, the characteristics of the outcomes of childbirth and abortion, the provision of contraceptives, and the anonymity of services. Well-organized work with adolescents subsequently leads to a decrease in maternal morbidity and mortality, the prevention of induced abortions, the prevention of diseases associated with the early onset of sexual activity, the prevention of AIDS and venereal diseases.

HORMONAL CONTRACEPTION. This type contraception is used in England by 22% of women of reproductive age, in France - 36%, in Germany - 48%, in Italy - 23%, in Russia - 8.6%. COCs can be used not only to prevent pregnancy, but also for therapeutic and prophylactic purposes. CLASSIFICATION OF HORMONAL CONTRACEPTIVES. COMBINED ESTROGEN-GESTAGENE ORAL CONTRACEPTIVES PROGESTAGENIC ORAL CONTRACEPTIVES PARANTHERAL DRUGS SUBCUTANEOUS IMPLANTS TRANSDERMAL CONTRACEPTIVE SYSTEMS HORMONAL INTRAUTERINE CONTRACEPTIVES

COC - each tablet contains estrogen and progestogen. As an estrogen component, COC contains synthetic estrogen - ethinyl estradiol (EE), as a progestogen - various synthetic progestogens (progetins). Clinical features of COCs: High contraceptive reliability Good tolerability Availability and ease of use No connection with sexual intercourse Adequate control of the menstrual cycle Reversibility of the anovulatory cycle Safe for most somatically healthy women

THERAPEUTIC EFFECTS OF COCs: Regulation of the menstrual cycle Elimination or reduction of the severity of dysmenorrhea Therapeutic effect in premenstrual syndrome Elimination of ovulatory pains Reduction of menstrual blood loss and, as a result, treatment and prevention of iron deficiency anemia, dysfunctional uterine bleeding Reduction in the frequency of PID risk of developing endometrial and ovarian cancer, as well as colorectal cancer Reduced risk of benign breast tumors Reduced risk of iron deficiency anemia Reduced risk of ectopic pregnancy medical indications

CLASSIFICATION OF COCs (subdivided according to the amount of the estrogen component and depending on the combination scheme of estrogen and progestogen). by the number of estrogenic components: - high-dose - EE 50 mcg / day - low-dose - EE no more than 30 - 35 mcg / day - microdosed - EE 20 - 15 mcg / day, depending on the combination scheme of estrogen and progestogen: - monophasic - with a constant daily dose of estrogen and progestogen in all tablets of one package - biphasic - 2 types of tablets with different estrogen / progestogen ratios - triphasic - 3 types of tablets with different estrogen / progestogen ratios

Combined single-phase oral contraceptives Drug Composition EE Gestagen High-dose Non-ovlon 50 mcg Norethisterone 1 mg Ovidone 50 mcg Levonorgestrel 0.25 mg Low-dose Microgynon 30 mcg Levonorgestrel 0.15 mg Rigevidon 30 mcg Levonorgestrel 0.15 mg Minisiston 30 mcg Levonorgestrel 0.15 mg Minisiston 30 mcg Levonorgestrel 0.15 mg Femodene 30 mcg Gestoden 0.075 mg Marvelon 30 mcg Desogestrel 0.15 mg Regulon 30 mcg Desogestrel 0.15 mg Silest 30 mcg Norgestrimat 0.25 mg Diane-35 35 mcg Cyproterone 2 mg Jeanine 30 mcg Dienogest 2 mg Yarina 30 mcg Drospirenone 3 mg Belara 30 mcg Chlormadinone 2 mg Microdosed Mercilon 20 mcg Desogestrel 0.15 mg Novinet 20 mcg Desogestrel 0.15 mg Logest 20 mcg Gestodene 0.075 mg Mirelle 15 mcg Gestodene 0.060 mg

Combined multiphasic oral contraceptives Drug Composition EE Gestagen Anteovin 50 mcg (table 11) 50 mcg (table 10) Levororgestrel 0.05 mg Levonorgestrel 0.125 mg Trikilar Tri-regol Triziston 30 mcg (6 dr.) 40 μg (5 dr.) .) 30 micrograms (10 others) Levororgestrel 0.05 mg Levororgestrel 0.075 mg Levororgestrel 0.125 mg Trimersi 35 micrograms (7 others) 40 micrograms (7 others) 30 micrograms (7 others) Desogetrel 0. 05 mg Desogestrel 0.15 mg

The mechanism of the contraceptive action of COCs suppression of ovulation thickening of the cervical mucus changes in the endometrium that prevents implantation The contraceptive effect of COCs is provided mainly by the progestogen component. Synthetic progestogens have a high affinity for progesterone receptors in the hypothalamic-pituitary region, cause a negative feedback effect, block the release of gonadotropins and ovulation. Some gestagens block the receptors of other steroid hormones - androgens, glucocorticoids and mineralocorticoids. Favorable for oral contraception are antiandrogenic and antimineralocorticoid effects, undesirable - androgenic. EE as part of COCs supports endometrial proliferation, i.e., provides “cycle control” - the absence of intermediate bleeding when taking COCs.

