October 18, 2006
Never before has one little pharmaceutical creation caused such an uproar. A proper name didn’t even have to be used; it was simply known as “The Pill.� Whoever thought to confer the same status on these little tablets as the Great Pyramids was having quite the telepathic moment.
Who but a great seer could have foreseen a time when most everyone who was anyone in high school and college was on some form of oral contraception?
How many of us wake up every morning and pop a little colored pill? Like candy they come in all sorts of “flavors� and varieties so how about we take a trip into Candy Land.
What is most important in choosing a method is deciding what works best for you. This means taking into account your health, frequency of sexual interaction, as well as several other factors, the most important being which method you are most comfortable with.
Physical barriers are 75 to 99 percent effective at preventing pregnancy. Latex or polyurethane condoms are the primary male condoms used, and, in addition to being effective at preventing pregnancy (84 to 98 percent depending on material), they are also the only method of preventing the transmission of viruses such as HIV, herpes and hepatitis. Lambskin condoms have pores that, while blocking sperm, do not guard against the passage of viruses.
Female condoms are not as popular, nor are they as effective as male condoms (79 to 95 percent effective). They do, however, offer the same convenience, as they can be purchased at most drug stores without a perscription and discarded after a single use.
Diaphragms, intrauterine devices, and cervical caps are other physical barriers that can be used by women, though these require a prescription. A diaphragm is a shallow latex cup that prevents sperm from entering the cervix. It is used with a spermicide and inserted into the vagina before sex. Irritation is a concern, as is toxic shock syndrome, but a benefit many people enjoy is that there is no physical barrier between partners.
Hormonal contraception is fast coming to be relied on by many women as a supplementary contraceptive device (supplement because it does not prevent sexually transmitted diseases), and it comes in several doses, hormone combinations and delivery methods.
Birth control pills have traditionally been combination pills of progestin and estrogen. They are designed this way to simulate a 28-day cycle that is considered normal. Long-term side effects do not seem to be an issue though there are increased risks involved for heart attack, stroke and cardiovascular disease in smokers and women over 35.
The mini pill was introduced in the 1970s and contains only progestin. It has the same success rate (98 percent with proper usage) as the actual pill, and due to the lower hormone content, has been shown to curb the side effects. If a patient forgets to take the pill for a day they are typically told to just take it the next day and the effectiveness will not be compromised.
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The mini pill, however, needs to be taken at the same time every day and if it is taken even three hours later, another method of birth control needs to be employed.
All of these pills prevent ovulation, though there seem to be no long term complications when it comes to fertility. Most women are agreeable to conceive within a year after going off of birth control.
Nuva ring is an insertable hormone delivery method that is available through prescription. It’s convenient because, once in place in the vagina, it releases hormones for three weeks after which it is removed. Time is once again an issue, however, and if it is removed for more than three hours, another form of birth control should be used.
Ortho Evra is a patch delivery system which releases estrogen and progestin into the bloodstream. The FDA recently has placed a new warning on the packaging saying women who use this may be at an increased risk for developing blood clots in the legs or lungs. The patch is thought to be more convenient because it only has to be applied once a week. But it contains substantially more hormones than a daily birth control pill, potentially increasing the severity of side effects of taking these hormones.
Depo Provera is an injectable form of birth control that prevents ovulation, but is more effective than the pill and considered equal to surgical intervention to prevent pregnancy. It is given once every three months by a physician. Though it has a high success rate, it also increases the rate of calcium loss from the bones and should not be used for longer than two years.
A new form of birth control that was just recently approved by the FDA is called Implanon. A synthetic fiber rod about the size of a matchstick is surgically inserted into the arm in an in office procedure and remains in place releasing a low dose of progestin for 3 years. It has been in use in more than 30 countries since 1998 and the success rate translates to less than one pregnancy per 100 women per year. It will be widely available in 2007.
There is a world of options and though options generate confusion they also allow for finding the perfect fit. The Women’s Center, the Health Center and even your own physician will be more than willing to accommodate any questions and concerns.
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