Lecture on family planning measures

2021-03-19 12:00 AM

Do not have sex when a woman has mucus in her vagina, insert two fingers into the vagina with mucus between her fingers until 4 days after the wet mucus is gone

General perception

Family planning is a couple's conscious effort to adjust the desired number of children and birth distance. Family planning often involves the use of birth control measures to avoid population growth, but also includes efforts to help couples have difficulty having a baby. Therefore, family planning is divided into two directions: positive family planning lies in increasing population growth and negative family planning to reduce population growth. In our country's population development, it is imperative to carry out negative family planning, which means emphasis on contraception. In the scope of this article, we only mention contraceptive methods. According to the nature of action, contraceptive methods are divided into two categories: temporary contraception and permanent contraception.

Temporary contraception

For women:

Diaphragm vagina, cervical cap, female condom.

Spermicide, vaginal foam.

Lactating amenorrhea.

A contraceptive intrauterine device.

Hormonal contraceptives.

For men :

Ejaculation out.

Male condom.

For both men and women:

Abstain from periodic sexual intercourse.

Permanent contraception

Female and male sterilization (also called sterilization).

The traditional methods of contraception

Coitus interruptus (intercourse ng surely stretch)

The method of vaginal ejaculation requires a male's initiative during intercourse. The penis is quickly withdrawn from the vagina before the ejaculation occurs. This method is very widely used in a number of developed and developing countries.

Mechanism of action: does not allow sperm to reach the ovule, prevents fertilization.

Failure rate: about 5-25 pregnancies for 100 people using this method in the first year.

Benefit:

No long-term or systemic effects.

This method is available, cost-free, and requires no training.

The disadvantages:

The failure rate is quite high, requiring very strict adherence to all actions during intercourse. Especially it requires determination and decisiveness of men and women, a prerequisite factor for the success of the method.

This method is completely not suitable for people with premature ejaculation.

Abstain from periodic sexual intercourse

Abstaining from periodic intercourse is to choose a time of intercourse far from the days of release, in order that the living sperm cannot meet the living oocyte. This method is sometimes used in conjunction with some other methods such as vaginal ejaculation, septum ... In this case, the contraceptive effectiveness will increase.

The schedule-based method had a fairly high failure rate (5-40 pregnancies per 100 women / year) (1981). This method is less effective, sometimes making it difficult for couples because they have to abstain from intercourse for a long time. Hence in 1982 the International Planned Parenthood Federation (IPPF) concluded that this approach was not seen as an effective family planning method.

Ogino (1928) - Knaus (1930): abstaining from intercourse on the 9th to 19th day of the 28-day menstrual cycle, need to monitor the previous two consecutive cycles to assess the degree of regularity of the menstrual cycle. This method is ineffective, and is not available in people with irregular periods.

The method of temperature recording proposed by Ferin in 1947 is based on the discovery of Van de Velde's two-stroke curvature in the menstrual cycle with ovulation (1904). According to this method, intercourse is only allowed 2 days after hyperthermia, the limitation of the method to only indicate the period after ovulation.

Cervical mucus method (Billings method): do not have sex when a woman has mucus in her vagina (inserting two fingers into the vagina showing mucus between the fingers) until 4 days after out of wet mucus.

Failure rate: if applied regularly fails at about 10-30 pregnancies for 100 women to use for a year. The scheduled method has a slightly higher failure rate. The effectiveness of contraception also depends on the determination and commitment of the couple.

Benefit:

The efficiency is quite high, once done properly according to requirements, the efficiency is over 90%.

Inexpensive.

No long-term or systemic effects.

No medication or tools are required.

Increases understanding of the reproductive cycle, which can be used to increase fertility when needed.

Disadvantage:

Requiring abstinence from intercourse for many days in a menstrual cycle, it is difficult to apply in case of irregular menstruation.

It is important to monitor the menstrual cycle for several months before deciding to apply the method.

Not suitable for couples living apart, not having sex often.

The failure rate is quite high.

Guidance and training is required to use this method effectively. The woman has the ability to determine the period of her fertility.

