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Many believe that when menopause occurs, especially if it began to manifest itself with the cessation of menstruation, the woman does not need contraception. The fact is that even in the absence of menstruation, ovulation can be, though not monthly. Therefore, this phenomenon during sexual activity and when there is no contraception during menopause, can lead to unplanned pregnancy in menopause.
In addition to the use of hormone replacement therapy during menopause, it is possible to combine business with pleasure. If you start taking oral contraceptives, especially at the beginning of menopause, then as a result we will receive both a contraceptive effect and the effect of HRT. In this case, of course, you must consult with your doctor to find the optimal drug, as well as this type of protection has a number of contraindications. It is also possible to use hormonal patches.
Intrauterine devices, especially those that secrete a hormone (levonorgestrel), have a fairly high contraceptive effect. Also, this method is used in the treatment of diseases of the genital organs: myomatous nodes, endometriosis.
Any contraceptive method, especially during menopause, should be approached responsibly and not without the help of a specialist.
Oral contraception in premenopause protects the body from the occurrence of diseases of the endocrine system. In addition, they block the leaching of calcium, and prevent diseases of the heart and blood vessels.
Is pregnancy possible with menopause?
When menopause in the body of a woman begin to undergo complex changes, the main action, which is aimed at the gradual cessation of the reproductive activity of the female body. To decide for yourself the question of whether to be protected during menopause or not, you need to consider the changes in more detail.
Changes begin with a reduction in the ovarian production of the female sex hormone progesterone, which ceases to compensate for the production of another sex hormone - estradiol. In parallel with this, the pituitary gland is trying to compensate for the deficiency of progesterone and stimulates the work of the ovaries by releasing luteotropic hormone into the blood. Hormonal "swing" begins, which are expressed by bouts of ill-being from various organs and systems.
And the process of menopause, meanwhile, does not stand still. With a decrease in hormone production, the number of follicles in the ovarian cavity gradually decreases, therefore, the regular ovulation process is disturbed, and interruptions in the menstrual cycle begin. Gradually monthly disappear altogether. After one year from the date of the last menstruation, one can first talk about the onset of postmenopause.
Given the changes in the woman’s body, it can be assumed that pregnancy cannot be ruled out during menopause. While in the body, albeit not regularly, the process of maturation of the eggs occurs, talking about the impossibility of conception is somewhat premature.
Only after the onset of the postmenopausal period can it be stated with a certain degree of certainty that unplanned conception is no longer a threat. It is rather difficult to determine the offensive of this safe state on your own. Therefore, the most reasonable solution would be to contact your doctor and pass the appropriate examinations, in particular, analysis of the content of follicle-stimulating hormone. Only after receiving medical confirmation that conception and childbirth are no longer possible, can you completely abandon the use of contraceptives.
Why protect yourself during menopause?
The human body itself is programmed by nature for specific life cycles, each of which is endowed with its own functional component.
Menopause is the time of completion of reproductive processes, when the resting phase occurs in the genital area. Therefore, the occurrence of pregnancy in this segment of life is undesirable. All organs and systems experience additional stress under the influence of menopausal syndrome, and physiological changes occur in the genitals. Conception in this age period creates additional stress for the organism, and its consequences can be quite dangerous.
Pregnancy and childbirth are transferred during menopause much harder, because the body has almost exhausted its genital functions. In addition, a woman by this age already has certain malfunctions in the work of the organs, which can adversely affect the process of carrying a child. The risk of having a child with developmental pathologies, for example, with Down's syndrome, increases with age.
No less dangerous consequences can result in abortions transferred during the period of menstruation. Needless to say, this is a double hormonal shock to the body of a woman. The onset of pregnancy during menostasis, and then its interruption - these are the strongest drops that can be the catalyst for the most dangerous ailments, including oncological ones.
In order to prevent negative consequences, it is necessary to reflect on issues of contraception during menopause. After all, any problem is easier to prevent than to deal with its consequences.
Methods of contraception for menopause
The modern pharmaceutical industry offers a variety of contraceptive options that are suitable for use during menostosis.
Determine how to properly protect themselves during menopause, can only an experienced doctor who has sufficient information about the patient's health status and peculiarities of the passage of climacteric changes.
Let us consider in more detail by what means protection is possible in this period of time.
