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Volume CXXXII, Number 10 |
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New Contraceptives
JEFF BENSON, M.D.
DUDLEY COE HEALTH CENTER
Dear Dr. Jeff: What have you heard about the new birth control rings and patches? A.A.
Dear A.A: There have been a number of interesting developments in birth control technology over the last few years. Some involve new "delivery systems" for familiar contraceptive medications. Others involve a new approach to medical contraception itself.
NuvaRing, OrthoEvra patches, and Lunelle injections are three of the newest contraceptive options. All three offer novel delivery systems for standard birth control pill hormones, and are particularly attractive options for women who prefer not to have to take a pill every day.
NuvaRing is a thin, flexible, silver dollar-sized vaginal ring that releases steady, low doses of contraceptive hormones into the bloodstream. It's left in place for three weeks, and removed the fourth week for menstruation. NuvaRing is at least as effective as regular birth control pills, and its steady dose of hormones causes fewer side effects.
The only reason NuvaRing is worn vaginally, of course, is discretion. In pre-marketing studies, though, about 18 percent of women and 30 percent of men reported feeling the ring at least occasionally during intercourse. NuvaRing can be removed before sex, but must be replaced within three hours for contraceptive efficacy. As a contraceptive strategy, though, this seems a little risky and self-defeating!
OrthoEvra is the new contraceptive patch. It also delivers a steady state of contraceptive hormones, but does so externally, through the skin. OrthoEvra is a small, thin, beige patch that is worn on the upper outer arms, abdomen, buttocks, or torso (but not the breast), for one week per patch, three weeks in a row. Menstruation takes place during the fourth, patch-free week. It also has at least the same, if not more, contraceptive efficacy as regular birth control pills, and has the same favorable side effect profile as NuvaRing. Clinical trials showed that patches adhere well while bathing, swimming and exercising, and in all kinds of hot or humid weather.
Lunelle is a once-a-month injectable contraceptive. It needs to be given in a medical office, every 28 to 30 days (but no longer than 33 days). Unlike Depo-Provera, an older, injectable contraceptive, the effects of Lunelle wear off within a month or two. It's highly effective, but may cause slightly more side effects than regular pills. Lunelle's appeal lies in its confidentiality and once-a-month single dosing. Its drawbacks are having to come into a medical office within a short window of time every month, and, of course, just getting a SHOT, EVERY month!
Seasonale is a new birth control pill designed to be taken for 91 consecutive days, rather than the usual 28. It will become available sometime in the New Year. Seasonale contains a cumulative amount of hormones that is slightly lower than most conventional birth control pills, and postpones menstruation until the last week of each three month cycle. In other words, taking Seasonale is like taking the first three weeks' of regular birth control pills, and then starting right into the first week's pills of the next month's pack, and then doing the same again at the end of that second pack - without "pausing" for the fourth week's placebo pills and menstruation.
This approach, called "continuous cycling" contraception, is very appealing in a number of ways. It makes the contraception even more effective (no one-week "breaks" for your own cycle and hormones to start up), and lessens cyclic side-effects. Many women are simply thrilled to skip two out of every three periods! And very interestingly, it may have definite health benefits, particularly in reducing one's risk for ovarian and endometrial cancers.
On the other hand, continuous cycling may increase slightly the risk of breast cancer, blood clots and stroke, particularly for women who smoke or whose blood pressure is high. And for some women, monthly periods are a reassuring sign that they're (most likely) not pregnant.
There's quite a discussion going on in the media these days, about whether it's "better" or "more natural" to menstruate monthly. It began with the publication in 1999 of a treatise by Elsimar Coutinho, M.D., entitled Is Menstruation Obsolete? More recently, it was pointed out in The New Yorker, that "modern" women have at least three times more periods over their reproductive lifetimes than did their "pre-modern" ancestors, who were far more often either pregnant or lactating, and hence not ovulating. "Excessive" ovulation and endometrial stimulation may in fact be unhealthy. Nuns, for instance, definitely have higher rates of ovarian and endometrial cancers. So do women whose periods begin at a very young age, and those who never have kids.
The (male) scientist who developed the first birth control pills was Catholic, and very much wanted to offer women a contraceptive that seemed so "natural" that it might slip under the radar screen of the Church. That's the reason conventional birth control pills have a 28 day schedule! Many researchers and clinicians are now questioning whether that schedule is natural or necessary or even healthy.
So: very much as it should be, more options, more flexibility and control, and more to consider!
Be well!
Jeff Benson, M.D.
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