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UDC 618.179
PECULIARITIES OF CONTRACEPTION OF WOMEN OF REPRODUCTIVE AGE LIVING IN OMSK
Omsk State Medical University, Omsk R.A. Morgunov, Ye.N. Kravchenko
Using the questionnaire of 321 patients, the most frequently used methods of contraception after abortion and the reasons for refusing to prevent the unwanted pregnancy of women of fertile age in Omsk were analyzed. The overwhelming majority of women of childbearing age refuse contraception in connection with mastalgia (75%), the second most important reason is headache and increased blood pressure (13%) with the self-institution of combined oral contraceptives. Most often, after an abortion, women of childbearing age use an intrauterine device (26.8%), a vaginal ring (21.2%), ethinyl estradiol in combination with desogestrel (12.1%). Key words: contraception, reproductive age, combined oral contraceptives.
One of the main ways to improve the demographic situation in the country is to strengthen reproductive health and preserve the genital function of women, which is directly related to the reduction in the number of abortions. Undoubtedly, a big role in this was played by the promotion of the use of modern contraceptives and the selection of the optimal method of preventing unwanted pregnancies for every woman who turned to the doctor with this question. It should be noted that the prevention of abortion is directly related to the use of modern methods of contraception to prevent unwanted pregnancies [1]. Contraception is as old as humanity itself. For millennia, people have been using contraception to protect themselves from unwanted pregnancies. The need for birth control led to the creation of a variety of methods of contraception, which were used in the primitive society and go on to exist at the present time. At present, there is no doubt that contraceptives do not reduce fertility, but are an effective method of preserving the reproductive health of women [2, 3]. Despite the wide experience of using hormonal contraceptives to protect against unwanted pregnancies, up to now, some aspects of the safety of their use remain a subject of discussion. In the Russian Federation, hormonal contraception is not the main method of birth control [4]. The risk of side effects and complications of hormonal contraception does not exclude the need for monitoring the childbearing of people suffering from diseases and conditions that pose a threat to life and health in the event of an unplanned pregnancy [5].
Research oobjective: to analyze the most frequently used methods of contraception and the reasons for refusal to protect the onset of unwanted pregnancy in women of fertile age in Omsk.
Materials and methods
In 2016-2017 within the framework of the preventive examination, there was conducted a questionnaire for 321 patients at OOO «Center for Contemporary Medicine «DoktorSash Clinic». When collecting anamnesis, special attention was paid
to age, sexual function (age of onset of sexual activity), features of reproductive function (course and outcomes of previous pregnancies), contraceptive methods used after abortion, history of pelvic organs, including cervical disease. All patients after the questionnaire were divided into the main group and the comparison group, each of which was divided according to age into three subgroups. The main group consisted of women of reproductive age (n = 89) who used combined oral contraceptives (COCs). Criteria for inclusion in the main group were the following: women of childbearing age (18-49 years old) who took COCs. Exclusion criteria from the main group were the following: women of fertile age who use other methods of contraception; age younger than 18 and over 49; women who have contraindications to taking COC. The subgroup IA included women aged 1830; in subgroup I B - 31-45 years old, in the subgroup IC - 46-49 years old.
The comparison group consisted of women of reproductive age (n = 232), using other methods of contraception or having contraindications to taking COC. The comparison subgroup IIA included women of 18-30 years old; subgroup IIB consisted of 31-45 years old women; subgroup IIC included women of 46-49 years.
The questionnaire for women consisted of 30 questions, where the most attention was paid to obstetric-gynecological anamnesis. Each person was informed that the survey was anonymous; the results of the survey and the answers to the questions, the name and other personal data would not be disclosed. The performed work did not infringe the rights, did not endanger the patients examined and was carried out with their informed prior consent to use medical documentation in research work.
Results and discussion
When analyzing the data it was found out that the average age of the onset of menstruation in the main group was 13.5 ± 1.1 years, in the comparison group - 15 ± 1.5 years. The onset of sex-
ual activity in the main group is 18 ± 2.1 years, in the comparison group - 16 ± 1.2 years. All women had an obstetric-gynecologic history: the number of births, abortions, and miscarriages was analyzed.
Most women of reproductive age in the history have one, two or more births, and the older the age group, the greater the number of births is observed (Table 1).
Table 1
Parity of births in women of fertile age in the study groups
Births group IA n=25 group IB n=48 group IC n=16 group IIA n=98 group IIB n=117 group IIC n=17
0 4 (16%) 7 (14,6%) 0 (0%) 23 (23,5%) 7 (60%) 1 (5,8%)
1 18 (72%) 17 (35,4%) 7 (43,8%) 59 (60,2%) 52 (44,4%) 2 (11,8%)
2 and more 3 (12%) 24 (50%) 9 (56,2%) 16 (16,3%) 58 (49,6%) 14 (82,4%)
Comparison of the groups C2= 1,2; df = 2; p = 0,55 C2= 20,4; df = 2; p < 0,0001* C2= 4,8; df = 2; p = 0,09 C2= 1,2; df = 2; p = 0,55 C2= 20,4; df = 2; p < 0,0001* C2= 4,8; df = 2; p = 0,09
Comparison among subgroupMM within the group C2= 14,2; df = 4; p =0,007* C2= 45,9; df = 4; p < 0,0001*
Comparison of all subgroups: c2= 60,3; df = 10; p <0,0001*
When analyzing the number of abortions in anamnesis, it was found out that the majority of the women studied (53.4%) have 1 abortion; 2 or more abortions were more frequent in group IIB
(Table 2, 3). Most often, unwanted pregnancy occurs when women use the method of contraception «interrupted sexual intercourse» (64%).