This group of products includes not only the administration of drugs in the form of tablets and pills, but also the use of various patches and hormone injections.
The use of such drugs significant pros and cons. For example, with the proper selection of hormonal contraceptives, it is possible to significantly reduce the adverse symptoms of menopausal syndrome due to the receipt of hormones from the outside. In addition, with timely admission hormonal drugs can reliably protect against unplanned pregnancy.
However, the use of hormonal drugs can cause problems in the activity of the cardiovascular system, impaired blood clotting, the development of varicose veins, an imbalance of lipid and carbohydrate metabolism. Menopause is not a time for experimentation, so any appointments should be made by a specialist.
Barrier Prevention Techniques
These include condoms (male and female), uterine caps and diaphragms. Their essence is defined by the word "barrier", that is, these methods create an obstacle to the reunion of the egg and sperm. The most popular were male condoms, as the most easily applicable and reliable method of protection, not only from unwanted pregnancy, but also from sexually transmitted diseases.
With the help of this group, spermatozoa are prevented from entering the uterine cavity. These drugs are presented in the form of a variety of candles, ointments, creams, gels, pastes and aerosols with a spermicidal effect. They must be used immediately before sexual intercourse, which is not very convenient for many couples. In addition, their use can cause local allergic reactions and discomfort.
These are the well-known spirals (IUD), whose action is based on the fact that they do not allow the zygote formed after the reunion of the egg cell and the sperm cell to attach to the uterine cavity. This method is based on abortive action. Its significant disadvantage is that the presence of a foreign body in the uterus often causes inflammatory processes. In addition, there is a risk of developing an ectopic pregnancy. Quite often used intrauterine spiral Mirena and with endometriosis in premenopausal.
This is an extreme measure, the essence of which is the so-called ligation of the fallopian tubes using laparoscopy. As a result, the egg just physically can not go into the uterine cavity, and fertilization becomes impossible. An important disadvantage of the method is that sterilization is an irreversible process, but during menopause, this feature is difficult to consider too significant, because menostasis itself is the process of complete completion of childbirth. In general, this method will help 100% protect themselves from unwanted pregnancy, moreover, it does not cause any significant negative health effects.
To protect or not during menopause is an individual decision of each woman. But we should not forget that when making a decision, we are responsible for its consequences. And sometimes they can be heavy and irreversible. Only an attentive attitude towards one's health can become a guarantee of a long and prosperous life.
Do I need contraception during menopause?
Despite the fact that in this period of a woman's life an age-related fertility occurs, the cases of birth of children over the age of 45 and even after 50 years are not so rare. Many women, even at the age of 50 and older, have regular menstruation with a certain number of ovulatory cycles. Thus, according to statistics from the countries of Western Europe, 50% of women aged 44 years and 30% aged 45-54 years are sexually active, have a preserved menstrual cycle and are capable of conceiving.
Due to the fact that the majority of women by the age of 40 have already solved the issues of family planning and the number of children in the family, the unplanned pregnancy has often ended with an induced abortion.
Abortion interrupts almost half of all pregnancies over the age of 40-45 years, and often it is complicated by inflammatory diseases of the genital organs, the development of uterine fibroids, endometriosis, severe menopausal period, and, most importantly, are subsequently the background for the development of oncological pathology in organs - targets: uterus and mammary glands.
Thus, there is no doubt that the main purpose of contraception in this group of women is to prevent abortion and its adverse effects.
When contraception is required during menopause
At present, the number of women is increasing, who, due to certain life circumstances and reasons, are planning the birth of their next, and often the first child after 40-45 years. Pregnancy in such cases is accompanied by a high risk of miscarriage, a high incidence of gestosis, abnormal location of the placenta, an extremely large number of complications during childbirth and the postpartum period, infant morbidity and mortality. This risk is 20 or more times higher than that of women of early reproductive age.
It is proven that the health of women after 40-45 years can be significantly impaired by the previous period of life. Pregnancy and childbirth occur on the background of extragenital pathology, which is recorded in 60% of cases, and in 2/3 of patients it is chronic. Most often these are cardiovascular diseases, diseases of the urinary system, liver, digestive organs, etc. As for gynecological morbidity, it is quite high and ranges from 44 to 65%. Among gynecological diseases, chronic inflammatory processes of the genital organs, uterine fibroids, menstrual disorders, prolapse of the uterus and vagina, etc., take the first place. In addition, 10% of women of this age previously underwent surgery on the genitals.
