План-конспект урока "The Sceleton", для студентов медицинских колледжей

Занятие 3.

(90 минут)

Тема: «Contraception methods».

Цели:

1. практическая - совершенствование лексических навыков по теме, совершенствование навыков навыков устной речи при обсуждении прочитанного.

2. образовательная - познакомиться с основными принципами контрацепции.

3. развивающая - развитие языковых и коммуникативных навыков.

4. воспитательная - воспитание интереса и любви к будущей профессии и формирование активной жизненной позиции.

При работе над данной темой формируются следующие компетенции:

ОК 1. Понимать сущность и социальную значимость своей будущей профессии, проявлять к ней устойчивый интерес.

ОК 11. Быть готовым брать на себя нравственные обязательства по отношению к природе, обществу, человеку.

ОК 5. Использовать информационно-коммуникационные технологии в профессиональной деятельности

ОК 6. Работать в коллективе и команде, эффективно общаться с коллегами. руководством, потребителями.

ОК 7. Брать ответственность за работу членов команды, за результат выполнения заданий.

ОК 4. Осуществлять поиск и использование информации, необходимой для эффективного выполнения возложенных на него профессиональных задач, а также для своего профессионального и личностного развития.

Оборудование:

ММ –презентации, видео.

Тексты и упражнения.

TEXT . Contraception.

Contraception is prevention of the fertilization of an egg by a sperm (conception) or the attachment of the fertilized egg to the lining of the uterus (implantation).

There are several methods of contraception. None is completely effective, but some methods are far more reliable than others. Each contraceptive method has advantages and disadvantages. Choice of method depends on a person's lifestyle and preferences and on the degree of reliability needed.

TEXT A. Hormonal Methods

The hormones used to prevent conception include estrogen and progestins (drugs similar to the hormone progesterone). Hormonal methods prevent pregnancy mainly by stopping the ovaries from releasing eggs or by keeping the mucus in the cervix thick so that sperm cannot pass through the cervix into the uterus. Thus, hormonal methods prevent the egg from being fertilized.

Oral Contraceptives

Oral contraceptives, commonly known as the pill, contain hormones—either a combination of a progestin and estrogen or a progestin alone.

Combination tablets are typically taken once a day for 3 weeks, not taken for a week (allowing the menstrual period to occur), then started again. Inactive tablets may be included for the week when combination tablets are not taken to establish a routine of taking one tablet a day. Fewer than 0.2% of women who take combination tablets as instructed become pregnant during the first year of use. However, the chances of becoming pregnant increase if a woman skips or forgets to take a tablet, especially the first ones in a monthly cycle.

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		Oral Contraceptives

The dose of estrogen in combination tablets varies. Usually, combination tablets with a low dose of estrogen (20 to 35 micrograms) are used because they have fewer serious side effects than those with a high dose (50 micrograms). Healthy women who do not smoke can take low-dose estrogen combination contraceptives without interruption until menopause.

Progestin-only tablets are taken every day of the month. They often cause irregular bleeding. About 0.5 to 5% of women who take these tablets become pregnant. Progestin-only tablets are usually prescribed only when taking estrogen may be harmful. For example, these tablets may be prescribed for women who are breastfeeding because estrogen reduces the amount and quality of breast milk produced. Progestin-only tablets do not affect breast milk production.

Before starting oral contraceptives, a woman should have a physical examination, including measurement of blood pressure, to make sure she has no health problems that would make taking the contraceptives risky for her. If she or a close relative has had diabetes or heart disease, a blood test is usually performed to measure levels of cholesterol, other fats (lipids), and sugar (glucose). If the cholesterol or sugar level is high or other lipid levels are abnormal, doctors may still prescribe a low-dose estrogen combination contraceptive. However, they periodically perform blood tests to monitor the woman's lipid and sugar levels. Three months after starting oral contraceptives, the woman should have another examination to be sure her blood pressure has not changed. After that, she should have an examination at least once a year.

Also before starting oral contraceptives, a woman should discuss with her doctor the advantages and disadvantages of oral contraceptives for her situation.