PROGESTAGE ORAL CONTRACEPTIVES Classification and pharmacological effects of progestogens: by origin (natural, synthetic) CLASSIFICATION OF SYNTHETIC PROGESTIONS: testosterone derivatives - 19 norsteroids. A. containing an ethynyl group: 1st generation - NORETHISTERONE, ETHYNODIOL DIACETATE, LINESTRENOL (have high androgenic activity - limited use). 2nd generation - NORGESTREL, LEVONORGESTREL (progestogenic activity is higher, androgenic properties are much less) 3rd generation - GESTODEN, DESOGESTREL, NORGESTRIMAT (gestagenic activity is very high, androgenic activity has no clinical significance) B. not containing an ethynyl group 1. hybrid gestogen - DIENOGEST progesterone derivatives - CYPROTERONE ACETATE (has a strong antiandrogenic effect - Diane-35), DYDROGESTERONE, MEDROXYPROGESTERONE, CHLORMADION ACETATE (weak antiandrogenic effect) spirolactone derivatives - DROSPIRENONE (Yarina)

Pharmacological effects of progestogens: Effect Progestogen Progestogen Androgenic Antiandrogenic Antimineralocorticoid Natural progestogen + - +/- + Cyproterone acetate + - +++ - Norethisterone acetate + - - - Levonorgestrel + + - - Desogestrel + + - - Gestodene + + - + Norgestrimate + + - - Drospirenone + - + ++ Chlormadione + - Dienogest + - ++ -

PARANTHERAL DRUGS (DEPO-DRUGS) Depo-drugs include "DEPO-PROVERA", contains 150 mg of medroxyprogesterone. Advantages: long-term effect easy to use high reliability (no errors of use) Disadvantages: delayed restoration of fertility inability to stop contraceptive protection at any time the patient wants the need for regular visits to the clinic for repeated injections

SUBCUTANEOUS IMPLANTS (CAPSULES) The "NORPLANT" system consists of 6 cylindrical silastic capsules containing progestogen (levonorgestrel). Capsules are installed subcutaneously, on the inner surface of the left shoulder. The hormone diffuses through the silastic wall at a constant rate - at first 80 mcg / day, then gradually decreases to 30 - 34 mcg / day by the end of the first year of use. Duration of action up to 5 years. Mechanism of action: suppression of ovulation due to the inhibitory effect on the hypothalamic-pituitary-ovarian system and suppression of gonadotropins LH and FSH inhibition of proliferative processes in the endometrium with the development of atrophic changes in the uterine mucosa, which prevents implantation changes in the concentration of cervical mucus, which complicates and disrupts sperm penetration

TRANSDERMAL CONTRACEPTIVE SYSTEMS The EVRA system is a beige patch with a skin contact area of ​​20 cm2. In terms of doses of hormones entering the blood, the EVRA system corresponds to microdosed COCs. Mechanism of action: suppression of ovulation and increased viscosity of cervical mucus. Advantages of "EURA": high efficiency with minimal doses of hormones no need for daily intake (requires weekly regluing of the patch) the possibility of use in women different ages secretion of minimal doses of hormones no effect of primary passage through the liver and gastrointestinal tract rapid restoration of fertility after withdrawal possibility of independent use a small amount side effects Disadvantages: Sometimes the patch may come off Possibility of local adverse reactions Limited number of areas of the body to which the patch can be applied

CLINICAL SIDE EFFECTS OF COCs Excessive influence of estrogens Excessive influence of progestogens Headache, Increased blood pressure Irritability, Nausea, vomiting Dizziness. Mastodynia Chloasma (skin pigmentation) Worsening of varicose veins Worsening of contact lens tolerance Weight gain Headache, Depression Fatigue, Acne Decreased libido Dryness of the vaginal mucosa Worsening of varicose veins Weight gain Insufficient estrogenic effect Insufficient progestogenic effect Headache. Depression Irritability Reduced breast size Decrease in libido Dryness of the vaginal mucosa Intermenstrual bleeding at the beginning and middle of the cycle Scanty menstruation Heavy menstruation Intermenstrual bleeding in the second half of the cycle Delayed menstruation

