1. Lecture on "" Basic Principles for advice on family planning "'
Lecturer Ph.D. G.M. Muldaeva
Discipline, "General medical practice"
Specialty "General Medicine"
course V

2. Modern methods of contraception
The purpose of the lecture: Writing the concept of family planning. The organization of family planning. Range of modern methods and means of contraception.
Plan lectures:
Family planning.
Modern methods of contraception
Efficacy and safety of family planning methods.

3. Family planning - a wide range of medical and social measures aimed at protecting women's reproductive health and provision of birth of children desired.
In recent years, our country is working to establish family planning services and eliminate the negative consequences associated with the underestimation of its importance. These effects include a high frequency of induced abortions, which have traditionally been the leading method of limiting unintended pregnancies. Long-term effects of abortion are the basis of these types of obstetric and gynecological pathology, as miscarriage, obstetric hemorrhage, abnormal uterine activity, genital endometriosis, inflammatory disease of the pelvic organs, secondary infertility. Complications of abortion account for about one third of the causes of maternal mortality. Thus, limiting the frequency of abortion can significantly reduce both the obstetric and gynecological morbidity and maternal mortality. Achieving these results is possible only with the broad use of modern high-performance methods and means of contraception.

4. Unplanned pregnancies are common in women younger (18 years) late reproductive (over 35) age. In either case there is a significant incidence of pregnancies at high risk of obstetric pathology, which increases perinatal and maternal mortality. The small interval between pregnancies (less than 2 years), as well as the large number of pregnancies (including births) in history are factors at high risk for complications of pregnancy and childbirth. Thus, aid to the population about family planning helps reduce the number of pregnancies at high risk , hence, maternal and perinatal mortality.

5. Organization of family planning services the widespread introduction of effective contraception is the most profitable in economic terms means of reducing maternal mortality. According to experts, the use of effective contraception 30% of women of childbearing age will halve the maternal mortality rate. One should not expect a negative effect on fertility, contraception prevents as abortion, not birth.
Family planning service can be provided by specialized agencies, where services are provided only on family planning, or be integrated with various medical institutions, as their functional units. In the latter case, the range of public services generally broader and includes maintenance of women with different gynecological pathology, habitual miscarriage, infertility, performing abortion, laparoscopy, including sterilization.

6. At the present stage of family planning service is an essential part of preventive direction of Reproduction. Priority in the work centers, clinics and offices of family planning is to protect women's reproductive health. The choice of contraceptive method shall be based on many factors: the non-contraceptive properties that can be used to improve the health of women prevention of diseases, the effectiveness of the method, its safety, side effects and individual attitudes to women this method. The decision to choose a contraceptive method after the patient receives the prior counseling, including information on all methods of birth control.

7. The effectiveness of any contraceptive method is defined by Pearl Index, which is expressed in number of pregnancies which occurred in 100 women using this method of contraception for one year.
Range of modern methods of contraception is wide enough. The modern contraception are hormonal, intrauterine, surgical contraception, barrier spermicides, natural family planning methods, methods of emergency contraception.
Modern methods of contraception
Hormonal contraception

8. In order to hormonal contraceptive use synthetic analogs of female sex hormones - estrogen and progesterone. Depending on the composition and method of application are following means of hormonal contraception:
combined (estrogen-progestin) oral contraceptives;
contraceptives containing only progestogens:
- Progestin oral contraceptives (mini-pill);
- Long-acting injectable contraceptives;
- An implant for subcutaneous injection;
- Hormone distinguishes intrauterine system.

9. The first synthetic oral contraceptives were of high-dose estrogen and progestogen components. The use of these drugs increased the risk of cardiovascular disease and venous thromboembolism. In today's oral contraceptives estrogen dose component is reduced to mg, and in some specimens up to 20 micrograms. Progestogens last (third) generation - desogestrel, gestodene and norgestimate - are different from progestogens, created earlier, a high tropism for receptors for progesterone and low - for androgen receptors. This provides effective contraception when used in low doses and minimize the impact on metabolic parameters. Modern oral contraceptives have minimal side effects and is safe for prolonged use.

