Development of contraception. The history of contraceptives: what was used in antiquity? Hormonal contraception: origins
Modern means contraception: barrier, chemical, biological, hormonal, intrauterine contraception, surgical - there are a lot of them, but often a woman cannot decide what to choose. And in the end, unexpectedly, she becomes pregnant. We will briefly describe the different contraceptives for women, their advantages and disadvantages.
Intrauterine systems
These are those that are installed in the uterine cavity for a long time. Usually recommended exclusively for women who have given birth due to possible side effects. But we'll start with the benefits.
1. You can not worry about unwanted pregnancy for several years, it has a positive effect on sexual relations.
2. High reliability. Slightly less than 100%.
3. Availability. The most inexpensive intrauterine device costs about 200-300 rubles. Purchased once.
And these are shortcomings.
1. Unpleasant sensations when installing. Some women require local anesthesia.
2. The possibility of falling out and displacement of the spiral, which provokes a decrease or termination of its contraceptive action.
3. Inflammatory diseases. The installation of the system can provoke the penetration of pathogens into the uterine cavity, which sometimes causes endometritis, the occurrence of adhesions in the intestines, fallopian tubes. Accordingly, the risk of infertility in the future increases. Therefore, spirals are usually recommended for women who have given birth.
4. The likelihood of an ectopic pregnancy. A fertilized egg cannot be fixed in the uterine cavity due to the spiral and can return back to the fallopian tube and implant there.
5. Increasing Probability heavy menstruation. Therefore, non-hormonal intrauterine systems are not recommended for women who have severe cyclic and acyclic uterine bleeding.
condoms
Barrier contraceptives have a number of advantages and can be used without consulting a doctor. Always welcome.
1. Reliability. Almost 100% protection not only from unwanted pregnancy, but also from sexually transmitted infections.
2. Ease of use and availability. Can be purchased at any pharmacy, supermarket. The abundance of models allows any couple to choose the right contraceptive for themselves.
3. Absence of contraindications. Only sometimes they appear allergic reactions. More often than not, it's the lubricant, dye, or flavor that's coated on the condom. In this case, you need to try another, ordinary, without "bells and whistles".
But there are downsides too. They are usually especially frightening for couples who have previously used other types of contraception.
1. Negative effect on erection, sensitivity. Usually in this case, a condom with ultra-thin walls helps.
2. Falling off the condom during intercourse. Again, due to poor erection. It happens when a condom is put on with insufficient sexual arousal.
3. Damage to the condom. It often happens if you try to apply various substances in the form of a lubricant to it, which are not intended for this. But damage can also be the result of a defective product. If the condom breaks, emergency contraception is used to prevent pregnancy.
By the way, an intrauterine device can be used as emergency contraception. It should be installed a maximum of 5 days after unprotected intercourse. Naturally, this method is suitable for those women who already thought about installing an intrauterine system.
Spermicides
They have no contraindications and can be used, if necessary, by women who are breastfeeding. The chemical method of contraception also has pros and cons.
Some benefits.
1. Availability. 10 vaginal tablets (or suppositories), for 10 sexual acts, cost about 300 rubles. Sold in all pharmacies.
2. They do not affect the body, like hormonal contraceptives, that is, they have only a local effect.
3. Have some antimicrobial and antibacterial action.
4. Have no contraindications and can be used in cases where no other contraception is suitable.
And these are the cons.
1. Often cause irritation of the vaginal mucosa and glans penis.
2. With regular use, 2-3 times a week or more, the vaginal microflora is disturbed.
3. Efficiency is significantly lower than stated if sexual intercourse is started earlier than the time specified in the instructions. After the introduction of the drug into the vagina, you need to wait a bit for it to start working.
Hormonal remedies
They are considered one of the most reliable and convenient, but at the same time having many contraindications and side effects. We will talk about oral contraceptives. First about the good.
This 2000 BC formula is the oldest known contraceptive that should actually work (on the same principle as modern diaphragms) and not just take male semen. It is one of several Egyptian recipes for preventing pregnancy, some of which may be from the 3rd millennium BC.
Spermicide
Also from Egypt comes a more elaborate version of the same idea in a Hebrew papyrus (circa 1600 BC) which recommends soaking a mixture of honey and acacia into a moss pillow. The tips of the acacia give lactic acid - the active element of most spermicidal preparations to this day.
Oral contraceptives
The ancients explored oral contraceptives from many plants. The recipes are the result not only of popular beliefs, but also of leading medical scientists. The gynecologist Saran, who worked for about 100 years after Christ in Egypt and Italy, wrote that dill plants are ideal. The pharmacist Dioscords (1st century AD) recommended wild mint. This birth control was widely used and is also understood in the works of famous writers such as Aristophanes (5th century BC).
Abortion remedies
Other popular birth control measures have been developed to induce early abortion. Around 400 BC an article by Hippocrates or a scholar of his school states that the best remedy to induce abortion is sea buckthorn. Soranus prescribes pomegranate, Dioscord, Galen and others prescribe other plants that can be administered orally or vaginally, such as juniper. Many modern experts scoff at the idea that any of these drugs can be relied upon and expect such a strong reaction as fetal expulsion.
But ancient observers confidently attribute low level fertility of them (these plants) widespread use. Certainly, some areas, including Greece and Italy, had very low birth rates, given the propensity of these peoples for sex, it must be said about the effectiveness of plants. Modern tests in rats and mice strongly support the claims of the ancients. Juniper was found to be only sixty percent effective. Sea buckthorn stops ovulation, and pomegranate is a source of steroidal estrogen.
Birth control pills
Although medical texts prior to Hippocrates (460-357 BC) did not mention oral contraceptives and abortion, they were popular long before that in Eastern Mesopotamia and were used for centuries. The Thesaurus Pauperum (13th century) listed not only thirty-four
Introduction
contraception hormonal teenager
Topic term paper"Contraceptives" is chosen because it is interesting and very relevant at the present time.