Choice of COCs Clinical situation Drugs Acne and/or hirsutism, hyperandrogenism Drugs with antiandrogenic progestogens – Diane-35, Yarina, Belara Menstrual irregularities (dysmenorrhea, dysfunctional uterine bleeding, oligomenorrhea) COCs with a pronounced progestogenic effect (microgenon, femoden, marvelon, janine) , when combined with hyperadrogenism - Diane-35. when DMC is combined with recurrent endometrial hyperplastic processes, the duration of treatment should be at least 6 months. Endometriosis Monophasic COCs with dienogest, or levonorgestrel, or gestodene, or progestin oral contraceptives are indicated for long-term use. The use of COCs can help restore generative function. Diabetes mellitus without complications Drugs with a minimum content of estrogen - 20 mcg / day Primary or repeated prescription of oral contraceptives to a patient who smokes Patients who smoke less than 35 years - COCs with a minimum content of estrogen, smokers after 35 years COCs are contraindicated Previous oral contraceptives were accompanied by weight gain body, fluid retention in the body, Yarin's mastodynia Poor control of the menstrual cycle was observed with previous oral contraceptives (in cases where other causes other than oral contraceptives are excluded) Monophasic or triphasic COCs

Principles of selecting COC drugs Clinical situation Tactics when selecting COC Estrogen-dependent side effects Dose reduction of EE, switching from 30 to 20 mcg / day, switching from triphasic to monophasic COCs Progestogen-dependent side effects Decreasing the dose of progestogen, switching to triphasic COCs, switching to COCs with another progestogen Decreased libido Switching to a three-phase COC, switching from 20 to 30 mcg/day EE Depression Switching to a three-phase COC, switching from 20 to 30 mcg/day EE Acne Switching to an antiandrogenic COC Breast engorgement Switching from a three-phase to monophasic COC, switching to Yarina, switching from 30 to 20 mcg/day EE Dryness of the vaginal mucosa Switching from a three-phase COC, switching to a COC with another progestogen Pain in the calf muscles Switching to 20 mcg/day EE, stopping COCs Scanty menstruation Switching from a monophasic to a triphasic COC, switching from 20 to 30 mcg/day EE Heavy menses Switching to monophasic COC with levonorgestrel, switching to 20 mcg/day EE Intermenstrual cramps mucus at the beginning of the menstrual cycle Switching to a three-phase COC, switching from 20 to 30 mcg / day EE Intermenstrual spotting in the second half of the cycle Switching to COCs with a higher dose of progestogen Amenorrhea while taking COCs (Pregnancy is required to be excluded) Together with Microfollin COCs during the entire cycle, switching to COCs with a lower dose of progesterone and a higher dose of estrogen, for example, triphasic

Contraindications to the use of COCs Absolute contraindications Deep vein thrombosis or high risk of thrombosis Pulmonary embolism Ischemic heart disease, stroke Hypertension (BP 160/100 mmHg) Migraine with focal neurological symptoms Complicated valvular heart disease Liver disease Diabetes mellitus Cancer breast lactation pregnancy

“RULES OF FORGOTTEN AND MISSED PILLS” If 1 tablet is missed: delay in taking less than 12 hours - take the missed pill and continue taking it according to the previous scheme; delay in taking more than 12 hours - take the missed pill + condom for the next 7 days. If 2 or more tablets are missed: Take 2 tablets daily until regular intake, plus 7 days of condom. If bleeding starts after the missed pills, it is better to stop taking the pills and start a new package after 7 days (counting from the start of missing the pills).

HORMONE-CONTAINING VAGINAL CONTRACEPTIVE RING NOVA-RING The NOVA-RING ring is an innovative method of contraception based on the vaginal method of hormone administration. Its diameter is 54 mm. 15 mcg of EE and 120 of etonogstrel, which is the active metabolite of desogestrel, are excreted per day. Mechanism of action: - suppression of ovulation - thickening of cervical mucus hormonal background- there is no primary passage through the liver and gastrointestinal tract - minimal systemic effect on the woman's body - does not affect body weight

INTRAUTERINE CONTRACEPTION More than 60 million women use an IUD. In Russia, this method is used by 14.5% of women of reproductive age. IUD CLASSIFICATION: - NON-DRUG (inert or neutral) are made of polyethylene with the addition of barium sulfate - MEDICATION (contains copper or gestagens) Mechanism of action of the IUD: in the endometrium, when the IUD is used, aseptic inflammation develops (like a foreign body). There is a discrepancy between the morphofunctional changes in the endometrium and the phase of the menstrual cycle, which is typical for NLF (luteal phase deficiency). THEORIES OF ACTION OF THE IUD: the theory of abortive action the theory of septic inflammation the theory of enzyme disorders and suppression of the functional activity of the endometrium, which makes implantation of a fertilized egg impossible the theory of accelerated peristalsis of the fallopian tubes and the spermatotoxic effect of copper ions One or another theory cannot be considered as prevailing, since in the implementation of the contraceptive action IUDs play the role of several mechanisms.

