Family Planning (Contraception/Protection)

It is the definition and purpose of family planning for married couples to have as many children as they want, as well as to prevent the unintended pregnancies. There are many methods for this. Which method will be most suitable differs from person to person. Therefore, it would be appropriate for the individuals who want to prevent pregnancy, by consulting with the physician, to choose the most suitable method of protection for them and to have full information about the method they will use.

1- Natural Methods in Family Planning

It is defined as the application of some rules that allow couples to prevent or attain pregnancy with fertility awareness. The World Health Organization has defined natural family planning as methods of planning pregnancy or preventing pregnancy by observing natural signs and symptoms during the fertile and infertile periods of the menstrual cycle.

Basal Body temperature method: After ovulation (release of egg), the body temperature increases by 0.2 – 0.5 ° C under the influence of the hormone progesterone. Body temperature is recorded regularly every day. The period following recording of increased body temperature above a certain level for 3 consecutive days is considered safe.

Calendar method: In women who have regular periods, it is assumed that ovulation will occur between the 14th and 21st days following the period, and calendar method is based on not having intercourse on these days. Pearl index is 20%, in other words, the success rate is 80%

Mucus method: During ovulation, cervical mucus increases in quantity, it gets thinner, more clear and becomes stretchy when held between two fingers. This method is based on the avoidance of sexual intercourse on the days when the structure and amount of mucus indicates the ovulation period.

Withdrawal method: It is the practice of pulling the penis out of the vagina before ejaculation. It is difficult to practice this method, individuals should be experienced and absolutely determined and psychologically ready for it. Otherwise, success rates decrease. The success of preventing pregnancy is 70-80%.

Breast feeding: In the first 6 months following the birth, if the mother breastfeeds her infant for no less than 60 minutes a day and does not have menstruation, it is considered that ovulations have not started yet. However, this is not a very reliable method since it does not mean that ovulation is not seen in every woman who is not menstruating.

2 Barrier Methods Used in Family Planning

These are all methods that mechanically prevent sperm from reaching the womb of the woman.

Condom: It is a rubber sheath that is worn on the penis after erection during sexual intercourse. After ejaculation, it prevents the semen, which contains sperm, from entering the woman’s vagina. The main advantage of this method is that it provides protection against sexually transmitted diseases in addition to family planning. If a condom breaks or slips off during sexual intercourse, or a hole is noticed, an additional method for protection must be used. The success rate of the method is 88% when used alone.

Diaphragm (cap): It is a hat-like rubber device placed on the cervix of the woman before the sexual intercourse. Applying spermicide (sperm-killing substance) to the cervix prevents survival of the sperm that physically passed over the diaphragm. The advantage of this method is that it can be applied without any harm to the body and a woman who is on her period can have sexual intercourse with the diaphragm. The success rate of this method is 82%, if used alone.

Spermicides: They are substances that can be in the form of cream, suppository or foam applied into the vagina before intercourse and prevent sperm from staying alive. Since their effectiveness is not very high when used alone (79%), using it with other barrier methods increases the effectiveness of this method.

3 Hormonal Methods in Family Planning

By giving the body a small dose of hormones, the function of the ovary and pituitary gland is suppressed. Ovulation does not take place and therefore pregnancy does not ensue.

Birth Control Pills

a. Combined oral contraceptives:

It is based on the principle that when female hormones (estrogen and progesterone) existing in the women body given at low doses, no pregnancy occurs as a result of suppression of natural balance. For this method to be effective, which has a high protection rate of 99%, it is necessary to take the pills regularly every day.

One of the biggest advantages of birth control pills is to prevent anemia by reducing the amount of menstrual bleeding. In some women, this reduction is so evident that menstrual bleeding can only be in the form of spotting, like coffee grounds, this should not be a concern.

Birth control pills diminish menstrual pain and reduce the chance of having ovarian and uterine (endometrial) cancer.

