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VERIFIED CONTENTConsultation: dr Tadeusz Oleszczuk, gynecologist-obstetrician

Although the most popular method of protection against unwanted pregnancy are pills, it is worth knowing that there are other options. IUD, vaginal ring, emergency contraception, or maybe a contraceptive injection? We talked to an expert, Dr. Tadeusz Oleszczuk, about what the selection of contraception should look like.

Patrycja Pupiec: There is a lot to choose from when it comes to female contraception. Why have others been superseded by them? Is it a question of effectiveness that, for example, chemical contraception must give way to hormonal contraception?

Tadeusz Oleszczuk:Efficiency and convenience count. Chemical contraception is an example of an ineffective and uncomfortable method. It can be said that such methods are history. In the short term, a condom will be a much better protection, which is also effective in the case of sexually transmitted diseases. Currently, the most convenient method is an intrauterine device, the insertion of which protects a woman against pregnancy, even for several years. There are also inserts that further reduce bleeding, so you can not only use contraception, but also save on the hygiene products that women use during menstruation.

What statistically speaking agent is responsible for the highest number of unwanted pregnancies?

Natural methods are a topic that should not be mentioned when discussing contraception because they are mainly used for the opposite action, i.e. getting pregnant. We have the impression that we are guarding the calendar, but ovulation has its own rules. Infections, high levels of stress, and hormonal disorders all affect the regularity of your cycles. Sometimes ovulation may shift to another day. It is similar in the case of the method of measuring mucus viscosity or temperature - all this does not work 100%. Inflammation, fever, and allergy symptoms can alter individual readings.

So it's more of a concept than contraception.

You can put it like this. Like the chemical method. For one thing, it is cumbersome to use, because you have to wait for the agent to dissolve, and the effectiveness of this method is not a good barrier. 30 years ago whenthere weren't that many ways of contraception, people were forced to use it, but right now the choice is much greater. Each method has its own specific security percentage. An example of the most effective and most frequently chosen methods are inserts or tablets. Although there may be occasions when a girl vomits while taking the tablets, she forgets to take it at a certain time of the day. Then the effectiveness is minimally reduced. However, the safest thing is the IUD, because when properly inserted, it causes changes in the uterine epithelium and even when a fertilized cell appears, there is nothing to attach to, so there is no pregnancy. This is a good security measure, because you cannot make a mistake. Efficiency 100%

What is the removal of the insert?

The woman has to go to the office, where the doctor will take out her IUD and that's it. This method is recommended and especially popular among women who have already given birth to children. It is very comfortable, because there are no or minimal periods with a hormone insert. You can safely go on vacation without worrying about bleeding. The overall effect on body weight or well-being is practically non-existent, because the IUD works only in the uterine cavity. There is only the question of possible sexually transmitted infections and diseases. The condom protects against this, the liner does not.

Is the insertion of the IUD painful?

It depends on the anatomical conditions, but also on whether the girl gave birth or not. The IUD is inserted during menstruation, when the cervical canal is slightly dilated. Additionally, we are sure that the girl is not pregnant. While inserting, a woman may experience pain similar to menstrual pain, but this is only temporary discomfort. In about 75 - 85 percent. there are no problems with the assumption. Of course, there are cases when a woman has adhesions, anatomical abnormalities or the canal is very narrow, then you have to flex a bit to put it on correctly. Insertion usually takes up to several dozen seconds.

Is there any age restriction for insoles?

There are no age restrictions as such, but there are generally two basic conditions, i.e. the fact that a girl has been menstruating regularly for 2 to 3 years. The anatomical conditions must also be defined. Additionally, the presence of contraindications should be excluded. Of course, there is also the issue of excluding infections, hormonal disorders or anatomical obstacles.

If you decide to insert a vaginal ring, you need to do it speciallyto prepare?

The vaginal ring containing certain hormones is inserted vaginally by the girl herself. After three weeks, he takes it out and after a week's break he puts on another one. During the break week, there is bleeding, but contraceptive protection remains on all this time.

Why are different contraceptive methods offered to women of different ages, e.g. an implant is rather not offered to women over 40?

The reason is simple - you have to choose the method according to the person, not the other way around. Each woman is different, each has different metabolic and hormonal conditions and expectations.

It is in a different stage of life - this variety is greater when we consider the pace of life. For example, a woman who gave birth to two children is offered a comfortable insert rather than putting on a vaginal ring, but the ring will be offered to a young girl in her 20s, because then she will not become pregnant and the risk of missing a tablet will disappear if she often forgets something. . There are also women who do not want to put anything into their uterus and that's fine too, so she should talk to the doctor about her expectations and then the specialist will suggest the best method - injection, pills, puck, insert, or hormone patches. The method is to be effective, safe and convenient.

How does return to fertility look like with these slightly more invasive methods, such as an IUD, which requires a doctor's visit to insert and remove it?

