For women and their mates, helping each better comprehend gynecological issues.
| What's New in Contraception: An Easy-to-Follow Guide About Several New Choices |
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| Birth Control - Birth Control | |
| Written by Andrew Goldstein, MD | |
| Tuesday, 24 July 2007 | |
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We know all about The Pill, but how about the Patch, the Ring, and the progesterone IUD? In the last few years the Food and Drug Administration (FDA) has approved several completely new forms of birth control for sale in the United States. They offer major benefits and some improvements over contraceptives such as The Pill, which works extremely well with correct use but less so with circumstances such as missed pills.
These new contraceptives require less frequent doses and put less responsibility on the user. The result should be less improper use and fewer unintended pregnancies- and as a bonus fewer side effects. This overview presents basic information about these new contraceptives and highlights advantages and disadvantages. Ortho Evra is a contraceptive patch that contains hormones similar to the hormones in birth control pills - an estrogen and a progestin. The 1 3/4-inch-wide square skin patch is placed on the skin weekly for 3 weeks, followed by a week of not wearing a patch. You will get a period the week you don't wear a patch. Because you use it weekly rather than daily, this method may lead to fewer mistakes and better results than with the Pill. Problems with skin irritation and detaching patches appear to occur rarely. (Those who do lose a patch should replace it with a new one rather than tape over it.) Ortho Evra contains less estrogen than some other contraceptives and it doesn't have to go through the digestive tract-so it causes less nausea (and less headaches). It also offers users a rapid return to fertility-women are able to become pregnant soon after they stop using the patch.Breast discomfort and irregular bleeding may occur in the first two cycles of use. The patch may be less effective for women who weigh more than 200 pounds.
MONTHLY INJECTION (LUNELLE) Women can now get a monthly injection of Lunelle, which has been on the market in Europe and other countries for years and is basically similar to a combination of oral contraceptives (OCs). You must go to a medical office for this procedure, although you may be able to give yourself this injection in the future. Lunelle should be taken every 28 days, with a five-day grace period, which means that it can be taken any time between days 23 and 33 of the menstrual cycle. Pregnancy is possible for women two to three months after they stop using Lunelle (a shorter time than with Depo-Provera, the other injectable contraceptive).
The disadvantages of Lunelle are: It is not an option for women who cannot take OCs because they contain estrogen. It can cause more spotting and irregular bleeding than OCs do (which users can reduce by taking doses every 28 days). Lunelle may cause some women to gain weight. Mirena is an intrauterine system (IUD) that European women have been using for more than a decade. A health care practitioner inserts the IUD in a position very close to the uterine lining. This is a very easy in-office procedure that takes only a few minutes. The Mirena lasts five years and is more effective than the copper containing IUD.
Mirena's advantages over the copper IUD (the Paragard IUD) go beyond efficacy. The copper IUD can cuase heavier, more painful periods. In contrast, the Mirena causes lighter (or absent) periods that are not painful. This is because the Mirena only contains a low dose of the hormone levonorgesterol - a progesterone, therefore it can be used by women who have problems with estrogen. This very dose of progestin acts locally to thin the lining of the uterus, and this accounts for its very positive effects on the users menses. Some studies show that anemia and pelvic infection is less common with Mirena than with copper-containing IUDs.
Mirena can cause irregular bleeding or spotting in the first six months of use. The Mirena costs slightly more than the copper IUD. Women who are at risk for sexually transmitted disease or ectopic pregnancy should not use the Mirena. Women who have never had a child are able to use the Mirena.
VAGINAL RING (NUVARING) The monthly contraceptive NuvaRing is a flexible plastic ring about 2 inches in diameter and 1/8-inch thick. It is inserted in the vagina for 3 weeks out of the month, then replaced with a new ring every month. Like the Pill and Ortho Evra patch, the Nuvaring contains both an estrogen and a progestin. Like Ortho-Evra the hormones diffuse through the skin - in this case the mucosa of the vagina. Because no hormones go through the gastrointestinal tract, users may have less nausea. But if you do experience nausea, by soaking the ring in water overnight before using it, nausea is usually prevented. You do not have to place it in an exact position for it to work. You and your sexual partner are not likely to feel it during sexual intercourse, though you can remove it for up to 3 hours. Possible side effects may include increased vaginal discharge and headaches. Like the patch, the NuvaRing uses less estrogen than OCs but is not recommended for women who shouldn't take estrogen.
