Current developments in birth control

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CURRENT DEVELOPMENTS IN CONTRACEPTION
Contraception is at the forefront of reproductive health issues that concern couples in every age. Most of the contraception methods can be used from puberty to menopause in our age. Despite this, there is an unmet need for contraception in our country, as in many developing countries. According to TDHS (Turkey Population Health Survey) 2008, although 99.8% of currently married women have heard of any contraceptive method, 46% of them are protected by an effective method and 27.1% by an ineffective method.
Developing technology provides widespread use of new contraceptive methods that are effective, safe and have additional benefits. The production of synthetic hormones, which are closer to natural hormones with reduced side effects, and their application via oral, intrauterine and outside the injection route (hormone weekly patches, skin spray, subcutaneous quarterly injection, implant, vaginal ring) increase the method application options and contribute to the development of contraception. . In addition, different forms of copper intrauterine devices, new barrier methods have been produced, permanent contraceptive method techniques and methods based on fertility awareness have been developed.
In our country, new methods such as the intrauterine system containing hormones, the implant placed in the forearm and the ring containing hormones placed in the vagina have been put into use.
Things to consider when choosing a contraceptive method; The method’s effectiveness, side effects, suitability, duration of action and fertility target, applicant’s choice, reversibility, non-contraceptive benefits, cost and individuality are the main factors.
It is important to know that the methods differ in their effectiveness in typical and ideal uses. For example, while the rate of conception for 100 women in a year is 12 in typical use of condom, this rate drops to 3 in ideal use (Keep it in a cool place, not tear it with teeth and nails when opening, carefully remove it immediately after ejaculation, put it on with a gap at the end, and only water-based). lubricant is required.)
The World Health Organization (WHO) stepped in in 1994 to provide consensus on which contraceptive method can be applied to whom, in which medical conditions, and in which cases the method can be continued. Experts on the subject, who come together approximately every 3 years from all parts of the world, evaluate the studies of the last 50 years based on evidence-based medicine (meta-analyses, randomized controlled studies, etc.) CONTRACEPTIVE COMPATIBILITY CRITERIA they are updating. The last update was released in 2008. In the United States, the CDC (Central for Disease Control) accepted the WHO criteria and published the appropriate update for its citizens in 2010.

WHO FOLLOWS CONTRACEPTIVE COMPATIBILITY CRITERIAIt is divided into 4 categories:
1.Category: Safe to use-There are no limitations for method usage.
2.Category: Available-The positive aspects of method use are generally more than the theoretical and proven risks (the presence of other method options or the frequency of follow-up should be considered in the decision).
3.Category: Not the first option –theoretical and proven risks generally outweigh the positive aspects (the decision should be made by evaluating the availability/accessibility of other options, close monitoring possibilities and severity of the situation).
4.Category: Should not be used-unacceptable health risk.
There are also separate categories for surgical sterilization in men and women.