Contraception is not only protection against unwanted pregnancy. This is the preservation of health and the path to the birth of a healthy child.
Choosing a contraceptive is a relatively difficult task. The applied method should suit the lifestyle, take into account the opinion of the partner, not have a harmful effect on the body, have maximum efficiency, be affordable, not expensive at a cost and satisfy with full awareness of oneself. oral hormonal preparations, intrauterine devices, modern surgical and chemical methods of contraception - all this effective methods we owe it to the 20th century.
Contraception has been used since ancient times. Nowadays, contraceptives have become safer and more convenient to use.
Modern contraception makes it possible to reliably avoid unwanted pregnancy in full, but has a number of side effects.
All this determined the relevance of this work.
The purpose of my course work is to study the methods of modern contraception.
To reveal the purpose of the work, the following tasks were set:
1. study the history of the development of contraception,
2. define and characterize the main methods and means of modern contraception,
3. reveal the features of each method of contraception,
4. identify the positive and negative aspects of modern methods of contraception,
Research methods:
Theoretical (study of methodological literature on this topic).
The structure of the work: introduction, three chapters, conclusion and bibliography
History of the Development of Contraception
The history of female and male contraception goes back to ancient times. The beginnings of almost all modern ways and methods of preventing pregnancy and terminating a pregnancy that has already occurred took place many centuries ago.
The Nandi African peoples and the Indians of South America for many centuries BC used abstinence from sexual intercourse on certain days to prevent pregnancy. menstrual cycle. This method of contraception in our time is called calendar.
In ancient times, a chemical method was used to prevent unwanted pregnancy. For this purpose, women injected substances into the vagina before sexual intercourse that killed spermatozoa. For example, an Egyptian papyrus describes a recipe for making a vaginal tampon, consisting of cotton, crocodile feces and honey. Crocodile feces have an acidic reaction, in which spermatozoa die, and honey, having a sticky consistency, makes it difficult for spermatozoa to penetrate from the vagina into the cervix.
In ancient Egypt, women used tampons soaked in acacia decoction and honey for contraception. Women of ancient India used vaginal tampons made from acacia leaves and elephant feces to prevent pregnancy. During the fermentation of these components, lactic acid is formed, which causes the death of spermatozoa. Arab women prevented conception by introducing tampons with the feces of ungulates, cabbage, earwax and some other substances into the vagina. Ancient Egyptians used sea sponges soaked in vinegar as tampons.
In the Middle Ages, women in Europe used cotton swabs and paper soaked in acetic acid for the same purpose. AT Ancient China as a contraceptive and abortifacient, a mixture of vegetable oil and mercury was used, which was injected into the vagina. Chinese women injected mixtures of cedar resin, alum, and pomegranate into the vagina for contraceptive purposes. The famous Casanova (1725-1798) described in his biography various methods pregnancy prevention, including inserting a slice of lemon into a woman's vagina immediately after intercourse. At the beginning of the 19th century, R. Gunther published a number of articles in which he described the results of studies of the influence of 101 names of various chemical substances(acids, alkalis, alkaloids and others) on the survival of spermatozoa. These were the first scientific works on chemical methods female contraception. Such substances are now called spermicides. In our time, these methods of contraception in a modified form refer to chemical methods of preventing pregnancy.
In America, Indian women, even before the arrival of the Spanish colonialists and other immigrants from Europe, for the purpose of contraception, washed the vagina after intercourse with a decoction of mahogany and lemon. In ancient times, in many countries, pregnancy prevention was achieved by washing the vagina after intercourse with an extract or decoction of willow leaves, juniper, aloe, lavender, parsley, marjoram, pineapple and other plants. Aristotle and Hippocrates recommended that women douche with their own urine to remove sperm from the vagina. Prevention of pregnancy by washing the vagina with decoctions and infusions of plants and solutions of various chemicals in our time is referred to as mechanical methods of contraception.
For many years BC, methods of contraception were known by taking juices, decoctions and infusions from various herbs through the mouth. So, in the ancient civilizations of the Incas, May and Aztecs, women prevented conception by using infusions and decoctions from the root of a plant called Dioscorea. in ancient Greece and Ancient Rome for contraception, they drank infusions and decoctions from the roots and herbs of various plants. At the same time, Greek women chewed the seeds of wild carrots, and Indian women still do it. It has been proven that wild carrot seeds inhibit the synthesis of the pregnancy hormone progesterone.
In Malaysia, women drank unripe pineapple juice as a contraceptive for several days after menstruation, and women in the Pacific Islands and Java Islands consumed unripe coconut juice. In North America, women have prevented unwanted pregnancies by drinking a decoction of crushed ginger root or burdock tea. In Western Europe, many years ago, to prevent the onset of an unwanted pregnancy, they drank a decoction or juniper oil. Germans and Hungarians in "critical days" drank tea from marjoram. In Southern Europe, women drank a decoction of asparagus daily for the same purpose. In Northern Europe, crushed shepherd's purse or psyllium powder was used. The latter not only has a contraceptive effect, but also suppresses a woman's desire for sexual intimacy with a man. In the old days in Malaysia, North and South America, women drank juice, decoctions or powder from milkweed, mistletoe, peas, etc. as oral contraceptives. Surgical methods contraception has also been known for a long time. The primitive tribes of the natives of Australia and Java carried out surgical sterilization of women by amputation of the cervix with a stone knife. Sterilization of males was achieved by incision of the vas deferens. In the same tribes, in order to avoid the birth of an unwanted child, later dates pregnancy, an abortion was performed by rupture of the fetal membranes of the embryo. The ancient Egyptians performed surgical sterilization of women by destroying the ovary with a thin wooden stick.