Advantages of intrauterine contraceptives: high efficiency no systemic metabolic effects on the woman's body quick restoration of fertility after removal of the IUD no connection with sexual intercourse no effect on breast-feeding economic benefits (low cost of the method, administered for a long time) Disadvantages of intrauterine contraceptives: pain in the lower abdomen, especially during the first year of IUD use, heavy menstruation, can lead to IDA (anemia) risk of developing inflammatory diseases (PID) limited opportunity use in young nulliparous women

Contraindications to the use of intrauterine contraceptives: Absolute contraindications: acute, subacute and often recurrent PID malignant tumors of the body of the uterus or cervix bleeding from the genital tract of unknown etiology suspected or existing pregnancy Relative contraindications: menstrual disorders endometrial hyperplasia and polyposis uterine fibroids endometriosis ectopic pregnancy history birth defects development of the uterus, the presence of several sexual partners, infectious and inflammatory diseases after termination of pregnancy during the last 3 months, extragenital diseases: anemia, coagulopathy, rheumatic heart disease, subacute endocarditis, valvular heart disease, treatment with immunosuppressants.

HORMONE-CONTAINING INTRAUTERINE CONTRACEPTIVES - "MIRENA" is a levonorgestrel-releasing system. Around the vertical rod is a cylindrical container filled with levonorgestrel (52 mg). Continuous release of the drug in an amount of 20 mcg / day. The period of use of "MIRENA" is 5 years, although the contraceptive effect persists for 7 years. Mechanism of action: inhibits the proliferation of the endometrium, which prevents implantation, a change occurs physical and chemical properties cervical mucus (viscosity increases), which makes it difficult for sperm to penetrate; sperm motility increases in the uterine cavity and fallopian tubes

Advantages of the method and therapeutic effects of MIRENA: reliable contraceptive effect high safety reversibility of the contraceptive effect (fertility is restored after 6-24 months after removal of the IUD) helps to reduce blood loss therapeutic effect in idiopathic menorrhagia and internal endometriosis of the uterus prevention of hyperplastic processes and endometrial cancer possibility of use as a component of replacement therapy in perimenopause

EMERGENCY CONTRACEPTION (EC) A method of preventing pregnancy after unprotected intercourse when immediate protection against unwanted pregnancy is required: after an accidental intercourse, when a condom breaks, rape, etc. The contraceptive effect is possible with the use of EC during the first 24 - 72 hours after unprotected sexual intercourse. EC is also called postcoital or emergency contraception. Currently, the following are used for EC: combined oral contraceptives copper-containing progestogens

METHOD YUZPE - two doses of 100 micrograms of EE and 0.5 mg of levonorgestrel. The first dose must be taken within 72 hours of unprotected intercourse and the second dose 12 hours later. You can use: - 8 tablets of a low-dose COC (containing 30-35 micrograms of EE) taken in 2 divided doses 12 hours apart; - 4 high-dose COC tablets (containing 50 mcg/day) taken in 2 divided doses 12 hours apart. Contraindications: pregnancy history of thromboembolism severe liver disease bleeding of unknown etiology breast and endometrial cancer

EC PROGESTAGENS - use POSTINOR (1 tablet taken within 48 hours after unprotected intercourse, 2 tablets - after 12 hours) and ESCAPEL (1 tablet taken no later than 72 hours after unprotected intercourse). EC WITH THE HELP OF A COPPER-CONTAINING IUD - administered within 5 days after unprotected intercourse. The method is contraindicated in nulliparous women and patients with a high risk of developing inflammatory diseases of the genital organs.

BARRIER CONTRACEPTION METHODS - all methods of contraception that mechanically prevent sperm from entering the cervical canal and / or contribute to the chemical inactivation of sperm into the vagina. These methods are used by 30-35% of women. Classification: - by gender: male - female condom - diaphragm, cervical cap, female condom (femidon), spermicidal agents in various forms: tablets, capsules, suppositories, pastes, foams. - by nature: mechanical chemical barrier methods of contraception, combining mechanical and chemical components.

PHYSIOLOGICAL CONTROL Awareness of a woman about the most probable time of ovulation (and hence the possibility of pregnancy) during the menstrual cycle helps to avoid an unplanned pregnancy. Classification: methods based on determining the day of ovulation - calendar (rhythmic) method, temperature method, method for assessing the state of cervical mucus, symptomometric method, enzyme immunoassay tests lactational amenorrhea coitus interruptus

ELISA tests for ovulation: household test systems that allow you to determine the day of ovulation. The most popular is "FRAU-TEST" to determine ovulation. The calendar (rhythmic) method is based on the determination of the fertile phase during daily observations of the duration of the menstrual cycle. The temperature method is a method for determining the fertile phase by measuring basal (rectal) temperature. A method for assessing the state of cervical mucus is a specific secret produced in the cervix and changing its properties during the menstrual cycle, under the influence of estrogen hormones. In the periovulatory period, the mucus becomes more watery, transparent, viscous, similar to egg white. This period is the most fertile. The coitus interruptus method eliminates the entry of sperm into the vagina and fertilization does not occur.

