CONTRACEPTIVE METHODS DEFINITION

CONTRACEPTIVE METHODS 

Oral Contraceptives

• Combined oral contraceptives
• Progestin-only pills (minipills)
• Emergency Contraceptive methods

Combined Oral Contraceptives

• COCs contain estrogen and progesterone. 21 and 28 day tablets are available.
•  21-day tablets are used for 21 days + 7 days apart. 28-day tablets, on the other hand, are switched to the other tablet without a break.

Mechanism of action;

•  It suppresses ovulation and thickens the cervical mucus, preventing the passage of sperm.
•  It thins the endometrium and prevents implantation.
•  Thrombosis is a complication that may develop depending on the estrogen dose in COC use.

Positive aspects;

•  It is effective
•  Menstrual bleeding is less and regular, reduces premenstrual tension and pain.
•  It reduces the risk of benign breast diseases, ectopic pregnancy, endometrial and ovarian cancer, and inflammatory disease.

Negatives;

•  One has to take pills every day.

Side effects;

•  Nausea, breakthrough bleeding and spotting may occur in the first three months. If amenorrhea develops, a higher dose estrogen-containing pill should be taken.

Indications

•  All healthy women who want contraception can use COCs at any age, from menarche to menopause. It is recommended to use condoms in addition to STD.

Contraindications

•  6 months for lactating, 3 weeks for non-breastfeeding
•  Smoking at least 15 cigarettes per day over the age of 35
•  Hypertension (≥ 160 mmHg systolic or ≥ 100 mmHg diastolic)
•  Venous thromboembolism (VTE) / pulmonary embolism
• It should not be used in cases of migraine with aura.
•  COC is started within the first 5 days of menstruation. If she is not pregnant within 6-28 days of menstruation, coke is started and an additional method is used for 7 days. 

Mini Pills (POP)

• They contain only low doses of progestin.
•  It can be used in lactation, perimenopausal period and when estrogen is contraindicated.
•  Bleeding irregularity is more common than COCs. But there is no harm.
•  Regular use is very important. Its effectiveness is reduced in clock delays. The pill should be taken every day.
•  Fertility begins immediately.
•  Breastfeeding is not affected by milk pop.
•  In the period with normal cyclic bleeding, it should be started on the 1st day of menstruation.

 Effect mechanisms;

•  Thickening of the cervical mucus prevents the passage of sperm.
•  The endometrium becomes thinner and the probability of implantation decreases.

Indications;

•  Women who want to be healthy and protected,
•  Breastfeeding mothers After 6 weeks
•  with hypertension
•  Those who complain about the estrogenic side effects of COCs
•  Smoking women over the age of 35 can use the mini pill.

Contraindications;

•  Pregnancy
•  breast cancer
•  It is also contraindicated if cerebrovascular accident and stroke occur during use.

Side effects;

•  Bleeding pattern changes
•  Headache
•  breast tenderness
•  Ovarian cyst development
•  mood changes
•  The period of non-menstruation may be prolonged in breastfeeding women, and this period may be prolonged.

Emergency Contraceptive Methods

• Ertes (Levonorgestrel)
•  Ella (Ulipristal Acetate)
•  Postpill one (Levonorgestrel)
•  Norlevo (Levonorgestrel)
• Indications;
•  unprotected sex
•  Failure of the current method (Condom rupture, forgetting POP or POP)
•  Exposure to potential teratogens
•  Forensic case, rape

Subcutaneous Implants Implanon

• It is placed under the skin and is effective for three years.
•  The rod secretes a progesterone called etonogestrel.
•  It does not contain estrogen, so it is suitable for women who are inconvenient to contain estrogen.

Levonorgestrel Secreting Intrauterine System

Mirena 

• Levonorgestrel Secreting Intrauterine System.
•  It has a local effect.
•  Side effects are few.
•  Over functions are not affected

Effect Mechanism;

•  It inhibits ovulation.
•  Cervical mucus thickens.
•  Endometrial perforation is prevented.
•  Sperm motility decreases.
•  Implantation is not inhibited, fertilization is inhibited.
•  In monthly injections and implants, steroids should be given to target tissues in amounts that can be effective.

 Usage period; 5 years

•  It reduces menstrual blood loss in women with normal periods and menorrhagia.
•  It is used in the treatment of pelvic pain related to menorrhagia, endometriosis and adenomyosis, endometrial hyperplasia and cancer.

İntrauterine Device

• It is produced from plastic and copper.
•  It secretes a small amount of copper every day to ensure fertilization.

