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New Contraception Options

by Monica J. Smith

Since 1998, a number of new birth control options have come on the market (although by mid-2004, some were being taken back off). The majority of these contain a hormonal component that prevents pregnancy by halting ovulation and by thickening cervical mucus, which makes it difficult for sperm to penetrate the uterus. The new methods differ from their predecessors in the means by which they deliver the hormones or, in the case of some of the latest oral contraceptives, in the way they affect a woman’s menstrual period. The side effects and possible complications are similar in most cases to those associated with other low-dose oral contraceptives: nausea, weight gain, fluid retention, breast tenderness, and headaches and, more seriously, blood clotting and hypertension. Hormonal methods should not be used by heavy smokers over the age of 35, because these women are at a higher risk of serious side effects. Women with diabetes must make sure their health-care provider is aware of their diabetes before taking any form of birth control.

To date, the best protection against sexually transmitted infections, short of abstinence, is still a latex condom used with each act of intercourse. However, condoms are not 100% reliable, and they are less effective at preventing transmission of viral infections such as herpes or genital warts that are passed from one person to another through skin-to-skin contact.

Unlike most oral contraceptives, which are taken for 21 days followed by seven days of placebo pills, Seasonale tablets are taken for 84 days (12 weeks) followed by seven days of placebo pills. This dosing regimen results in fewer menstrual periods (one every three months). The four yearly periods are no heavier or longer than the period of a woman taking a typical birth control pill and, in most cases, they are lighter than those experienced by women not taking oral contraceptives. Like conventional birth control pills, Seasonale is more than 99% effective when taken as directed. There is a higher incidence of irregular bleeding between periods with Seasonale than with conventional oral contraceptives, but such bleeding tends to decrease with time. It is still unclear what the long-term effects of absent periods may be, and there is some concern over the increased estrogen exposure from extra active pills. Women who have vascular complications are advised not to take Seasonale.

Yasmin contains a unique progestin, known as drospirenone, along with estrogen. Like other birth control pills, Yasmin is over 99% effective, but its special drug combination also cuts down on water retention and symptoms associated with premenstrual disorder, such as mood swings and weight gain. This form of birth control may not be the best choice for women with diabetes, however. Yasmin may increase potassium levels in some women, so it should be avoided by women who have kidney, liver, or adrenal disease. Women taking potassium-increasing drugs, including NSAIDs such as ibuprofen, potassium-sparing drugs, or potassium supplementation should also steer clear of this contraceptive. In addition, women taking ACE inhibitors, heparin, or angiotensin-II receptor antagonists such as irbesartan (brand name Avapro) or valsartan (brand name Diovan) should avoid taking Yasmin. This contraceptive is available by prescription and costs about $35 to $38 a month.

Emergency contraception
At this time, emergency contraception is available in the United States by prescription only, except in Washington, California, Alaska, New Mexico, and Hawaii, where it is available directly from a pharmacist. In May 2004, the Food and Drug Administration (FDA) voted against making the drugs available over the counter, citing concerns that women would be unable to properly use the drugs without a doctor’s supervision, as well as fears that increased availability would lead to risky sexual behavior among young people, although studies have shown this to be untrue. At the time of the FDA decision, there were two drugs available for emergency contraception: Plan B, a progestin-only pill, and Preven, an estrogen–progestin pill. However, Preven was later taken off the market.

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