10. Combined oral contraceptives (COCs) are highly effective and reversible contraceptive method. Pearl Index of modern COCs is 0,05-1,0 per 100 women / years and depends largely on the compliance of the drug. In composition, combined contraceptives differ in phase character, the drug dose within the components u1 type of progestogen (progestin progestogen). In the monophasic preparations (mersilon, novinet, logest, marvelon, regulon, femoden, silest, miniziston, etc.) all the pills have the same composition. Combined two-phase contraceptives (anteovin) contain a constant dose of estrogen and progestogen component changing the dose. Three-phase products (trikvilar, triziston, triregol, etc.) contain tablets of three different formulations, different doses of estrogen and progestogen components. The popularity of drugs in phase 1970 was due to reduction: doses of progestogen component in their composition. Modern low-dose monophasic COCs containing progestogens last generation, are the drugs of first choice as the most convenient and easy to use and with higher efficiency. Low-dose COCs are called, containing less than 50 micrograms of estrogen component.

11. Absolute contraindications to the use of COCs are:
- Pregnancy
- Vascular disorders currently or in the form of a history of severe, hypertension, deep vein thrombosis or thromboembolic pulmonary artery branches, cerebrovascular accident, coronary artery disease;
- Smoking women over 35 years, as smoking is combined with the COCs-increases the risk of cardiovascular disease;
- Liver disease at present or in history that led knarusheniyu of the liver;
- Breast cancer;
- The presence of vaginal bleeding of unknown etiology;
- Post-partum and breast-feeding in terms of less than 6 weeks after birth.

12. Regimen of COCs. Start COCs better in 1-day regular menstrual period, as in this case the maximum contraceptive effect is achieved in the first cycle of treatment. The usual mode of monophasic COCs is receiving 21 tablets for 21 days followed by 7-day break. Drugs can be used for many years without additional breaks.
If necessary, postponing withdrawal bleed bleeding (during the holidays, vacations, sporting events and so forth) receiving the next package of monophasic COCs should be started without the 7-day break. When you use the whole pack (21 tablets) menstruation is delayed for 3 weeks. In applying the three-phase products in the same situation from the second pack, you can use only pills "third phase" and to postpone bleeding for 7-8 days. To take full second-phase packing COCs without a break after the first is impossible, since the fluctuation of hormone levels lead to bleeding, in addition, it is possible and ovulation. It should be remembered that in the three-phase COC containing 28 tablets, 7 are not hormone-containing.

13. After receiving a three-phase preparation can begin non-stop reception monophasic COCs with the same composition as tablets third phase, and provide respite bleeding on day 21.
In some situations, we recommend three cycle up to receive monophasic COCs: 3 packs of COC accepted in a row without a break, then take a break for 4-7 days and again taken 3 packs of the drug. As a result, women will be only 4 "episodes" menstrual-like bleeding for a year. The indications for the three cycle mode COCs may be:

14. If you forget the pills, the following rules
If you forget the pills, the following rules. If after skipping pills was less than 12 hours, you should immediately take the missed tablet. In the event that more than 12 hours, you should take the missed pill and use additional measures of protection in pregnancy for 7 days at the same time, if before the end of the packaging have no more than 7 days, excluding the 7-day break from taking the drug and go directly to the next pack.
Following the appointment of COCs the patient should be examined after 3 months. then after 6 months. and subsequently observed at least 1 time per year. In the presence of relative contraindications to receive COCs first inspection is required after 1 month. after the appointment of the drug, then - after 3 months. and in the future - every 6 months. Depending on the nature of the disease were under examination to exclude the negative effect of hormonal contraception on women's health.

