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Gynecology
Is Your Birth Control Up-to-Date?Discover the latest birth control options and what’s right for you
How Do You Choose?"Every contraceptive method has pluses and minuses," says nurse practitioner Cheryl Lichner, "and the best choice for you is highly individual. Effectiveness is a critical factor and so is safety, especially if you have health risks. But also consider how important convenience is to you; whether cost, disease protection or menstrual control is an issue; how well you and your partner can communicate about birth control; and how quickly you want to be able to get pregnant after stopping contraception." To make the best decision, talk it over carefully with your health care provider. Think your contraceptive is foolproof? That's not a wise assumption. "According to the latest national data, 49 percent of pregnancies still are unplanned," says Lehigh Valley Hospital and Health Network obstetrician and gynecologist Rochelle Steiner-Friel, M.D., "and in half those cases it's due to contraceptive failure." Over-the-Counter OptionsThe familiar nonprescription contraceptives are spermicidal foams, creams or suppositories; and condoms, important because they prevent sexually transmitted diseases as well as pregnancy. "Over-the-counter contraceptives are inexpensive per-use and disposable," Steiner-Friel says. "But since the user must take action each time, there's more potential for mistakes."Prescription or Custom-Fitted OptionsBesides the familiar diaphragm, here are some of the newer developments:IUD - Intrauterine devices must be inserted professionally, but last up to 10 years and are 99 percent effective. Some new IUDs (Mirena and Progestasert) release the hormone progesterone, thinning the uterine lining and decreasing menstrual bleeding, cramping and weight gain. "This is a good option to control the heavy periods that often precede menopause," Lichner says. Pill - Though it's been studied for decades, the pill still generates breast cancer fears, Steiner-Friel says. "The risk is extremely low, and you're actually protected against ovarian cancer." A bigger concern with oral contraceptives is that other drugs, vomiting or diarrhea can affect absorption and raise pregnancy risk. "Used correctly, the pill is 99 percent effective and can help prevent uterine cancer, regulate your menstrual cycle and decrease cramping and bleeding," Steiner-Friel says. You can now custom-time your pills, too. "Studies show there's no need to have a period every month. You can cycle many of today's pills so you menstruate every two or three months, a big help if you have problems like menstrual migraines," Steiner-Friel says. Injectables - "The adolescent pregnancy rate in the United States is at a 25-year low, and Depo-Provera is one reason why," Steiner-Friel says. "It's highly effective and only requires going to the doctor's office for an injection every 12 weeks." Researchers are working on a self-injectable for home use. Implants - Two tiny rods are implanted in the upper arm in a minor surgical procedure. They slowly release progestin over five years. Implants are highly convenient, effective and reversible, Lichner says, and more options should be available soon. Ring - NuvaRing is a thin, flexible, hormone-releasing ring inserted in the vagina for a three-week period, then removed for a week to allow menstruation. “It has estrogen and progesterone just like the pill, but releases the medication slowly over the course of three weeks,” Steiner-Friel says. “It also has the lowest dose of estrogen available in a hormonal contraceptive.” Patch - Evra is a hormone-containing skin patch. You apply a new patch each week for three weeks, then skip a week to menstruate. Effectiveness is comparable to the pill, and it’s easier to comply because you don’t have to remember to take a pill every day. Male methods - Researchers are working to expand men's contraceptive choices beyond vasectomy and condoms. New options will include injectables, implants, patches and "temporary sterilization" (blocking the sperm duct rather than severing it). Emergency ContraceptionCondoms break and diaphragms disintegrate, so it's wise to have a backup like Plan B. "You take one pill within 72 hours, another 12 hours later," Steiner-Friel says. "Unlike RU 486, Plan B won't abort an existing pregnancy, but it will prevent a new one." Health activists are pushing to make the prescription product available over-the-counter.
Want to Know More? For a comparative chart of contraceptive methods, including costs, risks and benefits,
call 610-402-CARE.
This page last updated 2/12/08 04:08 PM
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Q: I have very painful periods. Could it be more than menstrual cramps?A: While pain during menstruation could indicate several conditions, the most common gynecologic cause is endometriosis. This condition occurs when functioning endometrial cells, normally found within the uterus, back up into the pelvis.
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