What’s New in Contraception?

It is likely difficult for young women today to appreciate the difficulties pioneers in contraceptive acceptance and development faced. Margaret Sanger, the founder of the birth control movement, was censored, jailed and forced to move overseas during her lifelong battle to both educate women about sexuality and contraception and increase their contraceptive options. It wasn’t until a few months before her death in 1966 that a Supreme Court ruling made contraception legal for married couples.

Since the arrival of the oral contraceptive pill in the 1960’s the availability of new types of contraceptives has been limited, but 2001 saw the release of 2 novel forms of contraception and the approval of 2 others, offering women more choices in the realm of reproductive health.

The FDA approved the Mirena intrauterine system in the winter of 2000. It is a type of intrauterine device (IUD) that provides very effective contraception and can also be used to manage menstrual disorders. Although new to the United States it has been available in Europe for over 10 years. It consists of a small plastic device that is impregnated with the hormone levonorgesterol. The device is placed into the uterine cavity by a simple office procedure. A low dose of levonorgesterol is released over the course of the device’s 5-year life span. Mirena prevents pregnancy by thickening cervical mucous, inhibiting sperm movement and thinning the lining of the uterus. It has a very low failure rate of 0.2% during the first year of use. Fertility is restored as soon as the device is removed.

An added benefit to the Mirena is a reduction in uterine bleeding. In fact monthly menstrual cycles are eliminated. Their may be frequent spotting during the first 3-6 months of use, this gradually decreases and about 20% of women have no bleeding by the end of the first year of use. Reported side effects (occurring in 2-10% of users) include lower abdominal pain, breast tenderness, headaches and mood changes. These significantly subside over time.

Another new contraceptive is called Lunelle, it is a once a month injection of estrogen and progesterone. The efficacy and side effects are very similar to low dose oral contraceptive pills but because it is a monthly injection it is suited to women who have a hard time remembering to take a daily pill. It works in the same way as birth control pills by preventing ovulation, thickening cervical mucus so that sperm can’t get to your fallopian tubes and prevents the development of the uterine lining. The hormones in Lunelle are in the form of microcrystals that are slowly dissolved by your body. Thus the injection will last for a month.

Lunelle is greater than 99% effective in preventing pregnancy. When the injection is discontinued fertility is restored 1-3 months after the last injection. Side effects are similar to birth control pills including bleeding between periods (in about 10% of women), no periods (in about 15%) and menses lasting longer than 7 days (in 29%); weight gain is also noted by some women using Lunelle.

On the horizon is a contraceptive patch. Called Ortho Evra, it is placed on the skin of the arm, buttocks or abdomen and releases low doses of the hormones ethinyl estradiol and norelgestromin. It provides contraception in a similar manner to birth control pills and Lunelle. The patch is changed weekly for three weeks and then menses occur during a patch free week. Its effectiveness is the same or slightly better than the birth control pills as are the side effects. This method has been approved by the FDA and should be available for use by the beginning of 2002.

The FDA approved Nuva-ring in October of this year. It is a flexible polymer ring about 2 inches in diameter that contains the hormones ethinyl estradiol and etonogestrel. The ring is placed in the vagina by the woman herself and left in place for three weeks. It is then removed for a week and menses occur. Side effects are similar to OCP. It has a 1-2% failure rate over the course of a year.

The advantage of each of the new contraceptive methods is their ease of use, effectiveness and eliminating the need to remember to take a pill every day. If any of these methods are of interest ask your health care provider for more information and whether they think it may be an appropriate method for you.