Birth Control Methods
What are Birth Control Methods?
Birth control methods are various methods used to prevent or plan pregnancy.
These methods can be broadly classified as natural, barrier, hormonal and surgical methods.
The most common birth control methods:
Natural methods
1. Calendar Method: Determines safe days according to the regularity of the woman's menstrual cycle.
2. Withdrawal Method: This is when the man withdraws before ejaculation and does not ejaculate into the vagina. It is defined in Latin as Coitus Interruptus.
3. Body Temperature Method: There is an increase in body temperature during the ovulation period. With this temperature increase, the ovulation period can be monitored.
4. Cervical Mucus Method: Cervical mucus becomes more watery and slippery during ovulation. By observing the changes in the structure of this cervical mucus, the fertile period can be determined.
Hormonal Methods
1. Birth Control Pills: Contain the hormones estrogen and progesterone. They prevent ovulation. With today's current birth control pills, maximum control can be achieved at minimum concentration.
2. Birth Control Injections: They are usually given once a month or every 1 month and prevent ovulation.
3. Hormonal Spiral (Mirena): It is inserted into the uterus and releases hormones. It is effective for 3-5 years.
4. Vaginal Ring (NuvaRing): It is inserted into the vagina and releases hormones. It is changed monthly.
5. Hormonal Skin Patch: Attaches to the skin and releases hormones. It is changed weekly. Not available in our country.
Barrier Methods
1. Condom (condom): Can be used by a man or a woman. It prevents sperm from entering the vagina.
2. Diaphragm: A barrier placed in the vagina. It is used together with spermicidal gel.
3. Cervical Cap: A barrier that closes the cervix
Surgical Methods
1. Tying the tubes (tubal ligation): Cutting and tying the fallopian tubes in women.
2. Vasectomy: Cutting and tying the sperm ducts in men.
Other methods
1. Intrauterine Device (IUD) (Spiral): There are hormone-free (copper) or hormonal types. It is inserted into the uterus and provides long-term protection.
Each contraceptive method has different advantages and disadvantages. To determine the most suitable method for your personal health, lifestyle and contraceptive needs
BIRTH CONTROL METHODS AND FAMILY PLANNING
Sexual health is defined by the World Health Organization as being in a state of complete physical, mental, emotional and social well-being related to sexuality.
Sexual health also includes effective contraception, protection from sexually transmitted diseases and appropriate psychosexual help for sexual problems.
Up to 70% of women of reproductive age regularly use a method of contraception. The decision on which method of contraception to choose depends on the individual's social, gynecological and medical history.
Whichever method is chosen, the person should be given detailed counseling on how to use the method and what to do in case of failure, such as forgetting to take medication or condom breakage.
HISTORY OF THE PATIENT
Important factors to be evaluated in the history:
Age; Birth control pills can be used until the age of 40 by reducing the hormone levels used.
Previous contraceptive methods, side effects and failures
Gynecological problems: heavy and painful menstrual bleeding periods, ectopic pregnancy or functional ovarian cysts
History of active sexually transmitted disease, pelvic inflammatory disease.
Arterial or venous diseases, liver disease, diabetes, mechanical heart valve, hypertension.
BARRIER METHODS
Male condom
Latex is a rubber or polyurethane sheath, usually coated with a spermicidal liquid.
It acts as a physical barrier, preventing sperm from entering the vagina.
Before coming into contact with the female genital organs, the condom is put on the penis when the penis is erect.
After ejaculation, it is removed and discarded together with the ejaculation fluid inside and after checking for defects in the condom.
The biggest advantage of condom use is that it is used only during coitus. In addition, the condom protects against sexually transmitted viral and bacterial diseases and has no hormonal side effects.
Disadvantages
Reducing sexual pleasure between partners,
Decreased sexual sensitivity in men,
Rare allergy to the latex or spermicide used in the female or male partner,
can be summarized as follows.
