About 90% of women of childbearing age use any method of contraception. But despite this, 55% of pregnancies are unwanted. About 43% of pregnancies end in childbirth, 13% in spontaneous miscarriages, and 44% in medical (elective abortions).
There are numerous methods of contraception, but none of them are 100% effective. The theoretical effectiveness of contraceptives is slightly greater than the clinical one, which is due to the peculiarities of the individual use of these methods.
Natural methods of contraception
Natural methods of contraception include intermittent abstinence, coitus interruptus, lactational amenorrhea, rhythm method (symptothermal, or calendar) and differ in that they use mechanical or chemical barriers. Many married couples, based on religious or philosophical views, use these particular methods of contraception, although they are the least effective.
Periodic abstinence (rhythm method)
Operating principle. The rhythm method is physiological method contraception, based on the fact that fertility is most likely during the periovulatory period, therefore it is during this period that abstinence is recommended. This method requires strict monitoring of menstruation and instructing patients on the physiology of menstruation and fertilization and the signs of ovulation. Signs of ovulation are determined by the nature of cervical mucus (liquid, transparent mucus on the eve of ovulation), basal body temperature (increase above 37 ° C in the postovulatory phase), documentation of preovulatory symptoms (there may be short-term pain, minor bloody issues) and premenstrual changes (premenstrual syndrome). The effectiveness of this method is low - 55-80%.
Advantages and Disadvantages ki. The advantages of the method are the absence of the use of exogenous both mechanical and chemical means, which is important for certain groups of people due to religious or philosophical beliefs. The disadvantages are the need for abstinence, the possibility of use only by married couples, the need for training in methods of monitoring ovulation, use only for regular ovulation.
Coitus interruptus
Coitus interruptus involves removing the penis from the vagina before ejaculation - one of the oldest methods of contraception. Most of the seminal fluid ends up outside the woman’s reproductive tract, reducing the chances of egg fertilization.
Efficiency. The failure rate of use is 15-25% of cases, which may be due to the deposition of seminal fluid into the vagina (pre-ejaculation) before orgasm or its deposition at the entrance to the vagina. The disadvantages of the method are high frequency failures and the need for self-control over ejaculation.
Lactational amenorrhea
There is hypothalamic suppression of ovulation caused by breastfeeding. Extending the breastfeeding period is used by many couples as a method of contraception.
Efficiency. The duration of the period of hypothalamic suppression of ovulation during the breastfeeding period varies greatly. In 50% of lactating women, ovulation is restored 6-12 months after birth, even if lactation continues. So, 15-55% of women who breastfeed can become pregnant.
Increasing the effectiveness of lactational amenorrhea can be achieved by using certain principles:
1) breast milk should be the newborn’s only food (on demand and without a night break);
2) the duration of use of this method should not exceed 6 months. If these principles are followed, the failure rate of the lactational amenorrhea method can be reduced to 2%.
Advantages and disadvantages. Lactational amenorrhea does not affect breast-feeding. But low efficiency in cases of disruption of the rhythm and pattern of feeding of a newborn reduces the number of supporters of this method.
Barrier methods of contraception
The principle of operation of barrier methods of contraception is based on preventing sperm from entering the uterine cavity and further into the fallopian tubes and abdominal cavity.
Male condom (condom)
The effectiveness of latex male condoms is 85-90% and increases with strict adherence to the rules of use, preventing sperm leakage before using the condom, using condoms with spermicides, or using condoms and spermicides together.
Advantagesand disadvantages. Condom actually protects against STDs, including HIV infection. The disadvantages are the possibility of hypersensitivity to latex, lubricants or those included in the condom; the need to interrupt sexual intercourse and possible decrease in sensitivity.
Female condom
The female condom is made of polyurethane and has 2 elastic rings on both sides. One ring is inserted deep into the vagina and the other is placed near the vaginal opening. The effectiveness of women's condoms is slightly less than that of men's, and the failure rate is 15-20%.
Advantagesand disadvantages. Female condom also protects against STDs; control over use is carried out by women. The disadvantages are its high cost and big sizes, the need for use immediately before sexual intercourse. The acceptance of this method of contraception is higher among men (75-80%) than among women (65-70%).