SURGICAL CONTRACEPTION - female voluntary surgical sterilization - a surgical operation that leads to the impossibility of fertilization of the egg and its transport to the uterus. Currently, this method is used by more than 166 million women. This method is referred to as irreversible methods of contraception. List of medical indications for medical sterilization of women. Diabetes mellitus (severe form) Leukemia Heart defects accompanied by circulatory failure II – Stage III or pulmonary hypertension Respiratory failure Chronic active hepatitis with signs of liver failure Repeated caesarean section in the presence of children, etc.

Male sterilization: Vasectomy is an operation to create an obstruction of the vas deferens, preventing the migration of spermatozoa (permanently or for the duration desired by the patient). The operation is undoubtedly preferable to analogous methods of female contraception. Physical Methods. The use of ultrasound - you can block spermatogenesis, but the changes are irreversible. Thermal impact. Spermatogenesis and maturation of spermatozoa are adversely affected by heat. Hormonal male contraception. Principles of hormonal male contraception - suppression of the production of LH and FSH (testosterone is theoretically ideal for hormonal male contraception, suppresses the secretion of LH and FSH, decreases and / or stops the production of endogenous testosterone and reduces spermatogenesis. - elimination of intratesticular testosterone - administration of testosterone to maintain androgenic effects

Family planning is a concept that is actively entering our lives. For many years, this term meant birth control. However, it is more likely to ensure the health of a woman for the birth of desired and healthy children. The right to family planning, or freedom and responsible parenthood, is an internationally recognized human right.

Principles of sound family planning

Sooner or later, every person, every family faces questions about when and how many children to have, how to avoid unwanted pregnancy, what contraceptives are best used and how to use them. Family planning helps people consciously choose the number of children in the family and the timing of their birth, plan their lives, and avoid unnecessary worries and worries.

The optimal age for conception and birth of children is 20-35 years. Intervals between births should be at least 2–2.5 years. If pregnancy occurs earlier or much later, it proceeds with a large number of complications.

Teaching teenagers the basics of family planning

Sex education and sexual education of children and adolescents will help maintain their health, prepare them for the future. family life and develop a sense of responsibility. Today there are many modern methods contraception that can reliably prevent unwanted pregnancy. Their use is many times safer for health than abortion.

Sexually transmitted diseases often cause infertility in men and women. Only a condom will help to avoid infection and at the same time protect against unwanted pregnancy.

Contraceptive methods for family planning

Competently selected contraception when planning a family makes intimate life more harmonious, eliminates possible worries and worries among spouses.

Currently existing contraceptive methods are usually classified in the following way:

barrier (or mechanical);

spermicides (or chemical);

rhythmic (or biological);

interrupted sexual intercourse;

intrauterine devices (intrauterine device);

hormonal contraception;

voluntary surgical sterilization.

Currently, the range of contraceptives has increased significantly, contraceptives have become more reliable and are selected individually for each woman. A gynecologist in a family planning center (office) or in a polyclinic helps a woman to understand this issue.

Methods of postpartum contraception in family planning

Return of fertility, i.e. of childbearing, and therefore the chance of becoming pregnant again, usually occurs six weeks after childbirth (this depends on the length of the breastfeeding period). female body rest after pregnancy and childbirth. The interval between pregnancies should be at least 2.5–3 years (the so-called “intergenetic interval”), therefore, after childbirth, it is important to strictly follow the rules for using one or another method of protection (contraception).

Women who exclusively breastfeed their babies are usually protected from pregnancy during the first 4 to 6 months after giving birth. In women whose children receive artificial nutrition, the ability to conceive is restored earlier. The use of breastfeeding as a means of contraception is called the lactational amenorrhea method (LAM). But, unfortunately, the effectiveness of this method is about 70%, and therefore, when it is used, a monthly examination by a gynecologist is necessary for the timely diagnosis of a possible pregnancy. A woman can resume sexual activity with a partner as soon as she feels disposed to this and provided that she does not have any health complications.

The method of lactational contraception is based on the physiological effect of suppression of ovulation by irritation of the mother's nipples during breastfeeding.