LAM - lactational amenorrhea method (LAM)

Breastfeeding is the most ideal nutrition for the baby, while also helping the woman to give birth. Amenorrhea is only effective when the following conditions are present:

No return of menstruation.

The woman must breastfeed her baby exclusively or almost completely.

The child is under 6 months old.

If one of the three conditions above is not guaranteed, then another method of contraception must be applied immediately. Once the above requirements are fully complied with, this contraceptive method is up to 98% effective. The method can be found immediately after birth, economical, easy to implement, suitable for all religions and cultures. This is a contraceptive method that deserves to be encouraged in developing countries with many economic difficulties because:

Breast milk has the best nutritional role for your baby.

Breastfeeding works to prevent pregnancy than all other methods of contraception combined.

As an important contraceptive method in the first 6 months, with high efficiency.

The septum contraceptive methods

Male condom (condom)

As a method of contraception applied to men, it is increasingly recommended for widespread use for contraception and for prevention of sexually transmitted diseases. Male condoms are used in developed countries. Contraceptive method completely restored, contraceptive effect only when using a condom. Condoms are an effective method of contraception and motivate men to participate in contraception and share the responsibility for family planning.

The condom is inserted into the penis when it is stretched, before being inserted into the vagina. Gentle mounting action to avoid tearing the condom. After ejaculation must pull out the penis and condom immediately.

In couples that have experience using it and really want to use it, the rate of failure is about 3 pregnancies per 100 women using a year. • The failure rate may be higher in the first year. The cause of failure is irregular or improper use, and the condom has been damaged due to poor storage conditions. Nowadays the failure rate is greatly reduced because more spermicide is used as a lubricant. Using male condoms has great effects in preventing sexually transmitted diseases (gonorrhea, syphilis, Trichomonas, Chlamydia, Herpes and especially HIV). However, the ability to protect is not absolute. It was also found that condoms were effective in preventing and improving suspected cervical adhesion, protecting women from cervical cancer and pelvic inflammatory disease.

Benefit:

No effects on systemic or long term.

Highly effective contraception when used correctly.

Easy to access by users (widely sold in the market), quality can be checked.

It is a good way to prevent sexually transmitted diseases including HIV / AIDS.

Disadvantage:

Need to be stored properly, in places that are too hot, humid, and exposed to sunlight, the storage period of more than 3 years reduces the quality of the condom, and is at risk of tearing when used.

Only used once, after sex need to find a place to throw away.

Can affect pleasure during intercourse.

A regular supply is required.

Sometimes people are allergic to latex.

Contraception in the vagina

There are many methods such as diaphragm diaphragm, female condoms, effervescent tablets, creams, siphons, tablets ... The mechanism of action may be the mechanical diaphragm, the physical diaphragm, but there are always with added spermicide added. All these measures have a temporary contraceptive effect, easily recover after stopping use.

Spermicides are chemicals for which the active ingredient can be one of the following: benzalkonium chloride (BZK), hexyl-resorcinol, 9-nonoxynol (N9). Medicines can come in many forms, such as creams, foam, paper, suppositories, and an effervescent tablet that is placed in the vagina. How it works: inactivates sperm and physically blocks sperm from entering the uterus. The drug also works to kill bacteria. Want to increase the contraceptive effect of spermicides should be placed 10 minutes before intercourse, deep in the vagina, in contact with the uterus. Contraceptive protection begins 10-15 minutes after insertion and is usually effective within 1 hour. Anvil has maximum compression results using drugs combined with a diaphragm. Avoid bathing for 6 hours after sex. In the case of proper use, the failure rate does not exceed 5 pregnancies per 100 women / year (1984).

Benefit:

No long-term or systemic effects.

Suitable for couples who do not regularly have sex, live far apart.

Some sexually transmitted diseases can be reduced.

Disadvantage:

Need a reliable supply, relatively expensive price.

The failure rate is still quite high.

May cause some local side effects (itching, irritation, burning ...), exceptions may be toxic dizziness syndrome.

Birth control pills

Birth control pills are a reversible method of contraception. Depending on the composition of the pill, one can divide the following categories:

Combined oral contraceptive: in the composition of estrogen and progestin.