Vaginal diaphragm
The vaginal diaphragm is a round rubber or latex device surrounded by an elastic ring that is inserted into the vagina just before sexual intercourse and covers the cervix. The diaphragm and spermicide should be inserted into the vagina immediately before sexual intercourse and remain there for 6-8 hours after sexual intercourse. If another sexual intercourse occurs within 6-8 hours after the first sexual intercourse, spermicides are additionally introduced into the vagina without removing the diaphragm.
Efficiency. Although the theoretical effectiveness of this method of contraception is 94%, the actual effectiveness does not exceed 80-85%.
Advantages and disadvantages. A side effect of using a diaphragm may be irritation. Bladder, colonization of microorganisms, including Staphylococcus aureus, which can lead to the development of the syndrome toxic shock. Women can have increased sensitivity to latex, rubber or spermicide. The diaphragm must be fitted and inserted by a physician and replaced every 5 years or when body weight increases or decreases >5 kg. Women with pelvic prolapse cannot use this method of contraception.
Cervical caps
Cervical caps are small, soft rubber cups that fit directly over the cervix to prevent sperm from entering the uterine cavity. The caps are selected by a doctor and used together with spermicidal gel. The effectiveness of using cervical caps is similar to vaginal diaphragms - 80-85%.
Advantagesand disadvantages. The cap can remain on the cervix for 1-2 days. But most women complain about the increase vaginal discharge after the first day, inconvenience when inserting and removing the caps. The main reason for failure is the violation of localization of the caps. In this regard, the frequency of use of this method is low, 50-70% of women refuse to use it after the first attempt.
Spermicides
Spermicides can be presented in various forms- creams, gels, suppositories, foams and contraceptive films. The most widely used spermicides are nonoxynol-9 and octoxynol-9. These agents rupture the cell membranes of sperm and also act as a mechanical barrier in front of the cervical canal. Spermicides must be introduced into the vagina at least 30 minutes before sexual intercourse to allow dispersion into the vagina. Spermicides can be used as a separate method of contraception. But their effectiveness increases significantly when used simultaneously with condoms, cervical caps, diaphragms and other contraceptive methods.
Advantagesand disadvantages. The advantages are the variability of forms and the low cost of the method, the ability of nonoxynol-9 to reduce the risk of STDs, including the transmission of HIV infection. The disadvantages are the possibility side effects(irritation of the vagina and external genitalia), relatively high failure rate when used alone.
Intrauterine contraception (spiral)
(IUD) is a plastic device that often has a metal component (copper, silver, etc.) and is inserted into the uterine cavity using a special cannula - a guide. This spiral has “antennae” that help control localization (possibility of expulsion or migration) and facilitate the removal of the IUD. The IUD has been used for contraception since 1800.
IN modern practice most common 3 typesNavy:
1) IUD with copper (Multiloud, Sorreg-T);
2) IUD with progesterone;
3) IUD with levonorgestrel (Mirena intrauterine system).
About 100 million women worldwide use an IUD, making it one of the most popular methods of contraception. It is usually used by patients with contraindications for use. oral contraceptives those with a low risk of STDs, married, multiparous women.
Principleactions. The mechanism of action of the IUD has not been fully elucidated. It is believed that the IUD causes a sterile inflammatory process in the endometrium, promotes the immobilization of sperm and their destruction by inflammatory cells. This reaction to foreign body is enhanced by the addition of copper, progesterone or levonorgestrel, etc. to the IUD. The IUD does not affect ovulation and does not cause miscarriages.
Progesterone-containing IUDs increase the thickness of cervical mucus and cause atrophic changes endometrium, prevents implantation. IUDs can also reduce fluid movement in fallopian tubes, which disrupts the transport of the egg, sperm and blastocyst. Copper interferes with sperm motility and capacitation.
Levonorgestrel-containing IUDs should be inserted in the first 7 days of the menstrual cycle or immediately after termination of pregnancy. Copper IUDs can be inserted on any day of the menstrual cycle after the diagnosis of pregnancy has been excluded, as well as immediately after an abortion or after childbirth, or 6 weeks after birth (“interval IUD insertion”).
EfficiencyNavy very high. The failure rate is 0.1-2% and is the smallest (0.1%) with Mirena. But during the first year of use, the failure rate may be slightly higher - up to 3%, which is associated with undiagnosed expulsions or dispositions of the IUD.