To use this method in family planning, the following factors must be absent:

the age of the child is 6 months;

the presence of menstruation;

feeding other food besides breast milk;

an interval of more than three or four hours between feedings in the daytime and in the evening;

an interval of more than 6 hours between feedings at night.

If after giving birth a woman has not yet chosen a specific method of postpartum contraception, then the best way for her is to use condoms and / or spermicides, until the moment when she is ready to use another method of contraception.

Spermicidal contraception in family planning

Spermicides - chemicals contraception. Let us consider in more detail the method of contraception with spermicides. Contraception with spermicides is based on the ability of the active ingredient in their composition to destroy spermatozoa within a few seconds. As an active ingredient, various substances that are potent on spermatozoa are used.

These contraceptives are available in the form

• creams,
• jelly,
• candles,
• tablets,
• films,
• foam.

Contraception with spermicides - foaming tablets are injected into the vagina 10 minutes before sexual intercourse. After 8-10 minutes after insertion into the vagina, they dissolve in the mucus present in it, forming a thick viscous foam. The foam fills the lumen of the vagina, and since it contains substances that are harmful to spermatozoa, the spermatozoa, once in such an environment, are immobilized and die very soon without penetrating into the uterus. The meeting of spermatozoa with an egg in the vaginal cavity cannot lead to conception, since their interaction with each other for the formation of an embryo must occur in the fallopian tubes, or at least inside the uterus.

Instead of pills when planning a family with the same success, you can use a paste, ointment or suppositories with foaming and spermatocidal (anti-sperm) components. Their use and contraceptive action is similar to pills. But in the case of using an ointment or paste, you will need a special syringe for administration and their dosage: 5–6 g of ointment or paste correspond to the full volume of such a syringe. In addition, foam-forming contraceptives are produced by our industry in cartridges with the ability to release under low pressure. With the help of such a can, a foaming aerosol is introduced into the vagina. It can be administered not for 10 minutes, but immediately before sexual intercourse. In the absence of these drugs, a pharmacy can make vaginal balls according to a prescription issued by your gynecologist.

Foaming contraceptives for contraception with spermicides are completely safe, except in cases of individual intolerance. Nevertheless, their frequent and regular use is undesirable, since in this case they can lead to irritation of the vaginal mucosa and sometimes inflammatory processes in the vagina.

Foaming contraceptives in family planning should be used in women who cannot tolerate hormonal contraceptives and do not want to have an intrauterine device. In addition, these drugs can be used in between taking hormonal contraceptives, as well as in all other cases when 5–10 minutes before sexual intimacy, its prognosis is possible.

Improvised methods of contraception

However, despite the variety of contraceptive methods, the means used by women in everyday life as contraceptives have survived to this day.

To protect against unwanted conception, it is possible to use any chemicals that damage spermatozoa, but do not damage the vagina and uterus, and also do not have a dangerous effect on the body as a whole.

Firstly, various acids can act as improvised contraceptive methods for women:

• lemon,
• acetic,
• dairy,
• boric,
• salicylic,
• ascorbic
• or drugs that have a detrimental effect on microorganisms of the protozoan clan (such as causative agents of malaria or trichomonas).

It is also possible to use products of plant origin: freshly squeezed lemon juice, red or white currants; tubers of an aquatic plant - yellow capsules.

These substances should be introduced into the vagina, preferably before sexual intercourse with a man or immediately after intercourse, in the form of a liquid solution by douching or using a swab moistened with them.

Douching should be done before and after intercourse. In this case, the syringe tip should be rotated in different directions, washing the entire inner surface of the vagina. The douching procedure should last 3-5 minutes. The vagina should then be rinsed with water to avoid possible irritation. In the case of the use of acids and drugs, one should beware of their irritating effect on the mucous membrane of the genital organs. Such a complication is possible when using highly concentrated solutions. Do not use acid solutions at a concentration of more than 0.5–1%.

And finally, in the absence of any means for contraception against unwanted pregnancy, abundant douching with plain water can protect you, although this method is far from one hundred percent.

All of the above methods of contraception for women do not completely protect against pregnancy, and complications are possible, such as an allergic reaction, burns if drugs and acids are diluted incorrectly, etc. Therefore, it is most advisable to consult a gynecologist and choose the most suitable contraception for you.

Abortion as a method of family planning

Abortion is not best method birth control. If an unwanted pregnancy does occur, you need to see a doctor as soon as possible, which will reduce the risk of possible complications. After childbirth and abortion, it is possible to become pregnant again before the arrival of the first menstruation, so you should choose a reliable method of contraception before resuming sexual activity.

