Reproductive health is a physical mental state. Human reproductive health: a look at the problem

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Reproductive period

The time interval during which a woman and a man can have children (from successful conception to the birth of a child) is called the reproductive period. In women, it formally begins from the first menstruation and ends with menopause. However, the optimal age ranges from 20 to 40 years. It is difficult for a young girl to bear a full-fledged child without suffering herself, and in women over 40 years of age, pregnancy can be complicated by chronic diseases that affect reproductive health. In men, the reproductive period begins after puberty and does not have a clearly defined upper limit, although fertility may decline due to age-related changes in the reproductive system.

The following factors negatively affect reproductive health:

Early entry into sexual activity.
Diseases and infections.
Poor quality food
Environmental pollution.
Amoral behavior.
Bad habits (drinking alcohol, drug addiction).
Hormonal disorders.

Basic criteria for reproduction

There are specific criteria that may indicate a deterioration in a person’s reproductive health:

There is a tendency for general health to deteriorate.
Pathological changes in biological materials sent for laboratory research.
Diseases of organs or organ systems.

How to protect?

Each state is interested in strengthening the reproductive health of its citizens. Therefore, in every country there is a set of legislative acts establishing the rights to procreation.

The main measures in this area are aimed at:

The desire to provide free healthcare.
Mandatory medical examinations.
Prevention of reproductive health disorders.
Explanatory work of social services.
Material and moral well-being.

But every person must understand that, first of all, his health depends on himself. The right image life, giving up habits that cause irreversible pathologies in the body, timely visits to the doctor for any diseases - these are the basic rules, the observance of which will help protect reproductive health.

Statistics

Statistics remind us that every second person, starting family life, already has chronic diseases that directly or indirectly affect the future generation. Can children born from unhealthy parents boast of health?

This situation arises partly because members of the younger generation seek to show their independence by challenging the rules and habits of their parents, which often leads to an unhealthy lifestyle.

In addition, according to various reasons Today, many children are born with various pathologies that also affect reproductive health. And poor heredity will significantly increase the chances of their children joining the ranks of the childless.

The statistics are inexorable - reproductive health on the planet is deteriorating.

How to save?

In order for the new generation to be born with good health, capable of giving birth to healthy offspring, it is necessary to adhere to the following recommendations:

Any teenager who enters into sexual relations should have the first thought about protection from unwanted pregnancy.
Active prevention is mandatory and surgical treatment possible diseases of the genital area.
Planning is recommended desired pregnancy, during which you should adhere to a healthy lifestyle.
Compliance with personal hygiene rules.
Constantly strengthening the immune system.
Proper nutrition(remove from the diet foods that have a negative impact on health, including reproductive health).

Everyone can adhere to these rules, but not everyone can think about such obvious rules.

Vitamins in the reproductive sphere

Many microelements and vitamins directly affect the reproductive system and participate in its work, and therefore are necessary in strengthening reproductive health. Let's give a few examples.

Iodine is a participant in the most important hormones thyroid gland, which also regulate the sexual behavior of women and men. A lack of vitamin E in men reduces the formation of seminal fluid, and in women it causes termination of pregnancy at various stages. Vitamin C affects the health of the reproductive system organs, protecting them from free radicals. Congenital defects of the nervous system are a consequence of a lack of folic acid in the mother’s body, and in the very early stages of pregnancy, when the woman may not yet be aware of her condition.

Therefore, in situations where the health of the reproductive system is important - that is, when planning a pregnancy, both future parents will benefit from taking specialized complexes containing essential vitamins and minerals.

External environment and health

Humanity has achieved a lot in protecting health and prolonging life, but at the same time, in pursuit of a comfortable life, civilization has seriously changed the environment and living conditions.

The air of cities contains huge amounts of exhaust gases, heavy metals and other harmful substances, which highlight cars, industrial enterprises, and thermal power plants. Space is literally permeated with electromagnetic radiation. We often give preference to “delicious” food with a large number of flavors and aromas, forgetting that the effect of many of them on the body has been poorly studied. In an attempt to free up some time for ourselves, we switch to semi-finished products, which do not contain the vitamins and minerals we need, but do contain preservatives that provoke the growth of free radicals in the body.

Each of these factors in itself may be invisible, but together they add up and affect the health of any person. We must remember that sex cells (sperm and eggs), which carry genetic material, are the most vulnerable and suffer from negative action external environment Firstly. Their damage manifests itself in different ways. This includes reproductive health disorders, the inability to conceive a child, habitual miscarriages, and the birth of children with genetic pathologies.

Therefore, in strengthening reproductive health, it is important to include the intake of antioxidant complexes, which help reduce the negative impact of the external environment on health. Pay attention to Synergin - it contains 6 powerful natural antioxidants in high dosages: beta-carotene, vitamins C and E, lycopene, rutin and coenzyme Q 10. Antioxidants are selected synergistically - that is, together they act much more effectively than taken separately. Regular intake of antioxidants into the body will protect the reproductive system from the negative influence of the environment and prevent unwanted changes in the body.

INTRODUCTION

Reproductive health is an important factor that shapes the country's favorable demographic prospects. Currently in Russia there is a problem of fertility, which is largely associated with reproductive behavior, a decrease in the number of women of childbearing age and the deterioration of their health.

Modern practice shows that preventing induced abortions, including illegal ones, using modern contraceptives can reduce maternal mortality by 25-50%. Therefore, family planning is currently considered as one of the essential elements protecting the health of women, mothers and children, as this allows them to maintain the health of adolescents, prevent unwanted pregnancy, infertility, venereal diseases, AIDS and ensure optimal intervals between births, taking into account the woman’s age, the number of children in the family and other factors, i.e. prevent too early, late and frequent births.