Table 2
Characteristics of obstetric anamnesis (abortion) in women of reproductive age in the study groups
abortion group IA n=25 group IB n=48 group IC n=16 group IIA n=98 group IIB n=117 group IIC n=17
0 5 (20%) 3 (6,3%) 2 (12,5%) 54 (55,1%) 21 (17,9%) 4 (23,5%)
1 17 (68%) 31 (64,6%) 11 (68,8%) 41 (41,8%) 56 (47,9%) 1 (5,9%)
2 and more 3 (12%) 14 (29,1%) 3 (18,7%) 3 (3,1%) 40 (34,2%) 12 (70,6%)
Comparison of the groups c2= 11,3; df = 2; p = 0,004* C2= 5,3; df = 2; p = 0,07 C2= 14,4; df = 2; p = 0,001* c2= 11,3; df = 2; p = 0,004* C2= 5,3; df = 2; p = 0,07 C2= 14,4; df = 2; p = 0,001*
Comparison among subgroupMM within the group C2= 5,1; df = 4; p =0,28 C2= 67,2; df = 4; p < 0,0001*
Compari son of all subgr oups: c2= 95,1; df = 10; p <0,0001*
Based on the data obtained in Table 2, it can be seen that the largest number of women in the main study group have a history of one abortion. Most often, this situation occurs when the intake of combined oral contraceptives is impaired. In agreement with the data of the comparison group it can be seen that the majority of 31-45-year-old women in the comparison group have one abortion, it happens more often when they use an interrupted sexual intercourse as a contraceptive. The prevailing number of women aged 18-31 had no abortions, and the majority of women over 45 years old have two or more abortions in the history, more often when using the calendar method of contraception.
Spontaneous miscarriages in the anamnesis were observed more often in group I C - in women over the age of 45 years who have an anamnesis of inflammatory diseases of the pelvic organs.
Due to the fact that almost every woman of childbearing age has at least one medical abortion, contraceptive methods used after the interruption of unwanted pregnancy were analyzed (Table 4).
18-30-year-old women (group I, II A) most frequently used a vaginal ring as a contraceptive method after abortion, those of 31-45 years old (group I, IIB) used the intrauterine device more often, women of late reproductive age (45 -49 years old) (group I, II C) prioritized the barrier method of contraception.
The gynecological anamnesis of the studied groups of women of the reproductive period is examined in detail. In all groups, inflammatory diseases of the pelvic organs occupy a prime place, especially in groups IA, IB and IIB (Figure 2).
Table 3
Characteristics of obstetric anamnesis (spontaneous abortions) in women of reproductive age in the study groups
Miscarriage group IA n=25 group IB n=48 group IC n=16 group IIA n=98 group IIB n=117 group IIC n=17
0 18 (72%) 32 (66,7%) 3 (18,7%) 71 (72,4%) 97 (83%) 12 (70,6%)
1 5 (20%) 13 (27,1%) 2 (12,5%) 24 (24,5%) 11 (9,4%) 4 (23,5%)
2 and more 2 (8%) 3 (6,2%) 11 (68,8%) 3 (3,1%) 9 (7,6%) 1 (5,9%)
Comparison of the groups C2= 1,4; df = 2; p = 0,50 C2= 8,6; df = 2; p = 0,014* C2= 14,4; df = 2; p = 0,001* C2= 1,4; df = 2; p = 0,50 C2= 8,6; df = 2; p = 0,014* C2= 14,4; df = 2; p = 0,001*
Comparison among subgroups within the group C2= 34,8; df = 4; p < 0,0001* C2= 10,6; df = 4; p =0,031*
Comparison of all subgroups: y.2= 85,9; df = 10; p <0,0001*
Table 4
Methods of contraception used by women of reproductive age after medical abortion
Methods of contraception group IA n=25 group IB n=48 group IC n=16 group IIA n=98 group IIB n=117 group IIC n=17
IUD 1 (5%) 27 (60%) 0 (0%) 5 (11,4%) 51 (53,1%) 2 (15,4%)
vaginal ring 16 (25%) 11 (24,4%) 2 (14,3%) 26 (59,1%) 12 (12,5%) 1 (7,7%)
COC: ethinyl-oestradiol with desogestrel 1 (5%) 7 (15,6%) 0 (0%) 11 (25%) 28 (29,2%) 2 (15,4%)
barrier contraception 0 (0%) 0 (0%) 12 (85,7%) 2 (4,5%) 5 (5,2%) 8 (61,5%)
Rigevidon 2 (10%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%)
Siluette 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%)
Comparison of the groups c2= 9,8; df = 4; p = 0,045* c2= 7,6; df = 3; p = 0,055 c2= 5,1; df = 3; p = 0,16 c2= 9,8; df = 4; p = 0,045* c2= 7,6; df = 3; p = 0,055 c2= 5,1; df = 3; p = 0,16
Comparison among subgroups c2= 96,7; df = 8; p < 0,0001* c2= 82,9; df = 6; p < 0,0001*
Comparison of all subgroups: c2= 214,4; df = 20; p <0,0001*
arterial hypertension edema
PPROM big fetus
threatened miscarriage without complications
0% 20% 40% 60% 80%
Figure 1.
