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Isaev D.D.

04.06.2004, 10:52

Very big and on this subject it is possible to write section of contraception much
Till now there is no ideal contraceptive which would be effective on 100 % and approached or suited absolutely to all. During the different periods of a life even it will be better to one woman to use different methods of contraception. On popularity hormonal tablets all over the world are in the lead - them use nearby 100 million women annually. The second on popularity there are endometrial agents (Naval Forces) to which prefer nearby 60 million women. To the most effective and safe methods of contraception, except for them, carry the hormonal preparations entered in the form of injections and implantov, possessing long obratimym action, and also surgical sterilization, both women, and men. The big variety of modern methods of adjustment of birth rate gives freedom for planning family, reduces a maternal mortality due to refusal of abortion, as basic way of planning of family in the past.
According to interrogation, in the USA approximately 90 % of women from group of risk of undesirable pregnancy used any contraceptive. Now the most popular methods of preservation from pregnancy in pairs or steams genesial age are oral contraceptive tablets (them 19 % use), sterilization of women (17 %), condoms (9 %) and sterilization of men (7 %).
In our country, according to Ministry of Health of the Russian Federation (1998) endometrial and hormonal contraceptions, accordingly 18 % and 8 % are most popular. About 40 % of women fertilnogo age use ineffective methods of prophylaxis of undesirable pregnancy.
Level of unreliability of various contraceptive agents.
The percent or interest beremennostej after a year of use of a contraceptive method is presented. Theoretical parameters of reliability (in brackets) and real results of use are given.
For an effective utilization it is important to choose such way of contraception which arranges (does not stir) or prevent) to both partners.
And *61623; Sterilization of women 0, 4 (0, 4)
And *61623; Sterilization of men 0, 15 (0, 1)
And *61623; Endometrial agents 2 (0, 6)
And *61623; the Combined tablets 3 (0, 1)
And *61623; Hormonal implants 0, 05 (0, 05)
And *61623; Injections of preparation Depo-Provera 0, 3 (0, 3)
And *61623; mini-tablets 3 (0, 5)
And *61623; Condoms 12 (3)
And *61623; Caps + spermitsidy 18 (6)
And *61623; Physiological methods 20 (9)
And *61623; Spermitsidy 21 (6)
And *61623; Interrupted the sexual certificate or act 19 (4)
The important step in development of contraception became successful creation of contraceptive tablets. They contain the synthetic hormones similar to that are developed or produced by a female organism and are necessary for it or him. The tablets containing an admixture of two hormones - estrogen and progestagena are most widely used. Them also name the combined oral contraceptives (OK). Estrogen warns an ovulation (an output or exit of a female ootid from an ovary), and the synthetic hormone Progestinum influences slime shejki uteruses, promoting its or her geling and an obstruction for a semen. He also influences internal layers of a wall of a uterus, doing or making impossible an attachment of the impregnated ootid.
Now are used OK the third generation. In them the share of estrogen with which some complications - thrombophlebites earlier have been connected, serdechno-vascular diseases is considerably lowered, and also hormones Progestinums of new generation (dezogestrel, norgestimat, gestoden) are included or switched on. It has led to essential decrease of by-effects and has made OK even more safe and attractive to long application. Their efficiency makes 97 99 %.
The parameter of reliability is closely connected with correctness of the use of tablets: OK usually are issued in packings on 21 tablet. They need to aspire to be accepted daily approximately in one and too time. After three-week reception of tablets, the woman does or makes a week break during which there comes a monthly bleeding. Upon termination of this term new packing OK opens. The packings containing 28 tablets, calculated on their constant reception during all cycle Sometimes are issued. In this case the part of tablets is not contained with hormones, as provides offensive or approach monthly. If in any day the woman has forgotten to accept a tablet next day it is necessary to accept two tablets.
All over the world OK use 180 million women, and in Russia them 8 % of women (data for 1998), while in the Great Britain - use 26 % of women.
OK possess the whole spectrum of advantages: simplicity in the use and high efficiency; a menses become more regular, less long, plentiful and morbid. Often decreases or the premenstrual syndrome disappears. The majority of women restore ability to become pregnant within two months after the termination or discontinuance of reception of tablets. Ability to conception even raises or increases. Approximately in 2 times the probability of a cancer of ovaries and endometrija decreases. This effect is saved within 10 15 years after the termination or discontinuance of reception OK. The quantity or amount decreases and the risk of occurrence of good-quality tumours of a mammary gland (in 4 times) and cysts of ovaries (in 14 times) decreases. Inspissation of slime shejki uteruses in 2 times reduces risk of bacteriemic or bacterial diseases of organs of a small basin, disappearance or eradication of acnes on the face is possible or probable.
Now the most frequent reason of refusal of reception OK are side effects of hormones - a nausea, a headache, augmentation of mass of a body (at regular reception the mass of a body increases on the average or is on the average enlarged for a year on 400), morbidity of mammary glands, rising of pressure and a mood swing.
Undesirable or dangerous there is use OK by smoking women 35 years (risk of an insult and an infarct), women suffering a hypertonia, disturbances of a circulation, illnesses or diseases of heart, a thrombophlebitis, some forms of a migraine, and also excessively full are more senior.