The condom is also an invention of distant times. Written information about him was found in Egyptian sources dating back to 1350 BC. It was a fish skin condom. The tomb of the Egyptian pharaoh Tutankhamun (circa 1400-1392 BC) contained a reusable condom, now in the Egyptian National Museum. The ancient Arabs used the prototype of the modern condom, made from the intestines of domestic animals. At the same time, the Japanese used a similar product, which was made from the finest leather, intestines or horn.
Intrauterine methods of contraception are a thousand-year-old invention. Before a long trip, the ancient nomads of the Middle East introduced small round stones into the uterus of a camel. In ancient China, women injected various substances into the uterine cavity to prevent pregnancy. In Japan, "kyotan" was used, which was made from thin skin and inserted into the cervical canal.
The first medical description of the condom was the work of Gabriel Fallopius (the organs of the female body bear his name). reproductive system, discovered by him for the first time). Fallopius wrote about a cotton "cover" for the male genital organ, used as a means of protection, but from syphilis, and not from pregnancy. That is, the first condoms known to medicine stood guard over the health of men, not women.
Other written sources belonging to approximately the same period (mid-16th century) testify that these "covers" were also made from intestines, gallbladder and animal skins. These materials had excellent stretch and were much smoother than cloth.
However, such a tool was very expensive and rare, so condoms came into use only a few centuries later. Even after Charles Goodyear's invention of the rubber vulcanization process and the mass production of condoms in the late 1860s, many governments banned all advertising of such products.
As a result, it was extremely difficult to buy condoms, and those who did choose them as a means of contraception had to use one product several times.
What did the first condom look like?
The history of contraception shows that almost all modern methods Pregnancy warnings had their predecessors in the past.
When did contraceptives appear? The history of contraception goes back almost to the beginning of human history. For the first time, ancient contraception is documented in Egyptian papyri of 1550 and 1850 BC. They talk about the use of honey and acacia leaves to prevent the penetration of spermatozoa 1 . It is believed that in ancient Greece and parts of Africa, the silphium plant (a relative of the well-known celery), specially cultivated for this purpose, was used to prevent pregnancy. 2
In the early 10th century, the Persian physician Abu Bakr Muhammad ibn Zakariya al-Razi described a number of ancient methods of contraception, including coitus interruptus and archaic barrier devices. At the end of the same century, his compatriot Avicenna devoted a chapter to this issue in his "Canon of Medicine" 7 .
In medieval Europe, prevention of pregnancy was condemned by the Catholic Church, but the history of contraceptives did not stop during this difficult time. The oldest condom to date was discovered in the ruins of Dudley Castle in England, the find dates back to 1640. Barrier contraceptives were made from the skin of animals and were used, among other things, for the prevention of diseases. In the 18th century, Casanova mentions the use of lambskin for that purpose. But, as we know, condoms became widely available only in the 20th century. four
The appearance of hormonal contraceptives generally refers to a later time. However, already in Greek myths, ancient contraception is described, associated with an effect on hormones. The goddess of spring, Persephone, after being kidnapped and raped by the god of death, refused to eat anything but pomegranate seeds. When answering the question of when oral contraceptives appeared, historians of medicine often recall this particular method 5 . The Greeks celebrated for a long time the day of the reunion of Persephone with her mother Demeter. Men were not allowed to the holiday, and four plants with contraceptive properties were used in the rituals: pomegranate, mint, pine and rod 5.
An interesting point in the history of contraception is that the first collection of contraceptive recipes was created by Peter of Spain, the man who later became Pope John XXI. His book on how to prevent pregnancy and induce menstruation was extremely popular. Modern scientists have come to the conclusion about the effectiveness of many of the methods he described 5 .
In the 20th century, the history of contraceptive methods opened new page when contraceptives appeared in the form known to us today. In 1909, Richard Richter invented the first intrauterine contraceptive, which was made from silkworm fibroin and was later introduced to the German market 6 . The introduction of hormonal contraceptives modern form happened in the 1950s, they went on sale in the next decade. The era of combined hormonal contraceptives begins.
At the very beginning, the content of hormones in the preparations was too high, which could cause a real threat in the form of thrombosis. Literally immediately, the drugs begin to be refined, doctors significantly reduce the level of estrogen, which has a positive effect on the safety of drugs.
The effectiveness of hormonal contraceptives was initially high, so the main vector of development for many years to come is aimed at improving safety. An important concept is the selectivity of the drug, that is, the ability to perform its task without affecting the work of other body systems. 6
Further development of these medicines is described in other articles on our website. To date, in order to select a suitable contraceptive method, a woman needs to consult a doctor who will conduct mandatory diagnostic procedures and prescribe an appropriate method of contraception.
- 1. Lipsey, Richard G.; Carlaw, Kenneth; Bekar, Clifford. "Historical Record on the Control of Family Size". Economic Transformations: General Purpose Technologies and Long-Term Economic Growth. Oxford University Press. 2005
- 2. Encyclopedia of birth control. Santa Barbara, Calif.: ABC-CLIO
- 3. McTavish, Lianne "Contraception and birth control". In Robin, Diana. Encyclopedia of women in the Renaissance: Italy, France, and England. Santa Barbara, Calif.: ABC-CLIO. 2007
- 4. A History of Birth Control Methods" (PDF). Planned Parenthood Report. January 2012
- 5. A H Birth Control Methistory ofods, Katharine Dexter McCormick Library, 2012
- 6. Fritz, A H Birth Control Methistory ofods, Katharine Dexter McCormick Library, 2012 Marc A.; Speroff. "Intrauterine contraception". Clinical gynecologic endocrinology and infertility (8th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2011
- 7. Middleberg, Maurice I. Promoting reproductive security in developing countries, 2003
Man used contraceptive methods, preventing the development of pregnancy, from the very beginning of his existence. The need for birth control led to the creation of a variety of contraceptive methods that were used in primitive society and exist at the present time.
