February 8, 2007
Shopping for birth control is starting to resemble shopping for shoes: There are so many options.
Implants, patches, rings, sponges — even a chewable birth control pill with a nice minty flavor. Oh, and how about fewer or shorter periods? Whatever you prefer, ladies.
“It’s just an explosion of people’s awareness of it,” said Alan Gilmore, director of education for Planned Parenthood Mar Monte in the Central Valley. “You open almost any women’s magazine, and you see tons of ads for birth control.”
But rather than going for the flashiest new contraceptive on the block, experts say it’s important to find the method that fits you and your lifestyle. Half of all pregnancies in the country each year are unintended, and about half of those occurred among couples who were using a contraceptive incorrectly or without consistency, according to the Guttmacher Institute, the New York-based nonprofit agency focused on sexual and reproductive health.
“I hope they walk out with a prescription for something that they know how to use with good compliance,” said Dr. Joel Cohen, chief of service for obstetrics and gynecology at Bakersfield’s Kaiser Permanente. “Whatever they choose, they should use it well and aggressively.”
THE PILL — REVAMPED
This isn’t your mother’s birth control pill.
“The Pill” has come along way since being approved by the FDA almost 50 years ago. Today’s options come tricked out with enough perks to make any woman a choosy shopper.
Several new pills entice women by shortening or cutting down the number of periods per year. And while this may be merely a lucky side effect for some, other women see this as an end to chronic pain and discomfort, Gilmore said.
Skipping periods is perfectly safe, most health experts say.
Birth control pills suppress the ovaries and make the lining of the uterus — the menstrual blood that women shed every month — very thin to nonexistent, so having a period isn’t needed, said Dr. Jigisha Upadhyaya, an obstetrician/gynecologist and medical director at San Dimas Medical Group.
Birth control regimens were originally developed to mimic a menstrual cycle so that the woman taking it didn’t feel “abnormal,” she said.
“For some strange reason, women needed to have a period every month,” Cohen said. “It turns out that none of that is true.”
Using these pills does come with a higher risk of breakthrough bleeding, the Food and Drug Administration warns. And a few physicians say suppressing periods can lead to a buildup of iron, which could lead to liver and cardiovascular problems.
With Seasonale and Seasonique, women take a pill containing estrogen and a synthetic progestin — both are hormones — for 12 weeks and then inactive pills for one week, during which time a period occurs.
Other regimens, like Yaz and Loestrin 24 Fe, still bring on the monthly period but it’s shorter. They provide active pills for 24 days and then four days of blank pills.
Some of these newcomers are just repackaged versions of old pills, Cohen said. Femcon Fe — which causes a monthly, weeklong period — is a newer, chewable version of Ovcon 35, which has been on the market for about 30 years.
“People have to be aware they are being heavily marketed to,” Cohen said.
Other pills are fortified with vitamins and nutrients, like iron, Upadhyaya said.
The failure rate and risks from all the new pills are similar to the regular monthly pills with week-long periods, like Ortho Tri-Cyclen, Estrostep and Mircette, the FDA says.
Out of 100 women, one to two a year are expected to get pregnant while on birth control pills. Risks include dizziness, nausea and changes in menstruation, mood and weight, with a small chance of cardiovascular disease, high blood pressure, blood clots, heart attack and stroke.
Low maintenance methods
Not interested in the peskiness of a pill? With some other birth control methods, you can get it and forget it for at least a week.
Much like its predecessor, the six-rodded Norplant, Implanon releases a steady dose of progestin for up to three years.
The manufacturer, Organon, says it is 99 percent effective, and a woman will regain the fertility she had before getting Implanon soon after the device is removed. The FDA had no information on Implanon’s effectiveness on its Web site.
The opportunity to be worry free comes at a price — but it may be less than what you would spend on years’ worth of pills or a new baby, Upadhyaya said. Wholesale, the device goes for about $500.
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“If you think this is expensive, the diapers will be more expensive,” she said. “Everything has to be put in perspective.”
Implanon can cause irregular menstrual bleeding, such as more bleeding or no bleeding at all.
Mirena, an intrauterine device, is being geared toward mothers who currently don’t want more children, not so much toward childless, single women.
The plastic device is inserted into the vagina and can stay there for up to five years. Mirena, which releases a small amount of progestin, is relatively painless and takes only a few minutes to insert, Upadhyaya said.
The risk of getting pelvic inflammatory disease — an infection of a woman’s upper genital tract or reproductive organs — is elevated during the first month on the device, but the risk is not as large as physicians once thought it was, according to health experts.
It has one of the lowest failure rates; fewer than one woman in 100 will get pregnant, the FDA says.
Mirena can cause heavier bleeding at first and then lighter to nonexistent periods.
The patch, Ortho Evra, and the ring, NuvaRing, came onto the market a few years ago. Both require prescriptions.
Ortho Evra releases progestin and estrogen into the bloodstream, is worn for a week at a time and is 98-99 percent effective, the FDA says.
The product contains a higher dose of estrogen than most other forms of birth control, which may lead to a higher risk of blood clots, the FDA warns. On Ortho Evra, a woman’s period should change little from her normal cycle.
NuvaRing is about two inches in diameter and releases hormones. The ring remains in a woman’s vagina for three weeks and on the fourth, she will have a normal period.
NuvaRing has the same effectiveness as the patch.
An old favorite
Gilmore of Planned Parenthood said he frequently is asked about the sponge, the once heavily favored birth control device that stopped being produced in 1994 due to manufacturing problems.
Immortalized in a “Seinfeld” episode in which Elaine, with a finite and dwindling cache of sponges, deems potential partners “sponge-worthy” (or not!), the Today Sponge is back and can be bought online and over the counter.
The sponge is made of polyurethane foam and coated with spermicide. To use, a woman wets it and inserts it into the vagina. According to the FDA, 14 to 28 women out of 100 get pregnant, which is comparable to other barrier methods like the diaphragm and cervical cap.
Many women prefer its convenience: The sponge can be used at a moment’s notice, Gilmore said.
In an emergency
Many people think Plan B, or “the morning-after pill,” is the “abortion pill,” which isn’t the case, Gilmore said.
Plan B should be taken within 72 hours after unprotected sex. It reduces the chance of a woman becoming pregnant by stopping the release of an egg from the ovary, preventing fertilization of the egg or preventing the egg from attaching to the uterus, the FDA says. If you are already pregnant, Plan B won’t stop it.
(FYI: Mifeprex, or RU-486, is the drug that stops a pregnancy.)
Plan B is available over the counter to women 18 and older, and usually costs $40 to $50, Gilmore said. It reduces the risk of pregnancy by almost 80 percent, according to the FDA.
“This would be something to use in the event the condom broke,” Gilmore said. “We don’t want people to think of emergency contraception as their primary source of birth control.”
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