How much do we know about contraception, the morning-after pill, about safe sex or sexually transmitted diseases? These questions have always caused discomfort, and it's no secret that many women are ashamed of these topics, which they shouldn't be, because the consequences of ignorance or prejudice can be serious.
In a conversation with pharmacists, we learned that recently on the market of Montenegro, and for many years in Europe, there is a pill - a new generation emergency contraceptive pill called EllaOne, a non-hormonal drug that is not abortive, rarely causes bleeding, does not delay - shifts cycle and three times more effective compared to the hormonal preparation. What is particularly important is that it can be taken by all women of reproductive age, i.e. from the first menstruation. The emergency contraceptive pill plays a significant role in preventing unplanned pregnancy when it comes to unprotected intercourse (sex without a condom) or when some other contraceptive method fails, when it is noticed that the condom broke during intercourse, when the woman forgets to take the regular contraceptive pill. , if the spiral is thrown out during intercourse and the like.
If you find yourself in a situation where you need a pill - the pill for the day after, you can buy it at any pharmacy without a doctor's prescription.
In order to confirm our new findings, as well as how much we know about this topic, we spoke with Dr. Milovan Jovanović, specialist in gynecology and head of the organizational unit of the Podgorica Health Center.
Why are women ashamed to talk about sex-related topics?
- Of course, this issue is not gynecological but sociological. It is true that topics about sex have always been a social taboo. It is also true that our society does not look favorably on women's more open sexuality. Prejudice has been planted that unprotected sexual relations and unplanned pregnancies occur within some primitive sub-populations, but it has been proven that they occur to all women regardless of their nation, age, education, marital and social status. Considering that sex is a normal and inevitable part of life, and that you should not run away from normal things, you need to know how to protect yourself, both from sexually transmitted diseases and from unplanned pregnancy.
More and more people talk about the pill for the day after, but less and less talk about the day before. Do you think it's time for sex education to enter school classrooms?
- Considering the existence of numerous modern, effective methods of contraception and their availability, it is completely incomprehensible that there is any problem related to contraception at all. Unfortunately, this problem is very present not only here in Montenegro, but in general in these regions, which results in numerous unwanted pregnancies that most often end in abortion. Moreover, it is incredible that even in the developed countries of Europe, approximately half of all pregnancies are unplanned, half of which end in abortion. I see the primary cause in the ignorance or lack of information of women, lack of support from the family, school and health system, but also irresponsibility towards health in general and lack of interest in reproductive health.
Not least, my patients are often burdened with numerous misconceptions, dilemmas and controversies related to contraception. We encounter this attitude among a significant number of doctors and even gynecologists. Thus, patients develop a negative attitude towards regular, modern and effective contraception, so that the use of this contraception in Montenegro and the entire region is at a low level.
When all this is taken into account, it is quite clear that the morning-after pill is being talked about more and more, because it is the last defense against unwanted pregnancy. It is good that women are informed about this method. However, in order to change the stated situation and in general to improve overall reproductive health, it is necessary that it be incorporated into regular school programs. Lack of information is the main cause of this state of reproductive health, inappropriate for the time in which we live.
What contraceptive methods do you most often recommend?
- There is no one-size-fits-all method. It is very important that the optimal type of regular contraceptive method is determined by the gynecologist, not the patient, certainly with good cooperation and information of the patient about all the advantages of the proposed contraception. Contraception must be safe, harmless, accessible, easy to use, and must in no way burden or interrupt sexual intercourse itself. Certainly, hormonal oral contraception (contraceptive pill) and the intrauterine device ("spiral") are the most desirable because they meet all the above requirements.
Which contraceptives are the safest?
- When it comes to the use of hormonal oral contraception, it is very important to leave aside controversies and dilemmas related to this type of contraception. All misconceptions such as thinking that there will be an increase in body weight, that acne and hair on the face and body will appear, and that contraception will cause cancer are completely unfounded. Today, we use these contraceptives precisely for the treatment of acne, malevolence, and it is reliably known that they have a protective effect on cancer of the ovaries and uterine lining, so that in the group of women who regularly use this contraceptive, the percentage of cancer is significantly lower.
When should the day-after pill be used?