Progestin pills: progestin only in the composition.

Combined oral contraceptive

Types of drugs :

Based on the amount of estrogen contained in the pill, one can divide the following categories:

Large-dose oral contraceptive: the ethinyl-estradiol (EE) content in each pill is 50pg. The classic estro-progestatií tablet contains 50 grams of ethinyl-estradiol (EE), either in combination or as a successor (the first 50 pg ethinyl-estradiol tablet appeared in 1964). Progestins are the main contraceptive, supplemented with estrogen, aimed at avoiding the blood-dripping effects of progestins.

Small-dose oral contraceptive: the content of ethinyl-estradiol (EE) contained in each pill is from 20-40pg (a tablet containing 30pg of ethinyl-estradiol first appeared in 1974). Because the estrogen in the pills has caused the undesirable effects, more and more people are trying to lower the estrogen dosage in each pill.

Based on the combination of estrogen and progestin, one can divide the following types:

Combined oral contraceptive: the content of ethinyl-etradiol and progestatií is the same in all tablets of the pack (eugynon, ovidon, microgynon, rigevidon, marvelon ...).

Next form: the first part of the pack is estrogen-only pills, and the back of the pack is pills that contain both estrogen and progestatií.

Two phases: the content of ethnyl-estradiol and progestatií changed once in the pack.

Three phases: the content of ethnyl-estradiol and progestatií changed twice in the pack.

The utility mechanism:

Contraceptive effect is due to many mechanisms of coordination and mutual complementation. The most important effect is to inhibit oocyte release by inhibiting the hypothalamus - pituitary axis, leading to inhibition of FSH secretion, and loss of LH peak. The hormones contained in pills that alter the structure of the endometrium often cause endometrial atrophy due to the effect of progestins, not suitable for implantation eggs. Birth control pills often thicken cervical mucus, preventing sperm from entering the uterus. The dominant role of each mechanism differs depending on the drug. In short, the oral contraceptive pill works in three places, one in the center of the hypothalamus - pituitary gland, two in the endometrium, and three in cervical mucus.

Effective contraception:

The effectiveness of the oral contraceptive pill is excellent, provided that it is taken regularly, not to be forgotten. Overall, the failure rate is very low, the Pearl index is less than 1, which means there is less than 1 unwanted pregnancy out of 100 women using it in a year, specifically:

Classic tablet: 0.15-0.45 pregnancy for 100 women / year.

Small dose: 0.4-0.7 pregnancies for 100 women / year.

Benefit:

Regular menstruation, decreased menstrual blood volume, decreased dysmenorrhea, decreased functional ovarian follicles (decreased 270 times) and ovarian inflammation, reduced premenstrual syndrome, decreased ovarian and endometrial cancer (tablets combination) (reduced 2 times), reduced benign breast diseases (reduced 4 times) and possibly breast cancer, reduced rheumatoid arthritis. It has been observed that the rate of ectopic pregnancy decreases with oral contraceptive pills (a 90% decrease). There is no increased risk of cardiovascular or liver disease with non-smoking conditions.

Highly effective contraception, contraceptive method with recovery, easy to use.

Absolutely not involved in intercourse.

Disadvantage:

Need to provide regular pill.

Reduces the amount of breast milk, so it should not be used while breastfeeding.

Sometimes it feels like morning sickness.

Disorder of sugar metabolism causes increased insulin, decreased sugar tolerance tends to increase blood sugar. Estrogen and also progesterone may be the cause.

Increased triglycerides and cholesterol due to the effect of ethinyl-estradiol on the liver. The level of effect depends on the concentration of estrogen. Estrogen causes a decrease in LDL cholesterol (lovv-density lipoprotein) and increases HDL cholesterol (high-density lipo- protein), which in turn increases cardiovascular disease. A high incidence of deep vein thrombophlebitis and pulmonary artery thrombosis were found in those taking oral contraceptives (3-11 times higher than non-users).

Increases blood clotting without knowing the exact mechanism, increases platelet adhesion, increases synthesis and some coagulation factors. This type of oral contraceptive eventually increases the risk of thromboembolism.

