Clinical recommendations on contraception for women at risk have been prepared

The project includes all modern methods – hormonal, non-hormonal and surgical sterilization. A personalized approach is emphasized: the doctor must take into account the patient’s age, medical history, body mass index, blood pressure and lifestyle.

The rules of diagnostic support are also established. Before prescribing or installing contraceptives, basic examinations are provided: microscopy of discharge before inserting an intrauterine device (IUD), tests for infections in women at risk, ultrasound examination of the pelvic organs and, if necessary, mammary glands. In case of an irregular cycle, an analysis for chorionic gonadotropin is performed to exclude pregnancy. If the patient has recently undergone a medical examination, the results can be taken into account without repeat procedures.

Key points include data on the risks associated with combined oral contraceptives (COCs). Their use increases the likelihood of venous thromboembolism by 3-3.5 times, but the absolute risk remains low – 5-12 cases per 10,000 women per year versus two cases for those who do not take the drugs. In addition, every 10 years of COC use increases the risk of breast cancer by 14%, while for women with hereditary risk factors, the rates remain comparable to the general population.

The rules for selecting contraception for women in special clinical situations are separately prescribed. Thus, during perimenopause, preference is given to non-hormonal methods and IUDs, and the use of COCs is possible only taking into account age and risk factors. The time frame for the need for protection during perimenopause is also specified: up to two years after the last menstruation in women under 50 years of age and 1 year after menopause in women over 50 years of age (if necessary, up to 55 years of age).

For obese women, it is indicated that the effectiveness of transdermal systems decreases with a body weight of 90 kg. In this group, IUDs are considered optimal, including hormonal ones, as well as progestin schemes. During lactation, it is not recommended to use drugs containing estrogens. Instead, barrier methods (for example, condoms) or progestin drugs are recommended, which do not have a negative effect on lactation and the health of newborns.

According to a 2021 study, Russian women's awareness of contraception methods remains high: 98% know about condoms, 87% about COCs, and 71% about copper-containing IUDs. However, actual use shows a different picture: 45% of women use condoms, 30% use COCs, and interrupted intercourse remains in third place at 23%. This picture is complemented by earlier data from VTsIOM and Gedeon Richter: in 2018, 41% of women reported that they had never used hormonal contraceptives, most often due to fears of side effects.

Clinical guidelines are intended to change the situation. The document is addressed not only to doctors, but also to patients: the choice of method is supposed to be made jointly, based on full information about the possibilities and risks. According to the ROAG, the introduction of new standards will reduce the number of unwanted pregnancies and improve the level of reproductive health of the population.