NON-SURGICAL TUBAL STERILIZATION (ESSURE PERMANENT BIRTH CONTROL) Women who desire a permanent form of birth control now have an alternative to "having their tubes tied," or tubal ligation. The Essure PBC is a small metallic implant placed into the fallopian tubes in a quick medical procedure that does not involve an incision or general anesthesia. The result is a blockage that causes irreversible sterility. Women must use an additional contraceptive for a 3-month waiting period after insertion and must undergo a simple second procedure to confirm blockage of both tubes.
Some positive aspects of this method are its low cost, the avoidance of surgery and anesthesia, and its purported 100% effectiveness. The most common side effect is cramping Possible problems include expulsion, in which the device moves out of place, and perforation of the uterus- this is very rare. It is important to remember that long-term studies of the Essure PBC have not been done yet. Therefore, a few physicians have some concerns about its long-term safety and effectiveness. Two specific products give women the option to use birth control after sexual intercourse-the oral contraceptives Plan B and Preven. Plan B has a better rate of success and a lower rate of side effects than Preven, and costs about the same. Women who have an established pregnancy should not use either. (Note: On December 16, 2003, an advisory panel recommended to the Food and Drug Administration (FDA) that "Plan B" should be available to women as an "over-the-counter" product available in such places as pharmacies, supermarkets and other similar locations. The FDA now needs to act on the recommendation. Plan B has been on the market since 1999 and has been used by more than 2.4 million women, the manufacturer of Plan B was quoted in newspapers. (Ourgyn will post a more comprehensive story when and if the FDA acts on the drug.)
For a complete look at Emergency Contraception, click here.
CONTRACEPTIVES OF THE FUTURE Learn about birth control methods that may or will be available in the future: Continuous oral contraceptives require women to skip or change the week they take placebos, which are normally prescribed and taken in rotation with the Pill. Seasonale is a continuous OC that should be on the market in late 2003 or early 2004. Future studies may show that it is safe to use some regular oral contraceptive or the Ortho-Evra patch so that your periods come only every 3 months.
Contraceptive rods that are implanted in the skin may soon be available in the U.S. once again. Earlier versions were Norplant, which caused some difficulties with removal, and Norplant 2, which is not widely available in this country due to manufacturing difficulties. A new two-rod system lasts for 3 to 5 years and can be removed more quickly and easily than the standard Norplant.
The so-called abortion pill, RU-486, can also work as a contraceptive after intercourse for women who are not pregnant. Male hormonal contraception is still in the very early stages of development. This method uses hormones to suppress sperm production and has only worked irregularly and required frequent injections. Researchers are also working on an anti-sperm contraceptive vaccine, smaller IUDs that are "frameless," longer-term and progestin-only vaginal rings, and other non-surgical sterility procedures. (May, 2003)
CONTRACEPTIVE PATCH (ORTHO EVRA) Advantages Rapid return to fertility Disadvantages Estrogen contraindications
Advantages Monthly dosing Disadvantages Less regular bleeding than with OCs
Mirena intrauterine device (IUD) Advantages Inexpensive over time Disadvantages Irregular bleeding in first six months, then decreased Advantages Rapid return to fertility Disadvantages Discomfort for some users
NON-SURGICAL TUBAL STERILIZATION (ESSURE PBC) Advantages Permanence Disadvantages Long-term trial results not yet available
POST-COITAL OR EMERGENCY CONTRACEPTION Advantages Taken after sexual intercourse Disadvantages Not suitable for women with an established pregnancy 5/2003 |
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| Last Updated ( Thursday, 12 February 2009 ) | |
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