Latest Birth Control Options What is right for me but not for you?

By Live Dr - Sat Mar 28, 2:12 pm

What kind of birth control is right for me?

The type of birth control you choose depends on your needs. Some people only need to prevent pregnancy. Other people may also want to protect themselves or their partners from diseases that can be passed by having sex. These diseases are called sexually transmitted infections (STIs). Some STIs include acquired immunodeficiency syndrome (AIDS), chlamydia, human papillomavirus (HPV), herpes, genital warts and syphilis.

Talk with your family doctor about the pros and cons of each birth control option.

Review Compares Latest Birth Control Options

ScienceDaily (Jan. 31, 2008) — With many women still searching for the perfect birth control method, a systematic review analyzes a host of studies comparing the contraceptive skin patch or vaginal ring to the pill. Although perfection remains elusive and choices are equally effective, the review authors were able to pinpoint some preferences.

condoms.jpg Condoms image by mbailey4357

“Basically, all of these methods were similar in preventing pregnancy,” said lead investigator Laureen Lopez, Ph.D., research associate at Family Health International in Research Triangle Park, N.C.

Recently,  the U.S. Food and Drug Administration added warning data to the drug label for the contraceptive skin patch, advising users that the women using the patch have a greater risk of blood clots than pill users. The study prompting the FDA action was not part of the review.

For the review, the researchers looked at 11 randomized controlled trials — three comparing the patch to the pill, and eight comparing the ring to the pill — comprising more than 6,000 women.

Women using the patch were more likely to use the medication as prescribed than those on the pill were. However, patch users experienced more side effects and were more likely to abandon their method eventually than pill users were.

Ring users generally had fewer serious side effects than pill users, but had more vaginal irritation and discharge. Despite this, vaginal ring users tended to stick with their approach longer than the pill group.

The patch is a small adhesive square that dispenses hormones and which a woman must replace every week for three weeks, and then leave off for a week. The Ortho Evra contraceptive patch is the only patch approved for use to date.

The NuvaRing, which Organon manufactures, releases hormones into the vaginal cavity. A woman inserts the ring, a flexible piece of plastic tubing, where it remains for three weeks; she then removes it for one week. Many consider the ring and patch easier to use than birth control pills because women do not have to attend to them every day.

Compared with pill users, patch users had more bleeding breakthroughs, breast discomfort, painful periods, and nausea and vomiting. Rings users, on the other hand, had more vaginal irritation and discharge. Of the two, patch users tended to discontinue the method more readily.

The contraceptive review updates one done in the past, for which only two studies of the patch versus the pill were available. The ring data are new. For all methods, several studies had women drop out, which can limit the value of the results according to the researchers.

“Women who used the ring had fewer bleeding problems than those on the pill, but they did have irritation,” Lopez said. “But discontinuation was similar for the ring and the pill in most of the studies.”

Clinicians have seen the ring increase in popularity, Lopez added.

Mitchell Creinin, M.D., professor and director of gynecological specialties at the University of Pittsburgh, is familiar with all of the review studies. “It all comes back to compliance.” Creinin said. “Once a week versus once a day, twice as much hormone entering the body (with the patch), or half as much (with the ring).”

Creinin, who was not involved with the review, said it is important to understand the people who would enter these studies: “These studies were done primarily when only the pill was available. Women who were unhappy with their present method of birth control were the ones likely to enter them.” He noted that the results differ among studies between European and American women. “North American women tend to have more complaints and are less compliant,” he said.

Overall, Creinin said, women are happy with their birth control because they are not getting pregnant.

Lopez said that women have to consider many issues when choosing a method of birth control. Ease of use, side effects and life situation are each important. For a contraceptive to be effective, the woman must be willing and able to follow the prescribed regimen.

“Women are finally beginning to understand that taking a pill every day is difficult.” Creinin said. He is working on an upcoming study comparing the ring to the patch.

Reference:  Lopez LM, et al. Skin patch and vaginal ring versus combined oral contraceptives for contraception (Review). Cochrane Database of Systematic Reviews 2008, Issue 1.

Adapted from materials provided by Center For The Advancement Of Health.

Is saying “no” to sex really an option?

Yes. No method of birth control is 100% effective. The risk of getting pregnant or catching an STI may outweigh the pleasure you get from sex. The only way to make absolutely sure you don’t get pregnant, get someone pregnant or get an STI is not to have sex at all.

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What are barrier methods?

Barrier methods include the diaphragm, the cervical cap, contraceptive sponges and condoms. These methods prevent pregnancy by blocking sperm from getting into the uterus. Barrier methods must be used every time you have sex.
diaphragm - cervical cap
A woman must visit her doctor to be fitted for a diaphragm or a cervical cap.

Using a diaphragm, cervical cap or contraceptive sponge may increase the risk of urinary tract infections in some women. Some women have allergic reactions with these methods.

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Are condoms a good choice?

Yes. Condoms aren’t expensive and are widely available. Condoms are an especially good choice if you or your partner are also having sex with other people or if either of you has had sex with other people in the past.

Condoms offer the most protection against STIs of all the barrier method options. Using a spermicide with condoms can offer better protection against pregnancy, but it does not increase your protection against STIs . Spermicides containing nonoxynol-9 can cause genital irritation and can actually increase your risk of catching an STI.