Undoubtedly, there is no ideal method of contraception for family planning: traditional methods of contraception for women have a relatively low contraceptive efficacy, and the use of modern ones is limited by a number of contraindications and side effects. There is also no universal method for all women, since during the reproductive period it is necessary to use various contraceptives, depending on

• age,
• sexual characteristics,
• attitudes towards contraception of sexual partners,
• the presence of gynecological and somatic diseases.

Lecture on gynecology.

TOPIC: FAMILY PLANNING. CONTRACEPTION.

Our country has the lowest birth rate, high percent abortion, a large number of complications after abortion.

All contraceptives are aimed at protecting yourself from unwanted pregnancy. There are many such means, their effectiveness is different.

1. Calendar method of contraception. It is based on determining the time of ovulation, which occurs on the 14th (+/- 2) day of the cycle, and limiting the number of sexual intercourse during the periovulatory period. Given the viability of the egg (48 hours) and sperm (48 hours), sexual intercourse should be avoided from the 10th to the 18th day of the cycle.

2. Barrier method of contraception.

· Male protection - condom. Protects not only from unwanted pregnancy, but also from all sexually transmitted infections (HIV infection, gonorrhea, syphilis, chlamydia, mycoplasma infection, etc.).

Women's protection - the diaphragm, is a rubber ring with a hemisphere-shaped cap. The diaphragm is inserted in such a way as to cover the cervix to create a mechanical obstacle to the passage of spermatozoa. The doctor must choose the size of the diaphragm and encourage the woman to insert it through the vagina. The diaphragm can be injected with spermicides - chemicals that inhibit the movement of spermatozoa and kill them. One of the spermatocides is zhenol. Spermatocides can be in the form of tablets, psta, cream (now - Pharmatex). Pharmatex is also good because it has a bactericidal effect, chlamydia, mycoplasmas, various viruses, gonococci, ureaplasmas, etc. are sensitive to it.

3. Chemical method.

Vaginal spermacids. In the form of vaginal balls, tablets, pastes and solutions. When using these agents, a foamy substance is formed, which is active against spermatozoa.

Douching with acidic solutions: a solution of acetic acid (one tablespoon of table vinegar per 1 liter of water); 5% boric acid solution; citric acid solution (1 lemon per 0.5 l of water). Douching should be done immediately after intercourse.

4. Intrauterine contraception. One of the most common methods of contraception in our country. However, intrauterine contraception is no longer popular abroad. 70-80% of women use oral contraceptives. Intrauterine devices contain copper, gestagens. Mechanisms of action: The IUD disrupts the implantation of a fertilized egg, which is associated with accelerated peristalsis of the fallopian tubes and the resulting inferiority of the egg or with the absence of favorable conditions for implantation in the endometrium: copper has a bactericidal and spermicidal effect.

5. Surgical methods.

· Sterilization of women. Women with at least two children over 35 years of age may be exposed.

· Sterilization of men.

6. Oral contraceptives. More than 120 types of hormonal contraceptives. They suppress the formation and secretion of gonadotropins by the anterior pituitary gland, which causes anovulation. One of the most important properties of these drugs is reversibility, that is, after stopping the intake, a normal pregnancy is possible. Hormonal contraceptives are in the form of tablets and in the form of capsules (depot) implanted subcutaneously, providing a prolonged effect (5-7 years), during this time the progestogen contained in the capsule is gradually, impulsively excreted into the blood and maintains the state of ovulation inhibition. Norplant is injected subcutaneously on the back of the forearm under local anesthesia. To date, the birth rate in the world is very high in countries: India, China. These are countries with overpopulation and the issue of family planning is very acute here. In Russia, there is a low birth rate, and abortions exceeded the birth rate by 2 times. Last year, 34.5 thousand births took place in St. Petersburg, more than 70 thousand abortions per year (about 10 thousand - infected abortions, 2 thousand abortions - for social reasons). 11% of women who have an abortion are nulliparous. In the 60s, American scientists R. Pincus and Garcia isolated a substance from Mexican grapes that had a contraceptive effect. Based on it, oral contraceptives were subsequently manufactured. The main components are estrogens and gestagens in different proportions. The estrogen component is ethinylestradiol. Gestagens - levonorgestrel, desogestrel. The point of application of estrogens and gestagens is the hypothalamus, pituitary gland. Estrogens and gestagens suppress the production of luteinizing hormone, thereby inhibiting ovulation. This mechanism of action is inherent in all oral contraceptives.

Classification.

1. Combined oral contraceptives. They consist of a combination of estrogenic and progestogen components. As a rule, containing them the same amount, or the proportion varies depending on the phase of the menstrual cycle. Therefore, there are: 1. Monophasic preparations (containing gestagens and estrogens in the same way in each tablet). 2. Multiphasic: two-phase and three-phase (the concentration of hormones changes, that is, at the beginning of the cycle, the estrogen component increases, then the concentration of progestogens begins to increase) - they maintain, as it were, normal menstrual cycle except for ovulation. Monophasic: marvelon, regividon, demolen, femoden. Multiphase: trizistan, triquilor, tririgan.