Advantages: The main advantage is reliable, continuous contraception if oral contraceptives are taken as instructed. Also, taking oral contraceptives reduces the occurrence of menstrual cramps, premenstrual syndrome, irregular bleeding, anemia, breast cysts, ovarian cysts, mislocated (ectopic) pregnancies (almost always in the fallopian tubes), and infections of the fallopian tubes. Also, women who have taken oral contraceptives are less likely to develop rheumatoid arthritis or osteoporosis.

Taking oral contraceptives reduces the risk of developing several types of cancer, including uterine (endometrial) cancer, ovarian, colon, and rectal cancers. The risk is reduced for many years after the contraceptives are discontinued. Breast cancer is slightly more likely to be diagnosed in women while they are taking oral contraceptives but not after the contraceptives are discontinued, even in women who have a family history of breast cancer.

Oral contraceptives taken early in a pregnancy do not harm the fetus. However, they should be discontinued as soon as the woman realizes she is pregnant. Oral contraceptives do not have any long-term effects on fertility, although a woman may not release an egg (ovulate) for a few months after discontinuing the drugs.

Disadvantages: The disadvantages of oral contraceptives may include bothersome side effects. Irregular bleeding is common during the first few months of oral contraceptive use but usually stops as the body adjusts to the hormones. Also, taking oral contraceptives every day, without any breaks, for several months can reduce the number of bleeding episodes.

Some side effects are related to the estrogen in the tablet. They may include nausea, bloating, fluid retention, an increase in blood pressure, breast tenderness, and migraine headaches. Others are related mostly to the type or dose of the progestin. They may include mood disorders, weight gain, acne, and nervousness. Some women who take oral contraceptives gain 3 to 5 pounds because of fluid retention. They may gain even more because appetite also increases. Some women have headaches and difficulty sleeping. Many of these side effects are uncommon with the low-dose tablets.

In some women, oral contraceptives cause dark patches (melasma) on the face, similar to those that may occur during pregnancy. Exposure to the sun darkens the patches even more. If the woman discontinues oral contraceptives, the dark patches slowly fade.

Taking oral contraceptives increases the risk of developing some disorders. The risk of developing blood clots in the veins is higher for women who take combination oral contraceptives than for those who do not. The risk is 7 times higher with tablets containing a high dose of estrogen. However, the risk is 2 to 4 times higher with tablets containing a low dose of estrogen: This risk is half of that during pregnancy. Because surgery also increases the risk of developing blood clots, a woman must discontinue oral contraceptives a month before major elective surgery and not take them again until a month afterward. Because the risk of developing blood clots in leg veins is high during pregnancy and for a few weeks after delivery, doctors recommend that women wait 2 weeks after delivery before they take oral contraceptives. For healthy women who do not smoke, taking low-dose estrogen combination tablets does not increase the risk of having a stroke or heart attack.

Use of oral contraceptives, particularly for more than 5 years, may increase the risk of developing cervical cancer. Women who are taking oral contraceptives should have a Papanicolaou (Pap) test at least once a year. Such tests can detect precancerous changes in the cervix early—before they lead to cancer.

The likelihood of developing gallstones increases during the first few years of oral contraceptive use, then decreases.

For women in certain situations, the risk of developing certain disorders is substantially increased if they take oral contraceptives. For example, women who are older than 35 and who smoke should not use oral contraceptives because the risk of heart attack is increased. For women who have certain disorders, risks are increased if they take oral contraceptives. But if closely monitored by a health care practitioner, such women may be able to take oral contraceptives.

Some sedatives, antibiotics, and antifungals can reduce the effectiveness of oral contraceptives. Women taking oral contraceptives may become pregnant if they simultaneously take one of these drugs.

TEXT B. Skin Patches and Vaginal Rings

Skin patches and vaginal rings that contain estrogen and a progestin are used for 3 of 4 weeks. In the fourth week, no contraception is used to allow the menstrual period to occur.

A contraceptive skin patch is placed on the skin once a week for 3 weeks. The patch is left in place for 1 week, then removed, and a new patch is placed on a different area of the skin. During the fourth week, no patch is used. Exercise and use of saunas or hot tubs do not displace the patches.

A vaginal ring is a small plastic device that is placed in the vagina and left there for 3 weeks. Then it is removed for 1 week. A woman can place and remove the vaginal ring herself. The ring comes in one size and can be placed anywhere in the vagina. Usually, the ring is not felt by the woman's partner during intercourse. A new ring is used each month.

