Devices & Technology

Advances in Birth Control

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By Jennifer Larson, NurseZone feature writer 

We’ve come a long way since Margaret Sanger opened the first birth control clinic in the United States in 1916. The Brooklyn clinic was raided and closed shortly after it opened, but it didn’t deter Sanger, a nurse who was concerned with women’s health issues, from continuing her pursuit to ensure access to birth control for all women.

Today, women have many choices when it comes to choosing a contraceptive method, according to Pat Dougherty, MSN, a nurse midwife and spokeswoman for the Association of Women’s Health, Obstetric and Neonatal Nurses. It’s not just all about the Pill anymore.

The Pill is still a very popular method of contraception. The Pill is a combined hormone method of contraceptive, meaning that it uses a combination of hormones similar to a woman’s own hormones to prevent ovulation or conception. According to Planned Parenthood, it is one of the most effective contraceptive methods, with a failure rate of less than one percent with perfect use.

But the Pill has changed since it was first introduced in the United States in 1960.

The first commercially available version was called Enovid-10.

“The first oral contraceptives contained 100 micrograms to 175 micrograms of estrogen and as much as 10 milligrams of progestin—significantly higher levels of both hormones than in today's pill,” wrote Sharon Snider in a historical account published in FDA Consumer magazine.

The Pill was a great commercial success; approximately 5 million women were taking it within five years.

Almost every year, a new version of the birth control pill is released. Women can choose from a long list of oral contraceptive pills, including well-advertised brands like Ortho-TriCyclen and Yasmin.

The newest version of the Pill is expected to hit the market next month. Seasonale will allow women to take 84 active pills in a row before taking seven days off, thus reducing a woman’s number of yearly periods to four.

Dougherty noted that many health care providers already recommend that women skip the placebo week of pills included in pill packs if they want to deliberately miss a period. Seasonale may give this process, often call bi- or tri-cycling, depending on how many placebo weeks are skipped, even more legitimacy.

New combined hormone methods that were introduced in recent years include Lunelle, a monthly injection of hormones; Nuvaring, a small, flexible ring that releases hormones when inserted deep into the vagina and Ortho Evra, a birth control patch that works similarly to the nicotine patch. However, Lunelle is no longer commercially available in the U.S.; it was withdrawn from the market in 2002 by its manufacturer.

Ortho Evra hit the market in November 2001. It is the first and only transdermal patch that has received FDA approval as a contraceptive device. The small, three-layered patch releases progestin and estrogen hormones in the form of norelgestromin and ethinyl estradiol into the blood stream.

Introduced commercially in 2002, NuvaRing remains in place for three weeks after insertion. It also delivers a steady dose of hormones.

“They’re both ultra low dose methods, which is great,” Dougherty said of the patch and ring. “We’re finding we can use lower and lower doses [of hormones] and still give women symptom control…and offer many of the same benefits as the higher dose methods.”

The ring is much smaller than a diaphragm, a non-hormone, barrier method of contraception.

“The drawback to it is that it has what we call the yuck factor,” Dougherty said. “But once they try it, people love it. Most people say they can’t feel it.”

Dougherty said she gets a number of requests for the patch and other newer contraceptive devices in her practice at the Midlife Health center at the University of Virginia. Many women are interested in trying a new birth control method, especially if they’ve had trouble adjusting to a different kind of contraception in the past. The devices also have a failure rate similar to that of the Pill.

Dougherty noted that women in many other countries rely on an intrauterine device, or IUD, for contraception but that few American women choose this method. The IUD is the number one contraceptive device in the rest of the world, but less than one percent of American women who use birth control choose an IUD.

The most recent addition to the list of available IUDs is called Mirena. It is designed to release progesterone for five years to prevent conception. The new IUD also reduces the heavy menstrual flow associated with older versions of this type of device. That can be a boon for women who suffer from anemia, Dougherty noted.

New non-hormonal contraceptive devices are also available.

The latest addition is the FemCap, a small cap that fits over the cervix and blocks sperm from entering the uterus. Developed by a physician at Scripps Memorial Hospital Chula Vista in California, the silicone-rubber FemCap received approval from the Food and Drug Administration earlier this year.

But the birth control method that received the most press recently is the Today Sponge. Removed from the shelves in 1995, the popular Today Sponge became commercially available again in March 2003.

The product, which gained fame thanks to a “Seinfeld” episode, was removed from the market when problems with the manufacturing plant were discovered. The Food and Drug Administration noted that there were never any problems with the device itself, a barrier that fits over the cervix and blocks sperm.  

© 2003. AMN Healthcare, Inc. All Rights Reserved.

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