Preference in young women was given to three-phase drugs, as they restore the regulation of the menstrual cycle. In women with congenital erosion of the cervix, mastopathy, fibroadenomatosis, monophasic drugs (Marvelon) are indicated, as they promote epithelialization, reduce the risk of developing ovarian and breast cancer.

2. Mini-drank. Contain microdoses of gestagen. The drug continuin, fermolen. They are prescribed continuously daily from the first day of the menstrual cycle for 6-12 months.

The contraceptive action is based on inhibition of the contractile activity of the fallopian tubes, an increase in the viscosity of mucus in the cervical canal, and a violation of cyclic processes in the endometrium. These drugs have a pronounced side effect and often lead to menstrual irregularities.

3. Postcoital oral contraceptives. Recommended for women with irregular sex life. This is postinone (0.75 mg of progestogen). Take it 8-10 minutes after sexual intercourse. The contraceptive action is based on the prevention of implantation of a fertilized egg, due to changes in the endometrium and its rejection, in response to a decline in hormones after taking the drug. Many side effects in the form of menstrual irregularities. It is not recommended to use more than 4 tablets during 1 cycle.

4. Long-acting contraceptives.

Depo-Provera is used more often in women after childbirth, when the menstrual cycle has not yet returned. Depo Provera is administered once every 3 months. Norplant - a depot of a progestogen, enclosed in a capsule, is implanted subcutaneously.

Indications for the use of oral contraceptives.

1. Contraception

2. violation of the menstrual cycle

3. Reducing the risk of endometrial cancer

4. reduce the incidence of ovarian cancer, breast cancer.

Side effects:

1. dyspeptic disorders (nausea, vomiting, discomfort).

2. Increase in body weight.

3. Pastosity of the face, limbs, engorgement of the mammary glands.

4. Increase in the concentration of lipids, cholesterol.

5. Changes in blood rheology (increased platelet concentration, increased aggregation leading to thrombus formation).

Intrauterine contraception.

The first studies of the German scientist Rechter date back to 1909. It is introduced into the uterine cavity with silk threads for the purpose of contraception. In 1980, Greferder inserted a platinum plug into the uterine cavity. In 1960 - a boom in intrauterine contraception, associated with the appearance of plastic polymer compounds and the manufacture of their intrauterine devices various forms. The IUD contains copper wire, as it has been proven that copper ions delay the progress of spermatozoa.

Theories of the contraceptive effect of the IUD:

1. Theory of abortive action. The endometrium is traumatized by the spiral, the tone of the uterine muscles increases as a result of the release of prostaglandins, and the embryo is aborted.

2. The theory of accelerated peristalsis of the fallopian tubes. The egg enters the uterus prematurely, as the fallopian tubes peristaltize rapidly, and since the trophoblast is incomplete by this time, the egg is not implanted.

3. Theory of aseptic inflammation. An intrauterine contraceptive as a foreign body causes polymorphonuclear leukocyte infiltration, which leads to the release of a large number of macrophages, an increase in the release of lysozyme, and a cytotoxic effect occurs. As a result, the cyclical development of the endometrium is disrupted, which leads to disruption of implantation.

4. Theory of spermatotoxic action. Phagocytosis of spermatozoa by macrophages and the addition of copper ion enhances the spermatotoxic effect. The IUD must be inserted under certain conditions and in the absence of contraindications.

Fully examined woman. The contraceptive is administered on the 4th-5th day of menstruation, it is possible to introduce it after an abortion, childbirth. During the first 10 days, observation is required, the prohibition of sexual intercourse. The Navy is installed for 2-2.5 years.

CONTRAINDICATIONS.

1. Acute inflammatory processes, or exacerbations of chronic processes of any localization.

2. Infectious-septic diseases (hepatitis, tuberculosis).

3. Isthmic-cervical insufficiency.

4. Tumors of the uterus and appendages.

5. Malformations.

6. Violations of the blood coagulation system.

COMPLICATIONS.

1. Pain due to various reasons - incorrect selection of a contraceptive, incorrectly placed contraceptive. There may be cramping or aching pain. This complication occurs in 3-4%.

2. Spontaneous expulsion (9-15% of cases).

3. Bleeding (3-9%). Hyperpolymenorrhea or premenstrual bleeding.

4. Perforation of the uterus (1 per 5 thousand introduced contraceptives): at the time of insertion, while wearing, when removing the contraceptive.

5. The occurrence of pregnancy (1-8%) - uterine and ectopic.

6. Inflammatory complications.