15. Progestin oral contraceptives
Progestin oral contraceptives. By gestagen oral contraceptives (mini-pill) are birth control pills without estrogen component and contain only progestin (exluton, microlute, etc.). Progestogenic component in these preparations are derivatives of 19-nortestosterone: linestrenol, levonorgestrel, etc.
Progestin oral contraceptives effectively protect a woman from becoming pregnant. Noted that the effectiveness of the method is higher in older women. Due to the fact that the maximum contraceptive effect occurs 3-4 hours after taking the pill and stopped after 24 h, to | be effective, it is important to adherence of the drug. About half of pregnancies in patients receiving minipiley occurs due to violations of the pill.

16. The mechanism of action gestagen oral contraceptive composed of several stages:
- Change in cervical mucus (thickening), which prevents the penetration of sperm into the uterus;
- Morphological changes in the endometrium that create unfavorable conditions for the implantation of a fertilized egg cell (seen in "mosaic" of different phases of the menstrual cycle and endometrial thinning);
- Anovulation (not all cycles of the drug) due to partial or complete suppression of the LH peak;
- Change the contractile activity of the fallopian tubes, which may impede the process of fertilization;

17. - Smoking women over 35 years; - In lactation
The use of gestagen oral contraceptives mainly shown in the following cases:
- Smoking women over 35 years;
- In lactation
- Patients with hypertension, uncontrollable, sickle cell disease, focal migraine, diabetes mellitus;
- In case of intolerance or the presence of estrogen dependent estrogen side effects.

18. Rules of admission gestagen oral contraceptives
1-day menstrual cycle, daily, strictly in the same time, in continuous mode. After the abortion pill are appointed on the first day after birth - 6 weeks if the woman is breastfeeding.
The patient should be aware of the need for additional precautions for 48 hours in the following cases;
a pill with a delay of more than 3 hours;
presence of vomiting within 3 hours after taking another pill;
in the presence of diarrhea precautions are needed within 48 hours after its termination.

19. Injectable progestogen contraceptive (Depo-Provera)
Injectable progestogen contraceptive (Depo-Provera). Among long-acting drugs for injection is the most widely used drug Depo-Provera (depot medroxyprogesterone acetate). Contraceptives in this group have a high efficiency, Pearl Index in their application is less than 1.0 per 100 women / years. The contraceptive effect occurs within 24 h after drug administration.
The mechanism of action of Depo-Provera is similar to the mechanism of action of gestagen oral contraceptives, Depo-Provera suppresses the secretion of gonadotropin-releasing hormone (LH especially), which prevents maturation of follicles and ovulation. In addition, there are typical progestin-induced changes in cervical mucus, and suppression of secretory changes in the endometrium required for implantation of a fertilized egg.

20. The advantages of long-acting contraceptive injectable progestogen-only component, are:
high efficiency;
the absence of estrogen side effects;
rapid and long-term contraceptive effect after injection;
ease of use;
opportunity to use during lactation.

21. When you use the non-contraceptive effects were positive: reduced abundance and painful menstruation, premenstrual syndrome and the manifestations of iron deficiency anemia, reduced the relative risk of developing endometrial cancer, prevention of inflammatory diseases of the pelvic organs.
The method has several drawbacks that limit its use. These are frequently occurring menstrual disorders, inability to quickly suspend the effect of the drug, weight gain, delayed restoration of fertility after the last injection of the drug to an average of 1.5 years. In the application of Depo-Provera can also occur as side effects of allergic reactions, nausea, headache, insomnia, nervousness.

22. Rules of injectable Depo-Provera
lie in the introduction of 150 mg intramuscularly every 3 months. The first injection is performed during the first 7 days of the menstrual cycle or 6 weeks after birth. In these terms exclude the possibility. pregnancy in a patient. Repeated injections performed with a delay of up to 2 weeks. Do not reduce the contraceptive effect of the method. The patient should be warned of the fact that at the beginning of the drug may be in breach of the menstrual cycle, which appears irregular bleeding, and as they continue therapy usually diminish until the development of amenorrhea. When prolonged or heavy spotting to stop the bleeding we recommend the following methods: 1) the use of low-dose COCs in a single tablet for days, and 2) to stop the bleeding can also be used estrogen preparations, and 3) possibly early execution of the next injection of depo- Provera, but not earlier than four weeks after the previous one, and 4) to reduce bleeding used non-steroidal anti-inflammatory drugs.

