New methods of contraception mean women must weigh choices

Puzzled by the onslaught of advertising that touts pregnancy prevention along with bonuses like clearer skin and a period-free lifestyle, Jennifer Meyer balked at a birth control pill that would reduce her monthly cycles to just four per year.

"It's just not something we should stop," says Meyer, a 33-year-old graduate student at Wayne State University. She's using a traditional pill because she says it's convenient, inexpensive and feels like the more natural choice. But she has also thought about whether an intrauterine device, or IUD, might be worth trying.

Meyer is like thousands of women bombarded -- and sometimes confused -- by commercials, billboards and Internet and radio ads touting new ways to prevent pregnancies.

Companies marketing prescription birth control methods like Seasonique, the multi-month pill; Mirena, an IUD, and others spent $188 million on advertising in 2008, according to a report from the New York-based Nielsen Co., which does market research. That's an increase of about $40 million over spending in 2007. In these ads, drug companies offer "birth control plus" -- better skin, fewer cramps, a period-free vacation or a reduction of premenstrual syndrome symptoms, the personality and physical changes that may occur in some women just before their period begins, says Andrea Tone, a professor of the social history of medicine at McGill University in Montreal.

"It's pregnancy prevention and a whole new way of life," says Tone. Dr. Brent Davidson, chief of women's health services at Henry Ford West Bloomfield Hospital, says he routinely fields questions from women trying to wade through the choices to pick the best option. He weighs a woman's health history -- some estrogen-like pills can exacerbate chronic illnesses like high blood pressure -- her insurance coverage and family planning goals when making a recommendation. "The key is we have choice -- many more than our parents' generation -- and safe choices," says Davidson, who also is the Michigan Department of Community Health medical director for contraception.

Most forms of birth control are effective if used exactly as directed. Davidson says the fail rate is 1 percent to 2 percent, but most methods do not prevent transmission of HIV, the herpes virus or the cervical cancer-causing human papilloma virus. The chart, right, outlines many of the birth control measures women can consider:

MONTHLY PILLS

Pills offer varying concentrations of estrogen-like and progesterone-like compounds. The most common are taken on a 28-day cycle, with three weeks of hormones and one week of placebo, during which a period happens.

The pill needs to be taken at the same time every day for maximum effectiveness.

Hormones in the pill signal the body to reduce levels of natural estrogen and progesterone, which are responsible for ovulation. Hormonal control is also linked to reduced acne, a selling point for pharmaceutical companies.

Examples include brands such as Yaz and Mircette, Ortho tri-cyclen and Ortho Novum. Cost: Up to $24 for a one-month prescription.

Side effects, says Davidson, include risk of heart attack, stroke, blood clots, nausea and high blood pressure. Some users also report tender breasts, spotting between periods and mood changes. Few long-term health problems are associated with the pill, but some estrogen pills can exacerbate chronic conditions such as diabetes and high blood pressure.

MULTI-MONTH PILLS

Seasonique is similar to monthly birth control pills in that users take one pill a day, but instead of the placebo pills once a month, there is a single week of low-dose hormone during the 12th week, so users have only four periods a year. Another long-term pill is Lybrel, which users take every day to suppress ovulation, and have no periods at all. Both cost $170 for a three-month supply.

VAGINAL INSERT

NuvaRing is a flexible plastic ring that is vaginally inserted once a month. It releases a low dose of hormones directly into the reproductive tract, rather than through the bloodstream, like pills. Users take the ring out after three weeks to induce a period.

It's a popular choice among women who have nausea problems with pills, says Davidson. Cost: Up to $50.

The side effects are similar to the pill, but also include the possibility of vaginal infections and increased secretions.

SHOTS

Depo-Provera is a progestin shot given once every three months, so there's no need to remember to take a pill. Its slow release of progestin suppresses ovulation, and Davidson says about two-thirds of women stop having periods altogether.

Long-term use of Depo-Provera has been linked to calcium loss, though no increased risk of osteoporosis, says Davidson, and some women gain weight. Another similar long-term birth control is Implanon, a matchstick-sized progestin implant placed in the arm that lasts for three years. Depo-Provera cost: Up to $64. Implanon cost: $400-$800.

IUDs

IUDs are progestin-containing devices implanted directly in the uterus. Mirena, a 5-year plastic insert, releases hormones slowly, which makes the female reproductive tract less friendly to sperm. A non-hormone option is ParaGard, a copper-lined IUD that can prevent pregnancy for up to 10 years. Cost: $400 to $665.

"It's the same effect as permanent sterilization," says Davidson, "but reversible."

STERILIZATION

Most sterilization procedures permanently prevent natural pregnancy, although in-vitro fertilization might still be an option, says Davidson. Essure is a form of permanent sterilization that does not require surgery. Instead, a flexible rod is inserted through the vagina into the uterus and fallopian tubes. Tissue grows over the rod in the fallopian tubes over three months, ceasing ovulation.

Tubal ligation, "getting your tubes tied," is a surgical procedure whereby the fallopian tubes are sealed or removed. Occasionally, the tubes regrow. Some women complain of cramps and discharge from this procedure and, as with any surgery, death is a rare possibility. Cost: $1,000 and higher.

DIAPHRAGM/FEMALE CONDOMS

Diaphragms are flexible rubber domes that cover the cervix and are often used with spermicides to prevent fertilization. They are fitted by doctors, inserted before sex and can be reused. Some women say they don't stay in place, and the possibility of bladder infections exists. Cost: $25 and less for the diaphragm and up to $112 for the fitting.

Female condoms, available over the counter, are similar to male condoms, but fit inside the vagina and, unlike other forms of birth control, can prevent the spread of STDs. Cost: $1 each.

NATURAL FAMILY PLANNING

Natural methods of family planning take advantage of ovulation cycles to prevent pregnancy. Planning intercourse around ovulation prevents sperm from reaching the egg. It requires women to track their cycles, and can use temperature, cervical mucus changes or a calendar to do so.

(NOTE: Prices come from Planned Parenthood Mid and South Michigan, which offers contraception on a sliding scale, but not sterilization. Pharmacies and other clinics may have different prices)

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