IUD types;

•  Intert IUDs
•  Copper IUDs: TCu 380A TCu 200, TCu 200B, TCu 220C,Multiload (MLCu 250 and 375) and Nova T (TCu 200Ag and 380Ag)
•  Hormone IUDs: Progestasert containing progesterone in the stem, LevoNova and Mirena containing Levonorgestrol

Copper IUDs;

•  It prevents fertilization, reduces the number of sperm reaching the fallopian tubes and the fertilization capacity of these sperms.
•  It prevents implantation.
•  Those containing progestins thicken cervical mucus.
• Mechanism of action of copper IUD
•  Intrauterine foreign bodies stimulate an inflammatory reaction with macrophages and leukocytes that migrate into the uterus. This effect starts immediately after administration and disappears quickly when the IUD is removed.
•  The synergistic effects of live and dead bacteria with the IUD accelerate the flow of inflammatory cells into the uterus.
•  These inflammatory cells create an environment hostile to the embryo and sperm.
•  A large number of macrophages enter the endometrial cavity and a "biological foam" is formed, which is responsible for the destruction of sperm and ovum.

Effectiveness;

•  Patients develop a transient bacterial infection in the endometrial cavity.
•  Copper T380A is used for up to 10 years. It is preferred in maternity hospitals.
•  Multiloid 375 IUD is effective for 5 years. It is preferred in private obstetrics clinics.
•  The LNG-20 IUD is effective for five years
•  Pregesterone T provides one year of contraception.

Who Can Use;

•  Breastfeeding
•  Those who want to be protected for a long time
•  Those who do not want to use POPs every day

Who cannot use it;

•  Those who are suspected of pregnancy,
•  Those with undiagnosed vaginal bleeding
•  Those who have had a pelvic infection in the last 3 months
•  Those with congenital urethral anomaly
•  Those with genital infections
•  Those with cervical endometrial cancer

When to Apply;

•  Preferably on the 3rd day of menstruation
•  Postpartum in the first 10 minutes- 48 hours postpartum, if this period has passed, after the 6th week
•  Immediately after or within the first 7 days of non-septic abortion

When to remove;

•  If you are considering pregnancy
•  If side effects persist When expired
•  If complications develop

Positive aspects;

•  It is very effective.
•  It is independent of sexual intercourse.
•  Suitable for breastfeeding women.
•  There is no delay in the return of fertility.
•  Once removed, a new one can be applied immediately.

Negatives;

•  It can be a little painful to apply and remove.
•  Some women may experience discomfort in the lower abdomen, increased menstrual bleeding, spotting and cramps between menstrual periods. These complaints decrease starting from the third menstrual period.
•  There is a slight risk of uterine perforation during the application.
•  The IUD can slide from the uterus to the cervix and be inserted into the vagina.
•  It is not protective against STDs.

Side effects;

•  Increase in the amount and duration of mens
•  Anemia
•  Dysmenorrhea in the first few menses
•  Disposal of the ria and loss of its threads

Complications;

•  Pregnancy with the IUD in place
•  ectopic pregnancy
•  Uterine perforation
•  Pelvic inflammatory disease

Side effects;

•  Bleeding: The most common side effect
•  Cramp
•  Syncope
•  Disposal of the IUD: It is seen in the first three months.
•  Uterine perforation

Monthly Injections

• 1 ml pre-filled syringe contains 50 mg of norethisterone enanthate and 5 mg of estradiol valerate.

Effect Mechanism;

•  Suppression of ovulation as in cokes,
•  Thickening of cervical mucus
•  Inactivation of the endometrium
•  IM- It is applied into the deep gluteal muscle or IM into the deltoid muscle. It should be administered slowly due to the risk of abscess.

Who Can Use;

•  obese
•  Benign breast diseases
•  Thyroid diseases
•  iron deficiency anemia
•  Epilepsy
•  Mild headaches
•  Infectious diseases such as tuberculosis, malaria

Who Cannot Use;

•  Those with migraine with aura
•  Pregnancy
•  Breastfeeding mothers up to 6 months
•  Those with breast cancer
•  viral hepatitis
•  Moderate HT, severe HT
•  thromboembolism

Positive aspects;

•  It is extremely effective.
•  It is easy to apply.
•  Older women (if they don't smoke) can also use it
•  It prevents ectopic pregnancies and iron deficiency anemia.
•  It has a protective effect against pelvic infection and ovarian cancer.
•  Its protective effect begins in 24 hours.
•  Fertility returns immediately.

Negatives;

•  Compared to preparations containing only progesterone, the necessity of doing it once a month makes it a little difficult to use.
•  Compared with COCs, it may cause disruptions in bleeding patterns.
•  In some women, periods may be delayed when use is discontinued.
•  It has no protection against STDs.
•  Nursing mothers cannot use it in the first 6 months after birth.
•  It can cause weight gain.
•  Women who are in the risk group in terms of estrogen-related complications cannot use it.