Motherhood and childhood are a necessary condition the existence of society, because without the process of reproduction the life of society is impossible at all. The phenomenon of motherhood and childhood has been and is currently the subject of scientific study. A number of federal laws adopted recently are aimed at improving the financial situation of women during pregnancy and after the birth of a child, as well as protecting the interests of the family and children, and increasing population reproduction. However, these and other measures, despite their certain positive impact, cannot fundamentally change the demographic situation in the country. It requires the implementation of a number of consistent comprehensive and targeted measures by the legislative and executive authorities both at the federal and regional levels, as evidenced by the adoption of Articles 18, 19 of the Federal Law “On the Fundamentals of Protecting the Health of Citizens in Russian Federation» dated November 21, 2011 No. 323-FZ.

As we see, women’s reproductive health depends on many factors, including the use of medicinal contraceptives, which not only prevent abortions, but also allow family planning.

The relevance of the topic is beyond doubt, because... Over the past two decades, the problem of human reproduction, planning children using contraceptives, prevention and treatment has been the focus of attention of scientists around the world.

CHAPTER 1. REPRODUCTIVE HEALTH

1.1 The concept of “Reproductive health”

The concept of “reproductive health” became widespread in the world in the 1980s and its content is closely related to the right of women and men to health care in the reproductive system and a healthy lifestyle. According to the WHO definition, “reproductive health is a state of physical, mental and social well-being and not simply the absence of disease or infirmity in all respects to the reproductive system of the body and its normal functioning.”

In this light, reproductive health includes:

safe and effective protection against unwanted pregnancy; - the ability to access and choose safe methods and means of contraception,

safe termination of pregnancy;

safe pregnancy and care before, during and after birth;

infertility treatment;

treatment of reproductive diseases;

treatment of sexually transmitted diseases.

In general, the reproductive health care system is focused primarily on providing assistance to women of childbearing age, and mainly during pregnancy and childbirth, as well as after childbirth. It does not include girls and boys, as well as adolescents, as well as men and women of late reproductive age and the elderly. Women aged 35-44 years make up 29% of the number of women of reproductive age in Russia. They carry out active professional activities, raise children and lead an active sex life. Meanwhile, the state of their reproductive health is alarming. During a sample examination of 1000 women conducted under her leadership, 2/3 of the patients were found to have chronic cardiovascular diseases. vascular system, urinary system and digestion - and all this against the background of gynecological diseases. “Gynecological morbidity is high - ranging from 45 to 65% according to various authors. Among diseases, the first place is occupied by inflammatory diseases (50-55%), followed by uterine fibroids, prolapse of the genital organs, and menstrual irregularities. About 10% of gynecological patients of this age suffered surgery on the genitals."

Women over 49 years of age are much more likely than others age groups suffer from oncological diseases genital organs, as well as diseases of the circulatory system, which are also largely initiated by the state of the reproductive system. More recently, in Russia they began to consider osteoporosis as a disease, which affects up to 3/4 of older women, and perhaps more. Doctors rarely provide qualified assistance in the treatment of osteoporosis, because they know little about the nature of this disease and treatment methods. Likewise, women rarely go to doctors for climacteric syndrome, and many experience it as a “natural state” of aging female body, using mainly traditional “folk” methods to alleviate their condition. Many of them, as is clear from the interviews we received, are afraid of menopause and have very vague ideas about it. The situation with the health of older women is as follows: as a rule, women of this age are more likely than others to provide assistance in caring for their loved ones - husbands, children, grandchildren. When situations arise that medical care They themselves need it, they do not receive it or receive it in a much smaller volume. According to the researchers, “in the urban population, older people make up up to 40% of those seeking medical care in clinics, about 60% of those seeking care at home, and 70% of those receiving treatment in a hospital.” But most of them are women. And very often they are denied hospitalization, calling an ambulance, or quality treatment. This group of women is much less likely to have access to paid medical services, as well as care services during illness. The situation not only cannot be resolved at the state level, but is simply ignored. But here we are dealing with discrimination of citizens on two grounds at once: gender and age, as well as a violation of the constitutional right to health care.

The number and quality of reproductive health specialists also needs to be increased due to extreme insufficiency, and in some cases - such as in andrology or pediatric gynecology - almost complete absence. The number of paramedical personnel, primarily nurses and midwives, has noticeably decreased. The number of beds for gynecological patients, as well as the number of women's and children's clinics, has not decreased much.

Great importance The possibility of access and choice of safe methods and means of contraception should be given attention.

2 STATE OF REPRODUCTIVE HEALTH OF THE POPULATION OF THE CENTRAL CHERNOZEM REGION

In the first decade of the 21st century, negative trends in the health of the population persist in the Russian Federation, which requires continued healthcare reform and the introduction of necessary adjustments to this process. The unfavorable indicators of reproductive health of the population are causing some concern.

