Birth Control: More & Safer Choices.

Taken From: Consumer Reports - http://www.consumerreports.org/cro/health-fitness/health-care/condoms-and-contraception-205/birthcontrol-choices/index.htm

Long gone are the days when there were just a few, well-known contraceptive choices. Today's options include rings, patches, and IUDs. Older contraceptive drugs are being used in ways that include emergency contraception, which is still misunderstood.

The latest developments are outlined below. To compare your birth-control options, see LINKMEADAM Condoms & Contraception - A Comparative Guide..

1. IUDs make a comeback.

This highly effective method of contraception has never recovered from the 1970s, when the Dalkon Shield intrauterine device turned out to put users at major risk for fertility-destroying pelvic infections. Fewer than 1 percent of reproductive-age American women use an IUD, and several surveys of gynecologists have found that many are reluctant to insert IUDs for fear of being sued.

Yet today's IUDs have an excellent safety record, allow women years of "set it and forget it" contraception, and can be less expensive overall than other birth-control methods. Two brands are available in the U.S. The ParaGard T380A, a T-shaped device, releases copper ions that prevent pregnancy by slowing down sperm and preventing eggs from maturing to the point where they can be fertilized. It can stay in place for up to a decade, but can cause heavier menstrual bleeding and cramps. That's not the case with the newest IUD, Mirena. "It's highly effective, completely reversible, and makes periods lighter and less crampy," says Mitchell Creinin, M.D., professor of obstetrics and gynecology at the University of Pittsburgh. The reason is that Mirena releases a steady trickle of the hormone progestin, which over time thins the uterine lining so that it can't support a pregnancy. It lasts for five years, but a woman can have it removed at any time and she doesn't have to wait before trying to get pregnant.

2. New hormone products.

Hormonal preparations containing progestin and estrogen are still among the most effective methods of reversible birth control. But these are not your mother's birth control pills. Today's pills and related products contain a fraction of the active hormones and result in fewer side effects and dangers than the original pill from 1960.

Woman wearing Ortho Evra patch.

THE UN-PILL Users of the Ortho Evra patch, above, replace it only once a week.

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Two newer forms of contraception, the patch and the ring, contain the same types and about the same doses of hormones as the pill and are as effective in preventing pregnancy. They're a boon to those who have trouble taking a pill every day. Ortho Evra, introduced in 2002, delivers the hormones through a skin patch that must be replaced only once a week. After three weeks, the user skips a week, has what is called withdrawal bleeding, then starts a new cycle.

The NuvaRing, also introduced in 2002 but less well known, is a flexible hormone-impregnated polymer ring about 2 inches in diameter. A woman inserts it into her vagina. One ring has enough hormone to last for three weeks, followed by a week of withdrawal bleeding.

3. The truth about risks.

Women used to fear that hormonal contraception increased the risk of cancer, but it now appears the opposite is true. Long-term studies involving thousands of women have established that having taken the pill reduces the risk of ovarian and endometrial cancer by 40 percent or more. Nor do modern birth control pills increase the risk of breast cancer. Since the 1960s, safety concerns about hormonal contraceptives have centered on their tendency to increase the risk of blood clots, and thus strokes, heart attacks, and pulmonary embolism.

In 2004, news reports raised the possibility that the contraceptive patch posed a particularly high risk of fatal strokes and heart attacks, based on voluntary adverse event reports to the Food and Drug Administration. However, an investigation by the Planned Parenthood Federation of America, which distributes the patch and other contraceptives, concluded that based on the number of prescriptions for the patch since its introduction, the number of fatal adverse events was less than that reported from the pill.

Women whose doctor has told them they have a greater-than-average risk of blood clots, such as women with a history of cardiovascular disease or those who smoke and are over 35, should not use hormonal contraceptives containing estrogen, though they may safely take the progestin-only "mini-pill." Overall, for healthy women of reproductive age the risk of blood clots is extremely low and remains low even when they use estrogen-based contraceptives. Pregnancy presents a slightly higher risk of developing blood clots than use of hormonal contraception.