If allergy occurs, non-latex condoms that are less allergenic or non-spermicidal can be used.
Failure occurs when the condom is damaged by jewelry such as fingernails, rings, oil-based lubricants or condom lubricants, or when the condom slips during insertion.
The risk of pregnancy is high when the penis comes into contact with the vagina when the condom is not put on correctly and is not in place (before and after ejaculation).
Female condom
A sheath is placed on the walls of the vagina to create a barrier to prevent sperm from reaching the cervix. It can be inserted into the vagina at any time before sexual intercourse.
It has similar advantages and disadvantages to the male condom.
Diaphragm and cap
The diaphragm is a dome-shaped contraceptive. Depending on the amount of vaginal support tissue, there are three types of diaphragms: flat, ring-shaped and spring-shaped. They are contraception devices that attach to the cervix on the basis of aspiration.
Both methods are used with spermicidal cream or gel and create a spermicidal barrier, preventing motile sperm from reaching the cervix.
Two scoops of spermicidal cream or gel are applied to each end of the diaphragm (1/3 of the head should be filled with spermicidal cream), then the device is inserted downwards and backwards into the vagina. Check that the position of the diaphragm is such that it completely covers the cervix. It should be inserted into the vagina no more than 3 hours before sexual intercourse. The diaphragm should remain in the vagina for at least 6 hours (up to 30 hours) after sexual intercourse. After removal, it should be washed with soapy water and stored in a plastic box. If it is damaged or torn, it should be removed earlier otherwise.
then it should be replaced every two years. The size of the diaphragm (which should be 5-10 mm in diameter) can be estimated by pelvic examination in the clinic.
Advantages
Its advantages are that it does not interfere with sexual intercourse and can be used whenever it is needed. It does not cause loss of pleasure during sex in men and women.
Partially protects against sexually transmitted diseases and minimally reduces the incidence of cervical cancer.
Disadvantages
Disadvantages are that it requires special training for application and insertion technique. It is not a commonly used contraceptive method and partially protects against sexually transmitted diseases.
Side effects include recurrent urinary tract infections, which are relieved by the use of a smaller size diaphragm.
After more than 3 kg weight change and childbirth, the size of the diaphragm to be used changes and needs to be measured again.
Who Cannot Use Diaphragm
It is contraindicated in cases of difficulty in reaching or recognizing the cervix by hand, poor pelvic floor support in the fitting of the diaphragm, history of toxic shock syndrome, recurrent urinary tract infection and allergy to rubber or spermicides.
Hormonal methods
Combined Oral Contraceptives
Combined oral contraceptive pills contain ethinyl estradiol and progesterone.
Mechanism of action
This type of contraceptive pill inhibits ovulation, thickens the cervical mucus and causes thinning of the endometrium, preventing pregnancy.
Combined oral contraceptive pill types
Monophasic preparations are commonly used and all tablets contain the same dose of estrogen and progesterone.
Biphasic and triphasic pills contain different doses of estrogen and progesterone depending on the day of the cycle and are used to provide better cycle control in patients with breakthrough bleeding (bleeding that starts outside the normal withdrawal period) and in patients taking monophasic medication without withdrawal bleeding.
The daily pill contains 21 active hormone pills and 7 placebo pills during the period when the pill should not normally be taken.
How to use the birth control pill?
The standard box contains 21 pills, one taken every day, followed by a 7-day drug-free period during withdrawal bleeding. The next box is started on day 8, regardless of the end of bleeding.
When to start the birth control pill?
When the first pack is used immediately, it is started on any of the first 5 days of menstruation to be effective. Birth control pill in amenorrheic or oligomenorrheic women
use can be started at any time of the menstrual cycle. However, the possibility of pregnancy should be ruled out and protection with an additional method should be used during the first 7 days of medication.