For general characteristics reproductive health of the population, the health status of women, pregnant women, women in labor and postpartum at the regional level, we used official data for 1992-2010. The dynamics of such indicators as the total population, the size of the female population, including women of reproductive age, birth rate, total mortality, infant and perinatal mortality, maternal mortality, abortion rate, number of abortions, proportion of normal and complicated births were analyzed. The total population at the regional (regional) level over 19 years decreased by 209.4 thousand people (the decline was 8.5%). It should be noted that during the analyzed period, the total population increased as much as possible from 1992 to 1995, which was associated with migration processes that led to the influx of Russian-speaking population from the former republics due to the collapse of the USSR and the reform of socio-economic relations in almost the entire post-Soviet space. Subsequently (since 1995), due to a decrease in migration flows, birth rates and an increase in overall mortality, the total population in the region began to decline and reached 2261.6 thousand people in 2010, a decrease (decrease) compared to 1995 amounted to 9.5%. It should be noted that the Voronezh region in the Central Black Earth Region (CHR) ranks 1st in terms of population (Table 1). However greatest decrease population growth was noted for the analyzed period from 2000 to 2010 in the Tambov and Kursk regions (the decrease was 14.2% and 12.7%, respectively), and in a region such as Belgorod there was a population increase of 1.9%. On average for Central Federal District the population decreased by 24.0 thousand people.

health contraception progesterone oral

Table 1. Population of the constituent entities of the Russian Federation that are part of the Central Chernobyl Region, according to data for 2000-2010 (thousand people)

The total female population of the Voronezh region over 19 years decreased by 7.9% and in 2010 amounted to 1235.36 thousand people or 54.6% of the total population of the region. The dynamics of the female population has undergone the same changes as the total population, that is, there was an increase until 1995, and then a decrease until the present. The main reason is the restructuring of socio-economic relations and the collapse of the USSR, which led to migration processes that have sharply decreased in recent years.

The size of the female population of reproductive age in the Voronezh region amounted to 573.8 thousand. Analysis of changes in the number of women of reproductive age (15-49 years) during the study period (from 1992 to 2010) indicates that the number of this population increased from 550, 4 thousand people in 1992 to 618.4 thousand people. in 2003, that is, by 12.3% or by 68.0 thousand people, after which it began to decline to 573.8 thousand people in 2010 (the decrease compared to 2003 was 7.2%). In general, during the analyzed period, the total number of women of reproductive age increased by 4.3%, which can be explained not only by migration processes, but also by the age transition of teenage girls into the group of women of reproductive age.

An analysis of the dynamics of the birth rate of the population of the Voronezh region revealed the following: initially, the highest level of this indicator was noted in 1992 (9.5‰), and the lowest in 1999 (7.1‰), after which it began to grow and in 2010 exceeded the level in 1992, amounting to 10.5‰ (the increase was 38.2% compared to 2000). Among the regions of the Central Black Sea Region, the highest level of birth rate in 2010 was noted in the Kursk, Belgorod and Lipetsk regions (11.2‰; 10.9‰; 10.9‰, respectively), and the increase in the birth rate was in the Lipetsk and Voronezh regions (39.7% and 38.2%, respectively) (Table 2).

Table 2. Fertility rate of the population of the constituent entities of the Russian Federation that are part of the Central Chernobyl Region, according to data for 2000-2010 (per 1000 population)

The overall mortality rate changed in waves, increased, decreased, and then increased again. In general, during the analyzed period since 1992 in the Voronezh region it increased by 19.7%, reaching 17.0% in 2010. Table. Figure 3 presents data characterizing the overall mortality rate of the population in the regions that are part of the Central Chernobyl Region according to data for 2000-2010, from which it can be seen that by 2010 the rate for all regions tends to decrease. In 2010, of the represented subjects of the Central Chernobyl Region, the highest mortality rate was noted in the Kursk region, and the lowest in the Belgorod region.

The infant mortality rate for the period 1992-2010 in the Voronezh region decreased from 17.6% in 1992 to 7.0% in 2010, that is, by 60.2%. Highest value This indicator was recorded in 1992, and the lowest in 2010. According to the forecast, its further decline is expected. Among the regions of the Central Chernobyl Region, the largest decrease in infant mortality from 2000 to 2010 was noted in the Tambov (by 70.4%) and Belgorod (by 64.1%) regions. In these regions, infant mortality became the lowest (4.2% and 5.1%, respectively) (Table 4).

Table 3. Overall mortality of the population of the constituent entities of the Russian Federation that are part of the Central Chernobyl Region, according to data for 2000-2010 (per 1000 population)

A similar pattern is typical for perinatal mortality. During 2000-2010, perinatal mortality in the Voronezh region decreased by 50.0% (Table 5). The largest decrease was noted in the Tambov region - by 60.6%. According to data for 2010, the most high rate perinatal mortality was registered in the Kursk region, and low - in the Belgorod region (8.5% and 5.5%, respectively).

Table 4. Infant mortality in the constituent entities of the Russian Federation that are part of the Central Chernobyl Region, according to data for 2000-2010 (per 1000 live births)

Table 5. Perinatal mortality in the constituent entities of the Russian Federation that are part of the Central Chernobyl Region, according to data for 2000-2010 (per 1000 live and stillborn births)

Study of the maternal mortality rate associated with pregnancy, childbirth, postpartum period in the Voronezh region indicates that it decreased from 36.9 cases per 1000 live births in 1992 to 12.6 cases in 2010, that is, by 65.9%. An analysis of maternal mortality in the constituent entities of the Russian Federation included in the Central Chernobyl Region showed that in 2000-2010 this indicator decreased in all regions. According to data for 2010, its highest value was noted in the Kursk and Lipetsk regions - 15.9 and 15.6 cases, and the lowest value is in the Tambov region - 9.1 per 1000 children born alive (Table 6).

Table 6. Maternal mortality in the constituent entities of the Russian Federation that are part of the Central Chernobyl Region, according to data for 2000-2010 (per 100 thousand live births)

The number of abortions in the Voronezh region per 100 children born alive and stillborn decreased by more than 3.5 times: from 220.4 cases in 1992 to 58.9 cases in 2010 (the decrease was 73.3%) ( table 7). It should be noted that there is a steady downward trend in this indicator.