Advantagesand disadvantages. Side effects are rare but can be serious and can cause pain, bleeding, pregnancy, IUD expulsion, perforation, and pelvic infection. Women using IUDs have greater risk inflammatory diseases pelvic organs associated with contamination of the edometrial cavity during IUD insertion. But on the other hand, pelvic infections are rare during the first 20 days after insertion of an IUD.
Prophylactic administration of antibiotics (doxycycline or azithromycin) during insertion of the IUD can prevent ascending infection. Before inserting an IUD, screening for STDs, especially gonorrhea and chlamydia, is mandatory. Modern progestin-containing IUDs may even reduce the risk of ascending infection by thickening cervical mucus.
The frequency of spontaneous abortions due to IUD reaches 40-50% of cases. If pregnancy occurs with an IUD, the latter should be removed by gentle traction on the antennae. IUD use is not associated with an increased risk of congenital anomalies. Intrauterine device administered by a doctor. This is a long-term method of contraception. "" is inserted every 5 years, IUD with progesterone - annually.
IUD does not increase risk ectopic pregnancy, as previously thought, but on the contrary, has some protective effect, although it is less than when using oral contraceptives. Mirena and progesterone-containing IUDs have healing effect in relation to dysfunctional uterine bleeding in women of reproductive age.
One of the ways to plan a family is to prevent pregnancy using a calendar. This method begins with the fact that the woman must calculate the expected day and abstain from sexual intercourse on the days most suitable days for conception. These days are called the fertile period and are the seven days before ovulation begins, as well as the day after it.
The calendar method of birth control is one of the most reliable “contraceptives”. There are many other ways you can prevent pregnancy, but natural methods are safer. Sperm can live in the vagina for a couple of hours, and in the cervix they can “last” about three days, sometimes a week. After leaving the ovary for 24 hours, the egg can be fertilized.
Twelve months are required for proper birth control according to the calendar. But for women with irregular menstruation this method will not work.
How to calculate pregnancy protection using the calendar?
To correctly calculate the days on which you can get pregnant, there is a certain formula:
- The fertile period is equal to the duration of the shortest cycle minus eighteen days.
- The end of the fertile period is equal to the duration of the shortest cycle minus eleven days.
For example, according to observations of twelve cycles, the shortest for the entire year is 26 days. The longest cycle is thirty-two days. So, the most favorable days For conceiving a child, the days of the cycle are from the eighth to the twenty-first. Therefore, in order to protect against fertilization, it is better to refrain from sex or use condoms and other methods of contraception. Already from the 21st day and from the first to the eighth, you can not use protection.
Natural birth control
Today, natural methods of birth control are the safest for women's health, as a result of which they are quite popular. But with such protection there are disadvantages, due to which such methods are not possible for some couples.
Fertility methods (i.e., the physiological ability of a woman or male body to participate in fertilization), also called “natural family planning methods” - a series of methods based on tracking changes in the body when it gives a signal of readiness for fertilization. A woman may only be fertile during one part of her menstrual cycle. By controlling certain changes in her body, a woman can more or less predict the time of the fertile phase and during this time, if she does not want to become pregnant, abstain from sexual intercourse. She can also use barrier methods if they are not prohibited by religious beliefs.
Temperature method
To determine the most likely time of ovulation and therefore the time of maximum possible conception, a woman must measure her basal body temperature, which rises and falls in accordance with hormonal fluctuations.
Every morning, before getting up, a woman must measure her temperature with a special basal thermometer and mark the result on a graph - a paper map. It is measured in the rectum at the same time every morning (for example, before getting out of bed). She should pay attention to the days of menstruation and sexual activity. The so-called “fertile windows” are 6 days. They begin 5 days before ovulation and end on the day of ovulation.
It is believed that days 10-17 in the menstrual cycle give a high chance of fertility (from the 1st day of the period, ovulation occurs approximately 2 weeks later).
However, not all women are able to conceive during this time period. Women who have longer or shorter menstrual cycles may have different periods fertility time.
Immediately after ovulation, in about 80% of cases, body temperature rises sharply. Some women can usually ovulate without this temperature regime. By studying temperature fields over several months, a couple can anticipate ovulation and plan their sexual activity accordingly. In order not to lose spontaneity, couples should try to avoid being fixated on a schedule when planning their sexual activity and use, for example, barrier methods of contraception.