With either method, a woman has a regular menstrual period. Spotting or bleeding between periods (breakthrough bleeding) is uncommon. Side effects and restrictions on use are similar to those of combination oral contraceptives.

TEXT C. Contraceptive Implants

Contraceptive implants are plastic capsules or rods containing a progestin. After numbing the skin with an anesthetic, a doctor makes a small incision or uses a needle to place the implants under the skin of the inner arm above the elbow. No stitches are necessary. The implants release the progestin slowly into the bloodstream. No implants are currently available in the United States. A single plastic implant, which is inserted through a needle and is effective for 3 years (but must be removed through an incision), will soon be available.

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		Contraceptive Implant

The most common side effects are irregular or no menstrual periods during the first year of use. After that, periods frequently become regular. Headaches and weight gain may also occur. These side effects prompt some women to have the implants removed. Because the implants do not dissolve in the body, a doctor has to remove them. Removal is more difficult than insertion because tissue under the skin thickens around the implants. Removal may result in a minor scar. As soon as the implants are removed, the ovaries return to their normal functioning, and the woman becomes fertile again.

TEXT D. Contraceptive Injections

Two contraceptive formulations are available as injections. Each is injected by a health care practitioner into a muscle of the arm or buttocks, and each is very effective as a contraceptive.

Medroxyprogesterone acetate, a progestin, is injected once every 3 months. Medroxyprogesterone acetate can completely disrupt the menstrual cycle. About one third of women using this contraceptive have no menstrual bleeding during the 3 months after the first injection, and another third have irregular bleeding and spotting for more than 11 days each month. After this contraceptive is used for a while, irregular bleeding occurs less often. After 2 years, about 70% of the women have no bleeding at all. When the injections are discontinued, a regular menstrual cycle resumes in about half of the women within 6 months and in about three fourths within 1 year. Fertility may not return for up to a year after injections are discontinued.

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		Injectable Contraceptive

Side effects include a slight weight gain and a temporary decrease in bone density. Bones usually return to their previous density after the injections are discontinued. Medroxyprogesterone acetate does not increase the risk of developing any cancer, including breast cancer. It greatly reduces the risk of developing uterine (endometrial) cancer. Interactions with other drugs are uncommon.

The other formulation is a once-a-month injection. It contains estrogen and a much smaller amount of medroxyprogesterone acetate than the injections given every 3 months. Consequently, bleeding usually occurs regularly about 2 weeks after each injection is given, and bone density does not decrease. Because the dose of medroxyprogesterone acetate is lower, fertility returns much more rapidly after the injections are discontinued.

TEXT E. Emergency Contraception

Emergency contraception, the so-called morning-after pill, involves the use of hormones within 72 hours after one act of unprotected sexual intercourse or after one occasion when a contraceptive method fails (for example, if a condom breaks).

Two regimens are available. The more effective regimen consists of one dose of levonorgestrel, a progestin, followed by another dose 12 hours later. With this regimen, about 1% of women become pregnant, and fewer side effects occur than with the other regimen. Alternatively, two tablets of a combination oral contraceptive are taken within 72 hours of the unprotected intercourse. Then two more tablets are taken 12 hours later. With this regimen, only about 2% of women become pregnant, but as many as 50% have nausea and 20% vomit. Antiemetic drugs, such as hydroxyzine taken by mouth, are given to prevent nausea and vomiting.

TEXT F. Barrier Contraceptives

Barrier contraceptives physically block the sperm's access to a woman's uterus. They include the condom (male or female), diaphragm, and cervical cap.

Blocking Access: Barrier Contraceptives Barrier contraceptives prevent sperm from entering a woman's uterus. They include condoms, diaphragms, and cervical caps. Some condoms contain spermicides. Spermicides should be used with condoms and other barrier contraceptives that do not already contain them.

Condoms made of latex are the only contraceptives that provide protection against sexually transmitted diseases, including those due to bacteria (such as gonorrhea and syphilis) as well as those due to viruses (such as HIV—human immunodeficiency virus—infection). However, this protection, though considerable, is not complete. Male condoms made of polyurethane also provide protection, but they are thinner and more likely to tear. Male condoms made of lambskin do not protect against viral infections such as HIV infection and thus are not recommended.

