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Contraception


Autor: ass dr Milan Stefanović    

contraception

The term contraception stands for a group of measures, procedures and methods used for preventing unwanted pregnancy. Every contraceptive method or means must satisfy certain conditions: it has to be efficient, it must not disturb a regular sexual intercourse, it must not be damaging, it has to be cheap and affordable, and it has to be simple to use.

The contraceptive methods (and the percent of women who will get pregnant during the first year of usage):


  • Male condom: 2%
  • Diaphragm: 6%
  • Spermicides: 18%
  • Interrupted intercourse: 4%
  • Male sterilization: 0.1%
  • Female sterilization: 0.5%
  • Intrauterine system (MIRENA): 0.1%
  • Intrauterine insertion with a copper addition: 0.6%
  • Combination of hormonal injections: 0.05%
  • Depo medroxiprogesterone-acetate: 0.3%
  • Combination of hormonal vaginal contraception: 0.3%
  • Combination of hormonal transdermal contraception: 0.3%
  • Combination of hormonal oral contraception: 0.3%
  • Progestational oral contraception: 0.3%
  • Postcoital oral contraception (applied within the first 72 hours after the unprotected sex, it reduces a pregnancy risk up to 75%)

Considering this information a woman can protect herself from the unwanted pregnancy with a great certainty – that is, she can choose a time to be a mother and by that avoid the possible complications that accompany the unwanted pregnancy. Here some aspects of hormonal oral and intrauterine contraception.

Combined hormonal contraception

By its definition it represents a type of contraception based on the application of the synthetic sex hormones estrogen and progesterone.  

It can be:
  • Combined oral contraception
  • Combined transdermal contraception: band aids
  • Combined vaginal circular rings
  • Combined hormonal pareteral, depo-preparations
  • Combined hormonal oral contraception

It can be safely used by the majority of women, and it is especially recommended to:

  • Healthy women up to 35years of age
  • Women who haven’t given birth yet
  • The women who do not smoke
  • The women who need an efficient protection (frequent sexual intercourse, fear from the unwanted pregnancy, long-term stable relationships)
  • The women to whom the so-called non-contraceptive positive effects of this kind of contraception are important (reduction of the intensity and length of bleeding, premenstrual syndrome, painful menstruations, cosmetic effects)

There are also medical indications for using oral contraception: polycystic ovaries syndrome, painful menstruation, period disorder, repeated functional ovaries cysts, premenstrual tension, the cases of ovary cancer within the family, pelvic pain caused by endometriosis.

Before beginning to use such contraceptives one should visit a gynecologist who will test the following:

Risk factor presence: deep venous thrombosis, pulmonary emboli, hypertension or some other cardiovascular disease.

General medical condition and eventual other system diseases presence which exclude the usage of such oral contraceptives (diabetes, migraine, liver diseases, suspicious breast changes).

Gynecological history of a woman (spontaneous – intentional miscarriages, pregnancies, deliveries, ectopic pregnancy, period character, prior gynecological diseases).

Whether a potential user takes some other medicines that can disturb their effect (rifampicin, fenitoin, barbiturates, primidon, topiramat, oksakarbazepin, grizeofulvin, antivirus therapy).

The amount of risk for the occurrence of sexually transmitted infections (including HIV) and then dual contraception is recommended (oral contraceptive and a condom).

Of course, before oral contraceptives one should do a clinical examination of a woman (colposcopy and PA, gynecological examination, breast examination and measure the blood pressure).

The control examination of the patient means regular blood pressure measurement, regular gynecological examinations, and modern contraceptives do not require any pauses in periodical time intervals. If pregnancy occurs during taking the contraceptives there is no risk for any embryo damage.

When prescribing an oral contraceptive the advantage is given to a low or a very low dosage of hormones.
 

The oral contraceptives that can be found in Serbia


  • LOGEST (a low dosage, modern medicine which is recommended the younger population)
  • JEANINE (a low-dosage, modern medicine with a excessively good cosmetic effect which is recommended to women with problematic skin and hair)
  • YASMIN (a low dosage, modern medicine, which is recommended to women with excessive PMS and painful period – one f the most frequently prescribed and the best medicines)
  • DIANE 35 (a medicine with an extensive antiandrogenic effect)
  • MERCILON (standard)
  • MICROGINON (standard)
  • LEGRAVAN (standard)
  • CILEST (standard)

When prescribing oral contraceptives if some other effects that are not related to contraception should be given the advantage over the low-dosage modern medicines. You can get more detailed information about the first four medicines on the following link: www.21dan.com

Intrauterine contraception

It stands for a kind of contraception which is based on inserting a plastic insertion in the uterus (spiral).
The intrauterine device can be with:

  • A metal addition (IUU)
  • A levonogerstrel (IUS)- MIRENA

Women who should use IUU:
  • Women who have already given birth
  • Women who have reached physical and psychosocial maturity
  • Women who are in a steady monogamous relationship

Medical indications for using IUS (MIRENA) are:
  • the rhythm and intensity disorders when it comes to uterus bleedings (excessive, prolonged and irregular periods)
  • the prevention and treatment of anemia caused by excessive menstrual bleeding
  • making the period and PMS more bearable
  • as a constituent part of sex hormone retribution in the perimenopause
  • the treatment of endometriosis and adenomiosis
  • the protection of the endometrium with the patients receiving tamoxifen during the breast cancer treatment

When deciding to put IUU it is necessary to make an adequate estimation based on anamnesis and clinical examination (as well as with oral contraceptives) and to discuss it with a gynecologist.

When it comes to deciding what type of IUU to take one should adequately consider the needs of the patient.

Using MIRENA is characterized by high contraceptive efficiency, intensity reduction of menstrual bleeding, and a lower risk when it comes to the inflammation of the inner sex organs when using IUU with copper addition, therefore, in the West, and even in our region MIRENA is the ultimate choice.

A list of medicines from IUU and IUS group that exist in Serbia.
  • IUS MIRENA (20 micrograms per day of levonorgestrel)
  • IUU Intragal M, S.
  • IUU Bio-Cuprum M, S.
  • IUU Bio-Argentum M, S.

The first control after inserting IUU is recommended after 6 weeks, and the time of usage is determined by the production specification.


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