Here are some tips for using the temperature method:
Measure your body temperature every morning without getting out of bed, preferably at the same time and in the same area of the body.
- If possible, use a special thermometer to measure basal body temperature.
- After each measurement, record the temperature readings in a special chart.
- During ovulation basal temperature increases by 0.2-0.5°C.
- Days of greatest likelihood of conception, or days of fertility, last as long as the basal temperature remains elevated for three consecutive days.
– Monitor your health closely to ensure that your fever is not caused by any other conditions or illnesses.
The cervical mucus method (or ovulation method) requires a woman to monitor the condition of her cervical mucus. She must write down the amount every day for at least a month, appearance, consistency and note others physical signs related to the reproductive system.
Cervical mucus changes in a predictable manner during each menstrual cycle:
Six days before ovulation, the mucus depends on estrogen and becomes clear and elastic. Ovulation may occur on the last day when the mucus has these properties;
- immediately after ovulation - mucus depends on progesterone, it is thick, sticky and opaque;
- separate models in the analysis of cervical mucus can provide high and accurate guidance to conception;
To observe, use the following rules:
Check the nature of your cervical mucus every day, three times a day after your period ends. To do this, wash your hands thoroughly with soap and take a sample of vaginal mucus. It is also possible to take a sample directly from the cervix with your finger.
- Look at the quality of the mucus (liquid, sticky, dry)
- Check if the mucus is sticky by simply spreading your fingers apart
- Check your underwear (if there are any stains)
- Try to make observations as often as possible (for example, when visiting the toilet)
- Determine the amount and color of mucus
- Try to identify cervical mucus (possibly the presence of male seminal fluid, lubricant. It could also be spermicides, if you use them)
- Record the results of the study daily and in detail. Note the consistency of the mucus (dry, sticky, creamy, egg white-like); its viscousness; presence of stains on linen; sensations in the vagina (dry, wet, slippery).
Number of days based on a 28-day cycle |
Features of slime |
||
Menstruation |
Present but not noticeable due to menstrual bleeding |
These days are not safe, since ovulation can also occur during menstruation. |
|
"Dry days" |
There is no mucus or is present in small quantities |
Sexual contact is permitted, but there is still minimal risk of conception |
|
"Wet days" |
Cloudy, yellow or white, has a sticky consistency |
Avoid sexual intercourse or use other methods of contraception. |
|
Ovulation |
Transparent, slippery, moist, viscous, with the consistency of raw egg white. The last day of slippery, wet mucus is called peak day, which means ovulation is near or has just occurred. |
Avoid sexual intercourse or use other methods of contraception. After the rush day, avoid sexual intercourse for the next 3 dry days and nights. |
|
"Dry days" |
Small amount of cloudy, sticky mucus or no mucus |
Starting from the morning of the fourth dry day and before the start of menstruation, you can have sexual intercourse without fear |
|
"Dry days" |
No mucus or very small amount |
Without dangerous days |
|
Wet mucus days |
Transparent and watery |
Safe days |
Calendar method
The calendar method (or rhythm method) is considered the least reliable fertility method. Women who have very irregular periods may have even less success with this method.
A woman first records her menstruation for 6-12 months, then subtracts 18 short-cycle days and 11 long-cycle days from the previous menstrual cycle. For example, if a woman's shortest cycle was 26 days and her longest cycle was 30 days, she should abstain from sexual intercourse from days 8 to 19 of each cycle;
Here are some tips to make this method easier:
Keep a menstrual calendar for 8 months, noting the length of each menstrual cycle starting with the first day of your period (the first day of your menstrual cycle) and ending the day before your next period (the last day of your menstrual cycle).
- Determine the longest and shortest menstrual cycles.
“Use the table to determine your likely fertile days.” The first day of fertility corresponds to the duration of your shortest menstrual cycle, and the last day corresponds to the duration of your longest menstrual cycle. Thus, the days with the maximum possible conception are in the interval from the first to the last - dangerous days.
Duration of the shortest cycle |
Your first dangerous day |
Duration of the longest cycle |
Your last dangerous day |
Symptothermal method
This method combines the temperature method, the cervical mucus method and the calendar method. Therefore, it is considered the most effective method fertility. In addition, women monitor signs that can identify her fertile period. These symptoms include changes in the shape of the cervix, breast tenderness, pain and cramping.