Table 7. The level of abortions in the constituent entities of the Russian Federation that are part of the Central Chernobyl Region, according to data for 2000-2010 (per 100 children born alive and stillborn)

A comparative analysis of data on the level of abortions per 100 children born alive and stillborn in the constituent entities of the Russian Federation that are part of the Central Black Sea Region showed that in 2000-2010 this indicator decreased significantly in Belgorod region(by 75.3%), and the smallest decrease was noted in the Lipetsk region - by 58%. According to data for 2010, the highest level of abortions per 100 children born alive and stillborn was registered in the Lipetsk region (62.6 cases), and the lowest in the Belgorod region (41.0 cases) (Table 7). The largest number of abortions per 1000 women of fertile age in 2010 was registered in the Lipetsk region (27.4 cases), and the smallest in the Belgorod region (17.0 cases). It should be noted that during 2000-2010, the level of abortions per 1000 women of fertile age decreased in all regions of the Central Black Sea Region, but the largest decrease (by 66.3%) was noted in the Belgorod region, and the smallest in the Lipetsk region (by 43.9%). . The presented data indicate that preventive work in general across the Central Chernobyl Region is yielding results, but in general the problem persists (Table 8).

The share of normal and complicated births in the Voronezh region tends to decrease (from 45.4% in 1992 to 37.5% in 2010), and the share of complicated births is growing - from 54.6% in 1992 to 62.5% - in 2010, i.e. by 7.9%. Despite the efforts made by obstetricians-gynecologists and other specialists, the proportion of complicated births is growing.

Table 8. The number of abortions in the constituent entities of the Russian Federation that are part of the Central Chernobyl Region, according to data for 2000-2010 (per 1000 women of fertile age)

It should be noted that in general the situation related to the state of reproductive health of the population of the Voronezh region and the Central Chernobyl Region remains tense, as evidenced by the dynamics of the listed characteristics, which in turn requires the search for new ways to improve medical care in order to improve reproductive health and increase population reproduction.

3 Family planning

Family planning is a concept that actively enters our lives. What is it and why is family planning so important for each of us, for every family? For many years, family planning was understood as birth control. But family planning is about ensuring a woman’s health to give birth to desired and healthy children. In other words, family planning is children by choice, not by chance. The right to family planning, or free and responsible parenthood, is an internationally recognized right of every person. Questions about when and how many children to have, how to avoid unwanted pregnancy, what contraception(contraceptives) is better to use and how to use them, sooner or later every person, every family faces problems. Family planning helps people consciously choose the number of children in the family and the timing of their birth, plan their lives, and avoid unnecessary worries and worries.

The optimal age for having children is 20-35 years. It has been proven that if pregnancy occurs earlier or later, it occurs with a large number complications and the likelihood of health problems in mother and child are higher.

Abortion is not the best method of birth control, it can be avoided by using modern methods of contraception (prevention of unwanted pregnancy). Contraception does intimate life more harmonious, eliminates unnecessary worries and expectations.

It is best to make the decision to use one method or another after you have learned about all contraceptives and consulted with a specialist.

Sexually transmitted infections are often the cause of infertility in men and women. Only a condom will help you avoid infection and at the same time protect you from unwanted pregnancy.

Scientific research on birth control has established a close relationship between a woman’s reproductive behavior and her health. Moreover, if previously reproductive choice was limited only to the right to abortion, today it includes the right to contraception, the right to pregnancy and the right to sterilization.

Frequent abortions in our country significantly increase the frequency inflammatory diseases genitalia, infertility, endocrine disorders and, as a consequence, various dyshormonal progesterone deficiency diseases, which leads to few children.

Today there is a need for an individual doctor's approach to the choice of contraceptives to prevent unwanted pregnancy in women. To preserve women's health, a doctor antenatal clinic must identify women who are at “high risk” for the development of possible complications during contraception, and promptly carry out appropriate preventive and therapeutic measures to ensure the preservation of the reproductive system and the woman’s health.

The widespread use of family planning through the introduction of modern contraceptive methods to regulate fertility, taking into account the woman’s age and her reproductive history, is an untapped reserve for further reducing gynecological morbidity and preserving women’s health.

The emergence of a market economy, in particular, the market for modern and high-quality contraceptives and private structures providing services to the population, played a positive role.

The information isolation of the country has been destroyed, including in this area. After information about abortion was declassified in the late 1980s, widespread discussion of the problem began in the scientific literature and the media. But the main thing is that for the first time in the country, a family planning and reproductive health service began to be created, the functions of which include the prevention of maternal morbidity and mortality, reducing the number of abortions through the distribution of modern contraceptives.

In line with these transformations, a public organization was formed - the Russian Association of Family Planning (RAPS).

Today the organization has 44 regional branches and implements its programs in more than 160 cities across the country.

RAPS has set itself difficult, but very relevant tasks for Russia, including, in particular, explaining the ideology of family planning and the essence of reproductive rights, educational work among the population, organizing sex education and education for young people, improving the qualifications of medical workers, improving the quality of planning services families and, ultimately, improving the reproductive health of the population. The active educational work of RAPS, especially among young people, has contributed to reducing the prevalence of sexually transmitted infections (Fig. 3), not to mention the significant contribution of the organization to the formation and development of civil society in our country.

CHAPTER 2. The importance of modern contraceptives

1 History of contraception

People have been using contraceptive methods to prevent pregnancy for a very long time. Some methods of contraception that were used in primitive society still exist today. Below are the most interesting methods of contraception that were used at different times.

