Contraceptive Confusion
There's a slew of new birth control methods to choose from. The best for you? It's the one you'll use correctly
For most people, the pill is considered extremely safe. The wide variety of hormone combinations available can help women minimize the headaches, nausea, and mood changes that often put them off the pill. But beware of paying more money for a new version that may not work any better for you, says Rebekah Gee, an obstetrician-gynecologist and a fellow at the University of Pennsylvania. (She recommends generic versions, in fact.) Smokers over age 35 and women who have had strokes should not take any pill that contains estrogen, nor should women who suffer migraines, especially if the migraines are accompanied by visual disturbances.
The latest trend--"continuous contraception"--doesn't address the compliance problem but dangles a vacation from menstrual periods. Rather than taking contraceptive pills for three weeks and then switching to dummy pills for a week, as women on traditional pills do, people on Duramed Pharmaceuticals' Seasonale, for example, take active pills every day for three months, then take dummy pills for a week, for a total of just four periods a year. In May, the FDA approved Duramed's Seasonique, which does the same thing with a slightly different formulation. "I love the idea of it," says Margaret Littman, a journalist in Chicago who switched to Seasonale last year after 18 years on the traditional pill. "But I was skeptical. There's something about it that seems it shouldn't be good for you."
Doctors say that really isn't an issue. "If Mother Nature had intended for women to have a certain number of periods, it would probably be far fewer than what most western women experience," says Mark Nichols, professor of obstetrics and gynecology at Oregon Health and Science University in Portland, Ore. Women stop menstruating when they're pregnant or breast-feeding, so someone using no contraception might not have periods for 20 years or more, if she has six or seven children and breast-feeds them all. Someone preventing pregnancy completely, on the other hand, might have periods for 40-plus years. And when women take the pill continuously, their uterine lining doesn't thicken as much and need to be shed every month.
But continuous contraception doesn't work flawlessly for everyone. Littman has had "all sorts of spotting," and, after 16 months on Seasonale, she isn't sure she'll stick with it. In fact, most women taking Seasonale experience spotting or unpredictable "breakthrough" bleeding during the first year. Even later, the total number of bleeding days about equals what women experience on a traditional pill.
Researchers are undeterred. Wyeth Pharmaceuticals' Lybrel, now nearing approval, will be taken 365 days a year straight. In clinical trials, many women found they had no bleeding at all after a year.
The vaginal ring. As effective as the pill if used properly, the NuvaRing, approved by the FDA in 2001, is a soft, flexible polymer plastic ring that releases daily doses of estrogen and progestin. Women remove it after three weeks, then insert a new one seven days later. The device, which costs $30 to $35, has been a particular hit among teens. "It's out of sight, so Mom won't find the birth control pills in the purse," says Nichols.
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