Nausea is the most common side effect when the pill is used for the first time. Taking the medication just before bedtime allows this side effect to be more easily tolerated by the patient. The second most common side effect is breakthrough bleeding when using birth control pills. The vast majority of breakthrough bleeding occurs in cases where estrogen, the female hormone in the pill, is present at lower doses than it should be. If you experience breakthrough bleeding , you should continue taking the pill as prescribed. If there is no improvement in complaints, it may be necessary to consider changing to another pill by consulting the physician. Some women may complain of gaining weight. This can be prevented by the use of lower dose pills. Pills should be taken at the same time every day as much as possible. When the pill is forgotten one day, it should be taken as soon as it is remembered. It is necessary to use an additional method of protection, since the effectiveness of the method will decrease when the pill is forgotten two days in a row.

Pregnancy status should be determined with pregnancy test before starting to take birth control pills. There are various birth control pills on the market. Some of them contain 21 pills in a package. It is necessary to start the first package within the first 5 days of the menstruation (preferably the first day). After 21 days of drug use, no pill is taken for 7 days, during this period, menstrual bleeding occurs. Following the 7-day pill-free period, a new box is started. Birth control pills which are available in packages of 28 pills are for use without interruption. Hormone is not found in the last pills of the package, menstrual bleeding begins while taking the medicine.

Who should not use birth control pills?

Patients with breast cancer, blood clotting problems, heart and liver diseases should not use birth control pills. Those who are breastfeeding, smokers, patients with diabetes, high blood pressure, migraine and depression should use the pills under control.

b- Minipills

These are the birth control pills that contain no female hormone (estrogen) but only ovulation hormone (progesterone). They provide birth control with the principle of cervical fluid thickening, hindering the passage of sperm and preventing ovulation. The success rate is 97%. The most obvious advantage of this method is that it can be used during breastfeeding when estrogen-containing pills cannot be used, and it is also important that it can be taken by women who cannot use estrogen due to any condition.

c- Morning after pills

This method, which is not suitable for routine use, is used only in mandatory cases. Taking the pill within the first 120 hours following unprotected sexual intercourse prevents the oocyte (egg) from settling in the uterus, even if the oocyte is fertilized. However, it is known that the protection of morning after pills decreases after the first 24 hours in daily practice. They can cause menstrual irregularity during the month in which they are used.

Birth control injections, birth control patches

Monthly Birth Control Injections

These medications, containing both estrogen and progesterone, have a high rate of protection when taken regularly every month. The biggest advantage over pills is that patient compliance is easier since they are taken once a month. Usage failures and skipping dose, which can be encountered in pills are not experienced when using these injections. It is recommended to use the injection within the first seven days (preferably on the first day) of menstruation. It is not recommended for breastfeeding women, as it reduces breast milk and lowers its quality.

Quarterly injections

Among the hormonal methods used, quarterly injections, which have the highest protective value, contain only the hormone progesterone. It suppresses ovulation and blocks the passage of sperm by thickening cervical secretions. The disadvantage of these drugs, which are administered as intramuscular injection, is that breakthrough bleeding is more common compared to other methods.

Subcutaneous implants

A 40 mm long, 2 mm thick, progesterone containing capsule, resembling a matchstick, is placed under the skin on the inside of the upper arm as an implant. In the first 24 hours following the procedure, the amount of progesterone in the blood reaches to the level enough to prevent pregnancy.

In this method, which provides protection for about 5 years, the intrauterine layer becomes thin due to the progesterone content of the capsule and pregnancy is prevented.

The most common problem of this method is irregular bleeding. After a while, the amount of bleeding gradually decreases and eventually, there may be no menstrual bleeding. This situation, which is unacceptable for some women, should be reminded to women who want to use the method.

It should be kept in mind that headache, nausea, worsening of acne, tenderness in breasts and mental changes may occur due to high progesterone hormone levels in the blood.