Already in ancient Africa were known various substances of plant origin, which were used like “a cocoon inserted high into the vagina.” In ancient Africa, "interrupted copulation" was described. In America, the Indians, even before the arrival of Europeans, used vaginal rinsing with a decoction of mahogany bark and lemon. They also believed that after chewing parsley, a woman would bleed for 4 days. In Australia, for example, contraceptive lumps were prepared from fucus extract. In Sumatra and neighboring islands, opium was also used. The issue of preventing pregnancy came to the fore in the Greco-Roman Empire, in connection with the orgies that became widespread at that time. To prevent pregnancy, various substances of plant and animal origin or their decoctions were used with some success. The attitude towards these methods, for example, towards elephant or crocodile droppings, of course, must take into account the conditions and level of development of a given era. The world-famous Casanova said that lemon peel placed in front of the uterus perfectly prevents pregnancy. Although this makes us smile today, the recommendation is not without common sense, given the acidifying effect of lemon on the contents of the vagina.

In the 20th century, methods and methods of contraception have undergone tremendous development. In 1933, a book was published in which 180 different spermicidal substances were described. Subsequent research led to the development of certain spermicidal contraceptives that could be used as powders, tablets, or vaginal pellets. Male condoms made from animal skin have been used since the ancient world, but became widespread mainly in the first half of the 20th century. Somewhat later, rubber condoms appeared, the improvement of their reliability continued until the end of the last century. Of particular note is an important date in the first half of the 20th century - 1908 - when the cervical cap was developed. Intrauterine devices, not only intrauterine loops, but also spirals of various shapes, became widespread only in the late 50s and early 60s. The creation of more effective intrauterine devices containing copper was of great importance.

The creation of hormonal contraception was a new milestone in pregnancy prevention. The idea of hormonal contraception arose at the beginning of the 20th century, when the Austrian physician Haberland discovered that the administration of ovarian extract causes temporary sterilization. After the discovery of the sex hormones estrogen in 1929 and progesterone in 1934, an attempt was made to synthesize artificial hormones, and in 1960, the American scientist Pincus and his colleagues created the first contraceptive pill, Enovid.

Happy Birthday contraceptive pill considered to be June 1, 1961, when the drug Anovlar appeared, developed by Schering - the first oral contraceptive in Europe. It contained three times less hormones than its American predecessor and was suitable for long-term use. From that time on, the history of the development of combined contraceptives began. Hormonal contraception developed along the path of reducing the dose of steroids (estrogens) and along the path of creating selective (selective action) gestagens.

At the first stage, drugs were created with high content hormones (enovid, infekundin) and many serious side effects. At the second stage, contraceptives with a low content of estrogens (30-35 mcg) and gestagens with selective action appeared, which made it possible to significantly reduce the number of complications when taking them. 3rd generation drugs include products containing low (30-35 mcg) or minimal (20 mcg) doses of estrogens, as well as highly selective gestagens (norgestimate, desogestrel, gestodene, dienogest, drospirenone), which have an even greater advantage over their predecessors.

Modern drugs contain minimal amounts of hormones, so they very rarely cause complications and can be used without interruption for years, of course, with appropriate medical supervision.

Most modern drugs are monophasic. All tablets in the package are the same, which ensures ease of use and guaranteed contraceptive effect.

2.2 Modern methods contraception

The problem of contraception - protection from unwanted pregnancy - has existed as long as humanity itself. The first contraceptives had only a spermicidal or barrier effect. Substances of plant and animal origin were used, as well as the method of periodic abstinence in the middle of the menstrual cycle or the method of coitus interruptus. All these methods have survived to this day. These are called "traditional" contraceptive methods.

Unfortunately, in our country, even at the beginning of the 21st century. the problem of contraception is far from being solved, as evidenced by high level abortions and low use of modern means of birth control. In the structure of contraceptive methods used by Moscow residents, modern and effective means are used by about 20% of women (12% hormonal, 8% IUD). According to the survey, 24% of women do not use contraceptives, 56% use ineffective traditional methods.

All contraceptives registered in Russia according to their mechanism of action can be classified into local and systemic, which, in turn, are divided into means of long-term and one-time use (Table 1)

Table 1. Modern means contraception

LOCAL SYSTEM Long-acting Single-acting Long-acting Single-acting Intrauterine devices (IUDs) Spermicides Combined oral contraceptives Postcoital progestin contraceptives Intrauterine Mirena system containing levonorgestrel Condom Combined hormonal contraceptives Progestogen oral contraceptives (mini-pills) Progestogen parenteral contraceptives

Basic requirements for contraceptives: - effectiveness (reliability);

health safety;

reversibility;

acceptability, ease of use;

availability;

additional therapeutic effect.

The effectiveness of the methods is characterized by the Pearl index, which shows the number unplanned pregnancies, emerging 100 women using this method within 1 year. The initial selection of contraceptives is carried out by a gynecologist. When choosing contraceptive methods, it is necessary individual approach, age, lifestyle, health status should be taken into account (Table 2)

CONTRACEPTION ADVANTAGES DISADVANTAGES LOCAL LONG-ACTING CONTRACEPTIVES Intrauterine devices Convenient to use. Cost-effective Not suitable nulliparous women. Increase the risk of pelvic inflammatory diseases. Increase the risk ectopic pregnancy. The method requires limiting the number of sexual partners. The Mirena intrauterine system containing levonorgestrel is convenient to use. Economically beneficial. Fast recovery fertility. Reducing the risk of ectopic pregnancy. Reducing the risk of pelvic inflammatory diseases. Reducing the volume of menstrual blood loss. No systemic side effects. Presence of therapeutic effects The method requires limiting the number of sexual partners. At the beginning of use, adverse reactions are possible in the form of changes in the menstrual cycle. Spermicides: vaginal suppositories, vaginal creams, vaginal tampons, vaginal tablets, vaginal films. No systemic side effects. Reduces the risk of sexually transmitted infections. For a reliable contraceptive effect, it must be combined with other methods of contraception. Used immediately before sexual intercourse. Short-term effect (candles - 2-6 hours, after each sexual intercourse - a new candle). Changes in sensations during sexual intercourse Condom No systemic side effects. Protects against sexually transmitted infectionsThe reliability of the method depends on correct use condom. Used immediately before sexual intercourse. Changes in sensations during intercourse

