Updated August 04, 2006

New Contraception Options

by Monica J. Smith

Ortho Evra patch
The first transdermal contraceptive, the Ortho Evra patch is worn for three weeks (each individual patch lasts a week) on the lower abdomen, buttock, or upper arm, where it delivers a continuous level of progestin and estrogen through the skin. Each three-week interval is followed by a patch-free week during which a woman has her period. The Ortho Evra patch is about 99% effective if used correctly. If a patch comes off before the week is over, a new patch should be applied as soon as possible for the remainder of the week. If more than 24 hours go by before a new patch can be applied, backup birth control must be used. This method is less effective in women who weigh more than 198 pounds and it should not be used by women with diabetes who have vascular complications. The Ortho Evra patch is available by prescription and costs about $30 a month.

NuvaRing
A novel concept in contraception, the NuvaRing is a flexible polymer ring worn in the vagina. It is approximately two inches in diameter and contains low levels of hormones. The ring is inserted by a woman on or before the fifth day of her period by pinching the sides of the ring together and gently pushing it into her vagina where it releases low levels of estrogen and progestin for 21 days. Because NuvaRing is not a barrier method, precise placement is not essential. Efficacy is compromised, however, if the ring slips out of the vagina and is not replaced within three hours, or if it is left in for more than four weeks or removed before the three weeks is up. In clinical testing, NuvaRing has shown to be 99% effective, the same as the pill. This method should not be used by women with diabetes who have kidney, eye, nerve, or vascular complications. NuvaRing is available by prescription and costs about $30 a month.

Mirena intrauterine device
Although they are very popular worldwide, intrauterine devices (IUDs) have had a bad reputation in the United States since the Dalkon Shield scare of the 1970’s. (This brand of IUD was linked to an increased risk of pelvic inflammatory disease, attributed to the wicking effect of the multifilamented string.) In spite of the negative associations caused by this episode, the risk of pelvic inflammatory disease related to IUDs is actually quite low, and they provide a highly effective, easily reversible birth control option for women who have had one or more children and who are in a monogamous relationship. The latest IUD to come on the market, Mirena, consists of a small, flexible, T-shaped plastic frame that releases small amounts of levonorgestrel, a type of progestin. This device does not contain estrogen, so it does not cause estrogen-related side effects and complications such as headaches and breast tenderness. Progestin-related side effects are kept to a minimum as well because all of the hormone released, about one-seventh of the amount released by birth control pills, goes directly to the uterine lining rather than through the bloodstream. There may be cramping and dizziness at the time of insertion, so it’s not a bad idea to take a painkiller such as ibuprofen prior to the office visit. There may be spotting or light bleeding between periods for the first three to six months, after which periods usually become lighter—in contrast to most IUDs, which tend to cause heavier periods. Mirena, which is over 99% effective, can stay in the uterus for up to five years, at which time a new Mirena can be inserted. The device costs about $475, plus the cost of insertion.

Today Sponge
Introduced in 1983, the Today Sponge was once the most popular over-the-counter female contraceptive choice. It was taken off the market in 1995 because of problems that were found at the factory where it was made, but the rights to the sponge were bought by another company, and the sponge was re-released in 2005. The Today Sponge, which is about 89% to 91% effective, consists of polyurethane foam with spermicidal nonoxynol-9. Once moistened and inserted into the vagina, where it works as a physical barrier to the cervix and as a sperm killer, the sponge protects against pregnancy for 24 hours even with repeated intercourse. It is currently available at some retail and online pharmacies and at www.thetodaystore.us for around $30 for a 12-pack. Women who are allergic to nonoxynol-9 should not use the Today Sponge. In addition, women who use barrier methods such as the sponge, a diaphragm, or a cervical cap are at an increased risk of urinary tract infections.

Monica J. Smith is a freelance writer and editor in Brooklyn, New York.

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