Birth control patch

It provides protection with the principle similar to birth control pills. There are 3 tapes in one package. These patches are adhered on the any of the arm, leg or hip areas; each patch stays for a week. With the hormones it releases into the blood, the patch prevents ovulation. As in all hormonal methods, most common side effect is irregular bleeding. Skin sensitivity may occur where the patch adheres, so it is recommended that each patch be attached on a different location. When the patch is displaced, it should be tried to be adhered again; If it does not stick again, a new patch should be applied, it should be kept until the day the previous patch was supposed to stay, and then it should be replaced with a new one. If the patch has not been in contact with the skin for more than 24 hours, a new package should be started and additional protection method should be applied for a week.

Vaginal ring

The vaginal ring is a flexible ring 4 mm thick and 5.4 cm in diameter. It is a birth control method that contains estrogen and progesterone hormone, as in pills. This ring, which is placed in the vagina, is removed after 3 weeks of use and during this one-week period, menstrual bleeding occurs. This ring, which is extremely simple to place, has a low hormone content, high efficacy, and breakthrough bleeding is less common than pills. The most common problem in women using the vaginal ring is an increase in vaginal discharge and infection. Vaginal rings are not yet available in our country.

4 Intrauterine devices (IUD)

Copper Intrauterine Devices:

The intrauterine device is today considered one of the safest methods of contraception by the World Health Organization.

Thanks to the copper in its arms and body, copper IUD prevents the movement of sperm, reduces the ability of the sperm to fertilize the egg, and most importantly, it prevents the attachment of the conception (embryo) to the intrauterine layer by creating a foreign body reaction in the uterus.

This method, which can be protective against pregnancy for up to 10 years, is safe to use since there is no possibility for user errors. Since a thin string coming out from the lower end of the spiral is cut to the length of the cervix during insertion, it does not cause any problems during sexual intercourse and when the IUD is desired to be removed, it can be easily done so by pulling this string.

The most common side effect of the IUD is increase in the amount of menstrual bleeding and prolonged menstruation (long periods). This effect is triggered by a foreign body reaction that develops against copper, and it can not be determined in advance who may develop it. Another disadvantage of the IUD is that it facilitates sexually transmitted diseases. When these diseases are not diagnosed early, they can cause adhesions in the tubes and problems in conception in the future as well as ectopic pregnancy. Therefore, it is not recommended as a first-line prevention method for women who have not given birth, but it is an ideal method for women who are breastfeeding.

Hormone IUD:

It exerts its effect by releasing 20 micrograms of total 52 mg of progesterone hormone derivative in its arms. This hormone level is sufficient to thin the intrauterine layer, hinder ovulation and prevent pregnancy.

The most common problem in this method, which has approximately 5 years of protection, is the menstrual irregularities seen in the first months of its placement. Over time, the amount of menstrual bleeding and intermittent spotting diminish, and some women may not have any menstrual bleeding at all. For this reason, it can be used as the first choice for women who have a heavy and long menstrual bleeding with anemia complaint. Since it has a slightly larger insertion device than the copper IUD, it will be less painful to place, preferably at the time of menstruation.

4.Surgical Methods

Tubal Ligation

In women, it is the process of ligating the tubes that carry the egg into the uterus. Since it is not reversible, tubal ligation is a suitable method for couples who do not have a desire for children in the future. Tubal ligation does not cause any physical, mental or sexual changes. It provides almost 100% protection. In cesarean deliveries, this procedure can be performed simultaneously with birth, it can also be done in a separate session, with a small incision or by keyhole (laparoscopic) method.

It provides almost 100% protection. In women who want to conceive, microsurgery can reconnect the fallopian tubes, but IVF treatment is widely used instead of such surgeries which have low chance of success.

Vasectomy: It is the surgical procedure of permanent disruption of the passage of sperm cells from the testicles to the areas where they are stored. After this procedure, there is no change in the appearance of the fluid spurted out during ejaculation, but pregnancy does not occur because there are no sperm cells in this fluid. Similar to tubal ligation, this method, which provides almost 100% protection, is also not reversible. The advantage of this method is that it can be performed in a short time with local anesthesia and a provides high rate of protection.


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