Table 2. Characteristics of contraceptives

CONTRACEPTION ADVANTAGES DISADVANTAGES LONG-ACTING SYSTEMIC CONTRACEPTIVES Combined oral contraception (COCs) High reliability. Lack of connection with sexual intercourse. Prostate application. Reversibility. Therapeutic and preventive effects There are contraindications due to chronic diseases or acute conditions at the moment COCs: vaginal rings, patches No need for daily use. Reduced systemic side effectsInconvenience of use. Contraindications are similar to COCs. When using hormonal vaginal rings, increased vaginal discharge due to changes in the vaginal microflora Progestogenic oral contraceptives (mini-pills) Low gestagenic content and absence of an estrogenic component. Presence of medicinal effects. Can be used during lactation. Possible use for women who smoke. Contraceptive reliability is lower compared to COCs. The need to strictly adhere to the dosage regimen. If you miss taking pills, use emergency contraception. Increased risk of ectopic pregnancy. Menstrual cycle disorders. Progestin parenteral contraceptives: Injections, Capsules, Subcutaneous injections(implants) Long-lasting action. Ease of use. High reliability Presence of significant systemic side effects. Delay in restoration of fertility. Inability to stop contraception at the desired time. Menstrual irregularities.

Chemical methods of contraception (spermicides).

The method is based on the destruction of sperm using the active chemical component of spermicides - nonoxynol-9, benzalkonium chloride. Spermicides come in a variety of dosage forms: vaginal suppositories, vaginal tablets, vaginal films, creams, tampons.

To ensure a contraceptive effect, spermicides must be used correctly - injected deep into the vagina 10-20 minutes before sexual intercourse. It is important to remember that the effect of spermicides lasts for 1 hour - for suppositories, tablets, films; up to 10 hours - for cream and tampons. Before each sexual intercourse, it is necessary to introduce a new suppository, tablet, film; for subsequent hygiene of the genitals, do not use soap-containing detergents for 2 hours, do not douche for 6-8 hours, do not take a bath.

How independent method Contraception is usually not used, since contraceptive reliability is 30% (Pearl index is 30). For effective contraception, it is used in conjunction with barrier or biological methods of contraception. The tetrogenic effect of spermicides should be taken into account during pregnancy.

Long-term (more than two weeks) use of spermicides leads to disruption of vaginal boicenosis, which increases the risk of bacterial vaginosis.

Hormonal contraception.

In the twentieth century, artificial termination of pregnancy became a global problem. According to experts, from 36 to 55 abortions are performed in the world (about 4% of women of fertile age annually), which corresponds to 300-500 abortions for every 1000 births. Every year, about 70 thousand women die from complications of abortion. The prevalence of secondary infertility is also high. The level of infertile marriages in the Russian Federation ranges from 10 to 13.5%. The prevalence of induced abortion varies widely across countries and continents: from 5-20 in Scandinavian countries, Western Europe, North America up to 150-200 per 1000 women of fertile age in some countries in Africa and Latin America. Such a low number of abortions in economically developed countries is due, first of all, to the use of modern and reliable contraceptives by women, such as hormonal contraceptives.

Hormonal contraception has revolutionized modern society. The creation of a contraceptive that would be close to 100% effective back at the beginning of the 20th century. It seemed unreal. However, already in 1960, the first hormonal contraceptive, Enovid, was introduced in the USA, and Anovlar in Europe. The first hormonal contraceptives contained a high dose of hormones - 50 mcg of the estrogen component in one tablet and often gave side effects. Modern hormonal contraceptives contain a minimum dose of the estrogen component - 15-35 mcg of ethinyl estradiol per day, which ensures the safety and good tolerability of the method. Increasing the selectivity of the gestagen component of hormonal contraceptives provided not only an improvement in their intolerance, but also additional non-contraceptive (therapeutic) effects - antiantogenic, antimineralkorticoid, and a pronounced antiproliferative effect on the endometrium.

Hormonal contraceptives may contain either a combination of analogs of female sex hormones - estrogen and progesterone - estrogenic and gestagenic components, or be pure gestagen.

A modern woman has fairly high requirements for contraception. It must, first of all, be effective and safe, have no or minimal side effects, be convenient to use and, if possible, have additional non-contraceptive benefits.

Combined oral contraceptives (COCs).

These means are the most common methods of contraception. In addition to the high reliability of the method (Pearl index is 0.1), modern COCs are well tolerated with long-term use, are simple and easy to use, provide control of the menstrual cycle, are reversible and have a number of therapeutic and preventive effects. The main methods of COCs are analogues of female sex hormones - estrogen and progesterone. The estrogenic component of COCs is ethinyl estradiol (EE). Synthetic analogues of progesterone are commonly called progestogens.

The contraceptive effect of COCs is ensured by:

by suppressing ovulation

thickening of cervical mucus

changes in the endometrium preventing implantation

There are several classifications of COCs

Derivatives of 19-norsteroids with an ethynyl radical are a historically earlier group of gestagens. A distinctive property is its pronounced gestogenic activity. A daily dose of gestodene 75 mcg in COCs such as Logest, Femoden, Mirelle, Lindinet is sufficient to suppress ovulation and, therefore, reliable contraception. An important advantage of gestagens of this group is the inhibition of endometrial proliferation, which helps reduce the abundance of menstruation. However, gestogens at a dose of 150 mcg and above have residual androgenic activity, which can lead to side effects. The replacement of the ethynyl radical at position C-17 with cyanomethyl radical led to the creation of a new class of gestagen - “hybrid gestagens, which retained a pronounced antiproferative effect on the endometrium and have an antiandrogenic effect. The only representative of the class of “hybrid” gestogens is dienogest (part of COK JANIN). Dienogest is registered as an antiandrogenic gestagen and, in addition to contraception, is used for the treatment of hyperandrogenism in women (acne, seborrhea, hirsutism)

Progesterone derivatives.

