What’s old? What’s new?

Get the pros and cons on the birth control options soon available to youGet the puGet the preuGet the preuGet the prere

BY DR. GRACE MORRISON

In our society, the desire to control reproduction has resulted in many contraceptive options, with many more on the horizon arriving at a dizzying rate. The numbers of options can be daunting and overwhelming.

Behavioral methods

Continuous abstinence from intercourse guarantees protection from pregnancy but is not often practical.

Another approach is “natural family planning,” based on prediction of fertility, both by the calendar and by the quality of cervical mucus and abstinence from intercourse during fertile days.

Generally, the success is greater if menstrual periods are regular. This method requires specific education, diligence and persistence on the part of the couple. Some people use the method of “withdrawal,” which relies on removal of the penis from the vagina prior to ejaculation. The failure rate for this method can be high because of leakage of semen and sperm prior to actual ejaculation.

Barrier methods

Condoms represent the most common barrier method, and although they provide some protection against sexually transmitted diseases, they can fail on the contraceptive front. Health care providers usually recommend use of a spermicide, such as foam, suppositories or gel, along with the condom, to maximize their contraceptive effectiveness.

Diaphragms are flexible rings with a soft latex cup, inserted along with a spermicidal gel, just prior to intercourse. They must be fitted and therefore are available only through a medical care provider. The cost is relatively low, but for success, the couple must be motivated to use it regularly.

Diaphragm usage can result in increased vaginal infections or urinary tract infections. The cervical cap, similar to the diaphragm but smaller, also requires fitting, and can be more difficult to place and remove.

Hormonal contraception

These methods are among the most popular because of their ease of use, preservation of spontaneity during intercourse, and often regulation of menses.

Oral contraceptives, or the pill, enjoy marked popularity for these reasons and for their 97 percent effectiveness. Numerous brands exist, but nearly all contain the two hormones, estrogen and progesterone, in various combinations and subtle permutations of dosages and chemical formulation.

In reality, most women do well with most pills, and there is no clear formula for success. Although side effects are usually mild and short-lived, they can include breakthrough bleeding, nausea and headaches. Usually menstrual periods are lighter, shorter and less painful.

Other significant benefits can include reduction in long-term risk of ovarian cancer and uterine cancer. We now know that most women can safely continue birth control pill use through menopause, and providers often prescribe them for alleviation of peri-menopausal symptoms.

Birth control pills shouldn’t be used by women who smoke and are older than 35 or who have a history of blood clots, stroke, heart disease, estrogen-dependent tumors, high blood pressure and other circumstances.

Depo-Provera, or the shot, contains progesterone only and is injected every three months. It is highly effective (99.7 percent), but troublesome side effects can include weight gain, irregular bleeding, abnormal hair growth, mood changes and acne. Sometimes resumption of menstrual periods and fertility is delayed significantly.

Intrauterine devices (IUDs) are plastic devices with copper or progesterone, which are inserted into the uterine cavity, and which can remain for five to 10 years. Effectiveness approaches 99 percent, and with the newest one, Mirena, menses are actually lighter and shorter.

Caution should be used if the relationship isn’t monogamous, as the risk of sexually transmitted diseases can increase.

The newest available methods of hormonal contraception are the birth control shot (Lunelle), the vaginal ring (NuvaRing) and the patch (OrthoEvra). All three contain estrogen and progesterone, and have similar side effects as the birth control pill.

Lunelle is administered as a monthly injection. NuvaRing, a flexible ring with imbedded medication, is placed in the vagina and left in place for three weeks, then removed for one week. Usually, neither the woman nor her partner can detect it. Ortho Evra delivers the hormones in patch form and requires the patch to be changed weekly for three weeks, then removed for one week.

Emergency contraception

The “morning-after pill” is gaining wide acceptance and is highly effective but must be used within 72 hours of unprotected intercourse. Pharmaceutical companies have developed “Plan B” and “Preven” specifically for this purpose, but many other standard birth control pills, if used according to specific instructions, can be equally effective.

Many care providers recommend that such contraception be provided and kept on hand at all times upon request.