According to the literature, menopause in a modern woman, as a rule, occurs between the ages of 45 to 55 years (average age 50-52 years). Menopause precedes the premenopausal period, characterized by a decrease in ovarian function. The duration of premenopause is on average 4 years. The onset of menopause does not mean complete cessation of ovarian function. It is proven that during 3-5 years the follicles with eggs remain in them, which explains the occurrence of pregnancy after the cessation of menstruation. In view of this, according to the recommendations of the WHO (1994) - contraception is recommended for women up to menopause and the absence of menstruation for 1 year.
Available methods of contraception during menopause
What methods of contraception can be used by women in this period of her life?
Intrauterine contraception with menopause
Intrauterine contraception with menopause (IUD) is one of the leading places among the effective and acceptable methods of contraception used. The IUD is highly effective, has no systemic effect on the body, is affordable, cost-effective, can be used for a long time, while the restoration of fertility occurs very quickly after removal of the intrauterine device - IUD.
At the age of 45 years and older, the IUD is often contraindicated due to pathological changes in the cervix and / or uterus, the presence of endometrial hyperplastic processes, large uterine fibroids, etc. However, it can also be applied in the absence of generally accepted absolute contraindications (WHO, 1995), which include: malignant lesions of the reproductive system, a history of abortion or childbirth complicated by sepsis, women undergoing inflammatory diseases 3 months before the IUD insertion genital organs with abnormal development of the uterus, genital tuberculosis.
Preference should be given to hormone-producing IUDs, such as Mirena, which help to reduce the amount of menstrual blood loss, prevent inflammatory diseases of the genital organs, and iron-deficiency anemia. According to the literature, the use of the Mirena Navy in women with menorrhagia reduces the amount of menstrual blood loss, bringing it to normal levels (less than 80 ml per menstruation). This is due to a sharp decrease in the volume of vascularization of the endometrium and its damage, as well as a decrease in the production of prostaglandins and fibrinolysis inhibitors. The mechanism of the protective effect of the Mirena Navy in relation to the development of inflammatory diseases of the pelvic organs is to change the properties of cervical mucus, increase its viscosity, and also significantly reduce the duration and intensity of menstrual bleeding. It should be emphasized that the Navy "Mirena" helps reduce vegetative-vascular symptoms in patients with menopausal symptoms in perimenopause. Thus, this system can be used in patients of transition age not only for the purpose of contraception, but also for the treatment of a number of pathological conditions. Unfortunately, this contraception costs for menopause is quite high.
Copper-containing intrauterine devices for contraception during menopause
Copper-containing intrauterine devices can also be successfully used: CuT380 (Germany), Multilood375 (Netherlands), in which the surface area of copper is above 300 mm2.
Oral contraceptives for menopause
Hormonal contraception in menopause has a high efficacy, pronounced healing properties in a number of gynecological diseases (endometriosis, uterine myoma, endometrial hyperplastic processes and mammary glands), patients using hormonal contraceptives are less susceptible to the development of postmenopausal osteoporosis, and ovarian and uterine cancer. Long-term studies have shown that the use of OK in menopausal women contributes to the preservation of the spongy and cortical bone. This is due to the fact that OK have a positive effect on mineral metabolism and prevent bone loss. According to WHO recommendations (1995), hormonal contraceptives are absolutely contraindicated for pregnant women, intensively smoking women, women with current and former thromboembolic complications, in diseases of the cardiovascular system, in severe form of diabetes mellitus, in severe liver diseases, in malignant tumors of the reproductive organs.
In the absence of the listed contraindications, low-dose and micro-dosed oral contraceptives of the last generation (femoden, mercilone, etc.) are acceptable. Sh. Bagdan et al. report high acceptability of low-dose OC regulon and microdose OK — new in women of transitional age.
Progestin contraception with menopause
With regard to women 45 years and older, progestin contraception (mini-pilli, injection, norplant) is very promising, which does not contain an estrogenic component and thus does not cause pronounced changes in coagulation factors, lipid metabolism, does not adversely affect liver function. .