In 1962, a unique and to this day only gestagen with 100% antiandrogenic activity was created - cyproterone acetate (part of the COC DIANE-35). The low-dose COC Diane-35 is widely used not only for the purpose of contraception, but also for the treatment of hyperandrogenism of varying severity in women. Chlormadinone acetate (part of the COC BELARA) has weak anti-antrogenic activity.

Spironolactone derivatives.

Research recent years were aimed at creating a gestagen, which in its properties is as close as possible to natural progesterone. Most women refuse the method of hormonal contraception in general due to estrogen-dependent side effects associated with fluid retention: weight gain, swelling of the legs, etc. Drospirenone is the only gestagen, a derivative of spironolactone (part of KOK YARINA) has antimineralkorticoid activity, preventing retention liquids, and eliminating most of the side effects of COCs. Antimineralkorticoid activity allows the use of COCs with drospirenone (Yarin) for therapeutic purposes - to relieve premenstrual syndrome. The COC is selected taking into account its individual characteristics necessary for a particular woman.

At simultaneous administration COCs and antibiotics reduce contraceptive reliability, so it is necessary to use additional methods of contraception. Of the parenteral forms of combined estrogen-progestogen contraceptives, the vaginal ring (Nuvo-Ring) has been registered in Russia since August 2004. Available in pharmacies.

Novo-Ring is a flexible ring made of hypoallergenic material, equipped with complex system membranes that provide a stable release of 15 μg of ethinyl estradiol and 120 μg of etonolgestrel throughout the day.

The main advantage of the new method is minimal systemic influence on the body due to the creation of a stable hormonal background in the body and the absence of primary passage through the liver and gastrointestinal tract intestinal tract, which reduces the incidence of side effects.

Intrauterine hormonal contraceptives.

The only one intrauterine system with a gestagen, registered in Russia, is the intrauterine levonorgestrel (LNG) releasing system Mirena. The contraceptive effect of Mirena is associated with the local action of LNG in the uterine cavity.

It should be noted that when using Mirena there is no effect of suppressing the effect of suppressing ovulation (unlike COCs), and there is also no systemic effect of LNG on the body. Mirena is indicated for women suffering from menorrhagia. With the use of this drug, menstruation becomes shorter and weaker; in 20% of women, menstruation is absent while using Mirena, which is associated with changes in the thickness and morphology of the endometrium.

Mini-drank.

Oral contraceptives containing a minimum dosage of gestogens are a fairly reliable method of contraception only for breastfeeding women (Table 3)

Table 3. Clinical and pharmacological profile of the mini-pill

Trade name International nonproprietary name Pharmacological characteristics Mocrolut 30 mcg levonorgestrel The lowest dosage drug. 100% bioavailability of gestagen Exluton 500 mcg linestrenol Highly dosed drug. The active metabolite, norethisterone, is formed during the breakdown of linestrone. Charosette 75 mcg desogestrel. The active metabolite, 3-ketodesogestrel, is formed during the breakdown of desogestrel.

The contraceptive effect is ensured by several factors:

thickening of cervical mucus and obstruction of sperm penetration into the uterine cavity;

changes in the endometrium that prevent egg implantation

decreased contractile activity fallopian tubes and as a consequence,

slowing down the migration of the egg through the tube into the uterine cavity;

in 25-50% of cases - suppression of ovulation;

Injections and implants.

Drugs intended for long-term contraception with a systemic effect. Progesterone derivatives in the form of an aqueous microcrystalline suspension are used as injections. The effect lasts for three months. Only one drug is registered in Russia - Depo-Provera, containing 150 mg of medroxyprogesterone acetate. After discontinuation of the drug, the ability to conceive is restored only at 7 months.

Implants (Norplant) - a system of 6 or 2 siloxane capsules with levonorgestrel. The capsules are installed subcutaneously on the inner surface of the left shoulder in the shape of a fan. Each capsule is 34 mm long, 2.5 mm in diameter, and contains 36 mg of levonorgestrel. After discontinuation of the drug, the ability to conceive is restored within a year.

CONCLUSION

Family planning means children by choice, not by chance. The right to family planning, or free and responsible parenthood, is an internationally recognized right of every person. Questions about when and how many children to have, how to avoid unwanted pregnancy, which contraceptives (contraceptives) are best to use and how to use them, sooner or later arise before every person, every family. Family planning helps people consciously choose the number of children in the family and the timing of their birth, plan their lives, and avoid unnecessary worries and worries. Contraception is the basis of family planning. It makes intimate life more harmonious, eliminating unnecessary worries and expectations.

The decision to use one method or another is made after a thorough medical examination.

Family planning and the use of safe contraceptive methods will help maintain health, give birth to healthy and desired children, and bring happiness to every home.

BIBLIOGRAPHY

Results of the work of healthcare institutions for 1992-2010 and priority tasks for 2011: analytical report. - Voronezh: Department of Health of the Voronezh Region, 1992-2010.

Kosolapov V.P. Study of the problems of maternal and child health in the Central Black Earth region and ways to solve them in modern conditions: Dis. ...Dr. med. Sci. - Voronezh, 2011. - 270 p.

Kostyukova N.B., Usova M.A., Klimenko G.Ya., Gatsaynieva Kh.A. Medical and social characteristics of women’s reproductive health based on materials from an in-depth examination in a antenatal clinic // Doctor-graduate student, No. 3.4(52), 2012. - P.614-623.

