Feature Article of the Month: May 2007

We could have titled this article, "Contraception: Not Your Mother's Birth Control," because women today have never had more options when it comes to birth control. Did you know there are at least 17 forms of contraception today? And that several of these options can do more than just prevent pregnancy.

So if you're still using the same form of birth control you were using a decade or more ago, it's time for an update. And, if your lifestyle or focus has changed over the past few years or even months, your health care professional can help you determine a method that best fits your current needs.

Hormonal-based options—several to choose from
Good options for women who have been using oral contraceptives with no problems but are now ready for a change are one of the two new estrogen-based contraceptives: NuvaRing and Ortho Evra.

NuvaRing is inserted into the vagina like a tampon, where it releases a steady amount of estrogen and progestin throughout the month. You wear it for three weeks, then take it out for a week and have your period. Then you insert a new ring. Side effects include hormone effects similar to those from the pill and a mild increase of vaginal discharge. As with oral contraceptives, NuvaRing may increase the risk of blood clots and stroke, primarily in women who smoke. NuvaRing is 91 to 99 percent effective when used consistently and correctly as directed.

Ortho Evra is a skin patch with hormones embedded in its adhesive layer. You stick it on your lower abdomen, buttocks or upper body (but not your breasts), where it slowly releases estrogen and progestin for a week. After a week, you peel it off and replace it with a new one. After you've used three in a row, you take a break for a week, during which you get your period. The patch delivers a higher dose of estrogen than most birth control pills, and it's unclear whether it increases the risk of blood clots or not. It also is 91 to 99 percent effective when used consistently and correctly as directed.

If you want to steer clear of estrogen, talk to your health care professional about progestin-only, long-term, reversible contraceptives. These are Implanon, a matchstick-sized rod implanted in your arm, and Mirena, an IUD.

Implanon relies on a progestin called etonogestrel for its protective effects. It is implanted in your upper arm and prevents pregnancy for up to three years. Common side effects include abnormal bleeding, headache and depression, and it's not recommended for women with a history of breast cancer. Implanon is 91 to 99 percent effective when used consistently and correctly as directed.

Mirena continuously releases progestin called levonorgestrel and can remain in place five years or longer. This IUD can reduce heavy menstrual bleeding, which can be an issue for some women as they near menopause. The major side effect is some irregular bleeding.

The copper IUD is a hormone-free, long-term reversible option that also prevents fertilization. It can be used for up to 10 years but isn't a good option if you experience heavy bleeding. IUDs are considered more than 99 percent effective at preventing pregnancy.

And, for those of you who prefer oral contraceptive pills as an short-term reversible birth control option, but need to avoid estrogen, then the "mini pills," which contain only progesterone hormone, may be indicated for you.

Barrier methods—there if you need them
Of course, you can always choose the protect-as-you-go option: barrier methods such as condoms (male or female), the cervical cap, diaphragm and spermicides. These are typically effective at preventing pregnancy 80 percent of the time (though spermicidal creams and jelly can improve their effectiveness), so they may be best if you're in a monogamous relationship and can generally predict when you're going to have intercourse. One caveat: If you're not in a monogamous relationship, add a condom to your contraceptive arsenal regardless of what you're using; it's the only thing shown to protect against most sexually transmitted infections—which can affect you no matter what your age!

Permanent birth control—when you know it's time
Permanent contraception is the most common form of birth control overall and the most popular type of birth control for women over age 35. In fact, 30 percent of women between the ages of 35 and 39 have opted for permanent birth control, while 10 percent of women in this age group have male partners who have been sterilized. Between the ages of 40 and 44, the percentage of women opting for sterilization jumps to nearly 35 percent.

There are three choices for ending fertility, each of which is more than 99 percent effective. You're no doubt familiar with vasectomy—the man's form of sterilization—and tubal ligation, in which your fallopian tubes are cut or blocked to prevent an egg from traveling down them to meet sperm. Today, however, women have a new option: the Essure system.

Essure can be done in your doctor's office in about 30 minutes with only a local anesthethic, unlike tubal ligation, which requires surgery. During an Essure procedure, your doctor uses a special instrument called a hysteroscope to place spring-like coils or micro-inserts through your vagina and cervix and into the opening of your fallopian tube in your uterus. Within three months, the micro-inserts cause your body to form a tissue barrier that prevents sperm from reaching the egg. During this three-month period, you need to use another form of birth control. After three months, the doctor performs a special x-ray to make sure your tubes are completely blocked. Risks include mild to moderate pain immediately after insertion. This method may reduce the risk of tubal (ectopic) pregnancy compared to tubal ligation. Women typically can return to their normal activities within a day or two.

As you can see, your options are much broader than that pill package that's been a fixture in your medicine chest for awhile. So make an appointment with your health care professional and talk about what's right for the woman you are today, not the woman you were then.

References

Association of Reproductive Health Professionals. Which contraceptive is right for you? 2005. Available at: http://www.arhp.org/files/ContraceptiveChoicesPoster.pdf. Accessed April 9, 2007.

Kailas NA, Sifakis S, Koumantakis E. Contraception during perimenopause. Eur J Contracept Reprod Health Care. 2005 Mar;10(1):19-25.

Bhathena RK, Guillebaud J.Contraception for the older woman: an update. Climacteric. 2006 Aug;9(4):264-76. Review.

Essure Web site. Available at www.essure.com. Accessed April 8, 2007.

This content was developed with the support of an educational grant from Conceptus, Inc.

Create Date: 5/7/2007
Last Date Updated: 5/7/2007