The best known of injectable progestin drugs are Depo-Provera-150 (DMPA), which has advantages not related to its contraceptive effect - reduces the risk of inflammatory diseases of the genital organs, cases of vulvovaginal candidiasis, does not adversely affect liver function, or gastrointestinal the intestinal tract, thereby reducing the likelihood of metabolic changes. It was established that Depo-Provera does not cause marked changes on the part of coagulation factors and lipid metabolism.
VN Prilepskaya and T.T.Tagiyev's studies showed that due to the high contraceptive effectiveness and the peculiarities of the influence of DMPA on hormone-dependent organs, its use is justified in women of late reproductive age and older, especially in the presence of endometrial hyperplastic processes uterus, endometriosis. The disadvantages of DMPA are prolonged bleeding, most abundant in patients with uterine myoma and endometriosis.
Norplant - a subcutaneous implant, is also an effective contraceptive agent for long-term. It consists of 6 small soft silastic capsules containing levonorgestrel. The capsules are implanted under the skin of the shoulder through a small incision under local anesthesia. The contraceptive effect is ensured due to the slow continuous release of levonorgestrel into the bloodstream and is manifested as early as 24 hours after the administration of the drug, continuing for 5 years. One of the disadvantages of the norplant is a violation of the menstrual cycle. These disorders are individual in nature and can manifest as intermenstrual bleeding, amenorrhea.
When using progestogens of prolonged action in women of transition age, menopause often occurs, which in many cases can be considered as a positive factor.
Surgical contraception with menopause
Currently, surgical contraception is also a widely used method of contraception and, as you know, is subdivided into female and male sterilization. Sterilization of women is a surgical operation in which the patency of the fallopian tubes is disrupted, as a result of which fertilization becomes impossible.
There is no doubt that surgical contraception for menopause could be the method of choice for women 45 years and older who have solved the number of children in a family. It is especially indicated for women with various extragenital and gynecological diseases, which are contraindicated due to their health status. It should be emphasized that for women with an increased risk of unwanted pregnancy there are no absolute contraindications to sterilization.
All patients seeking voluntary surgical contraception are required to obtain written consent in order to document the existence of an informed and voluntary choice, as well as recognition of the legal legality of the operation. This method is a very effective method of contraception, but irreversible.
As for male sterilization (vasectomy), this is a highly efficient method that stops a man’s fertile ability without changing hormonal, sexual functions, potency, and does not affect the process of seed formation, that is, male sexual functions remain unchanged.
However, in our country, in connection with the traditional attitude to surgical intervention as a very complex procedure, surgical contraception has not yet been properly applied. In addition, in many clinics there is no appropriate equipment that allows for sparing surgery by laparoscopy.
Barrier methods of contraception during menopause
Barrier contraception for menopause have low contraceptive efficacy, but they certainly have an advantage in preventing sexually transmitted diseases. However, in view of fertility decline, in transitional age, they can be successfully used for married couples who consider them suitable for themselves, especially in the presence of extragenital pathology and gynecological diseases, which do not allow the use of other methods of contraception.
Barrier methods are divided into: mechanical (creating obstacles to the movement of sperm - condom, caps) and chemical (affecting sperm, destroying their membrane and reducing their mobility - nonoxynol, benzalkonium chloride).
Barrier contraceptive methods require proper use, highly motivated behavior, which is usually found in women of this age, protects against sexually transmitted diseases (STDs), and some chemical spermicides, such as creams with nonoxynol, help eliminate vaginal dryness, which occurs in a number of women in menopause.
A popular method of barrier contraception is condom. Its use is shown in all age periods, including older couples. In terms of effectiveness, condoms are inferior to modern methods of contraception and its use is directly related to sexual intercourse, which is not always acceptable for a married couple. However, for some couples, it is the most acceptable, especially when having sex in a long marriage.
Emergency contraception for menopause
Emergency or post-coital contraception in menopause is very important in the problem of contraception, but for women 45 years and older, the use of estrogen-progestin drugs is undesirable because of the need for large doses that can cause a number of adverse reactions.
The most common means of emergency contraception is the use of hormone progestin drugs. The basis of the postcoital contraceptive mechanism is the suppression or separation of ovulation, impaired fertilization, egg transport, implantation, and the further development of the embryo.