Who is suitable for natural contraceptive methods?
Because of high risk During pregnancy, natural methods of contraception are recommended only to those couples whose religious beliefs prohibit standard, especially barrier, methods of contraception. Couples who want commandment-free sex life, use barrier contraception during the fertile phase and no contraception during the rest of the cycle.
However, they should understand that there will be a higher risk of pregnancy with this method. To be effective against pregnancy, a cycle based on the method requires attention, and on the part of the people involved, dedication, discipline, persistence and cooperation with a partner.
Advantages of the method
Natural methods are safe and do not cause any side effects
- Acceptable to all faiths and cultures
- Involving the partner in the family planning process, increasing feelings of intimacy and trust.
Method-based fertility cycles are not recommended for women unless they are in a committed, monogamous relationship and can count on their partner's willing participation. Awareness-based birth control methods do not protect against sexually transmitted diseases.
Some factors may interfere normal signs fertility, for example:
Recent discontinuation hormonal contraceptives
- recent miscarriage or abortion
- recent birth
- lactation
- regular travel in different time zones
- infection in the vagina, such as thrush or an STD
Other factors influencing biological characteristics ovulation:
Temperature measurement time
- alcohol consumption
- taking certain medications
- illness.
The effectiveness of natural contraceptive methods is about 60%, which means that up to 40 out of 100 women using this method become pregnant within a year.
The calendar method of birth control is the most affordable way reduce the likelihood of unwanted conception. Based on her menstrual cycle, a woman calculates approximate period the onset of ovulation and identifies dangerous and safe days for unprotected sex. On dangerous days, they abstain from sex. In short, the first 7-8 days of the cycle are considered the safest and the last week. But only those women who have a known exact duration of the menstrual cycle do not have long delays. Otherwise it is possible late ovulation and the onset of pregnancy on days that were considered safe.
The most reliable method of birth control is the calendar method for women with regular menstrual cycle. That is, for those whose cycle is always equal to, for example, 28 days. Ovulation, the day when an egg is ready to be fertilized by a sperm, is approximately the middle of the cycle. In a 28-day cycle, this is approximately the 14th day. However, there may be deviations in one direction or another for a couple of days. Thus, using the calendar method of protection, couples will not have sex from the 12th to the 16th day inclusive. Some people advise adding 1 more day on one side and the other, just in case, since sperm can remain ready for fertilization for several more days in the female genital tract.
If the cycle is irregular, then you need to remember the longest and shortest. This way you can find out the approximate date of the earliest possible ovulation and the latest. In this case, the calendar method of contraception will not be reliable unless a larger period of time is allocated. Capture the interval between possible ovulation dates, plus the days before and after them.
If you don’t want to count manually and you trust automatic programs more, then go ahead. The script on our website will help you use the calendar method of pregnancy protection; it will be able to accurately calculate online safe days specifically for you. More precisely, it will show you the most favorable days for conception. Well, your task will include exclusion during these days of sexual activity. By at least, without using contraception, preferably barrier.
If the calendar method shows you have a dangerous day, but you still can’t resist sex, or the condom breaks, you need to use emergency contraception. It can be purchased at a pharmacy without a doctor's prescription. However, you need to understand that emergency contraception is not always effective. And its effect largely depends on the speed of taking the pill after unprotected intercourse. In addition, emergency contraception has an effect on hormonal background women, can lead to disruption of the menstrual cycle.
At first glance, the calendar method makes preventing unwanted pregnancy safe. But really, only for the first one. Yes, you don't need to take any medications. Spoil the sensations with a condom too. But this method is very unreliable. And if he fails, conception occurs and you will have to have an abortion. Well, this intervention in the female body is much more unpleasant and dangerous than hormonal pills.
Natural contraception is based on the characteristics female cycle, in which days are distinguished that are suitable for fertilization and those that are not. The essence of each method is to determine these days. However important point is the fact that at least such protection from unwanted pregnancy good because it does not affect women and men, but it is not very reliable and does not protect against sexually transmitted infections.
The main advantages of biological contraception:
- no impact on the health of partners;
- saving money;
- it becomes possible not only to prevent pregnancy, but also to plan it;
- deep knowledge of the female reproductive system (important for maintaining health).
