Obstetrics and Gynecology - A.M. Hromova 2000

Modern family planning methods
Traditional contraception methods
Natural methods of contraception

Natural Methods (NMs) of Contraception are based on abstaining from sexual intercourse during the fertile phase of the Menstrual cycle—that is, on the days when a woman is most likely to conceive.

The Use of NMs of contraception takes into account the lifespan of the ovum (12–24 hours) and spermatozoa (7–8 days).

There are various options for NMs of contraception:

1. The calendar method (Ogino-Knaus method), which is based on determining the fertile period According to the duration of menstrual cycles over the past 8–12 months. The beginning of the fertile period is calculated by subtracting the number "18" from the shortest cycle, and the end by subtracting the number "11" from the longest cycle. For example, suppose the shortest cycle was 28 days and the longest was 32 days.

28-18 = 10; 32-11 =21

Thus, the fertile period in this woman lasts from day 10 to day 21 of the menstrual cycle, which is 11 days.

Undoubtedly, a regular menstrual cycle is a prerequisite for using the calendar method. The limitations of this method are associated with its low contraceptive efficacy (the Pearl index ranges from 14 to 50 per 100 woman-years) and The Need for prolonged abstinence from sexual contact. The difficulties in using the calendar rhythm method are caused by individual fluctuations in the timing of ovulation due to various illnesses, psychological or physical stress, or drastic changes in climatic conditions.

2. The basal body Temperature method. In 1876, Mary Putnam discovered that basal body temperature changes throughout the menstrual cycle. Basal temperature is measured rectally every morning for 7–10 minutes. The temperature readings are recorded in the form of a chart. Throughout the follicular phase, the temperature does not exceed 37 °C; 12–24 hours before ovulation, it drops slightly, and after ovulation, it rises on average by 0.2–0.5 °C, remaining above 37 °C throughout the luteal phase. Basal temperature drops 1–2 days before menstruation.

Class="center">Determining the fertile period using the temperature method

The fertile period under the basal body temperature method is determined taking into account the lifespan of the ovum and spermatozoa. That is, if the day of the pre-ovulatory temperature drop is designated as "0", then the beginning of the fertile period—which starts 6 days before ovulation—will correspond to the figure "-6" on the menstrual cycle chart, and its end to "+3".

The temperature method of contraception can only be recommended if the woman has a regular menstrual cycle.

The disadvantages of this method include a relatively low contraceptive effect (Pearl index of 0.3–6.6 per 100 woman-years), the need for daily basal temperature measurements, and potential difficulties in interpreting data during illnesses accompanied by hyperthermia.

3. The cervical mucus method (Billings ovulation method) is based on changes in The properties of cervical mucus during the menstrual cycle. The quantity and quality of cervical mucus depend on the levels of estrogens and progesterone in a woman's body. At the beginning of the cycle, when estrogen levels are low, there is little cervical mucus, and it is thick and sticky. Driven by rising estrogen levels due to follicular maturation, the cervical mucus gradually changes, becoming clear and watery. As ovulation approaches, the mucus becomes lighter, more abundant, and stretchy. The last day of significant wetness corresponds to the peak estrogen level in the body.

Ovulation typically occurs the day after the abundant, clear, and stretchy mucus disappears. The fertile period lasts for the entire duration of clear, watery mucus secretion and for 4 days after its disappearance, which occurs under METABOLISM/18.html">The Influence of progesterone.

The use of the Billings method is limited by its low contraceptive efficacy (Pearl index ranging from 6 to 39.7 per 100 woman-years). This limitation is due to the impossibility of interpreting The Nature of vaginal discharge in the presence of colpitis, cervicitis, and other genital diseases.

4. The symptothermal method is based on a combination of basal body temperature monitoring, the calendar method, changes in cervical mucus characteristics, and other physiological indicators of ovulation, such as breast tenderness, lower abdominal bloating, edema, and spotting from the genital tract.

The Pearl index for this multicomponent method is 2–14 per 100 woman-years. Its advantages are accessibility and the absence of side effects or any negative impact on the female body.

5. The Lactation Amenorrhea method is based on the Physiological Effect of ovulation suppression during breastfeeding.

The duration of anovulation varies from 4 to 24 months postpartum and depends on the frequency of breastfeeding per day. Provided that intervals between feedings do not exceed four hours, lactation amenorrhea persists for up to six months postpartum due to a decrease in the pulsatile release of gonadotropin-releasing hormone, which leads to the suppression of luteinizing hormone secretion necessary for ovulation.

When an infant suckles the breast, neural impulses from the areolar Skin areas are transmitted via the Vagus nerve to the Hypothalamus, where Neuropeptides stimulate prolactin production in the Pituitary Gland, resulting in milk secretion and anovulation.

Under conditions of exclusive breastfeeding and the presence of amenorrhea for 6 months postpartum, the lactation amenorrhea method provides greater than 98% protection against Pregnancy. If menstruation resumes, the woman is advised to choose another method of contraception.

6. Coitus interruptus (withdrawal method) is a TRADITIONAL METHOD OF contraception in which the man completely withdraws his Penis from the woman's Vagina prior to ejaculation, thereby preventing semen from entering the vagina and averting Fertilization. The prevalence of this method reaches 28%, especially in Catholic countries. Contraceptive efficacy ranges from 15 to 30 pregnancies per 100 woman-years. Low efficacy may be due to the persistence of viable spermatozoa in the Urethra following a recent ejaculation (less than 24 hours prior).

Disadvantages of the method include a potential reduction in sexual satisfaction for partners, The Development of neurosis, impaired orgasm in men, and impotence.