Causes cholestasis, cholestatic jaundice, increases gallstones. The use of oral contraceptive pills is contraindicated in a history of these signs.

Particularly for the next pill because the first part without progestatií seems to increase the incidence of endometrial cancer in the future. It is for this reason that it is not recommended to take this type of tablet for many years.

Contraindications to the use of oral contraceptive pills:

Absolute contraindications:

You are pregnant even though there has been no adverse effect on the mother or fetus of oral contraceptive pills while taking this medicine during pregnancy.

The lactation period has the potential to affect lactation, increase the risk of thrombosis, and the infant can be affected by exposure to steroid hormones.

History of arterial or venous thrombosis.

Pathology at risk of thrombosis: cardiovascular disease, long-term stay in place, major surgery.

Current or history of myocardial anemia.

Hypertension.

Cerebrovascular accident (history or treatment).

Increased blood lipids.

Insulin-dependent diabetes mellitus.

Primary liver disease, history of cholestatic jaundice in pregnancy, history of pruritus during pregnancy, viral hepatitis, cirrhosis, liver cancer.

Pathology of oocytes (pregnancy, chorio).

Endocrine cancers: endometrial cancer, breast cancer.

Tobacco addiction in people over 35 years old.

Relative contraindications:

Fat.

Family history of hyperlipidemia, diabetes mellitus, stroke.

During pregnancy, gaining excess weight or having high blood pressure.

Hyperthyroidism.

Fibroids.

Non-insulin dependent diabetes mellitus.

Some situations when d Brøndby teammates contraceptive pills :

Forgetting to take medicine: If you forget a pill at night, take the missed pill in the morning of the next day, the next night still take it as usual. If you forget to take from the two upwards pills, it is best to stop taking the pills, throw away the unfinished pack, wait for bleeding due to hormonal drop, and start a new pack.

Do I need to temporarily stop the contraceptive pill routine? Not necessary if all monitoring is normal. So far there is no scientific justification for the periodic temporary discontinuation of the oral contraceptive pill. Only stop taking the drug when you want to have a baby, have surgery (stop 4 weeks before surgery) and when there are abnormal signs (headache, breast pain, high blood pressure ...) It is recommended to stop the medicine when there is At least 3 months of pregnancy, it threatens the endometrium to return to normal, limiting the rate of multiple pregnancies due to the jump effect. Pregnancy while taking the drug (because of drug forgetting), the course of pregnancy is completely normal, there is no indication for abortion.

After curettage, aspiration should only use the next pill to help the endometrium to regenerate well, limit uterine adhesion.

Progestin-only birth control pills

Types of drugs:

Small doses, used continuously with no rest days, starting on the first day of the menstrual cycle, should be taken at one hour of the day (preferably with dinner).

Large doses: large, simple progestatiís can be used for contraception. Pincus, Chang and Rock themselves proposed a single, large-dose progestati contraceptive in 1954. Progestatiís such as Lutenyl (nomegestrol), Surgestone (promegeston), Androcur (cyproteron), Luteran (chlormadion) use from day one. The 5-25 menstrual cycle allows for safe contraception like estro-progestatif pills. However, the use of progestatiids in this form for therapeutic purposes is the subjective, contraceptive effect is implied.

Mechanism of action: thickens cervical mucus, prevents sperm from entering the quadruple chamber, atrophy of the endometrium is not suitable for implantation of eggs, inhibits oocyte release, makes imperial premature dissipation. Progestatií tablets alone in small doses have very few undesirable effects. Because the drug does not completely inhibit the hypothalamus-pituitary axis, and still has endogenous estrogen secretion, it is contraindicated in case of breast disease. When using this drug, there may be menstrual disorders: irregular menstrual periods, amenorrhea, mid-menstrual bleeding ... It is possible to use this pill while breastfeeding without affecting lactation.

T dependence of failure:

Progestin small dose, continuous administration: 1-1.6 pregnancies for 100 women using year.

Large-dose progestin: 0.5 pregnancies for 100 women using five.