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		Male Condom

Condoms must be used correctly to be effective. With some male condoms, the tip needs to be positioned so that it extends about ½ inch beyond the penis to provide a space to collect semen. Other male condoms have a reservoir at the tip for this purpose. Immediately after ejaculation, the penis should be withdrawn while the condom's rim is held firmly against the base of the penis to prevent the condom from slipping off and spilling semen. The condom should then be removed carefully. If semen is spilled, sperm could enter the vagina, resulting in pregnancy. A new condom should be used after each ejaculation, and the condom should be discarded if its integrity is in doubt. A spermicide, which may be included in the condom's lubricant or inserted separately into the vagina, increases the effectiveness of condoms.

The female condom is held in the vagina by a ring. It resembles a male condom but is larger and is not as effective.

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		Female Condom

The diaphragm, a dome-shaped rubber cup with a flexible rim, is inserted into the vagina and positioned over the cervix. A diaphragm prevents sperm from entering the uterus.

Diaphragms come in various sizes and must be fitted by a health care practitioner, who also teaches the woman how to insert it. A diaphragm should cover the entire cervix without causing discomfort. Neither the woman nor her partner should notice its presence. A contraceptive cream or jelly should always be used with a diaphragm, in case the diaphragm is displaced during intercourse. The diaphragm is inserted before intercourse and should remain in place for at least 8 hours but no more than 24 hours afterward. If sexual intercourse is repeated while the diaphragm is in place, additional spermicide should be inserted into the vagina to continue protection. If a woman has gained or lost more than 10 pounds, has had a diaphragm for more than a year, or has had a baby or an abortion, she must be refitted for a diaphragm because the vagina's size and shape may have changed. During the first year of diaphragm use, the percentage of women who become pregnant varies from about 3% when the diaphragm is used correctly to about 14% when it is used the way most people use it.

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		Diaphragm

The cervical cap resembles the diaphragm but is smaller and more rigid. It fits snugly over the cervix. Cervical caps must be fitted by a health care practitioner. A contraceptive cream or jelly should always be used with a cervical cap. The cap is inserted before intercourse and left in place for at least 8 hours after intercourse, up to 48 hours at a time.

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		Cervical Cap

 TEXT G. Spermicides

Spermicides are preparations that kill sperm on contact. They are available as vaginal foams, creams, gels, and suppositories and are placed in the vagina before sexual intercourse. These contraceptives also provide a physical barrier to sperm. No single type of preparation seems to be more effective than another. They are best used in combination with a barrier contraceptive, such as a male condom, female condom, or diaphragm.

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		Vaginal Foam

TEXT Н. Intrauterine Devices

Intrauterine devices (IUDs) are small, flexible plastic devices that are inserted into the uterus. An IUD is left in place for 5 or 10 years, depending on the type, or until the woman wants the device removed. IUDs must be inserted and removed by a doctor or other health care practitioner. Insertion takes only a few minutes. Removal is also quick and usually causes minimal discomfort. IUDs kill or immobilize sperm and prevent fertilization of the egg.

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		Intrauterine Device

Understanding Intrauterine Devices Intrauterine devices (IUDs) are inserted by a doctor into a woman's uterus through the vagina. IUDs are made of molded plastic. One type releases copper from a copper wire wrapped around the base; the other type releases a progestin. A plastic string is attached, so that a woman can check to make sure the device is still in place.

Two types of IUDs are currently available in the United States. One type, which releases a progestin, is effective for 5 years. The other, which releases copper, is effective for at least 10 years. One year after removal of an IUD, 80 to 90% of women who try to conceive do so.

An IUD inserted up to 1 week after one act of unprotected sexual intercourse is nearly 100% effective as a method of emergency contraception.

The uterus is briefly contaminated with bacteria at the time of insertion, but an infection rarely results. After the first month of use, an IUD does not increase the risk of a pelvic infection.

Bleeding and pain are the main reasons that women have IUDs removed, accounting for more than half of all removals before the usual replacement time. The copper-releasing IUD increases the amount of menstrual bleeding. In contrast, the progestin-releasing IUD reduces or, after 6 months of use, completely prevents menstrual bleeding.

About 10% of IUDs are expelled during the first year after insertion, often during the first few months. A plastic string is usually attached to the IUD so that a woman can check every so often, especially after a period, to make sure that the IUD is still in place. If she cannot find the string, she should use another contraceptive method until she can see her health care practitioner to determine whether the IUD is still in place. If another IUD is inserted after one has been expelled, it usually stays in place.