In women older than menopause in contraception, preference should be given to oral gestagens, due to the fact that they have no effect on the blood coagulation system, have little effect on lipid metabolism, cause fewer side effects. The most popular in Eastern European countries is the use of levonorgestrel (drug Postinor, Hungary) according to the following scheme: within 48 hours (but not later than 72 hours) after intercourse, a woman takes 1 tablet, and after 12 hours - the second one. The effectiveness of this method on the Pearl index is 2.4 per 100 women during the year. Emergency contraception as an urgent measure of protection from pregnancy should be recommended for women during unprotected intercourse, rape or if there is doubt about the integrity of the condom used, etc.
Natural contraceptive methods for menopause
Natural contraceptive methods are also popular with women 45 years and older. The effectiveness of these methods is not high enough and is 10-30 pregnancies per 100 users per year. In the first place among them is the method of interrupted sexual intercourse, and this is understandable, since it does not require the use of other contraceptives, planning sexual intercourse. However, its effectiveness is low, and for some men it is completely unacceptable.
Periodic abstinence is also suitable for couples who may accept sex restriction or sex life, but this method is not appropriate for women with irregular menstrual periods, i.e., with oligomenorrhea, which is observed in a number of women in premenopausal women. .
With periodic abstinence, several methods are used to determine the so-called "fertile phase" of the cycle:
- basal temperature measurement
- cervical mucus test
- calendar method
- symptothermal method.
The advantage of periodic abstinence is its safety and the absence of side effects. However, the effectiveness of the method depends on strict adherence to the rules of its application. It should be emphasized that periodic abstinence should be offered as an alternative method for couples who do not want to use other more effective methods of contraception for any reason (due to fear of side effects, religious or cult restrictions).
Thus, it should be emphasized that the reproductive health of women of transition age depends, in particular, on how well contraception is used. When selecting a contraceptive method, it is necessary to take into account the state and characteristics of the organism during this period of life, especially carefully consider the contraindications to any method, the acceptability of a particular method for a married couple. Medical counseling should involve an individual approach to each patient prior to the appointment of contraception with a detailed explanation of the characteristics of a particular method, its advantages and disadvantages. Only such a differentiated approach can provide reliable, convenient and even comfortable protection against unplanned pregnancy and its consequences.
What happens during this period
Climacteric changes begin with such parts of the brain as the pituitary and hypothalamus, which regulate the amount of sex hormones in the blood. It is allocated less estrogen. Because of this, many women gain excess weight, which is then difficult to lose and experience the following symptoms during menopause:
- insomnia and night sweats,
- depressed mood, tearfulness,
- heart palpitations
- leaching of calcium from the bones,
- dryness in the genital area
- decrease in sexual desire.
Why use contraception
During menopause, the level of hormones decreases gradually, but continuously, and ovulation (egg maturation) stops. Changes in hormonal levels affect menstruation in different ways. For some women, it stops suddenly. Most monthly become rare and not long before you stop completely. With such signs, many women find it possible not to protect themselves.
In the initial stage of menopause, the eggs continue to be produced for some time, but it is difficult to catch the moment of ovulation due to an irregular menstrual cycle. One of them can fully mature, meet the sperm and safely consolidate in the uterus. There will be an unwanted pregnancy. Theoretically, a woman can bear and give birth to a child during menopause.
But we must clearly understand all the consequences of such a step:
- the number of complications during childbirth in women after 40 years of age increases dramatically,
- the risk of congenital genetic abnormalities and diseases in newborns in such cases is very high,
- the woman has little time to raise her late child.
To have an abortion during menopause is also not the most reasonable decision. The tissues of the uterus and vagina during this period become less elastic and resilient. Therefore, the cervix is difficult to expand and perform an abortion without damage. Artificial termination of pregnancy can trigger many gynecological diseases and endocrine disorders.
That is why it is imperative that you protect yourself during menopause (drink birth control pills or use other contraceptives).
Contraceptive pills for menopause, in addition to protection from pregnancy, have a positive effect on the balance of hormones in the body. They contain the hormone estrogen, a decrease in the amount of which is manifested in the blood by severe climacteric symptoms.
Mature women can not take the same contraceptive with menopause, as the girls can not be categorically. We need special drugs that are selected by the doctor. Progestin oral contraceptives of low dosage have a long-lasting effect and eliminate the negative symptoms of menopause, prevent the occurrence and development of cancer, help fight hair loss due to an excess of male hormones.
