After half a century of use, the birth control pill is among the most popular methods of contraception in the United States. The formulation has changed over the years, significantly decreasing hormones and increasing safety. There are more than 40 brands on the market today. • After centuries of very few contraceptive options, the pill has given rise to a host of birth control medications and devices, some designed to cope with the pill's major drawback: You have to remember to take it. • Here are some of the most popular reversible birth control pills and devices. The hormone-based products are very effective contraceptives (with a 1 to 5 percent expected failure rate according to the FDA):
• IUDs, which are inserted by physicians, are back in favor and top the list of long-lasting alternatives to birth control pills.
In the 1970s, IUDs got a bad name when the Dalkon Shield was linked with pelvic inflammatory disease and infertility. Today's devices are much safer. "They are getting very popular with older women, those over 35, who are married or in a monogamous relationship, maybe they have started a family and aren't sure if they want more kids, it's a good option," said Dr. Madelyn Butler, an ob/gyn with the Women's Group in Tampa. One brand, the hormone-based Mirena, lasts up to five years, while the copper ParaGard can remain in place to prevent pregnancy for up to 12 years.
• Implants, such as the Implanon, a tiny rod injected under the skin usually in the underside of the upper arm, prevent pregnancy for up to three years. "It's a great form of long-lasting birth control," says Dr. Joan McCarthy of South Tampa Gynecology. "But people don't seem to know about it." Its predecessor, the Norplant, had to be withdrawn from the U.S. market in 2002 due to scarring that made the rods difficult to remove. "We have to take a special course now just to be sure doctors know how to put them in and take them out," says McCarthy. Butler adds that she only recommends Implanon for thin women because it can cause weight gain of 5 pounds or more per year.
• One of the newer devices is the NuvaRing, a flexible disc that a woman inserts into her vagina once a month. It delivers a continuous low dose of hormones that prevents ovulation for three weeks. After three weeks, it is removed for a week so the woman can have a menstrual period and a new one is inserted. NuvaRing, used correctly, is as effective as the pill in preventing pregnancy. "Women either love 'em or hate 'em,'' McCarthy said, "because they have to be inserted vaginally. It's good for women who like the way the pill works, but can't remember to take it every day."
• Another hormone-based device, the Ortho Evra patch, is worn and replaced each week, for three weeks. A woman has her period during one patch-free week a month.
• Newer forms of birth control pills now prevent ovulation continuously, allowing women to have as few as four menstrual periods a year (Seasonique) or no periods at all (Lybrel) for a year.
• An older form of hormonal birth control that lasts for three months is the Depo-Provera injection. It has a low failure rate (3 in 1,000 women) but requires a trip to the doctor every 11 to 13 weeks for followup injections.
Due to the risk of blood clots, hormonal birth control is not recommended for women who smoke, especially those over age 35 — "Not even one cigarette," says Dr. Butler — and those who have a history of heart disease, cancer or blood clots.
• Condoms for men (the only method considered effective at preventing STDs), female condoms (a pouch inserted in the vagina before sex) and the sponge, vaginal cup and the diaphragm all work by blocking sperm from entering the cervix.
Accidental pregnancy rates range from 15 to 30 per 100 couples in a year with barrier methods, if they're used consistently.
• Natural family planning, the so-called rhythm method, if used faithfully has a failure rate of 25 percent, according to the FDA.
• Least effective of all birth control methods? "Hope," says Dr. McCarthy. "That and withdrawal are the worst things you can do if you don't want to become pregnant."
Irene Maher can be reached at firstname.lastname@example.org or (813) 226-3416.