23. Progestin implant for subcutaneous administration, "Norplant"
Progestin implant for subcutaneous administration, "Norplant". Contraceptive consists of 6 silastic capsules up to 30 mm and a diameter of 2.4 mm, containing the progestogen levonorgestrel. The capsules are implanted subcutaneously, provide long-acting contraceptive effect for 5 years and then be deleted. Currently under development and testing of new contraceptive implant, including biodegradable (breaking up) capsules are not to be removed before the expiration of contraceptive action.
The use of the contraceptive "Norplant" provides high contraceptive efficacy for 5 years. Pearl Index using the method of per 100 women / years.

24. The advantages of the method are high efficiency, continuity and duration of contraceptive action, ease of use, rapid return to fertility after removal of caps, the lack of effect on lactation, the presence of non-contraceptive benefits, typical of gestagen preparations.
The disadvantages of the method are the side effects seen with other gestagen contraceptive methods (menstrual irregularities, weight gain, headaches, nervousness, nausea). Furthermore, the introduction and removal of contraceptive capsules "Norplant" is a surgical procedure and requires the involvement of specially trained professionals.
Absolute contraindications to the use of capsules, "Norplant" include pregnancy or suspected pregnancy, menstrual disorders of unknown etiology, breast cancer.
For relative contraindications include: postpartum, and breastfeeding during the first 6 weeks postpartum, stroke, diabetes, liver disease, in violation of its functions.

25. The method of introduction and removal of the implant
Implantation of capsules is carried out in the first 7 days of the menstrual cycle, subcutaneously in the inner surface of the shoulder (under infiltration anesthesia).
The capsules are introduced like a fan with a special trocar through a small incision (length approximately mm). Removing the capsule is made under local infiltration anesthesia through a small skin incision is made ​​as close to the ends of the implants. Each implant is brought into the wound by pressing a finger on its opposite end, is captured clip "mosquito" and after opening the capsule of connective tissue with a scalpel, the implant is removed through a second time.

26. Intrauterine devices
Intrauterine contraception - a method of birth control by devices introduced into the uterus, called intrauterine contraceptive (IUС) or intrauterine devices (IUСs). The method is widely distributed throughout the world, more than 80 million women use IUСs. Intrauterine contraception is an effective method of contraception, Pearl index when it is used is about 2 per 100 women / years.

27. Mechanism of action of IUСs prevent fertilization of an offensive, due to the following effects: a decrease in the activity and survival of spermatozoa (addition of copper enhances the toxic effect of spermatozoa); enhance spermicidal effect of endometrial mucus by increasing the amount of lysozyme and its decay products due to polymorphonuclear leukocyte infiltration of the endometrium in response to foreign body, reducing the lifetime of the egg. In cases where fertilization hinder a pregnancy following mechanisms: increased motility of the fallopian tubes, aseptic inflammation in the endometrium, leading to activation of phosphatases, changes in the concentration of glycogen, which also violates the implantation of the ovule.

28. Absolute contraindications to the use of intrauterine contraception are established or suspected pregnancy, menstrual disorders of unknown etiology, cervical cancer, endometrial cancer, inflammatory diseases of the pelvic organs at the present time or within the last 3 months, a malignant form of trophoblastic disease, tuberculosis, genital mutilation; malformations of the uterus. For relative contraindications include the presence of abundant, long and painful menstruation, increased risk of infections, sexually transmitted diseases, endometriosis, lack of parity.
With relative contraindications question on the application of intrauterine contraception is decided individually. In the presence of anemia, the patient, uterine fibroids, endometriosis gormonosoderzhaschie IUСs may be the method of choice.