When taking contraceptive drugs occur unpredictable reactions. Then you should immediately stop drinking pills and consult a specialist.
When hormonal contraceptives are dangerous
A woman who takes oral contraception during menopause should remember that such drugs can only be used after consulting a gynecologist. The doctor will prescribe a series of tests and conduct a general examination. Based on the results of the examination, he will determine whether this patient can take hormonal contraceptives.
They are forbidden to drink if a woman:
- It smokes. Nicotine constricts blood vessels, slows down blood circulation. An additional amount of hormones can lead to blood clots and disruption of the cardiovascular system.
- Is overweight. Hormones often add extra pounds.
- Has a heart attack or stroke for menopause, has signs of thrombosis or liver failure. Acceptance of hormonal pills for these diseases provokes exacerbations and complications.
- Ill with insulin-dependent diabetes mellitus. The vessels in this case become fragile and do not withstand the additional load.
Other contraceptive methods
Even if for objective reasons oral contraception is not available during menopause, you can choose another method of protection against accidental pregnancy:
- Natural contraception. This method proposes to refrain from sexual intercourse during the maturation of the eggs. To determine the date of ovulation (about 14 days after the start of the cycle), the menstrual calendar is kept. Be sure to monitor the basal temperature, note the change in viscosity of vaginal mucus and the position of the cervix.
- Sterilization. This is a surgical procedure to tubal ligation. As a result, the woman becomes completely barren. The process is irreversible, and each patient must carefully consider their decision: whether to protect themselves in this way. The main disadvantage of this method is the risk of getting an infection sexually.
- Barrier contraception. Today, there is a wide selection of cervical caps, sponges, diaphragms and condoms. The most popular way - the protection of a condom. It guarantees safety during sex in 8 out of 10 cases and perfectly protects against infection. The disadvantages have to include the need to use a condom with each sexual intercourse. Caps, sponges and diaphragms are not popular. They are difficult to introduce, and the contraceptive effect is low.
- Intrauterine contraception. Common and effective technique. Its advantage is the rapid restoration of the ability to become pregnant when the intrauterine device is removed. When menopause, this parameter is not critical, and the risk of inflammation of the uterus after 40 years of age increases dramatically. For women who have been protected by this method at a young age, it is safer to change the contraceptive method during menopausal changes.
- Spermicides (or chemical contraceptives). These are creams, gels, foams, candles with a special component, which either destroy the outer shell of spermatozoa, or reduce their activity and ability to penetrate through the shell of a matured egg cell. For women of childbearing age, this method is recommended only in combination with barrier methods. It has low contraceptive effectiveness.
Gynecologists advise to use special creams with a reduced risk of pregnancy (menopause or rare sexual contacts). Such means moisturize the surface of the uterus and vagina, kill fungi and microbes. It is important not to abuse vaginal suppositories, so as not to disturb the microflora and acidity of the genital organs during menopause, when the mucous membrane becomes thinner and drier.
- Contraceptive patch contains the same hormones as oral contraceptive drugs. It is advisable for them to replace tablets with problems with digestion and memory (tablets should be taken strictly according to the schedule, and the patch should be changed once a week). Disadvantages:
- the amount of hormones trapped in the blood through the skin is difficult to control,
- local reaction on the skin
- The patch sometimes comes off.
- Emergency contraception. "Postinor" and its analogues to take with menopause is very dangerous. The dose of hormones that gets into the blood with this drug can almost completely destroy the endocrine system of a woman.
All non-hormonal contraceptives have a common and very significant minus: they do not alleviate the symptoms of menopause.
Reviews of women and doctors
Все женщины и медицинские работники согласны, что предохраняться в период климакса необходимо. Вариантов контрацепции много. In order to choose the most convenient and effective one, it is necessary to be examined by a gynecologist, and then regularly come to the examination at least once a year.
If the climacteric symptoms do not greatly bother the patient, the doctor usually recommends combining barrier contraceptives with spermicides. Smoothing the complications of menopause helps therapy with hormones, which can be done only under the supervision of a gynecologist.
Many women over 40 who take hormonal contraceptive pills have suggested that they help prevent unwanted conception, improve overall health and appearance (high muscle tone, elastic skin, strong bones). Medical studies have shown that hormonal contraceptives prevent not only pregnancy, but the occurrence and development of cancer.