Example 3: Longer cycle length: 34 days: (34 – 14 = 22} 22 ± 2 = 20 – 24 Shorter cycle length: 24 days: {24 – 14 = 10} 10 ± 2 = 8 – 12 The fertile days in the example is between the 8th and the 24th day. It is obvious that the longer the cycle is unstable, the more difficult it is to calculate the fertile days and the days to avoid intercourse are many. Many times the cycle does not work like a clock. and anything can happen.Generally the diary method is not efficient enough and has a high failure rate (15–30 %).Intermittent intercourse Also called the Withdrawal method.There are two types of withdrawal (a) Coitus interruptus – Latin name for withdrawal with ejaculation outside the vagina.(b) Coitus reservatus – Latin name for pulling without ejaculation.Both methods have been used since ancient times for contraceptive purposes.It is commonly used by couples but is not recommended because it has the highest failure rates (15–30%) and in addition, it reduces sexual pleasure and pleasure for both partners.In women, it can lead to temporary or permanent impotence.There may also be partial ejaculation inside or outside the vagina and the woman may be at risk of becoming pregnant.Hormonal IUD The hormonal IUD carries a slow-release reservoir/pump of a progestogen hormone that releases a daily amount of hormone into the body.There are two such systems on the market.Progestasert ® which provides slow-release progesterone at 65 µg/day and has a 1-year shelf life, and Mirena ® which provides slow-release levonorgestrel 20 µg/day and has a 5-year shelf life.Hormonal glomeruli have a double mechanism of action, mechanical like simple glomeruli, but also hormonal, and thus their effectiveness reaches the limits of 99.9%.In addition, they have the advantage of reducing the number of days of the period as well as the amount of blood lost with the period.(4) Injectable progesterone Drug substance: Medroxyprogesterone Acetate (Depot).The injectable form of contraception was released three years after the pill.It is given in the form of injections every three (3) months.It suppresses ovulation and is more than 99% effective.Disadvantages: Period irregularities are a common side effect, as well as delayed return of fertility.It also does not protect against sexually transmitted diseases.It is a suitable method for people who forget to take the pill, and for those who do not want their partner to know that they are taking contraception.There are two preparations available abroad, Depo-Provera® and Megestron® Both are given by intramuscular injection, 150 mg every 3 months.In Cyprus, neither of the two preparations is available.(5) Vaginal Ring A round ring that is placed in the vagina and releases 15 μg of estradiol & 120 μg of etonogestrel daily.It stays in the vagina for 3 weeks and is then removed.After 1 week without the ring, a new one is placed.It is marketed abroad under the name NuvaRing®.It is not yet released in Cyprus.(6) Hormonal Implants This is highly effective hormonal contraception.Implants require minor surgery for placement and removal.They are effective for five years.Its mechanism of action is hormonal.Cons: Period irregularities are a common side effect, as well as delayed return of fertility.They do not protect against sexually transmitted diseases.The following preparations are available abroad: (a) Norplant® – contains crystalline levonorgestrel in 6 soft capsules, and provides contraception for 5 years.(b) Jadelle® (Norplant II ) – contains crystalline etonorgestrel in 1 soft capsule and provides contraception for 3 years.(c) Implanon® – contains crystalline levonorgestrel in 2 soft capsules and provides contraception for 5 years.They are not yet offered in Cyprus.