Already in ancient Africa, various substances were known plant origin in the form of a cocoon, which was inserted deep into the vagina. In ancient Africa, coitus interruptus (interrupted intercourse) was also described.
In America, the Indians, even before the arrival of immigrants from Europe, used after sexual intercourse washing the vagina with a decoction of mahogany bark and lemon. They also knew that after chewing parsley, a woman would bleed for 4 days.
Similar methods have been used throughout the world. In Australia, for example, contraceptive mixtures were prepared from the extract of the pond and fucus. Opium was also used in Sumatra and neighboring islands.
AT Ancient Egypt used a vaginal swab soaked in decoction of acacia and honey (Ebers papiras). According to information from the Berlin papirus, steam heating was very effective in preventing pregnancy. According to oral traditions, women used the introduction of crocodile droppings into the vagina for contraceptive purposes.
In the third section of the book of Genesis (Genesis), it is indicated that in ancient Palestine, "interrupted copulation" was considered a natural way to prevent pregnancy. Around the same time, Diascorides recommended the use of mandrake. Information about the use of mandrake decoction to prevent pregnancy is found in the writings of ancient authors many times.
It should be especially noted that in the territory of ancient Palestine, the following recommendations of Rabbi Johanan existed to prevent pregnancy: "... Take Egyptian thorn wood glue, alum and garden saffron ...".
At that time, various tampons and sponges were already widely used, which, after soaking them with various substances, were introduced into the vagina and prevented the development of pregnancy or caused its premature termination.
Later, Soranus noted the importance of introducing into the vagina a mixture of cedar, resin, alum and pomegranate. In Roman times, it was believed that inserting elephant droppings into the vagina prevented pregnancy.
The attitude to these methods, for example, to the droppings of an elephant or a crocodile, should take into account the conditions and level of development of a given era. However, there is no doubt that elephant and crocodile droppings can change the acidity of the vaginal contents and thus have a contraceptive effect.
Contraception has been the focus of attention since ancient times. Far East. In China, for example, various substances placed in the uterine cavity were used to prevent pregnancy, mainly mercury was used, introducing it into the vagina. In Japan, the so-called "ki-otai" was used, made of thin skin, which, when located in the area of the external cervix of the cervix, prevented the penetration of spermatozoa into it. Well-known in Japan was a bamboo leaf soaked in oil, which was used in a similar way.
In Europe, written instructions on contraceptive methods dating back to the 12th-18th centuries have been preserved. According to Spalazani, the vinegar solution makes the sperm immobile, unable to enter the uterine cavity and fertilize the egg. First of all, swabs made of cotton wool and paper impregnated with acetic acid were used.
The great conqueror of women of that time, Casanova, said that a lemon peel placed in the vagina perfectly prevents pregnancy. Although today it causes a smile, nevertheless, the recommendation is not without common sense, given that the acidic environment adversely affects sperm motility.
According to the Code of Pray, washing the vagina with a decoction of juniper can prevent pregnancy if it is used immediately after intercourse. In Hungary, douching of the vagina with extracts and decoctions of aloe, juniper, lavender, parsley and marjoram was used.
In the 20th century, methods and methods of contraception developed progressively. In 1933, Noke's book was published, in which 180 different spermicidal substances were already described. Subsequent controlled studies have developed certain spermicidal contraceptives that can be used in the form of powders, tablets, or vaginal boluses.
Animal skin male condoms have been in use since the ancient world, but became widespread mainly in the first half of the 20th century. Somewhat later, rubber condoms appeared, the improvement of the reliability of which continued until the end of our century. Condoms, having a contraceptive effect (unfortunately, not one hundred percent), have importance to prevent AIDS. Of particular note important date in the first half of the 20th century - 1908, when the cervical cap was invented.
Information about extracts from plants that were used for contraceptive and abortive purposes is given in Table 1.1.
Table 1.1 Herbal contraceptives and abortive traditional medicine (SheregeyD, 1973)
Name of the plant Place of application (country and region) Method and purpose of application
Pineapple (Ananas fruc-tus) Malaya Women drank the juice of the unripe fruit for several days, causing infertility.
Juniper (Juniperus sabina) Central Europe To prevent conception, women drank a decoction or oil.
Ginger Root (Gei urbani radix) North America The root of the plant was crushed, boiled and drunk daily to prevent conception.
Euphorbia (Taraxacum officinale) - dandelion North America To prevent conception, women drank a decoction of the plant weekly.
Asparagus Southern Europe Boiled and drunk daily for a long time to prevent conception.
Arum maculatum South America The Indians drank a decoction of the plant to suppress sperm production.
Shepherd's purse (Capsella bursa pastoris) Northern Europe To prevent conception, the powder was discreetly sprinkled on a woman's food.
Burdock (Arctium lappa) North America To prevent conception, Indian women drank a decoction of the plant as a tea.
Green Coconut Pacific Islands and Java Women drank unripe coconut milk to reduce their fertility.
Plantain (Plantago lanceolata) Central Europe Added plant powder to food in order to reduce libido and prevent conception.
Mistletoe (Viscu album) North America Indian women drank tea from the leaves of the plant daily to prevent conception.
Marjoram (Majoraima hortensis) Germany, Hungary Women drank tea during menstruation to ensure infertility for a month (plant powder was also mixed with honey and inserted into the vagina with a woolen swab).
Peas (Plsum sativum) England, Europe Women used the oil as a contraceptive.
Asa foetisa + banan Malaya Women ate this mixture three times a month to prevent conception.
HISTORY OF THE DEVELOPMENT OF INTRAUTERINE CONTRACEPTION
Sufficiently complete and reliable historical information about when, where and under what circumstances intrauterine contraception began to be used is not available. It is only known that even in ancient times, in some African tribes, nomads introduced small stones into the uterine cavity of camels in order to prevent pregnancy during long and difficult caravan crossings (Speroff L., 1996). Similar means were used by the doctors of ancient Greece. In particular, Hippocrates worked with a hollow lead tube - a probe, with the help of which he possibly carried out examinations or installed some kind of contraceptives.