There are tablets containing only the minimal dose of one hormone - gestagena (" mini-drank or saw "). In them there is no estrogen that removes or takes out a question on some collateral signs (a complex of "pseudopregnancy": a nausea, a vomiting, giddinesses, edemas). They are a little less reliable, than the combined tablets. Their effect is based or founded;established on a condensation of a mucous fuse shejki uteruses that appears an insuperable obex to spermatozoons. Peak efficiency of a contraceptive is necessary on 3 - 21 hour after reception of a tablet. "Minitabletki" can be used smoking, and also after sorts or labors.
Necessity concerns to minuses to accept tablet every day at a time day - only in this case they provide reliable preservation. There can be krovjanisty allocation not connected with a monthly cycle, pains in the field of a breast, sharp changes of mood and depression are possible or probable. Reception for the women had extrauterine pregnancies or salpingocueses is not recommended. Women with mass have more 70 kg reliability. It is silent tablets can to decrease.
Efficiency of contraception "minitabletok" hardly below - 95 97 %.

Hormonal implants.
Hormonal preparations of long action have been developed for the decision of a problem of a regularity of reception of contraceptive pills.
One of them is Norplant - six soft capsules in the size about a match from silikonovoj rubbers which are located under a skin of a brachium through a small cut or section and within 5 years the woman appears is protected from pregnancy owing to constant allocation progestagena (levonorgestrela). Time capsules are not felt as All this, and after proprocession of this term they is taken by the surgeon under a local anesthesia.
Minuses: vzhivlennaja the capsule appears through through a skin, after excision there is a small scar. By-effects are possible or probable as well as at use of tablets. The most widespread is the irregularity of monthly cycles, long bleedings. Efficiency decreases at weight of the woman more than 60 kg a little. Usually pregnancy comes only in 6 months after excision of capsules.

Inektsionnyj a hormonal contraceptive.
Other alternative to tablets is inektsionnyj preparation Depo-the Probelief. The method consists in an injection of Progestinum which warns pregnancy within 3 months. The first injection is done or made in area of a brachium or a breech in one of first seven days of a cycle. The subsequent repeat in 12 weeks. The preparation interferes with an ovulation and implantation of an ootid in a wall of a uterus.
Its or His efficiency appears even hardly above, than at the combined contraceptive tablets, t. To. The opportunity of an irregularity of reception of a preparation is excluded.
Not always it is possible to foresee what influence a preparation will render on a cycle. Sometimes there are headaches, depression, addition of weight. After a cancelling of injections genital function is restored after 6 months.
During perfection inektsionnyh contraceptives, have been developed and introduced combined monthly inektsionnye contraceptives (Perlutal, Mezigina, TSiklofen, etc.), deprived the by-effects of preparations of long application containing only gestageny (Depo-Probelief, Noristerat). At application of these contraceptives frequency of bleedings not connected with a menses below, by the efficiency and safety they are close to OK.

