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.
On the horizon. By the end of this year, women may have the option of getting their birth control from a simple skin patch--if the FDA approves it. Ortho Evra, from Ortho-McNeil Pharmaceutical in Raritan, N.J., packs a week's worth of estrogen and progestin. Designed to resist moisture, the patch caused minor skin irritation in some women during trials, says Colleen Brady of Ortho-McNeil. Also under review is NuvaRing, a flexible vaginal ring made by Organon of West Orange, N.J., that a woman inserts after her period and removes three weeks later, just before her next period. It fits near the cervix and secretes estrogen and progestin.
Organon will soon submit yet another device for review: a rod-shaped implant called Implanon that is inserted under the skin in the arm. Implanon is reminiscent of Norplant, a six-rod implant that hit the market 10 years ago. Norplant users complained of problems including scarring at the insertion site, and some doctors found the rods hard to remove. Implanon's single rod should make it easier to insert and remove, its developers say.
While all these contraceptives were over 99 percent effective in preventing pregnancy during clinical trials, none will protect women from sexually transmitted diseases, a concern that Grimes calls "the coffeepot conundrum." At a meeting last fall, he asked, "If my coffeepot makes a great cup of coffee, but it can't receive faxes, should I consider this a defect?" It got a hearty laugh, but it also made a point. Contraception never promised to do more than prevent pregnancy. Those at risk of contracting STDs need to take additional precautions.
New contraceptives
Hormonal birth control doesn't come only in a pill.
Ortho Evra. The hormone patch, still awaiting FDA approval, stands up to bathing and stays in place for a week.
Lunelle. One shot is the equivalent of a monthly pack of birth control pills.
Mirena. The hormonal IUD is smaller and more flexible than past copper IUDs.
This story appears in the April 2, 2001 print edition of U.S. News & World Report.