The course of pregnancy in women of childbearing age (n =321)
Note. * Here and in the remaining graphs, the null hypothesis was rejected at p<0,05 (критерий %2). Comparison of all subgroups: %2=109,8; df=25; p<0,0001*. Comparison among subgroups within the group I: %2=32,4; df=10; p=0,0003*. Comparison among subgroups within the group II: %2=72,6; df=10; p<0,0001*. Comparison between subgroups IA and IIA: %2=24,4; df=5; p=0,0002*
Comparison between subgroups IB and IIB: %2=6,7; df=5; p=0,24. Comparison between subgroups 1С and IIC: %2=13,7; df=5; p=0,018*.
Note. * Here and in the remaining graphs, the null hypothesis was rejected at p<0,05 (criterion %2). Comparison of all groups: %2=222,2; df=20; p<0,0001*. Comparison among subgroups within the group I: %2=49,2; df=8; p<0,0001*. Comparison among subgroups within the group II: %2=127,5; df=8; p<0,0001*. Comparison among subgroups IA m IIA: %2=30,9; df=4; p<0,0001*. Comparison between subgroups IB and IIB: %2=10,6; df=4; p=0,03*. Comparison between subgroups IC and IIC: %2=4,7; df=4; p=0,32.
90% 80% 70% 60% 50% 40% 30% 20% 10% 0%
1
1
1
1 1
1 □z
L
B ■ iii lj
1" ■ 11* rPI 1 1
I inflammatory diseases of the pelvic organs
I uterine myoma
cystic ovary
I uterine cervix pathology without treatment
group I group I group I group group group A B C IIA IIB IIC
Figure 2.
Gynecological anamnesis in women in the study groups
Among women of comparison groups using other methods of contraception, the reasons for abandoning the COC were analyzed, and in most cases, the woman prescribed a combined oral contraceptive quite individually: in 75% of cases there appeared pain in the mammary glands, 13% suffered from headache and increase in blood pressure, in 7% intermenstrual secretions occurred, in 5% -weight gain. The most common contraindications to taking COC were smoking - 23%, pregnancy -3%, and diabetes mellitus with angiopathy - 1%.
Conclusions
1. The overwhelming majority of women of fertile age refuse contraception in view of mastalgia (75%), the second most important cause is headache and increased blood pressure (13%) with the self-administration of combined oral contraceptives.
2. On average, women of reproductive age had one abortion in an anamnesis. Most often, after an abortion, women of childbearing age use an in-trauterine device (26.8%), a vaginal ring (21.2%), ethinyl estradiol in combination with desogestrel (12.1%).
3. When analyzing the course of previous pregnancies, it was revealed that both in the main and in the comparison group they were most often complicated by edema during pregnancy and premature rupture of the membranes, especially in groups II C, II A, the patients of which used the natural method of contraception and interrupted sexual intercourse.
4. When analyzing a gynecological anamnesis, it was found out that the prevailing majority
of the subjects had a history of cervical pathology (49.5%), and pelvic inflammatory disease (19%).
References
1. Sinchikhin S.P., Mamiev O.B. Socio-medical aspects of the interruption of unwanted pregnancy. Effective pharmacology. 2013; 51: 30-35.
2. Prilepskaya V.N., Letunovskaya A.B., Ivanova E.V., Sasunova R.A., Tagieva A.V. Contraception: from antiquity to our days. Pharmatec. 2011; 13: 12-17
3. Shah I, Ahman E. Unsafe abortion: global and regional incidence, trends, consequences and challenges. Journal of Obstetrics and Gynecology Canada, 2009, 31:1149-1158.
4. Morgunov R.A., Kravchenko E.N. Possibilities of combined oral contraceptives. Collection "Actual questions of medicine in modern conditions: a collection of scientific papers on the results of the III International Scientific and Practical Conference." Omsk, 2017.
5. Kravchenko E.N., Mordyk A.V., Puzyreva L.V., Valeeva G.A. Hormonal contraception in patients at risk (Review of the literature). Reproduction problems. 2016; 1: 60-66.
Contacts
Corresponding author - Morgunov Roman An-dreyevich, the lecturer of the Central Medical Center "Obstetrics, children and infectious diseases" Omsk State Medical University College, Omsk. 644099, Omsk, Petra Nekrasova Ulitsa, 5. Tel.: (3812) 238285. Email: [email protected]