The forerunner of modern intrauterine devices is a small plant that has served as a contraceptive since the beginning of the 19th century. Its flower covered the internal pharynx, and the stem was placed in the cervical canal.
By the end of the 19th century, special buttons or bulb-shaped cervical caps with lateral branches began to be used, which were sometimes inserted into the uterine cavity. They have also been used to fix the uterus in case of prolapse (Southern, 1975). Such contraceptives were made from ivory, ordinary and ebony, glass, tin alloys, gold and platinum with diamonds (Tatum H.J. et al., 1975).
In 1902, Karl Hollweg from Germany invented a cervico-intrauterine pessary in the form of a metal spring (Speroff L., 1996; Thiery M., 1997). Karl Pust in 1923 made a pessary from silk twisted into a ring (introduced into the uterine cavity) that was attached to a glass stem. The leg from the other end was connected to a glass plate located outside the external pharynx of the cervix. Contraceptives of this design served as a bridge between the external genital organs, the vagina and the upper parts of the genital tract and created favorable conditions for the emergence inflammatory diseases pelvic organs (PID). Since gonorrhea was widespread and poorly treated at that time, doctors reacted negatively to such IUDs.
It is believed that they have been thoroughly engaged in intrauterine contraception since 1909, when Dr. Richter from Waldenburg published the article “ New method prevention of pregnancy” in a popular German medical journal. The author suggested using a contraceptive made of two silk threads and a bronze thread connecting them, twisted into a ring, which was inserted into the uterine cavity through a metal catheter (Richter R., 1909). However, Richter's invention was not widely used.
The next gynecologist who made a great contribution to the creation and improvement of the IUD is Grafenberg, known as the author of the first study on determining the time of ovulation (Thiery M., 1997). Since 1920, he began to work on the creation of a new intrauterine device. At first, he experimented with various constructions from silkworm threads (1924), but they had to be abandoned due to frequent expulsions, menorrhagia and pain. As a result of subsequent creative searches, the famous Grafenberg ring made of silk threads braided with German silver wire (an alloy of copper, nickel and zinc) appeared. Publications 1928-1930 made the invention known outside of Germany. In 1929 the London Safety Control Commission medicines recognized the Grafenberg silver ring as acceptable for contraception in women with psychosexual disorders. After the introduction of such a contraceptive, stress was removed due to fear of pregnancy.
Rice. 1.1. Grafenberg and Ota rings.
With the spread of such IUDs, the number of concomitant inflammatory diseases of the pelvic organs increased. For this reason, in 1931, at the Congress of Obstetricians and Gynecologists in Frankfurt, the Navy declared a danger to the health of women. After the establishment of the Nazi regime and the repression of Jewish doctors, intrauterine contraception was banned as "a threat to the mental and mental health of Aryan women." Grafenberg, persecuted by the authorities, was forced to emigrate to the United States in 1940, where he died without receiving during his lifetime the recognition that he undoubtedly deserved.
A serious drawback of the Grafenberg ring - a high percentage of expulsions - was eliminated by the Japanese Ota in 1934. He improved the Grafenberg design (added a central disk and called the new tool the Pgecea ring, which means pressure ring in Japanese), which gained fame and was secretly continued use (Fig. 1.1). Few people know that it was Ota who first used plastic in the manufacture of Navy, but it was still of very low quality and was not used in production.
The Grafenberg and Ota rings were forgotten during the Second World War. However, in the first decade after it, the population in many countries grew rapidly, and this provided an incentive to continue scientific developments in the field of contraception.
In 1959, Dr. Ogatenheimer from Jerusalem published data on the successful use of Grafenberg rings by 1500 women (Oppenheimer W., 1959), and the Japanese gynecologist Ishigama published the results of a study involving 20,000 patients with Ota rings (Ishihama A., 1959).
In 1962 Christopher Tietze - medical statistician, an admirer of Grafenberg - organized the first International Symposium on intrauterine contraception in New York, where Margulis and Lipps demonstrated their IUDs and the results of their clinical use.
Dr. Margulis is the author of the first product made of thermoplastic and known as the "Perma-coil", or Margulis coil. It was he who introduced barium sulfate into the plastic of the Naval Forces to impart radiopaque properties. Subsequently, the author added a rod with seven small thickenings to the spiral to facilitate its removal from the uterine cavity (TatumH.J., 1983).
In 1961, after numerous experiments, Lipps creates an IUD with a serpentine configuration in the form of a double S. The contraceptive is usually called the Lipps loop, although it looks more like a zigzag. It is made from a copolymer of ethylene with vinyl acetate, which is inert to body tissues, non-toxic, sufficiently elastic and resilient, retains its shape at a temperature of 35-40 ° C, does not cause reactive inflammation and can be in the body for a sufficiently long period of time. Due to its elasticity and flexibility, the Lipps loop was easily inserted into the syringe guide, and then into the uterine cavity without dilating the cervical canal. Lipps believed that his design conformed more to the uterine cavity than a coil or ring. It was the first device to have a nylon thread attached to the bottom of the device to facilitate removal of the IUD, as well as to make it easier to control its presence in the uterine cavity. The rounded and thickened upper loop tip reduced the risk of perforation (Fig. 1.2).
Rice. 1.2. Lips loop.
Based on studies of the comparative efficacy and acceptability of various IUDs, performed in 1962-1970, it was allowed to use Lipps loops and some other similar means, called inert, or non-drug-mental, in order to prevent unwanted pregnancy in healthy women of reproductive age.
