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
Because the NuvaRing uses both estrogen and progestin, it carries the same risks as the pill; however, a lower level of hormones is absorbed into the blood. One drawback: The ring can slip out. But as long as you replace it within three hours, it still works.
The patch. You wear the Ortha Evra skin-colored patch on your stomach, back, arm, or buttocks for three weeks, changing it weekly, while it doses you with estrogen and progestin. It comes off for a week and then is replaced with a new patch. Assuming you never forget to replace it, the patch is 99 percent effective. It costs $30 to $40 a month. In 2005, the FDA required the manufacturer to warn on the label that women are exposed to 60 percent more estrogen than with most forms of the pill--though it's not clear that the extra estrogen poses extra risk.
The shot. Depo Provera injections, which contain progestin only, are given by your doctor every three months. The shots cost $30 to $75 per injection and are slightly more effective than the pill. But the injected hormones can lead to a temporary thinning of the bones, so most women are advised to use the method for no longer than two years. It can also cause heavy bleeding and irregular spotting. And it's not a good choice if you want to become pregnant right after you go off birth control: Because the hormones build up in your system, you may find it takes a year to get pregnant after stopping the injections.
The IUD. Yes, the intrauterine device is back (box). "We're seeing a lot more women asking for IUDs," says Philip Darney, chief of obstetrics, gynecology, and reproductive sciences at San Francisco General Hospital. "I think we're overcoming the undeservedly bad reputation in the U.S." Typically, the devices run $175 to $500, including insertion by a doctor; about 40 percent of employer plans cover them.
Barrier methods. Not a great choice for someone who lacks discipline. Like the diaphragm, the over-the-counter Today sponge and two new prescription methods--Lea's Shield and FemCap--work with spermicide and are inserted to cover the cervix and prevent sperm from passing. "I don't recommend barrier methods unless a patient is married and would be fine having a baby," says Gee. "They're only 80 to 90 percent effective." And unlike condoms, women's barrier methods offer no protection against the spread of sexually transmitted disease.
Implants. Remember Norplant? The implant--six matchstick-size plastic rods that were inserted under the skin of the upper arm and released progestin--disappeared from the market in 2002 after the effectiveness of one batch was called into question. In mid-July, the FDA approved the next generation: a single slender rod called Implanon that stays in place for up to three years. Problems can include irregular bleeding, although many women stop having their period altogether. A welcome side effect: In clinical trials, 59 percent of women who had acne when they began using Implanon said it improved or went away.
While researchers continue to look for safer, easier-to-use, more effective methods, one long-talked-about option remains conspicuously absent: a pill for men. "The concepts have been proven, but finding a sponsor to develop [them] has been difficult and slow," says Archer. His best guess about when a men's pill might hit the shelves? "Ten years."
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