The pill for emergency contraception (or popularly for the day after) is intended for women of childbearing age who do not want to get pregnant and have had unprotected sex or have failed one of the methods of contraception (e.g. condom rupture, diaphragmatic hernia, missed dose of regular contraception). It is important to emphasize that the pill for the day after is taken regardless of the day of the menstrual cycle. I advise all women, if they do not use safe regular contraception and if they do not use it regularly, that they must have the day-after pill with them in advance, so that, in case of unprotected intercourse, they can use it as soon as possible and prevent unwanted pregnancy.
So the rule is to get this tablet the day before, so that you have it in case of need for the day after. If unprotected intercourse occurs, and the woman does not have the pill for the day after, she should hurry to the pharmacy where EllaOne can be bought without a prescription. I would like readers to remember that it is important to act quickly, because the chances of success, ie. prevention of unwanted pregnancy is greater.
If the pill prevents ovulation, should a woman take the pill if ovulation has passed?
If we knew exactly when certain women ovulated, theoretically we shouldn't. Unfortunately, a woman cannot know that for sure. Only 12% of women ovulate on the 14th day after the start of menstrual bleeding, and less than half of women ovulate in the so-called fertile period between 10 and 16 days after bleeding. All other women ovulate on a different day. Theoretically, women could go to a gynecologist to have an ultrasound of their ovaries, but that wastes valuable time. Precisely because of the unpredictability of ovulation, it is a clear recommendation of all professional associations and all regulatory agencies that emergency contraception be taken regardless of the day of the menstrual cycle, as soon as possible after unprotected intercourse.
No fear
The morning-after pill: Many women know very little about it or are very afraid of it. Is there any reason to be afraid?
- There is no justified reason to be afraid of morning-after pills, which is why they are available without a prescription both throughout Europe and here in Montenegro. Recently, although with a considerable delay compared to the EU and countries in the region, the drug EllaOne (ulipristal acetate), a non-hormonal molecule, has been available in Montenegro. The key advantage of EllaOne (ulipristal acetate) is three times greater efficiency compared to hormonal preparations. EllaOne prevents significantly more pregnancies than hormonal drugs for the simple reason that it is also effective in the phase of the cycle when the risk of pregnancy is highest. This emergency contraceptive can be used up to five days after unprotected intercourse, with the fact that it is best to take the pill as soon as possible after unprotected intercourse, ideally in the first 24 hours because then the chance of success is greater. The pill for the day after is effective, harmless and does not affect the course and outcome of pregnancy if they are taken and the pregnancy already exists. In other words, contrary to common prejudices, this pill for emergency contraception is not an abortifacient, and what is especially important, it can be taken by all women of reproductive age, i.e. from the first menstruation.
There are safe days, but we don't know what they are and when they occur
Are there any "safe" days when we don't have to worry about the risk of pregnancy?
There are safe days, but unfortunately we don't know what those days are. Male gametes in a woman's organs survive up to five days after intercourse, during which they "wait" for ovulation, i.e. the release of a female gamete from the ovary. A female gamete survives for 24 hours after ovulation. So in each cycle we practically have only six fertile days. However, given that ovulation is unpredictable, and that the fertile days in the cycle do not depend on it, I would not recommend female readers to rely on "counting the days" in family planning, but to behave in their sex life as if there are no safe days. .
What three short pieces of advice would you give to a person who is just entering sexual relations?
Before entering into sexual relations, a person should get to know his partner well and be sure that he is ready for sexual intercourse. Furthermore, responsible sexual behavior implies that a person familiarizes himself with regular contraception, as well as with contraception for the day after, before engaging in sexual relations. Finally, responsible sexual behavior implies the mandatory use of condoms, which have the primary role of protection against sexually transmitted diseases.
Prevention of ovulation
What does that pill do in the body from the moment we take it into the body?
The morning after pill was previously thought to work on multiple levels in a woman's genital tract. Today, after numerous studies that explain this problem, we know that the pill for the day after has only one mechanism of action, which is delaying ovulation. It all happens through a negative feedback mechanism that reduces the production of luteinizing hormone. This prevents the peak of this hormone which prevents ovulation.
If you have questions about the use of the pill for the day after, you can contact Dr. Milovan Jovanović for a consultation at 069 052 560
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