Benefit:

Highly effective contraception, the method is reversible, does not affect fertility in the future.

Does not reduce the amount of breast milk, completely can be used in the period of breastfeeding.

Suitable for women with contraindications to estrogen (diabetes, hypertension, cardiovascular disease ...).

Disadvantage:

It is necessary to provide regular supply of pills.

Not as effective as combined oral contraceptive pills.

Occasionally cause drip bleeding.

In addition, emergency contraceptive pills should be used for infrequent sexual intercourse. The most common method of emergency contraception that has been used in many countries over the past 20 years has been to increase the dose of the combined oral contraceptive pill. Specifically, we can use the types such as rigevidon, ideal, microgynon ... with the following materials:

Take 4 capsules within 72 hours of unprotected sex (this starting dose is taken as soon as possible, should be taken within 8 hours of intercourse).

Take 4 more tablets 12 hours after the first dose.

If it is a classic tablet containing 50 mcg, take 2 times 12 hours apart, 2 tablets each time.

Another method is to take postinor tablets containing 750mcg levonorgestrel: take 1 tablet within 72 hours of unprotected sex, and take another 1 tablet 12 hours after the first dose.

The method of emergency contraception prevents most pregnancies but is not 100% effective. It only prevented three-quarters of pregnancies that were supposed to happen.

The oral contraceptive pill is a highly effective contraceptive, simple to use. However it is necessary to respect contraindications and a system of regular drug delivery to the customer.

Contraceptive injection

The contraceptive injection is a highly effective, long-lasting, reversible method that ensures privacy and convenience for the user. This method can be used for women who are breastfeeding 6 weeks after birth.

Depo-provera (DMPA - medroxyprogesterone acetate) 150mg intramuscularly with one dose of contraceptive effect for 3 months.

Noristerat (norethisterone enantat) 200mg intramuscularly, the first three injections are 8 weeks apart, the next injections are injected 12 weeks apart to completely ensure the contraceptive effect.

Both drugs are progestatií in nature, the contraceptive effect is due to atrophy of the endometrium, thickening of cervical mucus, and inhibition of oocyte release. The failure rate is about 1 pregnancy for 100 women a year. The undesirable effect is to cause blood dripping or amenorrhea. There are cases where the endometrium is atrophy leading to menstruation, especially when used for many years, then it is necessary to add estrogen in time for treatment. This method of contraception should not be indicated to people with menstrual abnormalities.

Contraceptive graft piece

The contraceptive piece is a reversible contraceptive method, commonly used in developing countries, especially in Indonesia. The piece consists of 6 bars, each containing 6mg levonorgestrel, silastic shell. The Progestati released at a slow speed. When first implanted, the amount of progestin released per day was about 80 pg. After a few years the daily release of progestin was only about 25pg. Therefore, the contraceptive effect decreases over time. Progestin inhibits oocyte release, thickens cervical mucus, prevents sperm from entering, and atrophy of the endometrium is not favorable for egg filling. Duration of effect for 5 years. Low failure rate: 0.2 pregnancies for 100 users in the first year. This effect is slightly reduced for women over 70kg. The main disadvantage of this method is that the period is less, amenorrhea or causes blood between menstruation. Also may experience headache, dizziness, weight gain and benign ovarian cysts. The graft can be used even while breastfeeding. Recently, implanon has only one rod 4cm long, 2mm in diameter containing 68mg etonogestrel whose bioactive metabolite is desogestrel. Effective contraception for 3 years. Hormone content released from the bar in the first time was 60p g / day, at the end of the second year it decreased to 30 pg/day. The contraceptive efficiency is very high, 53,530 cycles have been followed, no case of failure occurs. Hormone content released from the bar in the first time was 60p g / day, at the end of the second year it decreased to 30 pg / day. The contraceptive efficiency is very high, 53,530 cycles have been followed, no case of failure occurs. Hormone content released from the bar in the first time was 60p g / day, at the end of the second year it decreased to 30 pg / day. The contraceptive efficiency is very high, 53,530 cycles have been followed, no case of failure occurs.

(Intrauterine contraception and sterilization).