By J. M. Anderson, M.D. published in Style Magazine March 2004

Today’s premenopausal woman is finding options of contraception very different from that of twenty years ago.  Older methods are being refined to minimize adverse side effects and provide better rates of pregnancy prevention.  In addition to the patch, progesterone containing IUD, and extended OCP use, all of which are discussed below, there are other relatively new methods that many women are not aware of:  1. the vaginal ring, 2., an implantable rod similar to the old Norplant which is pending approval from the FDA, and 3.,  the emergency contraception pills.  I encourage women to ask themselves why they are using their current method and if they are aware of the alternatives. 

The contraceptive patch is an alternative for women who find taking an oral contraceptive pill (OCP) every day difficult to remember.  The patient is required to apply the patch and leave in place for one week, then replace it with a new one for three of the four weeks in a given cycle.  The method of action is the same as that of OCP’s, hormonal suppression of ovulation. Side effects profile is essentially the same as those of the birth control pill but additionally include some local skin irritation in some patients.  Irregular spotting, bleeding is common (as is with the pill) for the first 3 months.  The same contraindications for OCP’s exist for the patch.   

The intrauterine device (IUD) is a very effective method of contraception that prevents pregnancy rates similar to that of surgical sterilization (tubal ligation).  The failure rate of both is under 1%.  The advantage of the classic IUD is that it is a low maintenance form of birth control which relieves the woman of having to remember to take a pill or replace a patch.  Additionally, the IUD is reversible and each device can be used for five years before needing replacement.  In the U.S.,  this highly effective method is only used by 1% of the women seeking a contraceptive method.  However, the IUD is the most commonly used, and most reliable method, in Europe and Japan accounting for its use in 15 to 25% of women using contraception.  A common misconception is that an IUD acts as an abortifacient which could explain why it is so underutilized in this country.  New on the market is a progesterone containing IUD which has been shown to greatly reduce the amount of menstrual blood loss to a few days of spotting, with less cramping, at one year from placement of the device.  This modern day IUD has an efficacy of more than 99.5%, minimal side effects, is low maintenance, and is allows for fertility to be preserved on removal.    

More and more women are finding out and inquiring about continuous or extended oral contraceptive pill use which results in having fewer periods than the conventional monthly schedule.  Depending on how prescribed, women essentially are in control of when they will experience their period, about once every three to four months.  It is also reasonable for some patients to omit periods altogether by following a continued pill regimen outlined by their gynecologist.  The contraceptive benefit is equal to that of a monthly regimen but extended cycles also can provide convenience of timed periods with less menstrual related problems (i.e. headaches and cramps).  Contrary to what most women believe, a period is not a mandatory part of hormonal contraception and neither is it unhealthy to prevent periods with extended use of OCPs. 

For more specific information on these and other forms of contraception, please contact your physician.  Each form discussed above has indications and contraindications to its use therefore it is important that each woman and her health care provider discuss her medical history before deciding on the most appropriate method.