In cases of pregnancy termination and abortion, the drug should be started on the day of termination. In patients who have had a miscarriage, the contraceptive pill should be started immediately after the miscarriage. Due to the high risk of thrombosis and possible irregular bleeding, contraceptive pills should not be used in the first 6 weeks immediately after delivery.
Advantages of combined oral contraceptive pills
It improves irregular periods with heavy and heavy bleeding.
When used for more than 5 years, it reduces the risk of ovarian cancer by 50% and this effect persists after stopping the drug
Reduces the risk of endometrial cancer by 40% when used for more than 5 years,
Reduces the formation of functional ovarian cysts,
Improves premenstrual tension and endometriosis,
Useful in the treatment of fibroids
Treats acne and hirsutism.
The drug effect disappears with discontinuation; conception can occur immediately after discontinuation.
Disadvantages of combined oral contraceptive pills
The most important disadvantage is the need to take a pill every day
It does not protect against sexually transmitted diseases and increases the incidence of cervical cancer.
Information that it increases the incidence of breast cancer is still under investigation.
Side effects of birth control pills
The most important side effects are thrombosis, hypertension and migraine.
The most important side effects are thrombosis, hypertension and migraine.
If these side effects are suspected, the drug should be stopped immediately.
Less common side effects include irregular menstruation during the first few cycles, weight gain or weight loss, decreased libido, nausea, bloating, breast tenderness, headache and mood changes.
Most of these side effects are not common after the first three months of use.
Contraindications for birth control pills
Who cannot use birth control pills?
Pregnancy
Hypertension (>160/100),
Severe migraine
History of thrombosis or presence of risk factors,
Ischemic heart disease,
Cardiovascular disease,
Liver disease
Porphyria,
Diabetes,
Over 35 years of age, smoking and
The use of birth control pills is not recommended in cases such as the presence of vaginal bleeding of unknown cause.
Interactions of birth control pills with other medicines in use
Drug interactions should be avoided. Anti-epileptics and enzyme inducers such as griseofulvin increase the metabolism of contraceptive pills, so high dose contraceptive pills can be used if there is no suitable alternative contraceptive method.
In addition, since rifamycin and rifabutin have a very high enzyme-inducing effect, oral contraceptives can be used no earlier than 8 weeks after discontinuation.
Contraception Bands
The contraceptive adhesive contains estrogen and progesterone and its mechanism of action is similar to the contraceptive pill. It is applied on the first day of menstruation, changed once a week and removed on day 21. Withdrawal bleeding also occurs when the medication is not used. The advantages, disadvantages and side effects are similar to those of oral contraceptives.
Progesterone-only pills
Pills containing only progesterone are also known as mini pills.
These drugs thicken the cervical mucus and prevent sperm from passing into the cervical canal. They also thin the endometrium and in some cases inhibit ovulation.
How is it used?
Progesterone pills are taken continuously in packs of 28 pills, with no breaks between packs.
They should be taken at the same time every day; if taken 3 hours later, contraceptive efficacy drops sharply.
Similarly, vomiting and diarrhea impair the absorption (and therefore the effectiveness) of the pill.
If the pill is forgotten (taken late or absorption is impaired by diarrhea or vomiting), it is treated as with combined oral contraceptives.
Many women continue to menstruate with the mini-pill. In some cases, menstrual bleeding decreases, while in very few cases amenorrhea occurs. Heavy or irregular bleeding
When to start?
Within the first 7 days of menstruation, on the day of termination of pregnancy (abortion), immediately after miscarriage, after ruling out pregnancy in cases without menstruation; it should be started on any day of the cycle (provided that additional contraception is used for 7 days).
Unlike combined pills, it can be started immediately in the postpartum period.
Advantages of progesterone-only pills
It is a safe option in cases where estrogen-containing contraceptives cause side effects or are contraindicated, such as advanced age, smoking, immediate postpartum, breastfeeding, hypertension, risk of deep vein thrombosis, hypertension, migraine or diabetes.