In subsequent years, several more IUDs were invented, differing in size, shape, material, etc. One of them - Dalkon Shield (author - Davis X.J., 1970) - turned out to be unsuccessful and to some extent compromised intrauterine contraception in general. So, when using it, the frequency of tubal infertility increased by 2 times, and inflammatory diseases of the pelvic organs - by 5 times compared with the use of other types of IUDs. The cause of the complications was supposedly rubberized threads, through which microorganisms penetrated from the vagina into the uterine cavity (Tatum H.J., 1983). Non-drug plastic IUDs belong to the first generation. Their effectiveness is estimated at 5.3 pregnancies per year per 100 women.
The second generation of IUDs - copper-containing intrauterine devices - appeared in 1969 (authors - Zipper J. and Tatum H.). The first discovered the anti-indulation effect of copper during experiments on rabbits, and the second added copper to plastic IUDs.
A large number of different copper-containing IUDs are currently available, and new ones are being developed. In order to increase the effectiveness and duration of use, reduce complications and adverse reactions a search is underway for optimal shapes, sizes and surface areas of copper. The following contraceptives are most common: T Cu-200, Cu-200 B, T Cu-200 C, T Cu-200 Ag. The numbers indicate the area of the copper surface in mm2.
Copper-containing products can be divided into two groups:
1) With a relatively low copper content: Cu-7
Gravigard (USA) - fig. 1.3, Copper T-200 (Finland), T Si-200, T Si-200 V, T Si-220 C (USA), Multiload-250 (Netherlands), Nova-T (Finland), etc.
2) With a large amount of copper: T Si-380 A (Germany),
Multiload-375 (Netherlands), etc.
Below are the main characteristics of the listed IUDs.
T Si-200, T Si-200 V, T Si-220 C and T Cu-200 Ag are made of polyethylene with the addition of barium sulfate, have a T-shape. The leg of the contraceptive is wrapped with copper wire with a total area of 200 mm2. The size of the horizontal branches - 32 mm, vertical - 36 mm. Conductor diameter - 4.4 mm. At T Cu-200 Ag - copper wire with a silver core. T Cu-200 V has a ball at the end of the rod to prevent retrograde perforation of the uterus. T Cu-200 C has copper collars instead of a copper thread. This design slows down the loss of copper, and, accordingly, the efficiency and service life of the IUD are increased.
The developers of these funds are Howard Tatum (USA), Jaime Zipper (Chile). Contraceptives have been on the world market since 1972. Their standard service life in the USA is 4 years, in European countries - 3 years.
Rice. 1.3. Cu-7 Gravigard (Searl, USA). Rice. 1.4. Multiload Cu-375.
Made in the form of the number 7, contains 89 mg of copper with a total surface of 200 mm2. It was produced in two sizes: Gravigard standard (with horizontal size - 26 mm, vertical - 36 mm) and Mini-Gravigard (22x28 mm).
Nova-TCuAg (Finland). On the market since 1979. Service life in European countries - 5 years. It is made of polyethylene with the addition of barium sulfate, contains silver, which slows down the corrosion of copper wire, thereby increasing the duration of contraceptive use. Copper wire diameter - 0.2 mm, copper surface area - 200 mm2. There is a loop at the lower end of the stem to prevent possible retrograde perforation of the cervix. Nova-T maximum dimensions: 32x32 mm. Conductor diameter - 3.6 mm.
Multiload Si-250 (Netherlands). On the market - since 1979. Service life in European countries - 5 years. Copper surface - 250 mm2. The horizontal size is smaller than that of other IUDs, has increased flexibility, and does not irritate the uterine angles. Styloid protrusions reduce the percentage of expulsions, fix the contraceptive in the highest possible position, resting against the bottom of the uterus and not stretching it. Multiload Cu-250 is available in three types: standard - for the uterus with a probe length of 6-9 cm; short - for the uterus 5-7 cm long; mini-type - for a uterus less than 5 cm long. The vertical size of these funds is 35, 29 and 24 mm, respectively. The diameter of the pistonless conductor is 12 mm (shoulders remain outside the tube).
The third generation of copper-containing IUDs are contraceptives with a copper surface area of more than 300 mm2 and a service life of 5 to 8 years. These include Multiload Cu-375 (Netherlands), T Cu-380 A (Germany), T Cu-380 Ag (Finland), T Cu-380 S and Multiload Cu-375 (see Fig. 1.4). Two types are produced: standard - for the uterus with a probe length of 6-9 cm and a mini-type - for the uterus with a length of 5-8 cm. The length of the first IUD is 35 mm, the second - 29 mm.
T Cu-380 A (USA, Germany), T Cu-380 Ag (Finland), T Cu-380 S (Canada). On the market - since 1982 Service life: T Si-380 A in the USA and Europe - 10 years, in Russia and the CIS - 6 years; T Cu-380 Ag in FINLAND - 5 years; T Si-380 S in Canada - 2.5 years, in Europe - 5 years.
These IUDs are T-shaped contraceptives (36x32 mm) with a high copper content, made of polyethylene with the addition of barium sulfate. A copper wire 0.4 mm thick with a surface area of 314 mm2 is mounted on a vertical rod, and two additional copper braids (with an area of 2x33 mm2) are mounted on horizontal sleeves. At T Cu-380 Ag the wire has a silver core. In the 380 S model, the copper plates are thinner, attached to the outside of each shoulder of the IUD and recessed into the plastic. This design facilitates the installation of the agent in the conductor and its introduction into the uterine cavity using a conductor with a diameter of 4.4 mm.
T Cu-380 A is the "gold standard" against which all existing IUDs are compared when evaluating their effectiveness and acceptability (see Figure 1.5). According to published data, the pregnancy rate when using T Cu-380 A is less than one case per 100 women in the first year and only 1.8 after 8 years.
The next stage in the development of intrauterine contraceptives is the creation of hormone-releasing agents - the third-generation IUD. They appeared as a result of attempts to combine the advantages of hormonal and intrauterine contraception.
Rice. 1.5. C T 380 A. FIG. 1.6. Progestasert.