29. The method of introduction and extraction of the IUС.
Before the introduction of IUСs to conduct a survey of patient and make sure there are no contraindications for the use of intrauterine contraception. IUСs can be administered on any day of the menstrual cycle, but many doctors prefer the early days of the menstrual cycle. There are techniques of IUС insertion immediately after the end of the III stage of labor, after the postpartum period after an abortion and the introduction to emergency contraception.
IUС insertion is performed under aseptic conditions after sounding the uterus. IUСs are inserted into the uterine cavity with an applicator, which is then extracted.
Removal of IUСs is the end of their effective use in cases of acute or exacerbation of chronic inflammatory diseases of the pelvic organs, menstrual cycle, one year after menopause.

30. Barrier methods of contraception
By barrier contraception include: 1) male and female condoms, 2) diaphragms and cervical caps, and 3) spermicides, products that contain chemicals that inactivate sperm.
The mechanism of action of barrier contraceptives is a mechanical obstruction to the sperm into the vagina (condoms) and cervix (diaphragms, cervical caps), or inactivate sperm (spermicide). The effectiveness of barrier methods is lower than the methods of hormonal and intrauterine contraception. Pearl Index for the use of condoms, diaphragms and cervical caps is 12.4 per 100 women / years. The lowest efficiency is observed when the isolated use of spermicides (15-20 per 100 women / years).

31. Spermicides in combination with other barrier methods provide a higher effect of contraception. Using condoms and other barrier methods of contraception is important for the prevention of sexually transmitted infections by: gonorrhea, chlamydia, mycoplasma, trichomoniasis, herpes and cytomegalovirus infections and AIDS. Barrier methods of contraception also provide disease prevention of cervical cancer, including cancers, the development of which is set to an infectious factor. Spermicides are also able to reduce the risk of certain bacterial infections, sexually transmitted diseases.

32. Male condoms have a length of 15-20 cm, 2. 5-3
Male condoms have a length of cm, cm diameter and thickness of 0,03-0,7 mm. Condoms made ​​of latex provide protection against transmission of HIV and hepatitis B. The condom is worn on the penis is erect. At the end of the condom to leave about 1.5 inches of empty space.
Female condoms are a new means of contraception. They are made of flexible polyurethane plastic and are of a cylinder 15 cm long and 7 cm in diameter, one end is closed and contains a locking ring. The open end of the condom has a soft ring that is located in the vulvar area. The female condom can be inserted into the vagina for some time before you have sex.
Vaginal diaphragm is a dome-shaped rubber cap with a flexible rim that is inserted into the vagina before intercourse so that the ring was in the vaginal vault, and dome covers the cervix. There are different types and sizes of vaginal diaphragms.

33. Cervical cap is shaped like a cup that fits over the cervix and is held in place by negative pressure between the strong and flexible rim cap and the surface of the cervix and upper part of the vaginal walls.
In recent years new types of female barrier contraception: vaginal rings containing levonorgestrel, disposable diaphragm and the diaphragm, releasing nonoxynol-9, the new model of female condoms.
Spermicides come in many forms: creams, gels, tablets, pads, films, sponges, candles. Most spermicides contain nonoxynol-9 or benzalkonium chloride, which, as potent surfactants, disrupt the cell membranes of spermatozoa. Spermicides inhibit the growth of gonococci and chlamydia, as well as inactivating certain viruses in vitro.