Makatsaria A.D., Saidova R.A., Bitsadze V.O., et al. Hormonal contraception and thrombophilic conditions. M.: Triada-X 2004.240 p.

Methods for preliminary processing of information in system analysis and modeling medical systems/ HE. Choporov, N.V. Naumov, L.A. Kutashova, A.I. Agarkov // Doctor-graduate student. - No. 6.2(55). - 2012. - P. 382-390.

Main indicators of maternal and child health, activities of child welfare and obstetric services in the Russian Federation in 2010 / Federal State Budgetary Institution Central Research Institute of OIZ. - M., 2011. - 173 p.

Features of the reproductive health of the population of the Voronezh region against the background of the Central Chernobyl Region / V.P. Kosolapov, P.E. Chesnokov, G.Ya. Klimenko, O.N. Choporov // System analysis and management in biomedical systems: journal. practical and theoretical biology and medicine. - 2010. - T.9, No. 3. - P. 649-655.

Prilepskaya V.N., Mezhevitinova E.A., Tagieva A.V. Intrauterine contraception. M.: Medpress, 2000.192 p.

Modern methods of preventing abortions. Scientific and practical program of the Ministry of Health of the Russian Federation. M.2004.

Tadzhitdinov E.E., Nishanova F.P. Clinical and anamnestic analysis and reproductive losses in women with gestational diabetes // Doctor-graduate student, No. 2.1(51), 2012. - P. 238-243

Chesnokov P.E., Klimenko G.Ya., Kosolapov V.P., Sych G.V., Zhidkov M.L. On the issue of reproductive health of the population of the Voronezh region // Doctor-graduate student, No. 5.3(54), 2012. - P. 479-483

Federal Law “On the fundamentals of health of citizens of the Russian Federation” dated November 21, 2011 No. 323-FZ

15. Decree of the President of the Russian Federation of August 18, 1994 N 1696 (as amended on February 19, 1996, as amended on January 15, 1998) “On the presidential program “Children of Russia”

Traditionally, population problems were studied within the framework of demographic science, but as a result of their long-term understanding by the international scientific and political community, this problem began to be interpreted more broadly, including medical and socio-psychological aspects. Health, as defined by the World Health Organization (WHO), is a state of complete physical, mental and social well-being, and not just the absence of disease or infirmity. At the same time, the concept of “health” is relatively conditional and is objectively established based on a combination of anthropometric, clinical, physiological and biochemical parameters, determined taking into account gender and age factors, as well as climatic and geographical conditions.

The most important component of this concept is reproductive health. According to the recommendations of the Program of Action of the International Conference on Population and Development (Cairo, 1994), reproductive health means not only the absence of diseases of the reproductive system, disorders of its functions and/or processes in it, but also a state of complete physical and social well-being. This means the possibility of a satisfied and safe sexual life, the ability to reproduce (have children) and independently decide on family planning issues. Provides the right of men and women to information about and access to safe, effective, affordable and acceptable methods of birth control that are consistent with the law. The possibility of access to appropriate health care services is affirmed, allowing a woman to safely undergo pregnancy and childbirth, creating optimal conditions for the birth of a healthy child. The concept of “reproductive health” also includes sexual health - a condition that allows a person to to the fullest test sexual desire and implement it, while receiving satisfaction.

This phenomenon is of particular interest to sociologists and social psychologists, since reproductive health is almost entirely determined by behavior - a long-standing object of both empirical and theoretical sociological and socio-psychological research. To specify the area of study, sexual and reproductive behavior is distinguished from the entire behavioral field. Of particular interest in this regard is the sexual and reproductive behavior of adolescents and young people, since adolescence behavioral patterns are formed, many of which in the future have an impact on health and life expectancy.

The second interesting aspect of the problem is related to the concepts of “sexuality” and “reproduction” and the processes behind them.

Thus, today the issue of reproductive health of the population is of interest not only to doctors and psychologists, but also to sociologists. Special attention adolescent sexuality, which has strong social determinants, deserves. The importance of the problem of teenage sexuality cannot be underestimated, because it leads to serious and sometimes tragic consequences. Being extremely sensitive and long banned for discussion at any level, issues related to this problem have always worried teenagers, giving rise to myths, shame, and sometimes fear.

Based on the type of impact on reproductive health, two types of reproductive toxicity effects can be distinguished, which are the result of an impact directly on male and female sexual function (fertility) and the development of offspring.

The first type of effects manifests itself in the form of such changes in male and female reproductive health as delayed sexual development, decreased fertility and libido, persistent disorders of the menstrual cycle and spermatogenesis, gynecological diseases, disruption of pregnancy (threatened abortion, spontaneous abortion, threatened premature birth, complications of the second half of pregnancy), childbirth and lactation, premature reproductive aging, etc.

The second type of effects includes disturbances in the normal development of the fetus both before and after birth, caused by adverse effects on either parent before conception or influence the development of the offspring in the prenatal and postnatal period. These could be stillbirths birth defects development, morphogenetic malformations, small or large weight of the newborn, disturbances in the proportion of newborns, etc.

We will consider changes in individual indicators of the state of reproductive health under the influence of a polluted environment according to the physiological cycle - starting from the inability to conceive a child and ending with violations of the health of newborn children. Adverse changes in the reproductive health of children when parents and offspring are exposed to a polluted environment can appear quite early. The reproductive system in childhood and adolescence is highly sensitive to the effects of various environmental factors. The risk of reproductive health disorders in children and adolescents increases during critical periods of growth and development of the body and largely determines the usefulness of reproductive function. The pathogenesis of emerging disorders of this function is very complex.