4. The pill's other function.

Gynecologists have known it for years, but the word is just now getting out to everyone else: There is no need for women who aren't planning a family to menstruate every month. Indeed, many researchers believe that fewer periods may be healthier. Surveys have found that at some point two-thirds of women seek medical attention for menstrual symptoms such as cramping, bloating, excessive bleeding, or endometriosis, a condition that can cause severe pain or infertility. Suppressing menstrual periods is easy with the use of hormonal contraception. Standard birth control pills, as well as the patch and the ring, build in a seven-day break from hormones every month, during which there is withdrawal bleeding as the uterine lining breaks up. The bleeding is usually lighter than normally occurs because the hormones keep the uterine lining only about a third as thick as with a natural cycle. When the pills are used continuously, the uterine lining is kept in place indefinitely, although slight breakthrough bleeding is possible. Several studies of extended contraception have found that many women like it because it reduces or eliminates menstrual discomforts. Surveys of female gynecologists find that most use it themselves, and virtually all of them consider it a safe practice for their patients.

For standard, monthly-cycle birth control pills, continuous use is not approved by the FDA. For that reason, women wishing to try it should consult their gynecologist to make sure that it's safe for them and that they are taking the correct pill. (Some pills have too much estrogen for this purpose.) Another option is a new product called Seasonale, an oral contraceptive that received FDA approval in 2003. Taken as directed, it extends the menstrual cycle so that users have withdrawal bleeding every three months. Clinical trials showed that the product improved menstrual symptoms and overall "quality of life" in the vast majority of users; the main unwelcome side effect was breakthrough bleeding.

5. Help in emergencies.

For a method that's been available for decades, albeit by prescription, emergency contraception is a mystery to many women. A 2003 Kaiser Family Foundation survey of California residents of reproductive age found that 50 percent confused it with the abortion pill, Mifeprex, and about the same percentage weren't sure it was available in the U.S. They were wrong on both counts. The fact is, emergency contraception is available in the U.S. as a last-ditch method for preventing pregnancy after unprotected sex or contraceptive failure. It uses a large dose of progestin, an ingredient in birth control pills. The so-called abortion pill is a completely different drug that interrupts an established early pregnancy.

Taken within 72 hours after intercourse, a high dose of progestin will prevent pregnancy by preventing ovulation or preventing the sperm and ovum from reaching each other. If the fertilized egg already has implanted in the uterine wall, progestin won't stop or harm it. The FDA approved the first progestin pills specifically designed for emergency contraception in 1998. Users take the first of two doses as soon as possible after unprotected intercourse, but not later than 72 hours afterward. They take another pill 12 hours later.

For now, emergency contraception sold under the brand name Plan B is available only by prescription, which can make it hard to get if you need it urgently, say, early on Saturday morning. So consider this advice:

  • Have the drug on hand. The American College of Obstetricians and Gynecologists has recommended that doctors give women advance prescriptions during their annual checkup.
  • Go straight to the drugstore. Qualified pharmacists can dispense emergency contraception without a prescription in Alaska, California, Hawaii, Maine, New Mexico, and Washington.
  • Use the Internet. Planned Parenthood, at www.plannedparenthood.org, and the Princeton, N.J. based Emergency Contraception Hotline, at www.not-2-late.com, list providers who will prescribe emergency contraception over the phone.

6. Insurance gaps shrinking.

Twenty-one states now have laws requiring that if employee health plans cover prescription drugs or devices, they must cover contraceptives. Also, the federal Equal Employment Opportunity Commission and a U.S. District Court in Seattle have ruled that excluding contraceptives from prescription drug plans represents sex discrimination.

The legal protections, which began in 1998, have made a difference. But women still may run into trouble getting coverage for the contraception they desire, especially newer methods such as the patch or the ring. Another common problem is the refusal of some health plans to allow women to buy more than a month's supply of hormonal contraceptives at a time, which results in missed doses, a major risk factor for unwanted pregnancy. Women's advocacy groups suggest the following for handling such problems:

  • Ask your doctor for free samples.
  • Offer to pay cash for an extra month's supply.
  • Inform the employer that offers the health plan of your problems.