In 1970, Dr. Antonio Scommegna (Michael Reese Hospital, Chicago) reported the results of 34 women with a Lipps loop containing a silastic capsule with progesterone (30 mg) gradually released (300 micrograms per day) into the uterine cavity. Ovulation was not suppressed, the nature of menstruation did not change, but endometrial changes were noted that prevented implantation. The effect on the endometrium was noted already after 18 hours. When such a drug was introduced into one of the horns of the uterus of a rabbit, an autopsy did not find a single site of implantation in it.
Pandya and Scommegna later replaced Lipps' loop with Tatum's T-shaped design. Seemmegna, in the manufacture of a new contraceptive, excluded copper, and placed a reservoir (an ethylene-vinyl acetate copolymer body) with 38 mg of a mixture of progesterone and barium sulfate in a vertical rod. As a result, Progestasert (Alza Corporation, USA) entered the market in 1976. The service life is at least a year at a hormone release rate of 65 mcg per day. IUD length - 36 mm, width - 32 mm. The conductor diameter is 8 mm (Fig. 1.6). Its advantage is that after the introduction of the IUD, blood loss during menstruation turned out to be much less than when using other types of spirals. However, Progestasert did not become popular due to the short duration of the hormone's action. Approved service life in the USA - 1 year, in France - 18 months. (Speroff L. et al, 1996).
Subsequently, the scientific search and improvement of various IUDs continued actively. Among them, the most promising hormone-releasing IUDs of the Mirena type and copper-containing Gine-frx should be highlighted.
Dr. T.Luukkainen - the author of NOVA-T - removed copper from it and fixed a reservoir with levonorges-trel on a vertical rod. As a result of long-term testing and refinement, a levonorgestrel-releasing intrauterine system (LNG-IUD) Mirena (Leiras-Schering) was created. Mirena has been on the market since 1990, its standard service life is 5 years. Dimensions - 32x32 mm. The length of the hormone-containing cylinder is 19 mm, the outer diameter is 2.8 mm, the inner diameter is 1.2 mm, and the conductor diameter is 4.75 mm. Levonorgestrel, which is part of Mirena, has the same effect on a woman's body as levonorgestrel tablets. This gestagen acts on the endometrium and thickens the cervical mucus, making it difficult for sperm to penetrate from the vagina into the uterine cavity.
The hormone-releasing agent Mirena (another name for Levonova) is currently recognized as one of the best contraceptives and is therefore discussed in detail in a separate chapter.
HISTORY OF THE DEVELOPMENT OF HORMONAL CONTRACEPTION
The creation of hormonal contraception was a new milestone in the prevention of pregnancy. Back in the second half of the last century, it was noted that during pregnancy, the maturation of follicles stops, that is, during this period, repeated pregnancy becomes impossible. Proceeding from this, Ludwig Haberbladt, already in the first years of our century, proved in an experiment that the extract corpus luteum contains progesterone, which blocks ovulation, and recommended the use of ovarian extract as a method of "hormonal sterilization". He found that the implantation of ovarian tissue and placental tissue from pregnant animals leads to infertility. Schmidt in 1929, using an extract of the corpus luteum, managed to prevent ovulation in rats, thereby confirming that ovulation does not occur in the presence of the corpus luteum.
The discovery of sex hormones (in 1929 - estrogen, and then - progesterone, synthesized in 1934 by Gutenacht) was a new stage in the development of contraception. Gutenaht proved the blocking effect of progesterone on the rupture of follicles. Following this, a large number of reports appeared on the physiological actions of these hormones. In 1944, Bickenbach and Pavlovich experimentally induced anovulatory cycles in humans by parenteral administration of progesterone. The results of these experimental studies were used in clinical practice after Pincus had shown in 1955 that pregnancy could be prevented by daily administration of healthy women progesterone at a dose of 300 mg. However, this type of contraception was not widespread at that time due to the need to prescribe large doses of progesterone due to the high metabolic rate and clearance of the drug.
Subsequently, the efforts of scientists were directed to the synthesis of gestagens, which would have the ability to undergo metabolic transformations more slowly, compared to natural steroids, and surpass the latter in biological action, which would make it possible to prescribe them orally in small doses and with good effect. As the main substance for the synthesis of sex steroids, they began to use the extract of the Mexican licorice root. The first to receive a semi-synthetic derivative of progesterone - norethisterone - Jerassi. Simultaneously with Jerassi, but independently of him, Colton synthesized norethinod-rel. These two drugs, which have a progesterone-like effect, are called "gestagen" (gestagen, progestin). In the mid-1950s, a number of animal experiments were carried out, the results of which made it possible to establish the biological properties of progestins.
In 1956, the first clinical trials of norsteroids began in Puerto Rico. They confirmed the antiovulatory effect of progestins. The results were reported by Rock et al. Pincus and collaborators have shown noretinodrel and mestranol to be 100% effective in preventing pregnancy.
The first drug proposed for everyday medical practice in the form of tablets was Enovid (1960). It contained 15 mg of norethinodrel and 0.15 mg of mestranol. Since that time, the history of the development of combined contraceptives began, which can be divided into several stages. At the first stage, the so-called preparations of the first generation with a high content of hormones were created.
PREPARATIONS OF THE I GENERATION
Combined birth control pills Generation I was characterized by a low Pearl index, a high content of hormones (Enovid and Infekundin), as well as life-threatening complications such as thromboembolism. The development of thrombosis and thromboembolism was associated with a high content of estrogens. This is due to the fact that estrogens, depending on the dose, increase the concentration and activity of I, II, VII, X and XII coagulation factors. At the same time, they lower the level of antithrombin III. Estrogens in high doses stimulate the synthesis of angiotensinogen, which can cause an increase in blood pressure. Other serious side effects include fluid retention, swelling, nausea, a feeling of tightness in the mammary glands and chloasma.