Rarely, the uterus is perforated during insertion. Usually, perforation does not cause symptoms. It is discovered when a woman cannot find the plastic string and ultrasonography or x-rays show the IUD located outside the uterus. An IUD that perforates the uterus and passes into the abdominal cavity must be surgically removed to prevent it from injuring and scarring the intestine.

The risk of miscarriage is about 55% in women who become pregnant with an IUD in place. If a woman wishes to continue the pregnancy and the string of the IUD is visible, a doctor removes the IUD to reduce the risk of miscarriage. For women who conceive with an IUD in place, the likelihood of having a mislocated (ectopic) pregnancy is about 5%—5 times higher than usual. Nonetheless, the risk of an ectopic pregnancy is much lower for women using IUDs than for those not using a contraceptive method, because IUDs prevent pregnancy effectively.

TEXT 4 I.  Timing Methods

Some contraceptive methods depend on timing rather than on drugs or devices.

Natural Family Planning Methods

Natural family planning (rhythm) methods depend on abstinence from sexual intercourse during the woman's fertile time of the month. In most women, the ovary releases an egg about 14 days before the start of a menstrual period. Although the unfertilized egg survives only about 12 hours, sperm can survive for as long as 6 days after intercourse. Consequently, fertilization can result from intercourse that occurred up to 6 days before the release of the egg.

The calendar method is the least effective natural family planning method, even for women who have regular menstrual cycles. To calculate when to abstain from intercourse, women subtract 18 days from the shortest and 11 days from the longest of their previous 12 menstrual cycles. For example, if a woman's cycles last from 26 to 29 days, she must avoid intercourse from day 8 through day 18 of each cycle.

Other, more effective natural family planning methods include the temperature, mucus, and symptothermal methods.

For the temperature method, a woman determines the temperature of the body at rest (basal body temperature) by taking her temperature each morning before she gets out of bed. This temperature decreases before the egg is released and increases slightly after the egg is released. The couple avoids intercourse from the beginning of the woman's menstrual period until at least 48 hours after the day her basal body temperature increased.

For the mucus method, the woman's fertile period is established by observing cervical mucus, which is usually secreted in larger amounts and becomes more watery shortly before the egg is released. The woman can have intercourse with a low risk of conception after her menstrual period ends until she observes an increase in the amount of cervical mucus. She then avoids intercourse until 4 days after the largest amount of mucus has been observed.

The symptothermal method involves observing changes in both cervical mucus and basal body temperature as well as other symptoms that may be associated with the release of the egg, such as slight cramping pain. Of the natural family planning methods, this one is the most reliable.

Withdrawal Before Ejaculation

To prevent sperm from entering the vagina, a man can withdraw the penis from the vagina before ejaculation, when sperm are released during orgasm. This method, also called coitus interruptus, is not reliable because sperm may be released before orgasm. It also requires that the man have a high degree of self-control and precise timing.

Фильм «Контрацепция.»

Структура занятия.	Хронометраж.	Примечания.
1.     Организационный этап. T. : Good Morning. How are you? Do you feel really good?	3-5 мин.	Проверка готовности к уроку, диагностика эмоционального микроклимата.
2. Речевая зарядка, проверка домашнего задания T: One of the most important things, determining our  health is the proper choice of contraceptives. This can help to avoid abortions. Do you remember how abortions influence women’s health?	10 мин.	Введение в тему занятия, создания мотивации к участию в общению по данной теме. Выступления с сообщениями по теме предыдущего занятия.
3.     Работа с текстами. Before reading! T.: There is a big choice of contraceptives. Let’s read more about them.	50 мин.	Jig-saw reading. В парах. Перевод фраз, необходимых для понимания текста, учитель предлагает толкование либо предложения дающие возможность понять смысл по контексту.
4.     After reading! Task 1. Change information with your neighbours. Task 2.Make a summery of the texts.	20 мин.	После прочтения теста пары объединяются в четверки и обмениваются информацией.
3.   Подведение итогов занятия.	5 мин.
4.   Домашнее задание: Рассказать о методах контрацепции, которые вы считаете наиболее оптимальными. Обосновав свою точку зрения.