The Pill Has Company: The Patch, The Ring, The Shot
It seems like such a simple task. Yet for many women, including Andrea Tangas, a 33-year-old travel agent from Chicago, remembering to take a birth control pill at the same time every day can be a challenge. Leading busy lives and having no symptoms to serve as a reminder, about 16 percent of oral contraceptive users miss two or more pills in any three months. For eight years, Tangas tried to be diligent, but "occasionally I'd miss a day or a few days and then suddenly I would have my period when I wasn't supposed to," she says.
Tangas's hit-and-miss record ended three years ago when she enrolled in a clinical trial of a once-a-month contraceptive injection. The product, called Lunelle, received approval from the Food and Drug Administration last fall. "I love it," Tangas says. "I only have to think about birth control once a month."
Lunelle is part of a new wave of contraceptives, just on the market or awaiting approval, that don't require daily vigilance. "After 10 to 15 years with very little that was new," says David Grimes, an expert on contraception at the University of North Carolina-Chapel Hill School of Medicine, "suddenly we are seeing a burst of new products." Featured at a contraceptive-technology meeting in Washington, D.C., earlier this month, they include an intrauterine device, a skin patch, and a vaginal ring. All are vehicles for the same pregnancy-fighting hormones found in the pill, and they are at least as effective--but they also may not eliminate the pill's occasional side effects, such as weight gain, nausea, and headaches.
Injectable contraceptives are not new; one called Depo-Provera has been on the market since 1992. But Depo-Provera, which contains the hormone progestin, can cause irregular bleeding, Grimes says, adding that it can take up to 18 months for a woman to regain her fertility after using it. Lunelle, made by Pharmacia Corp. in Peapack, N.J., combines estrogen with the progestin and has fewer side effects, researchers say. "The woman gets the shot during the first five days of the cycle," says Anita Nelson, an OB-GYN at the University of California-Los Angeles School of Medicine. "Then three weeks later, she has her period." Fertility returns in two to four months after a woman gets her last shot. At $30 to $35 an injection, Lunelle costs slightly more than a monthly pack of pills, but health plans that pay for contraception will generally cover it.
For those who cringe at the thought of a monthly trip to the doctor's office for a shot, there's Mirena, marketed by Berlex Laboratories in Montville, N.J. It slowly releases progestin directly to the uterus from a T-shaped intrauterine device. Mirena works for up to five years, but users face what Felicia Stewart, codirector of the Center for Reproductive Health Research and Policy at the University of California-San Francisco, calls an "initial shakedown phase": three to six months of unpredictable, sometimes heavy menstrual bleeding. Women can expect to pay between $500 and $600 for the device, insertion, and follow-up by a physician; plans that cover hormonal contraception are likely to help pay the costs.
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