The goal of improving combined oral contraceptive drugs at the first stage was the maximum reduction in the incidence of these serious complications. Then drugs with a low content of estrogens were developed. These preparations contained progestogens in the same amount, but the content of estrogen in them decreased by 5 times and amounted to 30-35 mcg/day. As a result, the risk of thrombosis decreased by 4 times. It should be noted that in women who smoke, the thrombogenic effect of estrogens is enhanced by increased release of thromboxane. Therefore, smoking, especially in women over 35 years of age, was a contraindication to taking any contraceptive drug.
Although the side effects caused by estrogen with these drugs have become less frequent, less pronounced and, as a rule, reversible, it was recognized that further improvement of oral hormonal contraceptives in order to further reduce their inherent side effects was recognized. To this end, it was necessary to create second-generation drugs containing estrogens and progestogens in even smaller quantities.
There are currently two main groups of gestagens used in oral contraceptive preparations: estrans (eg, norethinodrel, norethindrone, ethinodiol diacetate) and gonans (eg, levonorgestrel, desogestrel, norgestimate, and gestodene). The main side effects of gestagens are the following: a decrease in glucose tolerance (which is of particular importance when using these drugs in patients diabetes), increased blood pressure, increased body weight, unwanted changes in lipid composition, increased hair growth and depression. The emergence of some of these side effects is also explained by the androgenic and mineralocorticoid action of progestins.
DRUGS OF THE II GENERATION
The second generation group of drugs includes contraceptives containing levonorgestrel (LNG).
Levonorgestrel was the first synthetic progestogen. It, unlike the so-called pro-hormones, does not require additional metabolic transformations for the manifestation of its action. The bioavailability of levonorgestrel (the portion of the ingested dose that reaches the systemic circulation) is 100%. Levo-norgestrel has the strongest androgenic, mineral-locorticoid and glucocorticoid effects when used in high doses. Small doses of it do not have the above effects.
Levonorgestrel in the minimum effective dose was included in the composition of phase contraceptive drugs, developed for the first time in the United States in the early 80s in order to bring the composition of these drugs closer to the level of hormones during the physiological menstrual cycle.
These drugs containing the lowest dose of levonorgestrel have no effect on arterial pressure and glucose tolerance, do not cause changes in the spectrum of lipids.
DRUGS OF THE III GENERATION
Third-generation drugs include drugs containing progestogens (gestagens) of a new type, synthesized in order to reduce the side effects inherent in these hormones. Their tests were carried out in Switzerland, Holland and the USA. These drugs are called gestagens 111 generations.
Norgestimate contained in silest. In the intestines and liver, it quickly and completely turns into levonorgestrel and its derivatives. Compared with levonorgestrel, norgestimate has a less pronounced gestagenic effect, and therefore its effect on the blood lipid spectrum is less significant.
Desogestrel contained in Mercilon, Marvelon, Regu-lon, Novinet, Tri-Merci, as well as norgestimate, is a prohormone. In the liver and gastrointestinal tract, desogestrel is rapidly and completely converted to the active derivative, 3-keto-desogestrel. The bioavailability of deso-gestrel is 76%. The advantages of oral hormonal contraceptives containing desogestrel are a mild androgenic effect and the lack of the ability to change glucose tolerance.
Finally, a third-generation progestogen is gestodene, which contains an active progestogen. Its bioavailability is almost 100%. The amount of hormones in contraceptive preparations containing this progestogen is the lowest. K| these drugs include femoden, logest, lindinet. The androgenic effect of these drugs is slightly pronounced.
Recently, combined hormonal contraceptives containing dienogest (Zhanin) and | drospirenone (Yarina), which have an antiandrogenic effect. In addition, Yarina, possessing an antimineralocorticoid! effect, has found application in the treatment of premenstrual syndrome-1.
In addition, hormonal contraceptives with an alternative route of administration have appeared, suggesting that there is no primary passage of steroids through the liver. These include the NovaRing vaginal ring, the Otto Evra skin patch, and the Mirena intrauterine hormone releasing system.
HISTORY OF INJECTABLE CONTRACEPTION
Depot medroxyprogesterone acetate (DMPA) was initially used in medicine as a treatment for cancer, threatened miscarriage, and endometriosis. The first clinical trials of the drug as a contraceptive began in 1963.
The first report on contraceptive efficacy was published in 1966. Based on the results of the study, scientists concluded that the suppression of reproductive function for several months by progesterone derivatives is quite reasonable. Initially, 3 progesterone steroids were used for injectable contraception, the effectiveness of which persisted for 3 months: DMPA at a dose of 150 mg, norethisterone enanthate - 200 mg and chlormadinone acetate - 250 mg.
Subsequently, it was found that, in contrast to other long-term active drugs Depo-Provera 150 (medroxyprogesterone acetate) has received the most widespread use in clinical practice; a standard contraceptive regimen was established: DMPA 150 mg every 3 months.
In the future, injectable contraceptives caused a lot of discussion. Despite the proven high contraceptive efficacy of DMPA, the decision of the FDA (US Food and Drug Administration) to introduce the drug was delayed due to cases of breast cancer in beagle dogs in the experiment.
Later, WHO experts reviewed the data obtained from testing in dogs and concluded that progestogen-induced mammary tumors do not provide any basis for predicting possible changes in the mammary glands of women using steroid contraceptives. In 1981, after a second meeting of WHO experts, it was confirmed that DMPA at an effective dose (150 mg) does not have teratogenic properties for humans.
The history of the development of contraception shows that oral contraceptive hormonal drugs, created during the last four decades, made it possible to abandon most other means and methods of preventing pregnancy. These drugs are widespread throughout the world. Today, more than 150 million women worldwide take oral contraceptives. The composition of these drugs has changed, which has led to an increase in their acceptability and safety. With the creation of hormonal contraceptives gynecologists have at their disposal contraceptives that provide effective prevention of pregnancy.
