Contraceptives

Contraceptives are methods that prevent conception so they are used to avoid unwanted pregnancies. Also called contraceptives, contraceptive methods are classified into different categories according to their mechanism of action.

The criteria that guide the choice of one method rather than another are many and depend on the preferences and needs of both partners, and not only of the woman, as the contraceptive choice can also have repercussions on the couple’s sexuality.

To influence the choice can be, for example, the lifestyle or sexual habits, or the greater or lesser disposition of the couple to accept with serenity a possible pregnancy. In the first case, you can also evaluate the choice of unreliable methods such as natural ones, while in the second it is advisable to rely on safer contraceptives, such as hormonal or barrier contraceptives.

Another criterion for choosing the most suitable contraceptive is the presence of any contraindications, such as taking a drug that can interfere with the effectiveness of hormonal contraception, as in the case of some antibiotics. Conversely, if cortisone therapy is taken, it is possible that the hormonal contraceptive may increase or prolong the action of cortisone, or increase its side effects.

Also not to be underestimated are the tolerability of the chosen contraceptive, which must not negatively affect sexual understanding or cause any side effects, and the risk of contracting sexually transmitted infections, better known as venereal diseases, from which only condoms and other barrier methods can protect.

Whatever the method chosen, in the case of absence of menstruation it is good to perform a pregnancy test that can be purchased at the pharmacy to evaluate the possibility of being pregnant.

Natural contraceptive methods

They do not require the use of substances foreign to the body. Their goal is to identify the woman’s fertile days, in which the egg is emitted and remains viable.

Abstaining from sexual intercourse these days reduces the risk of fertilization and therefore of conception.

The different methods of natural contraception are based on different principles (observation of changes in cervical mucus, measurement of basal temperature, LH hormone production, calculation of fertile days according to the calendar, coitus interrupted) and do not offer high contraceptive protection. In fact, it is estimated that one in four couples who rely on a natural contraceptive method risks an unwanted pregnancy.

They are also not indicated for women with an irregular menstrual cycle.

Among the best known we remember the Billings method and the Ogino Knaus method: the first provides that the woman is able to recognize ovulation, and therefore the fertile period, based on the characteristics of the cervical mucus, while according to the Ogino Knaus method, considered among the most unreliable, it is necessary to avoid unprotected sexual intercourse in the central phase of the cycle (between the 9th and 16th day).

Equally ineffective is the so-called “coitus interruptus”, according to which the man should retract the penis from the vagina before ejaculation. In addition to the possibility that already in the early stages of intercourse small amounts of sperm fluid are released that may contain sperm, this method also risks reducing sexual pleasure in the woman and creating anxiety in both partners during and after intercourse.

Finally, there is also the symptothermal method, according to which, to identify the fertile period, to the observation of cervical mucus provided by the Billings method it is also necessary to add the measurement of basal temperature and the evaluation of changes in the uterine cervix.

Barrier methods

They act by preventing the entry of sperm into the female reproductive organs and thus avoiding the meeting between egg and sperm.

The most used barrier contraceptive method is the condom, also called condom, which, in addition to reducing the risk of pregnancy, also protects against sexually transmitted diseases (AIDS, chlamydia, gonorrhea, syphilis, hepatitis, etc.). It is a thin latex sheath that covers the penis and that, during ejaculation, collects seminal fluid.

The diaphragm is also a barrier method, but it is currently little used. Its action is increased by the simultaneous use of a spermicidal substance.

Finally, the female condom is not widespread and used.

The effectiveness of barrier methods depends on the correctness of their application.

Hormonal contraception

It involves the use of female hormones, usually the combination of estrogen and progestin, which can be taken by mouth (birth control pill), through the walls of the vagina (vaginal ring) or through the skin (patch) depending on the doctor’s prescription.

The mechanism of action of hormonal contraceptives is common and has as its main objective the blocking of ovulation. Other effects include thickening of cervical mucus and thinning of the uterine walls.

There are different types of pills, which differ in the type of molecules present and the ratio between the quantities of hormones. As for the estroprogestin pills, in the monophasic one each tablet contains the same amount of steroids, while in the biphasic one estrogen is fixed and progestin is taken in two different dosages. Triphasic and four-phase pills, on the other hand, contain hormones combined in three and four different dosages respectively. Triphasic is also characterized by a very low total dose of hormones that approaches the body’s production of estrogen and progesterone. The estroprogestin pills on the market also differ in the number of tablets present in each package: if they are 21, a break of one week must be made between one pack and the next, during which the pseudomenstrual flow will appear. If there are 28, the first 24 or 26 pills will count hormones, while in the remaining “placebo” pills (respectively 4 or 2) no active ingredient will be present.

Finally, there is also the so-called mini pill, which contains only progesterone. Also in this case there are different types characterized by a more or less high dosage. Contraception with the pill involves taking a dragee a day, possibly always at the same time. In case of forgetfulness, most pills can be taken with a delay of up to 12 hours, within which the contraceptive efficacy is not reduced and it is therefore not necessary to use another contraceptive method. However, today there are oral contraceptives of the latest generation (in 24/4 regime) that allow you to lengthen the contraception window in case of forgetfulness from 12 to 24 hours.

Unlike the pill, ring and patch allow hormones to enter the bloodstream directly without passing through the digestive tract. Their effectiveness is not, therefore, modified by any episodes of vomiting or diarrhea.

Both contain an association of estrogen and progestin: the ring can be inserted into the vagina by the woman, where it must be left for three weeks, followed by a 7-day interval before the insertion of another ring, during which pseudomenstrual flow appears. The patch must instead be replaced every seven days, for 3 consecutive weeks, followed, also in this case, by a suspension.

Among the different contraceptives, the hormonal methods are the most effective. If taken regularly, they allow maximum contraceptive protection, as well as ensuring the woman also a series of non-contraceptive benefits, ranging from the attenuation of cycle irregularities and symptoms typical of premenstrual syndrome, to the beneficial action on acne and seborrhea. Also to dispel some “false myths”, according to which hormonal contraceptives would reduce fertility once the intake is suspended, would favor water retention and the consequent appearance of cellulite and would have a negative influence on sexual desire.

Hormones, on the other hand, are contraindicated in the presence of high cardiovascular risk and in heavy smoking women. In addition, in case of familiarity with breast cancer it is good to carefully evaluate its possible intake with your gynecologist.

Whatever the health conditions, age and family history of the woman, it is always advisable that hormonal contraceptives are prescribed by the gynecologist, who may decide to subject the patient, before and / or while taking the hormonal contraceptive, to some tests to evaluate the best choice in terms of efficacy and tolerability.

Intrauterine system (IUS)

It is a T-shaped device that contains progestogen hormone in a reservoir. It is inserted inside the uterus by the gynecologist, where it can remain for a few years (usually 3 to 5).

Copper spiral (IUD)

There are several models with different characteristics, shape and size, from which to choose with the help of the gynecologist. To distinguish it is the presence of a copper wire wrapped around the device. It is precisely the copper ions released into the uterine cavity that have a contraceptive action as they are able to inhibit sperm motility and alter their ability to fertilize the egg.

Emergency contraception

It is the so-called morning-after pill. A preparation based on estrogen and progestogen hormones that prevents the embryo from taking root on the walls of the uterus.

It should be used within 72 hours of unprotected intercourse.

Its use must be limited (as the name implies) to real emergency situations and not be used if necessary.

Sterilization

It can be implemented in both women and men and consists of surgical interventions that make sterile in an irreversible way, canceling the possibility of procreation.