Ovulate while preventing conception

contraception

Which contraception method is suitable?

There are many good ways to protect yourself effectively against unwanted pregnancy. However, people's needs change in the course of a lifetime, and so it is not uncommon for the methods used by women and men to also change.

Hormonal agents such as the “pill”, barrier methods such as the condom or methods of natural contraception are available. Each of these methods has its advantages and disadvantages. When deciding which one best suits your needs, the following considerations can help:

  • How safe is the method of contraception?
  • Does it also protect against sexually transmitted diseases and HIV / AIDS?
  • Which side effects can occur?
  • Does it correspond to the current life and relationship situation?
  • Does it suit how you deal with your own body?
  • Does it offer enough security and protection even during spontaneous sex?

Contraception methods and methods at a glance

All important contraceptive methods and methods are briefly presented below. The website www.familienplanung.de of the Federal Center for Health Education provides detailed information on the respective advantages and disadvantages.

The pill usually contains a combination of the hormones estrogen and progestin and, like all hormonal contraceptives, must be prescribed by a doctor. Its main effect is to prevent ovulation, which prevents fertilization. It is taken daily for 21, 22 or 24 days (depending on the preparation). Then a withdrawal bleeding starts. When used correctly, the pill provides very safe contraception from day one.

The mini pill contains either levonorgestrel or desogestrel as hormones. In order to work safely, it must be taken at the same time every day, if possible. Under their action, the mucus in the cervix solidifies so that no sperm can enter the uterus. In addition, the lining of the uterus does not build up sufficiently, which makes it difficult for a fertilized egg to implant. The hormone desogestrel usually also prevents ovulation and is therefore more reliable than a levonorgestrel preparation.

Condoms Usually made of latex and rolled over the stiff penis. When unrolled correctly, they are quite tight. After ejaculation, they must be held by the penis shaft when pulling the penis out of the vagina. When used correctly and of the right size (see www.kondometer.de), condoms are a safe contraceptive.

The spiral is a T-shaped plastic stick that is wrapped with a wafer-thin copper wire. It is inserted into the uterus by the doctor and can remain there for up to 5 years. It triggers a permanent stimulus in the uterus, which prevents a fertilized egg cell from implanting. In addition, the copper of the spiral inhibits the sperm cells in their mobility. The contraceptive safety is very high.

The hormonal IUD is made of plastic and has a small hormone depot. The doctor inserts it into the uterus and can stay there for up to 5 years. It combines the effect of a coil with that of a pill by preventing the lining of the uterus from building up and making it difficult for the sperm to get to the egg cell.

The hormone implant is a soft stick containing the hormone progestin that is implanted under the skin on the inside of the upper arm by specially trained doctors. It inhibits ovulation and also prevents the sperm from entering the uterus. The contraceptive safety is very high.

The three-month injection contains the hormone progestin and is injected into a woman's gluteal muscle. It is suitable for women who cannot tolerate other methods or who cannot take the “pill”. The progestin inhibits ovulation and also prevents the sperm from entering the uterus. The contraceptive safety is very high.

The vaginal ring (Contraceptive ring) is a flexible plastic ring containing hormones that is inserted into the vagina and left there for three weeks. Withdrawal bleeding begins in the fourth week. The ring adapts to the vagina and cannot be felt during sexual intercourse. A low dose combination of estrogens and progestins inhibits ovulation and prevents the sperm from entering the uterus. The security is very high.

The contraceptive patch releases a combination of estrogens and progestins. It is attached to the stomach or bottom and changed weekly. After three weeks there is a “patch-free” week in which the withdrawal bleeding begins. The hormones inhibit ovulation and prevent the sperm from entering the uterus. The patch generally adheres well, even in the sauna or swimming pool. The security is very high.

Barrier methods have in common that a cap made of latex or silicone blocks the cervix and thus prevents sperm from reaching the egg. A distinction is made among other things. the diaphragm, the lea contraceptivum and the FemCap. The Femcap must be individually adjusted by a doctor. The diaphragm and the lea contraceptivum are available in one size. Shortly before sexual intercourse, the woman inserts the cap into the vagina and places it in front of the cervix so that no sperm can enter. With proper handling and the simultaneous use of sperm-killing or sperm-inhibiting gels, the diaphragm and the lea contraceptive are safe methods. The security of the FemCap also depends on the correct application.

Natural Family Planning Methods (NFP) determine the (un) fertile days in the woman's cycle. The woman measures her daily basal temperature in the morning before getting up. After ovulation, the body's basal temperature increases so that the measurement can be used to determine the following infertile days. The same applies to the daily examination of the cervical mucus (cervix = cervix), which liquefies shortly before ovulation. Both methods require both a good knowledge of your own body and a good relationship with it. If condoms are also used on the fertile days, contraception with NFP is relatively safe - if used correctly.

The sterilization is a very safe method of contraception. In women, the fallopian tubes are cut, clamped or obliterated during an operation. In men, the vas deferens are cut or closed with clips (vasectomy). However, the step needs to be carefully considered, because it is final and therefore only comes into question once the family planning has been completed.

In addition, there are means and methods which, when used alone, do not offer sufficient security. These include gels and vaginal suppositories that have a sperm-killing or inhibiting effect. Small special computers can help calculate the date of ovulation. However, the devices often work imprecisely.

The research on the “pill for men” has not yet led to any approved results in the past few decades.