Vulval or Vaginal ring with hormones.
Other interesting development became vulval or vaginal contraceptive rings. The ring is located in a vagina for three weeks where it allocates the hormones similar to combined oral contraceptives. That there was a menses, it is necessary to remove it or him for a week.
Their advantage before OK is more convenient form of application. A by-effect can be a nausea and a vomiting.
Endometrial agent.

The endometrial agent (Naval Forces) or "spiral" is entered into a uterus. It small on the size (nearby 2, 5 sm), is made of plastic, can be wound by the most thin copper wire or contain a hormone Progesteronum. One spiral can be established or installed for some years (according to all available information - till 10 years). Naval Forces influences change of an internal environment of a uterus and in 5 7 times accelerates passage of an ootid on uterine pipes, as a result of it or this the ootid has not time to find the qualities necessary for implantation, as prevents pregnancy.
Usually Naval Forces are recommended healthy and given birth or travailled women 25 years (at not given birth or not travailled women of complication in the form of inflammatory diseases arise in 7 times more often) which conduct a sexual life with the constant partner are more senior. It is considered, that at chaotic contacts the spiral does or makes sexual system of the woman of more vulnerable for an infection. But at the settled attitudes or relations this variant of contraception can be ideal. The world organization of public health services considers or examines;surveys Naval Forces as one of the most safe and effective time or temporary methods of a contraception. In the world 60 million women, and efficiency of endometrial contraceptives - 98 99 % uses it or him. In Russia they even are more popular, than contraceptive tablets.
Advantages: the adaptation cheap, long-term, does not demand leaving or care; any hormonal influences, the woman for some years is relieved of pavors and efforts that promotes rising of sexuality; the female organism receives biologically active substances containing in a semen; at will of the woman, Naval Forces can be removed at any time.
Possible or Probable intensifying bleedings concerns to minuses during monthly, occurrence be ill or sick during this period. Within 20 days after the equipment or installation the risk of a becoming infected raises or increases. There are cases of abaissement of Naval Forces (in 7 % of cases).
Diaphragm and cap.
Diaphragm - a soft round rubber cap in diameter of 5 10 sm with utolshchennym elastic edge or territory. From cervical caps the greatest diffusion was received with aluminium or plastic caps Kafki. A diaphragm establish or install across a vagina, and the cervical cap is less on the size and puts on immediately on shejku uteruses. They happen different forms and 20 sizes, therefore originally the size is selected by the doctor. The diaphragm is entered into a vagina by an arm or a hand shortly before the sexual relations and fixed directly ahead of fauces of a uterus. It is not enough one mechanical obex more often, therefore caps and should be applied diaphragms with spermitsidami which put or render on edges or territories and an internal surface of a cap. For rising efficiency it is desirable to leave them at least at 6 o'clock after the sexual certificate or act. After their use wash with soap in warm water, dry up and store or keep in a firm rectangular approach traffic pattern. After sorts or labors, abortion or at change of weight more than on 3 kg it is necessary to select the size of a cap repeatedly.
The diaphragm almost does not give by-effects, inexpensive, reliable enough at skilful use. A minus: during the sexual certificate or act it can be displaced.
The theoretical level of efficiency should be 95 %, but in practice makes 80 90 % iz-for misuse (the incorrect equipment or installation, the improper size, shift during affinity).

Spermitsidy
Spermitsidy are the substances, having pernicious an effect on the spermatozoons killing them or depriving to mobility before their hit in a uterus. Spermitsidy, containing nonoksinol-9, reduce risk of infection with the diseases passed sexual by. One dose spermitsidov operates or works approximately within an hour. They are issued in the form of candles, creams, tablets, jelly, foams, pessaries (the uterine capsule entered into a vagina). All of them are entered into a vagina up to the sexual certificate or act. Insufficiently high efficiency (70 75 %) forces to use them together with barrier methods (a condom, a cap or a diaphragm). Before each subsequent sexual certificate or act the new dose spermitsida is required.

