Surgical contraceptive methods
Voluntary surgical sterilization is an irreversible and highly reliable method of contraception. In women, the procedure involves occlusion of the fallopian tubes using various surgical approaches (laparoscopy, mini-laparotomy) and occlusion techniques (Pomeroy, Parkland, and Filshie methods). In men, a vasectomy is performed — the transection of the vas deferens, with complete infertility achieved after 12 weeks. According to Russian legislation, the surgery can be performed upon the citizen's written request upon reaching 35 years of age or if they have two children, and for medical indications — regardless of these conditions.
Emergency (postcoital) contraception
Emergency protection methods are used exclusively in unforeseen situations (condom failure, rape) and are not suitable for regular use. The main approaches include:
- Insertion of an intrauterine contraceptive within 5 days after intercourse (contraindicated after rape).
- Administration of hormonal agents (combined oral contraceptives using the Yuzpe regimen, progestin-only pills such as Escapelle, or antiprogestins such as Mifepristone).
The timeframe for taking medications ranges from 72 to 96 hours depending on the chosen drug.
Contraception in specific age and physiological periods
Optimizing protection requires considering individual physiological characteristics:
- Adolescents: Require high efficacy and reversibility. Micro-dose combined oral contraceptives are prescribed only after the menstrual cycle stabilizes (2–3 menstrual cycles post-menarche), as estrogens can affect bone growth plates. Barrier methods also protect against infections.
- Postpartum period: During breastfeeding, the lactational amenorrhea method and progestin-only pills (mini-pills) are used. Without breastfeeding, combined hormonal contraceptives are permitted starting from day 21, and IUD insertion from week 5 postpartum.
Briefly: answers to topical questions
What is the dosing schedule for combined oral contraceptives using the Yuzpe regimen?
The Yuzpe regimen for combined oral contraceptives involves a two-dose administration with a 12-hour interval.
- First dose — taken no later than 72 hours after unprotected sexual intercourse.
- Second dose — 12 hours after the first one.
The total dose of ethinyl estradiol must be at least 100 mcg per dose.
What are the absolute contraindications for the emergency insertion of an intrauterine contraceptive?
Absolute contraindications for the insertion of an intrauterine contraceptive include pregnancy, malignant neoplasms of the cervix and uterine body, as well as acute, subacute, and frequently recurring chronic pelvic inflammatory diseases. For emergency contraceptive insertion, an additional strict condition is the complete absence of any risk of reproductive tract infection. Therefore, this method of emergency contraception is strictly contraindicated after rape.
The rule of three sixes for LAM: 6 feedings per day, intervals up to 6 hours, protection lasts for 6 months.
Class and exam questions
What are the legal grounds for performing surgical sterilization in the Russian Federation?
The surgery is performed upon the patient's written request if they have reached the age of 35 or have at least two children. In the presence of medical indications, sterilization is performed regardless of these criteria.
What is the essence of the lactational amenorrhea method?
The method is based on the suppression of ovulation by prolactin during breastfeeding. It is effective during the first six months postpartum provided that feedings occur regularly at least six times a day and in the absence of menstruation.
What are the established timeframes for emergency hormonal contraception?
Depending on the chosen medication (Yuzpe regimen, progestin-only pills, or antiprogestins), administration is carried out within 72 to 96 hours after unprotected sexual intercourse.
What else to study on this topic
- Natural methods of contraception and the causes of their low efficacy
- Specific complications of laparoscopic and open abdominal surgeries during sterilization
- Transcervical sterilization as an experimental method
- Regimens and dosages of emergency hormonal contraceptives
- Promising developments: contraceptive vaccines and male hormonal contraception
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- Complete study guide on "Medical Eligibility Criteria for Contraceptive Use" and 973 more pages of the subject
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