The morning-after pill

After a breakdown in contraception, the morning-after pill is available for emergencies. Since male sperm cells can persist in the uterus and fallopian tubes for up to five days (in rare individual cases longer), pregnancy can occur a few days before or during ovulation after unprotected sexual intercourse. If ovulation has not yet taken place, the morning-after pill can inhibit it or delay it until the sperm cells have died and fertilization is no longer possible.

There are two morning-after pills on the market with different active ingredients. The preparation "PiDaNa®" contains the hormone levonorgestrel and works for up to 72 hours (three days), the preparation "ellaOne®" with ulipristal acetate has a duration of action of about 120 hours (five days). The morning-after pill is most effective when taken within 12 to 24 hours of unprotected sex. After that, their effectiveness gradually decreases. The morning-after pill no longer works if ovulation has already taken place and / or the fertilized egg has implanted in the uterus.

Contraception after childbirth

In order not to become pregnant again immediately after the birth of a child, after the weekly flow has dried up, couples ask themselves about a safe method of contraception that is also compatible with breastfeeding.

Under certain conditions, breastfeeding itself offers a certain degree of protection against conception. Every time you breastfeed, the hormone prolactin is released, which stimulates milk production and at the same time inhibits the activity of the ovaries. However, the woman must breastfeed fully, i.e. at least six times within 24 hours - a total of at least 80 minutes a day. She must not feed during this time and have not yet had a menstrual period after the weekly flow. However, if you want to be absolutely sure, you should also use contraceptives.

Barrier methods such as the condom and diaphragm are best for breastfeeding because they do not affect milk production or the health of the infant. However, a diaphragm used before pregnancy will very likely no longer fit because of the physical changes caused by pregnancy. A new diaphragm can only be fitted about three months after the birth, when the regression of the pelvic organs has largely been completed.

An IUD can also be used during breastfeeding as it has no effect on milk production or the baby's health. However, it should only be inserted after the uterus has completely regressed, i.e. six to eight weeks after the birth at the earliest, as otherwise there is a risk that it will be expelled again.

The minipill is also well suited, as it only contains a progestin as a hormone that does not have a negative effect on milk production. However, it cannot be started until six weeks after the birth at the earliest. The hormone implant and the three-month injection are also suitable.

Because of the hormonal changes after childbirth, it takes a while before the woman's cycle and thus her fertile days are restored. Natural methods of family planning such as the mucus and temperature method are therefore not suitable during this time. The various combination preparations of the commercially available “pill” should also not be used, as the estrogens they contain can reduce milk production. There is also a risk that the baby will absorb too much hormone with breast milk. The same applies to the vaginal ring and the contraceptive patch.

The morning-after pill: The preparation PiDaNa® contains levonorgestrel as a hormone, which hardly passes into breast milk. However, if you want to be on the safe side, you should take the PiDaNa® immediately after breastfeeding and then not breastfeed for at least eight hours. After taking the preparation ellaOne® with the active ingredient ulipristal acetate, it is recommended to stop breastfeeding for at least 36 hours.

Contraception in midlife

Changes in the female cycle are usually the first signs of "menopause" after the age of 45. Due to hormonal changes, ovulation becomes less common with increasing age, which is why pregnancy is unlikely in women over 45 years of age, but quite possible. The menstrual period can stop for a few months and suddenly start again regularly - even with ovulation. Contraception therefore remains an issue until the woman has not had a period for at least a year.

Since the end of fertility cannot always be precisely identified, women and their partners are often unsure at this stage of life how much longer they will have to use contraception. In principle, all conventional contraceptives can be used, but due to the possible health problems associated with aging, it is particularly advisable to find out more about the advantages and disadvantages of the means and methods. Further information about contraception in mid-life can be found at www.familienplanung.de/wechseljahre/.

Study: Contraceptive Behavior in Adults

On behalf of the Federal Center for Health Education, the “forsa” institute carried out a representative survey on contraceptive behavior among adults in Germany in 2011. It was investigated which methods of contraception 18 to 49 year old women and men use. Questions were also asked about knowledge about sexuality and contraception as well as about information requirements. A total of 997 people took part in the survey.

More than half of women and men (53%) stated that the pill was used as a contraceptive. The second most common use is condoms (37%). For pill users, safety and reliability are crucial when choosing a contraceptive. Respondents who prefer the condom particularly appreciated the good tolerance and the low side effects.

92% of women stated that they use combined contraceptives, while three out of ten men named alternate use.

10% of the respondents said they used an IUD to use contraception. 5% of women and men named sterilization. Other contraceptive methods such as the three-month injection, the hormone implant or the calendar method were each named by less than 2% of the respondents.

13% of women have already used the morning-after pill once. The group of 25 to 29 year olds had the most experience with the morning-after pill (20%).

The study “Contraceptive Behavior Adults 2011” can be downloaded from www.forschung.sexualaufklaerung.de.

additional Information

The free BZgA brochure “Safe contraception for him and her” provides detailed information about the individual contraceptive methods and methods. Order or download

Author

Prof. Dr. med. Elisabeth Pott was director of the Federal Center for Health Education until February 2015.

Contact

Federal Center for Health Education
Ostmerheimer Str. 220
51109 Cologne

Tel .: 0221 / 8992-0
 

Created on August 24, 2004, last changed on September 18, 2014