Side effects;

•  depressed mood
•  Headache
•  nausea, vomiting
•  Breast pain, tenderness, breast enlargement
•  allergic reactions
•  Vaginal discharge
•  Venous and thromboembolic disorders

Injectable contraceptives containing only progestin

• It has also been used in the treatment of endometriosis, endometrial cancer, dysmenorrhea, hirsutism, and bleeding disorders.
•  Its effectiveness is high.

Effect Mechanism;

•  It inhibits ovulation.
•  It creates a thick mucus in the cervix that reduces the penetration of sperm.
•  The endometrium becomes inactive and atrophic with continued use.

Indications;

•  Contraception (If a vasectomy was performed, to provide protection until it takes effect)

Who Can Use;

•  Smoking women
•  obese
•  Breast-feeding
•  iron deficiency anemia
•  Bening breast diseases
•  Women with congenital heart disease, thromboembolic disease
•  Gallbladder diseases
•  thyroid disease
•  Thalassemia or sickle cell anemia
•  Epilepsy

Who Cannot Use;

•  Gynecological obstetric variables
•  existing breast cancers

Positive aspects;

•  Extremely management.
•  It is easy to apply.
•  It can also be used by older women.
•  is not in sexual intercourse.
•  It has a protective effect against pelvic, endometrial and ovarian cancers.
•  The fertility left to time returns.
•  Prevent ectopic pregnancies and iron use anemia.
•  It does not prevent what comes from breastfeeding mothers, do not wean.
•  Estrogen use can be used in terms of risk.

Negatives;

•  Injections are required by the clinic.
•  May cause menstrual irregularity.
•  Some may delay periods when left to use.
•  It has no protection against STDs.
•  It can cause weight gain.

Side effects;

•  Disruption in menstrual pattern: menses, spotting menses, amenorrhea
•  headache
•  in the breasts
•  be protected
•  abscess at the injection site
•  Breast viruses are risky
•  Bone mineral value.

Vaginal Ring

•  Contains estrogen and progesterone.
•  The ring releases an average of 120 micrograms of etonogestrel and 15 micrograms of ethinylestradiol per day, respectively, over a 3-week period.
•  The ring is left in place for three weeks.
•  It should be checked regularly whether the ring is inside the vagina.
•  It is removed after three weeks and a week break is taken. In the ring-free period, menstrual bleeding occurs.

Voluntary Surgical Contraception

1.  Tubal ligation in women,
2.  male vasectomy

•  It is a suitable method for families who no longer want children.
•  Reversible is possible, but expensive and difficult.
•  All tubal sterilizations are applied in the isthmus area.

Tubal Ligation;

•  It is very effective and safe
•  One-time cost
•  Independent of the time of sexual intercourse
•  The activity starts immediately after the application.
•  It is difficult to return.
•  It requires a long and expensive operation.
•  It does not protect from sexually transmitted infections.
•  There may be pain in the incision site and lower abdomen for a few days following the operation.
•  There may be surgical complications
•  Since it is an irreversible contraceptive method, in order to avoid regret in the future, consultancy service must be obtained before the procedure, a conscious decision must be made and the consent form must be signed by both spouses.

Types of tubing;

 A. ELECTROCOAGULATION: Destruction of a tubular segment by unipolar or bipolar current

 B. LIGATION AND/OR EXCISION: Tubal ligation, cutting and removal of the cut portion

 C. MECHANICAL: Application of silastic tape or clips by laparoscopy.

For whom is it suitable?

•  Those who definitely do not want to have children again
•  Those who are inconvenient to have children

Danger Signs;

•  days after application;
•  extreme abdominal pain
•  If bleeding occurs, a healthcare provider should be consulted.

Vasectomy;

•  It is an irreversible, permanent surgical sterilization method.
•  In men, it is effective by preventing the passage of sperm to the semen as a result of the vas deferens being tied and cut.
• It is applied easily, simply and in a short time,
•  It has no effect on sexual intercourse.
•  Recycling is difficult and expensive.
•  It does not protect from sexually transmitted infections.
•  The contraceptive effect starts after 20 ejaculations or 2 months later. This time requires an additional method.
•  There may be pain, bleeding and swelling in the scrotum during the operation and for a few days following it.
•  Within a few days after the application;
•  bleeding from the wound,
•  Ache,
•  There may be swelling (hematoma)

Barrier Methods

• These are the methods that prevent the sperm from passing into the woman's vagina during sexual intercourse.
•  They are used safely
•  It has very few contraindications.
•  It can be purchased and used without a prescription.
•  They also protect against sexually transmitted diseases.

Methods;

•  female condom
•  male condom
  
•  Diaphragm
•  cervical cap
•  spermicide
  

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