34. NATURAL FAMILY PLANNING METHODS
The natural family planning methods (NFPM) include: evaluation of basal body temperature, cervical mucus characteristics, calendar and symptothermal methods, interrupted sexual intercourse, temporary abstinence, lactational amenorrhea method (LAM).
The principle of operation of most natural method is to use periodic abstinence or other methods of contraception during the fertile phase of the menstrual cycle. Natural (biological) methods of contraception are based on the monitor control of the physiological manifestations associated with hormonal changes during the menstrual cycle, which may indicate the beginning or end of the fertile period. At the beginning of the menstrual cycle on the background of low levels of estrogen produced by a small amount of cervical mucus. By the mid-cycle, the peak period of estrogen, which coincides with ovulation, cervical mucus becomes abundant and well-stretchable. During this period may be ovulatory pain associated with rupture of the follicle.

35. In the second, or luteal, phase of the menstrual cycle, cervical mucus is thickened. Progesterone effect on the thermoregulatory center in the hypothalamus leads to an increase in basal body temperature, which remained high throughout the second phase of the menstrual cycle. Elucidation of the expected life of ovulation, taking into account the viability of sperm and egg can determine fertile phase of the menstrual cycle.
NFPM are low efficiency of contraceptive methods. Pearl Index in their use of approximately 25 per 100 women / years.
When using the calendar method for determining the fertile days of the menstrual cycle, taking into account the time of ovulation (when the 28-day cycle, ovulation occurs on day 14, and the possible physiological fluctuations within two days), the life expectancy of sperm (on average 4 days) and eggs (an average of 24 hours). Given these data, fertilization in the 28-day cycle is possible with an 8-to 17-day cycle. On other days the probability of pregnancy is greatly reduced.

36. The basal temperature after ovulation increased by 0,2-0,5 ° C and maintained at this level for days. Measurement of basal body temperature can not predict the time of ovulation, but only states the fact of its occurrence. Therefore, using this method will be considered fertile period from the beginning of the menstrual cycle and during the three days of fever. In the remaining days of pregnancy is unlikely.
Usually, ovulation occurs the day after the appearance of abundant mucus. In this regard, using estimates of changes of cervical mucus, you can predict time of ovulation. A woman should know that pregnancy is possible for 2 days prior to a discharge of mucus and abundant over the next 4 days.
Symptothermal method includes monitoring basal body temperature, cervical mucus changes and other symptoms associated with the menstrual cycle ( ovulatory pain). When considering the multiple-indicator can be set as the start (changing the cervical mucus, ovulatory pain), and the end of the fertile period (basal temperature).

37. Lactational amenorrhea method is based on the temporary loss of fertility, occurring during breastfeeding. The main mechanism of action of LAM is to suppress ovulation. At the hypothalamus caused by the sucking stimulus response changes in the level and rate allocation of gonadotropin-releasing hormone, which, in turn, alters the secretion of prolactin pulse and gonadotropin-releasing hormone (FSH, LH). The result is a slow development of follicles. As a result, women who are breastfeeding at least 8 times a day, the conditions that lead to a lengthening of the period of postpartum amenorrhea. LAM provides protection against pregnancy only if the following three conditions: 1) exclusive breastfeeding, which means breastfeeding on demand no less than 4 hours during the day from night interval of 6 hours, 2) lack of menses, and 3) the term after giving birth to 6 months.
The effectiveness of LAM in the presence of all three conditions are quite high: when using the method for 6 months, the number of pregnancies did not exceed 1-2 per 100 women.

38. Surgical Contraception
Surgical contraception methods include male and female voluntary sterilization. Female sterilization is achieved by occlusion of the fallopian tubes, resulting in fertilization is impossible. With male sterilization (vasectomy) is blocked vas deferens patency, which prevents the entry of sperm into the ejaculate. Currently, methods of voluntary surgical contraception are the most common methods of birth planning in many countries around the world. Voluntary surgical sterilization in our country is allowed in 1993, before surgical intervention to sterilization performed solely for medical reasons

39. Surgical contraception has almost one hundred percent efficiency
Surgical contraception has almost one hundred percent efficiency. Pregnancies after female sterilization due to recanalization of the fallopian tubes. After a vasectomy for 12 weeks. in the ejaculate contains sperm, and during this period may be an unwanted pregnancy in the future there is proof contraceptive effect. Surgical sterilization is a permanent method of contraception. Existing methods for restoring patency of the fallopian tubes and the vas deferens are complex, require special microsurgical equipment and inefficient for achieving fertility. The disadvantages of surgical contraception should include the risk of complications associated with surgery (hematoma, infectious complications, etc.).

