Contraception: You Have Come a Long Way Baby!

Since the early 1900’s, when Ludwig Haberlandt, an Austrian physiologist working out of the University of Innsbruck, was feeding ovarian extracts to mice, we have known that the administration of certain hormones leads to inhibition of fertility thus providing contraception. However, it was not until the 1960’s, coincidentally coinciding with the sexual revolution, that ‘The Pill’ made its rather conspicuous debut.

Decades later this relationship continues to flourish as a third generation of women begin to reap the benefits of reliable contraception. Hormonal contraceptives provide numerous well-documented non-contraceptive benefits also. In fact, in March of this year a study of 46,000 women conducted over a 40 year period found that women on ‘the pill’ are less likely to die prematurely of any cause including cancer and heart disease. Indeed, approximately 100 million women world wide are taking some form of oral contraception.

But this is the United States of America. We love our freedom. We love choice. And we REALLY love freedom of choice. As such, women today have a plethora of options when choosing a contraceptive. With the pill alone you have mono-phasic, multi-phasic, 21 day, 24 day, continuous, progesterone-only, as well as numerous estrogen and progesterone combination options just to name a few. These are just ‘pill’ options.

What makes the choice landscape that much more rich and interesting are the non-pill options. These options are as unique and varied as the individual women they are designed to serve. They include patches, rings, implants and intra-uterine devices. Each of these options have specific advantages and disadvantages to fit the lifestyle and medical needs of different patients.

First, let us consider the patch, Ortho Evra. These patches are structured and work in much the same way as oral contraceptives in that women receive a combination of estrogen and progesterone for the first three weeks of the month with the fourth week hormone free during which time she will experience menses. However, with this method, she will not need to remember to take a pill everyday. Rather, she simply needs to change the patch once a week during the first three weeks and is patch free in the fourth week. Another advantage espoused by this method is that it avoids what is known in the medical field as the ‘first-pass effect’ where by a medication is first processed by the liver.

You like the idea of not having to take a pill daily but are not so sure about wearing a patch on your skin? No problem! The Nuva Ring may be the answer for you. The Nuva Ring is a vaginal ring that is placed vaginally and the hormones are absorbed through the vagina, also avoiding that ‘first-pass effect’ through the liver. Additionally, because the vagina is very vascular, it readily absorbs hormones easily, allowing the makers of Nuva Ring to use a lower dose with less fluctuation in hormone levels that one might have when taking an oral contraceptive. Lower dose with less fluctuation of hormone levels can equal fewer side effects.

To use the ring, you simply place it vaginally, leave in for three weeks, then remove and menses will occur in the fourth week. Then repeat the cycle. Additionally, if you would like to skip a menstrual cycle, say for vacation or convenience, each ring has enough hormone to last for four weeks. Therefore, simply leave the ring in for a full four weeks, remove, and immediately replace the ring with a new one.

The Nuva Ring is left in during intercourse. Nine out of 10 men reported not feeling the ring at all and the 10% who did, stated that it did not bother them.

If you like the idea of less frequent dosing of hormones and these less labor intensive options but would like to take it even further, perhaps an implant is the answer for you. Implanon is a distant cousin of the once popular implant, Norplant.

Implanon has the convenience of, once being placed by your physician, providing effective contraception for 3 years. Implanon is placed via a simple in-office procedure where by the device is placed just under the skin of the non-dominant arm in the space between the biceps and triceps muscles on the inner-arm. Implanon is a progesterone-only option and although some women will have some irregular bleeding, many have no period, at all, which they find convenient.

Finally, for those women who would like an even longer term and either completely non-hormonal or less-hormonal option, there are intra-uterine devices. These have the benefit of, once being placed, providing reliable, effective contraception for 5-10 years with minimal or no hormone.

Mirena is a progesterone IUD that once placed provides 5 years of contraception with minimal use of hormones. The progesterone that is present in the IUD helps some women decrease the amount of menstrual flow they experience with their periods.

Paraguard is a completely hormone-free copper IUD that, once placed, provides 10 years of hassle-free, cost-effective contraception. Should a couple decide they are ready to conceive again, both IUDs can be removed easily by their physician and the couple can proceed with trying to conceive.

All of the above options have their risks and benefits which must be discussed with your physician. But the women of 2010 have more choices now than ever before and enough freedom to choose to make anyone from the 1960’s envious of the contraceptive environment of today!