Despite the simplicity of the method and its safety, there are also disadvantages:
- low efficiency (out of 100 women using natural contraception during the year, from 10 to 25 become pregnant);
- lack of protection against sexually transmitted pathology;
- use is possible only if the woman is in ideal health;
- the need to refuse sexual intercourse during certain periods.
Physiological basis of natural methods of contraception
The menstrual cycle, during which the egg matures and is eventually released, lasts ideally 28 days, but may vary within 7 days. There are three main phases in it:
- Proliferative (relative sterility). It starts from the first day of menstruation and ends with the onset of ovulation.
- Ovulatory (fertility). This phase occurs approximately in the middle of the cycle, when the egg is formed and is in the fallopian tubes. This period is most favorable for conception.
- Luteal (absolute sterility). This phase, accordingly, begins with the completion of ovulation and lasts until the first day of menstruation.
Knowledge physiological cycle allows you to accurately determine the days when conception is impossible. However, natural birth control is not for everyone.
Contraindications for the use of biological contraception:
- irregular menstruation (often even minor deviations from 28 days do not allow using the method);
- in cases where pregnancy is dangerous to the health and life of a woman (the use of more reliable methods is recommended);
- after artificial termination of pregnancy or after physiological childbirth (since the menstrual cycle has not yet recovered from hormonal disruptions).
Calendar method of contraception
Before Use this method contraception, you should analyze the menstrual cycle for six months or a year. Having chosen the shortest cycle, subtract 18 from the number of days, getting the first day of the dangerous phase. Having chosen the longest menstrual cycle from those analyzed, subtract the number 11 from the number of days, thereby finding out the last day of the period of possible conception.
The effectiveness of the method is influenced by several factors:
- gynecological health of women;
- environment;
- psychological state of the woman;
- level immune defense body;
- hormonal imbalances.
Any deviations in the menstrual cycle significantly reduce the effectiveness of calendar contraception.
Standard days method
This method of contraception is a type calendar method and is suitable for women whose menstrual cycle is regular but varies significantly. Its meaning is that the period from the 8th to the 19th day of the menstrual cycle is considered dangerous. The rest of the time you can have sex without fear of getting pregnant.
This contraception is suitable for partners who are confident in each other. Women for whom pregnancy protection is not so important. This type of contraception is also used by couples who are unable to use other methods.
Basal temperature measurement
By using this method determine the onset of ovulation, which means a dangerous period for pregnancy.
The measurement must be carried out in a certain place (the same each time). Suitable for this:
- oral cavity;
- vagina;
- rectum.
Temperature measurement is carried out every day in the morning, before the woman gets out of bed and lasts 5 minutes.
During the onset of ovulation, the basal temperature rises by about half a degree and remains at the same level throughout the fertile phase. For a more precise definition safe days draw up a special temperature schedule.
However, in some cases, depending on individual characteristics female body, the temperature remains unchanged throughout the menstrual cycle. In this case, you cannot use this method.
With an ideal menstrual cycle (repeated day after day) and a schedule, there is no need to measure temperature every morning, which makes a woman’s life much easier. However, it is still impossible to insure against unexpected changes, so the method, like the calendar method, is not very reliable.
Cervical method
The use of this method of birth control is based on the different nature of discharge from a woman’s vagina in different periods menstrual cycle.
The change in secretion occurs because during a period favorable for fertilization, a secret is released that helps sperm move toward the egg. Mucus appears, which is viscous and transparent. Abstinence from sexual intercourse should last until the dry period, when the secretion disappears.
This method is not suitable for women suffering inflammatory processes in the genitals of any etiology. Also, the effectiveness of the method is low due to the individual characteristics of the genital tract of each woman. Besides, cervical method quite inconvenient to use.
Multicomponent method
A method of protection that includes all of the above methods is called symptothermal or multicomponent. In addition to temperature, mucus and calendar calculations, the method includes accounting psychological state women.
However, this method, despite all its complexity, practically does not increase the effectiveness of contraception, and therefore has not found widespread use among sexual partners.
Coitus interruptus is one of the methods of biological contraception
This technique stands out separately, since it has no connection with a woman’s menstrual cycle. The point of contraception is that the penis is removed from the woman's vagina before ejaculation occurs.
Coitus interruptus has many disadvantages in terms of mental stress for both men and women. It causes a number of complications from the genital organs and is not recommended for use.
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