Female condoms aren’t as effective as male condoms, but they may be a good choice if a man won’t use a male condom.

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What about the pill?

Birth control pills work mostly by preventing ovulation (the release of an egg by the ovaries). Most pills are made of two hormones called estrogen and progestin. For the pill to work, you have to take it every day.

Some common side effects of birth control pills are nausea, headaches, acne, increased blood pressure, breast tenderness, bloating, weight gain and depression. However, not every woman who takes the pill will have side effects. You may have to try several types of birth control pills before you find the type that is best for you. The pill may reduce cramping and shorten the number of days of bleeding during the menstrual period. The pill may also help premenstrual syndrome (PMS). Women who take the pill should not smoke.

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What about the patch?

The hormonal birth control patch (brand name: Ortho Evra) uses estrogen and progestin to prevent pregnancy. It is applied to 1 of 4 places — the buttocks, abdomen, upper torso or outer arm. The patch is used on a 4-week cycle. You put on a new patch once a week for 3 weeks. You don’t use a patch during the 4th week and your period will start.

The patch’s side effects are similar to those of the pill. Women who use the patch should not smoke.

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What is the vaginal contraceptive ring?

The vaginal contraceptive ring (brand name: NuvaRing) is a thin, flexible ring that is inserted into the vagina. It releases hormones that keep you from getting pregnant. These hormones are the same ones used in most birth control pills. The ring is left in the vagina for 3 weeks. It doesn’t have to be in a specific position in the vagina. You remove the ring after 3 weeks and your period will start. After 7 days, you insert a new ring.

If the ring is out of your vagina for more than 3 hours, it may not work effectively when you put it back in. To protect against pregnancy, you will need to use another form of birth control until the ring has been in all the time for 7 days in a row.

Women who use the vaginal ring should not smoke.

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What about hormone shots and implants?

Hormone shots (brand names: Depo-Provera, Lunelle) work much like the pill to prevent pregnancy. They may have some side effects, such as headaches and changes in your period, mood and weight. A Depo-Provera shot prevents pregnancy for 3 months. A Lunelle shot prevents pregnancy for 1 month.

Hormone implants (brand name: Norplant System) are no longer available. If you are currently using hormone implants, you should talk to your doctor to see what your birth control options will be when your hormone implants expire. The implants prevent pregnancy for 5 years, but you can have them removed at any time.

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What about an IUD?

“IUD” stands for “intrauterine device.” An IUD is put in a woman’s uterus by her doctor. It’s made of flexible plastic. It isn’t known exactly how IUDs prevent pregnancy. They seem to stop sperm from reaching the egg or prevent the egg from attaching to the uterus.

Some IUDs used in the past were related to serious health problems. Today IUDs are safer, but they still have some risks. Most doctors prefer to use IUDs only in women who have already had a baby. Side effects of IUDs include heavier bleeding and stronger cramps during periods.

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What about being sterilized?

Sterilization is when a man or woman has an operation to permanently prevent pregnancy. If you’re sure that you don’t want to have children or you don’t want more children, sterilization may be the right choice for you.

Tubal ligation (also called “getting your tubes tied”) involves closing off a woman’s fallopian tubes so eggs can’t travel through them to reach the uterus. A device called Essure can also be used to close off a woman’s fallopian tubes. Essure is a metal coil that is inserted into your fallopian tubes by your doctor.

Men are sterilized with a vasectomy. The man’s vas deferens (sperm ducts) are closed off so sperm can’t get through.

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What is natural family planning?

Natural family planning requires a couple to learn when in the woman’s cycle she can get pregnant (usually 4 days before and 2 days after ovulation). They must use a barrier method of birth control or not have intercourse during those days. There are a number of ways to keep track of a woman’s ovulation. All of them require a lot of planning and commitment.

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Is withdrawal effective?

No. When a man tries to pull out before ejaculating (“coming”), he usually leaves behind a small amount of fluid that leaks from the penis during sex. This fluid has enough sperm in it to cause pregnancy.

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How well does birth control work?

The box below shows the failure rates (number of pregnancies per 100 women per year) for different types of birth control. These numbers are for couples who use the methods the correct way every time they have sex. The failure rates are higher if you don’t use birth control the correct way every time.

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Failure rates for birth control methods when used correctly

(Number of pregnancies per 100 women per year)
Male condom alone 11
Female condom alone 21
Diaphragm with spermicide 17
Cervical cap with spermicide 17 to 23
Sponge with spermicide 14 to 28
Spermicide alone 20 to 50
Oral contraceptives 1 to 2
Contraceptive patch* 1 to 2
Vaginal contraceptive ring 1 to 2
Hormone shots less than 1
Hormone shots less than 1
IUD less than 1
Periodic abstinence 20
Surgical sterilization (female) less than 1
Surgical sterilization (male) less than 1
Contraceptive patch is less effective in women weighing more than 198 pounds.

Information from U.S. Food and Drug Administration. Birth Control Guide. Retrieved August 4, 2004, from the World Wide Web: http://www.fda.gov/fdac/features/1997/babytabl.html


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