Contraceptive sponge
The round sponge moistened spermitsidom, is entered into a vagina before the sexual certificate or act and there is there a minimum of 8 hours after the relations. Similarly to a condom, it is widely accessible way of contraception well suitable those who conducts an irregular sexual life. Unlike other barrier methods of contraception the sponge can be in a vagina for a long time (till 24 o'clock). However tests have shown, that its or her efficiency does not exceed 80 %.
One of methods of contraception is the contraception after the made sexual certificate or act without preservation (not protected sexual certificate or act). Such method is called emergency, or postcoital contraception (EK).
The most effective methods EK are purpose or appointment of high doses of hormonal preparations or postcoital introduction of an endometrial contraceptive.

" Morning tablets "
Abroad tablets for EK often name " morning tablets ". They are effective in cases of reception within 72 hours after not protected sex. But the earlier tablets, the above their efficiency are accepted! One dose, and in 12 hours - repeated first is accepted. The basic mechanism of action hormonal EK is influence on a mucosa of a uterus and disturbance of process of implantation of the impregnated ootid.
With purpose EK it is possible to use practically any combined oral contraceptive available on sale (OK), but the number of tablets will vary depending on their structure and a dosage.
So, if with purpose EK Rigevidonum in the first dose there should be 4 tablets, and in the second, accepted through 12 hours - 2 tablets is used.
At use of preparation Ovidon it is necessary to accept 2 tablets, and later 12 hours - 2 more tablets.
At reception modern OK type marvelona, mikroginona, silesta acceptance of three tablets for the first time and repeatedly in 12 hours is recommended.
Other type of tablets for EK contains only a hormone Progestinum. These tablets are more effective combined OK, and risk of occurrence of by-effects below. From this group of preparations in our country diffusion was received with Hungarian preparation postinor. Its or his efficiency - 98 % at double reception with a break at 12 o'clock, not later than 48 hours after the certificate or act.
At its or his use at 8 % of women the nausea and at 8 % - disturbance of a menstrual cycle in the form of intermenstrual krovjanistyh vydeleny was observed. postinor it is not recommended to apply more than 4 times a month.

As a perspective agent the synthetic antiProgestinum known as Ru-486 (France) now is considered or examined;surveyed. At it or him the highest efficiency at smaller quantity or amount of by-effects. From undesirable effects - elongation of a menstrual cycle after reception of a preparation.

Emergency hormonal contraception has shown the efficiency, however it or she cannot be recommended for constant use for a long time as thus high doses of hormones are used. Therefore after application EK it is necessary to pass to any other method of preservation from pregnancy.
Emergency contraception should be applied in extreme situations (for example, after rape or at doubts in integrity of a condom). She also is recommended to the women, seldom living a sexual life and after casual sexual communications or connections.
Contraindications to use: thrombophlebites, age are more senior than 35 years in a combination to smoking (more than 15 cigarettes in day), diseases of a liver, an idiopathic hypertensia, a diabetes mellitis, disturbance of a lipide exchange.
Frequency of offensive or approach of pregnancy depending on terms of application EK after the sexual certificate or act. Efficiency of a method depends on duration of an interval between the sexual relations and application EK (the less interval, the above efficiency).
In the first day - 2 % (combined OK) and 0, 4 % (postinor).
In the second day - 4, 1 % and 1, 2 %.
In the third day - 4, 7 % and 2, 7 %.
Syringing.
Use of a lavage of a vagina by any solution after the sexual certificate or act is the extremely unreliable way of contraception. By the moment of the termination or ending of affinity the appreciable part of spermatozoons appears outside of striking distances. It is considered also, that the lavage chemically active substances breaks a natural microflora of a vagina, raises or increases risk of inflammatory processes. Probability of offensive or approach of pregnancy at constant use of syringing - 39 %.