It is also a useful option in premenstrual syndrome.
Disadvantages of progesterone-only pills They are less effective than combined oral contraceptives and have sharper limits on pill-taking times.
Side effects
Increases functional ovarian cysts.
Increases the possibility of ectopic pregnancy
Side effects such as acne, headache, breast tenderness, vomiting, irregular menstruation tend to subside after a few months.
Weight change may occur in some cases.
Slight increase in the incidence of breast cancer
EMERGENCY CONTRACEPTION:
How Long Does the Morning After Pill Protect?
The morning-after pill is an emergency contraceptive used to prevent pregnancy after unprotected sex.
The morning-after pill should be taken as soon as possible after intercourse and its effects diminish over time. In general, the duration of effectiveness and protection rate of the morning-after pill are as follows:
Efficacy by Time of Use
1. Within the First 24 Hours: It has the highest protection rate. Approximately 95% effective.
2. Between 25-48 Hours: The effectiveness rate drops slightly. It is approximately 85% effective.
3. Between 49-72 Hours: The effectiveness rate decreases even further. It is approximately 58-61% effective.
4. Between 72-120 hours: Some morning-after pills are also effective late after intercourse and can provide protection, but with a lower efficacy rate.
Mechanism of Action
The morning-after pill prevents pregnancy by delaying and preventing ovulation. If ovulation has already occurred, the effectiveness of the pill may be reduced.
These pills do not prevent a fertilized egg from implanting in the uterus and cannot terminate an existing pregnancy.
The morning-after pill
- Not a Regular Birth Control Method: The morning-after pill should not be used as a regular contraceptive. It is only intended for emergencies.
- Side Effects: Side effects may include nausea, dizziness, breast tenderness, irregular menstruation.
What are the side effects of the morning-after pill?
Side effects of the morning-after pill are usually mild and temporary, but are more pronounced in some women. Common side effects:
1. Nausea and vomiting: This is the most common side effect and usually occurs within a few hours after taking the pill.
2. Menstrual Irregularities: There may be changes in your menstrual cycle. Your period may start earlier or later and the amount of your period may also change.
3. Headache: Some women may experience headaches.
4. Bleeding or Spotting: You may have spotting or light bleeding outside the menstrual cycle.
5. Dizziness: Some women may feel dizzy.
6. Fatigue: You may feel tired after taking the medicine.
7. Abdominal Pain or Cramping: You may have pain or cramping in the abdomen.
8. Breast tenderness: Tenderness or pain in the breasts.
9. Emotional Changes: You may experience emotional fluctuations or mood changes.
These side effects are usually short-lived and go away within a few days. However, if severe side effects occur or if the side effects last for several days
1. Early or late onset of menstruation: The morning-after pill can cause your period to start a few days earlier or later than expected.
2. Change in the amount of menstrual bleeding: Your menstrual bleeding may be lighter or heavier than usual. For some women, the duration of bleeding may also change
Intrauterine Devices (IUD) (Spiral)
The IUD is preferred by 5% of women.
The intrauterine device consists of a T-shaped frame coated with copper. Two strings are attached at the lower end and the cervix (cervix) is visible. The spirals are removed by grabbing these strings.
Frameless intrauterine devices are also available, which are attached to the fundus with a knot.
Mechanism of action
Virgin is spermicidal and toxic to the premature baby.
Intrauterine vehicle prevents implantation of the baby in the uterus by inducing an inflammatory response in the endometrium.
How is it used?
Intrauterine devices are inserted into the uterus through the cervix.
When an IUD is inserted into the uterus, it is important to make sure that there is no infection. The IUD is usually inserted in the first 7 days of menstruation but can be inserted up to day 19 (the earliest estimated day of implantation).
It is inserted immediately after termination of pregnancy or miscarriage and in the postpartum period at the 6th week after the end of the puerperium.
Be sure to check at 1 month after the procedure!