After removing the IUD everything returns to normal almost immediately, but with each method, one condition must be met - before using any method, the woman must be he althy, fertile, i.e. have no hormonal disorders. Then everything will be fine, and if not, the cause of fertility problems will not be contraception, but these disorders.

Therefore, before starting any type of contraception, you should do some research and check that everything is okay.

In the case of contraceptive injections also?

Yes, receiving the injection is over, it cannot be reversed, so for these 12 weeks, and sometimes a little longer, we have contraceptive protection. There are cases after many months of using this contraceptive, that the lack of fertility may persist even several months after stopping the injections, so this effect is visible and cannot be reversed immediately, as in the case of removing the IUD or resigning from taking the pills.

But still a contraindication to useany type of contraception are hormonal disorders?

Of course, you can even perversely say that infertility is actually a contraindication to contraception. To use contraception you need to make sure the cycles are fertile.

Emergency contraception is wrongly indicated as being the same method as abortion. You can't talk about the relationship between abortion and the use of emergency contraceptive pills, right?

After intercourse, the sperm has a long way to go. At the end of this path, in the bulb of the fallopian tube, it meets an egg. Then there are two options - fertilization can take place, but only 20 percent. fertilized eggs result in the birth of a live, he althy baby. 80 percent of them, for various reasons, do not try to establish themselves in the uterine cavity or do not continue to develop during such an attempt.

Taking the "Po tablet" causes the epithelial reconstruction, thickening of the mucus, and thus preventing the implantation of the egg, and therefore no pregnancy occurs, therefore it is not a method of abortion.

In the case of emergency contraception, time plays an important role, because it's not that I will definitely take the "Po pill", then I will definitely not get pregnant?

Yes, of course. It is best to take the tablet as soon as possible, because it takes several days for the egg to travel to the uterine cavity. If a woman takes a pill within 5 days, she will almost certainly not be pregnant, although of course it is best to take it as early as possible, because this affects its effectiveness - the sooner we take it, the faster the uterine epithelium will start to change. It is best to swallow it within the first day after intercourse. Then the effectiveness is 100%.

The emergency pill can only be purchased with a prescription. Can another specialist recommend it, apart from the gynecologist?

Maybe, but it's best if it should be a gynecologist. This is a hormone and you should be aware of the indications and contraindications of hormone therapy. Generally speaking, even a family doctor can issue such a prescription based on an interview and a recommendation from a specialist gynecologist.

Are there any restrictions on taking emergency contraception, such as not taking more than a few pills in a year?

It is not a contraceptive to be used continuously for many months or years. The dose of hormones in one tablet is strictly defined and it should not be taken more than four in a month. You have to remember that this is an emergency method. If we are concerned that we may become pregnant after intercourse, it is better to accept it than hope to do sopregnancy will not appear. You can't just be pregnant a little.

Can a doctor refuse to prescribe a contraceptive or not?

He shouldn't say no. The doctor is supposed to help choose the appropriate method - also by ordering appropriate tests, excluding certain disorders during the interview, but he is a specialist in, among other things, where the woman should go? I have heard about such cases, but the vast majority of doctors are on the side of women and use proven and safe methods. It is the free woman to decide whether or not to use contraception. The doctor expertly helps her in this.

Can we expect more male contraception in the future?

Currently, the only effective method is vas ligation, but this is an invasive method, so the man must be determined to undergo this procedure. Men are left with condoms and there are no other effective methods of contraception available for this group. The research and search for such a method are still ongoing.

So the most important thing is to prepare for contraception and its proper selection.

Yes, it is even good for mental he alth, because you can be calm that the doctor has checked it, carried out tests and everything is fine. If a woman wants to get pregnant and decides not to use contraception, she knows that everything is fine and she will be able to become a mother. Contraception must be reversible, which means that when you stop using a certain method, you can decide for yourself when to get pregnant. You need to prepare for everything and plan the discontinuation of contraception early enough.

gynecologist-obstetrician Tadeusz OleszczukGynecologist-obstetrician with over 30 years of experience. Author of the books "What the gynecologist will not tell you" and "Calm your hormones". / drtadeusz

Read other articles from the StrefaKobiety series:

  • First visit to the gynecologist: what can you expect?
  • Dr. Oleszczuk: If a woman comes to the doctor with stage II or III cancer, the chances of successful treatment are reduced
  • 20 percent couples deal with infertility. Mostly not the fault of the woman
  • Last menstruation and menopause. How to prepare for it?
  • Hormonal contraception: advantages and disadvantages, selection and fertility effects
  • How to take care of intimate hygiene to avoid infections?
  • Allergies - where do they come from? Allergy to semen and condoms
  • Dr. Oleszczuk on the prohibition of abortion: I am always on the side of women and this is the case in this case
  • Pain in the intimate areas. Is it normal to feel pain?
  • Sexually transmitted diseases. How to take care of your safety?

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