40. To perform sterilization are three abdominal access - laparotomy, minilaparotomy and laparoscopy. Laparotomy with a view to sterilization is performed rarely, in severe cases or during the operation in conjunction with other surgical interventions. Minilaparotomy is an adaptation of the traditional laparotomy, at which the length of the abdominal incision is 3-4 cm This option is used to access during the operation immediately after birth, and post-abortion interval sterilization. Laparoscopic sterilization was not performed in the postpartum period, and after abortions beyond 12 weeks. Occlusion of the fallopian tubes is achieved by their resection, ligation, coagulation, blend brackets and rings.

41. Progestogenic oral contraceptives are used within 72 hours after unprotected intercourse. For the purpose of emergency contraception should be taken at once 750 mg of levonorgestrel (the drug Postinor tablets or 20 mini-pill) and repeat the technique in the same. dose after 12 hours (total of 2 tablets of the drug Postinor tablets or 40 mini-pill).
Danazol - anti drug gonadotropic to emergency contraception may be used at a dose of 600 mg twice with an interval of 12 hours no later than 72 hours after sexual intercourse.
Miphepristone (Ru 486) - anti-progesterone drug, is used a single dose of 600 mg within 72 hours after sexual intercourse.
Intrauterine devices can be used for emergency contraception within 5 days after unprotected intercourse.

42. Emergency contraception
Emergency contraception includes the emergency method of contraception after unprotected sexual intercourse for contraceptive use. For the purpose of emergency contraception uses hormonal (estrogen-progestin combinations and progestin drugs, danazol, miphepristone) and intrauterine devices. The mechanism of action of hormonal methods of emergency contraception involves a change in ovarian function (inhibition of ovulation and luteal function), violations of the migration of sperm, changes in the endometrium, preventing implantation. IUC insertion within 5 days after unprotected intercourse violates the implantation of a fertilized ovacytes.

43. Combined oral contraceptives for emergency contraception in order to be taken within 72 hours after unprotected sexual intercourse (Yuspe method). In order to use a method of emergency contraception pills four COCs containing 30 mcg ethinyl estradiol twice within 12 hours (total of 8 tablets). If a tablet contains 50 mcg COC, it is necessary to take two tablets, and 12 hours later, repeat this dose (total of 4 tablets). Thus, the minimum single dose of estrogen should be 100 mcg of ethinyl estradiol and a minimum total dose of estrogen mcg. When applying this method, possible side effects such as nausea or vomiting.

44. Literatures
Ailamazyan E.K. Obstetrics. - St. Petersburg.: Spec. References s.
Bodyazhina V.I. and others, Zhmakin K.N., Kiryushchenko A.P. Obstetrics: A Textbook / V.I. Bodyazhina, K.N. Zhmakin, A.P. Kiryushchenko. - 4th ed. - Kursk: AP "Kursk", s.
Duda VI. IV, VI Duda Pathological Obstetrics: Study Guide - MH.: Vyssh.shk., s.
AylamazyanE.K., Ed. Nachnibeda A.N., Pavlova L.P. Emergency Conditions in obstetrics and gynecology at the prehospital stage: Ref. - St. Petersburg., 2000.
Ailamazyan E.K. (eds) Emergency care under extreme conditions in obstetric practice: A Guide. - L., s.
Current issues of Obstetrics and Gynecology: Proceedings. Issue 1. - Petrozavodsk: Izd PSU, c.
Grishenko, A.N. "Late gestosis pregnant" M. Medicine, 2000.

45. Questions Family planning. Modern methods of contraception
Efficacy and safety of family planning methods.