ANN ARBOR, MI - New innovations in contraception, from hormone-based medications to internal devices, are giving women more birth control alternatives that fit better in today’s lifestyles — providing women with nearly effortless methods and safer choices.

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But with all this new information and array of choices, what’s a woman to do? Vanessa Dalton, M.D., M.P.H., department of Obstetrics and Gynecology at the University of Michigan Health System offers information to help women unravel the ever-changing options, including a summary of the newest forms of hormonal birth control and the overhaul of the intrauterine device, or IUD.

“When women are choosing or trying to select among many different kinds of birth control, there are a few things that they need to consider,” says Dalton. “One of them is whether they have any medical problems that would make some forms of birth control a poor option for them. The other thing they need to consider is what kind of user they would be. Are they someone that can remember to take a pill everyday on schedule; or do they feel more comfortable interrupting sexual activity to use, for example, a diaphragm or condom?”

Some women may prefer to use natural methods of pregnancy prevention for religious or cultural reasons. But for those who choose drugs or devices, the options can be dizzying — ranging from hormone-based medications, such as oral contraceptives, implants, injections, and patches to contraceptive devices, such as the male and female condom, the IUD, the diaphragm and the cervical cap.

Hormone-based Birth Control

New innovations in hormonal birth control, which stop the ovaries from releasing an egg each month, provide many options with a high rate of success.

“In hormone contraceptives there are actually quite a few new advancements. If you consider what we used for birth control pills even 10 years ago, the dosage just keeps getting lower and lower. What that means for women is that the side-effect profiles, such as weight gain, are quite a bit better,” says Dalton.

The vaginal ring, which has only been available for a year, is a new hormone medication that is inserted into the vagina by the woman using the contraceptive. Instead of remembering to take a pill every day or even having to insert and remove a contraceptive device multiple times throughout the month, the vaginal ring is inserted only once, delivers hormones throughout the cycle and is then removed at the end of the three weeks.

“The vaginal ring builds on the idea that you can deliver medications through the skin, and in this case, through the vagina, which happens to be a very effective way to deliver drugs,” says Dalton. “It will slowly release estrogen and progesterone components the whole time.”

There are many advantages to choosing the vaginal ring over other forms of contraception. Unlike oral contraceptives and other hormone medications, the vaginal ring has not been associated with large weight gain problems.

Also, the ring’s effectiveness is extremely high, with only a 1 percent to 2 percent failure rate.

Another new oral contraceptive called Seasonale will likely be released later this year with the benefit of extending the “normal” cycle to three months, with menstruation only occurring on a tri-monthly schedule, says Dalton.

Contraceptive Devices

The IUD (intrauterine device) is making a comeback after a bad reputation made it less common in the late 1970’s. The problem came from just one type of IUD, the Dalkon Shield, while other types of IUD’s (Copper 7, Lippes Loop, Saf-T-Coil) were still deemed safe to use. But amid the panic from the Dalkon Shield, the public perceived that all IUD’s were prone to infection, even though this was not the case.

The IUD is a small T-shaped plastic device containing copper or hormones that must be inserted into the uterus by a physician. Instead of acting as a barrier, the IUD works more like a hormone medication to change the physical environment of the woman’s uterus. This will either prevent the egg from being fertilized or stop a fertilized egg from implanting and growing in the uterus.

“The problem with that one particular type of IUD [Dalkon Shield] was that it had a higher rate of infection after insertion,” says Dalton. Having an infection inside your uterus affects future fertility and that, coupled with unawareness about the safety of other types of IUDs, was the major reason why the IUD got such a bad reputation.”

The IUD has recently been given a makeover. The new IUD, the Mirena, is different because it delivers a smaller amount of hormone, which affords women the advantage of having lighter menstruation.

“Almost all women by six to nine months report a decrease in their menstruation, and in fact, some women stop having periods all together. For many women, the IUD is not only a contraceptive advantage, but is used very frequently for women who have menstrual irregularities,” says Dalton.

Although it may seem like women are the only ones responsible for birth control, men may be able to do more than just wear a condom in the near future.

“Some hormone-based options for men have been under investigation for years, but those options are not on the market at this point. It will be a major shift for our cultural norms to have men responsible for taking a pill every day for contraception,” says Dalton. “It will be very interesting to see how well that is received.”

Facts about birth control options:

U-M Health Topics A-Z: Choices in birth control
http://www.med.umich.edu/1libr/womens/contra06.htm

Additional Information:

U-M Health Topics A-Z: Methods of Contraception
www.med.umich.edu/1libr/aha/aha_contra_crs.htm

U-M Health Topics A-Z: Intrauterine Device (IUD)
www.med.umich.edu/1libr/aha/aha_iud_crs.htm

U-M Health Topics A-Z: Oral Contraceptives
www.med.umich.edu/1libr/aha/aha_contrace_crs.htm

Department of Health and Human Services: Birth Control Guide
www.fda.gov/opacom/lowlit/brthcon.html

Planned Parenthood
www.plannedparenthood.org/bc/

Written By Erin Block

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