If we give examples according to these categories;
Antibiotics, antifungals, antiparasitics for all contraceptive methods according to 2008 update category 1It has been accepted (It can be used safely for the beginning and continuation of methods such as birth control pills, injections, implants, intrauterine devices.).
Intrauterine devices (IUD) in those who had ectopic (ectopic pregnancy) and those with ectopia (wound in the cervix) were also introduced in 2003. Category 1accepted (can be used safely).
It is also menarchate category 2 (method can be used).
Just; pregnancy, postpartum/postabortifepsis; Unexplained vaginal bleeding before administration, fibroids distorting the cavity, time of administration PID, purulent cervicitis (gonorrhea and chlamydia), endometrial or cervical cancer, or pelvic tuberculosis before administration, IUD cannot be applied (Category 4).
Copper-containing IUD models in our country; Cu T 380 A (protection period increased to 12 years), Multiload 375 Cu (5 years protection), Multiload 250 Cu (3 years protection). Since the pregnancy rate will increase from 1% to 14% when the copper they contain is depleted, they immediately expire when their usage period is over. (without rest!)they should be replaced.
In addition, dislocation rates are higher in the first 3 months after the application, and therefore, since the pregnancy risk will increase, the follow-up periods should be determined, it should be emphasized in the counseling before and after the application, and care should be taken in the follow-up evaluations.
In our country, it is one of the methods containing estrogen and progesterone synthetically. oral contraceptives (OC-Birth control pill), monthly intramuscular injection and newly available vaginal rings.Methods containing synthetic estrogen are present in thrombogenic mutation carriers, those with deep vein thrombosis, those with antiphospholipid antibodies (systemic connective tissue diseases such as lupus), those over the age of 35 who smoke more than 15 cigarettes a day, hypertension over 160/110 mm/Hg, those with nephropathy and retinopathy. It cannot be used in those with long-term diabetes. (Category 4).However, those with varicose veins, adiposes, thyroid patients, hepatitis carriers, those over 40 years of age who do not have any health problems, and those who are breastfeeding can be used safely 6 months after birth. (Category 1).
In oral contraceptive counseling, it should be emphasized that the method reduces the probability of ovarian and endometrial cancer by 50% and this protection lasts until 25-30 years after discontinuing the method. It is also known that ovarian follicle cysts are seen 75% less, colon (large intestine) cancer is 20-30% less, and fibroids are 30% less common.
Although the dose of ethinyl estradiol, which is used as an estrogen in today’s oral contraceptives, has been reduced by 15 times since 1960 due to the risk of thromboembolism, its contraceptive protection has not changed. The probability of getting pregnant is one in a thousand with regular use (Use in 100 women for one year). When you forget the pill one day, this probability becomes 3%. Especially when a new box is started after 7 days or the first pills are forgotten, there will be a risk of pregnancy. It is also possible to use birth control pills continuously for three months without a break. It is frequently applied in developed countries, especially during the sea season or in those with severe dysmenorrhea.
New generations produced close to natural progesterones in synthetic progesterones in birth control pills are also used in our country. Their antiandrogen properties are known to have positive effects on blood lipid and cholesterol levels, and the advantages of use over the age of 40 are mentioned.
It has been observed in evidence-based studies that OCs containing drospirenone reduce water and salt retention and are effective on premenstrual syndrome for at least 3 months.
In the meantime, it’s important to note that today’s low-dose birth control pills do not cause weight gain, and all OCs are useful in the treatment of hirsutismus (hair growth), acne, and acne.
In the use of oral contraceptives, menstrual bleeding will be regular, dysmenorrhea (painful menstrual bleeding), excessive, long menstrual bleeding and anemia will be less common. Sometimes the bleeding may decrease to one or two drops, and the inner lining of the uterus can be seen very thinly by ultrasonography. It is useful to know that this is a physiological condition. Complications such as infections, PID, and ectopic pregnancy, which will go up with the intensification of the discharge in the cervix, will be less common.
As a new method containing estrogen and progesterone in our country vaginal rings made available. These rings, whose estrogen dose is lower than birth control pills, remain in the vagina for 3 weeks, and a new one is placed after 7 days. Spontaneous fall rate has been reported as 2.5%. In case of being noticed and uncomfortable during sexual intercourse, it can be temporarily removed for not more than 3 hours a day and rinsed with warm water and reinserted. It is a good option for those who complain of vaginal dryness due to increased discharge.
Among the methods containing only progesterone in our country; 3-month injectable (DMPA –depomedroxiprogesteronacetate has been reported to protect up to 4 months), intrauterine system containing pregnancy-protecting hormone for 5 years and protective subcutaneous implants for 3 years. . They are suitable method options for those who cannot use estrogen due to the risk of embolism and for those who breastfeed within 6 months after delivery. It is worth emphasizing that those who use these methods will experience irregular bleeding in the first months, and menstrual delays and amenorrhea in the future.
Barrier methods Diaphragm and Femidom (Female condom) have been found in our country for a while. For now, latex condoms are used as the only contraceptive option.
Methods based on fertility awarenessStudies have been carried out in our country regarding the two new methods recommended by WHO.
Of these TWO DAY METHOD In , a woman asks herself the following question? Did my discharge increase today and yesterday? If the discharge has increased in one of every two days, there is a possibility of ovulation (ovulation) and sexual intercourse is not recommended (menstruation should be regular and factors such as infection that will increase the discharge should be excluded.).
IN STANDARD DAYS METHOD A rosary-like tool with different colors is used, sexual intercourse is not recommended around ovulation days. In both methods, the risk of getting pregnant in suitable cases is as much as condom use (~3%).
Surgical sterilization in womenIn our country, laparoscopy and suprapubic minilaparotomy are performed in the interval period, postpartum subumbilical minilaparotomy and cesarean section. vasectomy tooIt is performed in some centers with classical or non-scalpel (bloodless and knifeless) methods.

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