Topics in Gynecology - Contraceptive Options

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Not Your Mother's Birth Control

Pills, patches, rings and things - these are a few of the contraceptive options available for women who wish to preserve their long-term fertility potential but who also disdain barrier methods such as condoms. Make no mistake; the modern options are not your mother's birth control. From newly engineered insertable devices to super low-dose continuous oral contraceptives, the choice a woman makes can be tailored to her lifestyle.

Birth control pills are still the most popular option in virtually all age groups mainly because they are fairly inexpensive, readily available and easily reversible. In addition, oral contraceptives often solve menstrual problems such as heavy and/or irregular bleeding. They are generally well tolerated and have some indisputable long-term health benefits including a lower lifetime risk of uterine and ovarian cancer. The downside is the fact that the pill must be taken daily in order to be effective, and women who smoke beyond age 35 are at significant risk for a lethal blood clot on the pill.

Intrauterine devices (IUDs) have made a comeback since the days of yore when they fell into disfavor among physicians and patients because of infection risk and other problems. Today's IUDs are easy to insert and very effective as a birth control option for 5 to 10 years at a time. The hormonally active IUD under the trade name of Mirena is particularly effective at lessening menstrual flow and acting as a therapeutic agent for abnormally heavy periods. The copper IUD (Paraguard) can last for 10 years and works without the adjunctive hormonal component. Both are safe for use even in women who have never conceived.

A novel implantable contraceptive device called Implanon has replaced a similar product known as Norplant. The Norplant has been off the market for quite some time, and the Implanon is a welcome addition to the contraceptive options list. Unlike its predecessor, which required six implants into the arm, Implanon has only a single, thin, flexible, 4-centimeter rod to be inserted subcutaneously. Removal is required after 3 years of use, and the pregnancy rate with this method is low.

For women who have difficulty remembering to take a pill each day but who do not want an implantable device, the contraceptive patch (OrthoEvra) or the insertable ring (Nuvaring) are viable options. When compared with oral contraceptive pills, the patch has an overall higher degree of estrogen exposure. In contrast, the Nuvaring, as compared with pills, has the lowest doses of estrogen and progesterone. Despite that discrepancy, both the patch and the ring have the same effectiveness in prevention of unwanted pregnancy, as do pills. The patch is applied weekly to the lower abdomen/hip area for a total of 3 weeks per month. After the third week, the patch is removed and a menstrual withdrawal flow is expected. Similarly, the Nuvaring device is self-inserted into the vagina for 3 weeks followed by removal and discard prior to the expected monthly flow.

These modern contraceptive options reflect ongoing research in the area of women's reproductive health, and the future is full of promise. More effective, safe and well-tolerated methods are in the pipeline of which your mother would surely approve. Be sure to discuss your specific needs and potential risks with a women's health specialist.

Hormone-Containing IUD

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The progesterone-containing IUD lasts for up to 5 years and can be used to control problem-bleeding as a therapeutic measure in addition to providing contraception.

Non-Hormonal IUD

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The copper IUD has been around for decades and has proven to be an excellent long-term choice since it can provide up to 10 years of continuous birth control. There is no hormonal effect, and some women experience an overall increase in their menstrual flow with this method.

Implantable Contraceptive Rod

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The relatively new implantable rod device contains only progesterone, which is released in small increments into the body from its location in the subcutaneous tissue of the upper, inner arm. Unlike the now off-the-market Norplant, this new contraceptive has only a single rod to supply coverage for birth control for up to 3 years. A drawback of this method is a high rate of irregular bleeding.

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