If PID occurs, it usually happens in the first 20 days after administration. In case of infection, even if the infection is mild, the IUD should be removed and antibiotic treatment should be given immediately.
The IUD should preferably be removed within the first 7 days of menstruation.
If it is removed mid-cycle and sexual intercourse has occurred within 5 days, emergency contraception should be used.
Advantages
Long-term efficacy and no hormonal side effects.
Disadvantages
The main disadvantage is that the copper spiral increases the amount of bleeding.
There is also an increased risk of PID.
The uterus can be damaged during insertion and there is a risk of expulsion during the first menstrual period.
In the presence of pelvic pain or a mass, the spiral should be removed and antibiotics should be given for several months to treat the infection.
In which cases the spiral cannot be inserted????
Pregnancy
Irregular vaginal bleeding of unknown cause,
Untreated sexually transmitted disease,
Being at high risk of infection,
Heavy and prolonged periods of bleeding,
Anemia,
No previous ectopic pregnancy,
History of uterine scarring,
Presence of a mechanical heart valve,
Wilson's disease and
Women with copper allergy cannot have a spiral....
What if the thread of the spiral cannot be seen in the cervix?
If the spiral threads cannot be seen during vaginal examination, they may have entered the cervical canal. If the strings are still not found, ultrasonographic evaluation should be performed to reveal that the IUD has not fallen off and the spiral should be removed under ultrasonographic guidance. If the IUD is in the normal fundal localization on ultrasonography, pregnancy should be ruled out with a pregnancy test and an alternative contraception method should be recommended.
Rarely, the spiral is localized outside the uterus and is localized by X-ray or ultrasonography and surgically removed.
What is a hormonal spiral (Mirena)?
Mirena is an intrauterine device (IUD) that releases hormones into the uterus and acts as a contraceptive.
Mirena's contraceptive mechanism:
1. Hormone Secretion: Mirena releases a type of progesterone hormone called levonorgestrel. This hormone prevents pregnancy in several different ways:
o Thickens cervical mucus: Levonorgestrel thickens the mucus in the cervix, making it harder for sperm to reach the uterus and fallopian tubes. This prevents the sperm from fertilizing the egg.
o Thinning of the endometrium: Mirena thins the lining of the uterus (endometrium), making it harder for a fertilized egg to implant in the uterine wall.
What is a hormonal spiral (Mirena)?
Mirena is an intrauterine device (IUD) that releases hormones into the uterus and acts as a contraceptive.
Mirena's contraceptive mechanism:
1. Hormone Secretion: Mirena releases a type of progesterone hormone called levonorgestrel. This hormone prevents pregnancy in several different ways:
o Thickens the cervical mucus: Levonorgestrel thickens the mucus in the cervix, making it harder for sperm to reach the uterus and fallopian tubes. This prevents the sperm from fertilizing the egg.
o Thinning of the endometrium: Mirena thins the lining of the uterus (endometrium), making it harder for a fertilized egg to implant in the uterine wall.
o Suppression of Ovulation: In some women, the hormone release can completely suppress or reduce ovulation (ovulation), further reducing the chance of pregnancy.
2. Physical Barrier: Mirena is a small T-shaped device that is inserted into the uterus. This physical presence is considered a foreign body inside the uterus, which helps prevent sperm movement and fertilization of the egg.
Mirena has a very high contraceptive effectiveness. When inserted and used correctly, the contraceptive rate is more than 99%.
Can Every Woman Have a Hormonal Spiral?
Every woman can have a hormonal spiral as long as her physician deems it appropriate.
What are the side effects of hormonal spiral?
The most common side effect is continuous vaginal bleeding. Although the amount of bleeding is not excessive, it can disrupt the quality of life. This side effect completely disappears within 6 months-1 year on average. Women who have Mirena inserted should be adequately warned about this and given detailed information that these bleeding will be temporary.
Implants should not be used together with enzyme inducing agents
