Contraception: What's New?

Last Editorial Review: 10/1/2004

WebMD Live Events Transcript

There are a wide variety of contraception choices out there, and more are on the horizon. What method is best for you, and what are the advantages and risks of each form of birth control? Mary Jane Minkin, MD, co-author of The Yale Guide to Women's Reproductive Health, joined us on May 19 to sort through the options.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

MODERATOR: Welcome back to WebMD Live, Dr. Minkin. What's new in the world of contraception?

MINKIN: Well, there is a lot new in the world of contraception. There are many new hormonal-type contraceptives. For example, a pill that was introduced in this country about two to three years ago, a pill called Yasmin. This is a pill that actually has a new kind of progestin in it, which tends not to make women bloat, or get irritable. They tend to like it. People who have not done well on other pills often times will do well with this pill.

There are also new contraceptive patches for women who like the concept of birth control pills but who don't like pills or who forget to take them. This is the Ortho Evra patch, and this works well for many women.

There is also a new contraceptive ring out there called the NuvaRing. This is a little ring that you can place in the vagina basically once a month. You put it in; it stays there for three weeks, you take it out, get your period, then you put in a new ring for the next month.

These are all hormonal and reasonably new methods and they work very well for many women.

There is also a new method to this country, an intrauterine system called Mirena. This has been used in Europe for many years. It's basically like a progesterone-coated IUD that protects against pregnancy for five years. What's nice is that it in general makes your periods much nicer, whereas the old IUDs often times made periods nastier. So the new Mirena system is often a good thing for people who have nasty periods. These are probably the newest things on the contraceptive horizon here.

MEMBER QUESTION: I am the mother of a 16-year-old who has had menses since she was 12-years-old. Are there any negatives due to age for taking Seasonale or skipping the sugar pills of regular birth control pills? She has been on Yasmin for 1.5 years now. We have done this periodically in the past due to vacations, etc. and there was such relief for her and I in her not having to deal with monthly PMS issues!

MINKIN: One of the advances that I should have mentioned in the last question is the concept of continued use of birth control pills without skipping a week off every month. In other words, just taking active pills continuously. This is indeed what the new pill Seasonale does.

Basically you take hormone pills for 84 days and then you're off for seven, and get your period. With this regimen, you get your period four times a year. It's totally safe and you can actually do this with other pills. It's just that Seasonale is marketed this way, which is fine. Many people do prefer four periods a year instead of 12 or 13.

"If you're a smoker, you should be off the pill by the time you're 35. But then I would recommend stopping smoking, not stopping the pill. Birth control pills are much healthier for you than cigarettes."

MEMBER QUESTION: Is there a time frame that a woman should be on the pill? I heard that 10 years is the maximum.

MINKIN: Basically there is no upper limit to staying with birth control pills. The most important thing is if you're not a smoker. If you're a smoker, you should be off the pill by the time you're 35. But then I would recommend stopping smoking, not stopping the pill. Birth control pills are much healthier for you than cigarettes. As long as one is not a smoker and has normal blood pressure and is doing well with the pill, you can stay on it. There is no time limit.

MEMBER QUESTION: Are generic forms of oral contraceptives as reliable as the brand names? I have been advised not to use the generic version of the birth control pill I currently take (Ortho Tri-Cyclen).

MINKIN: To be honest, the generic versions are fine. They should be equally effective as far as preventing pregnancy. What you do find with generics is slightly more variation from pill to pill, as far as exact amount of hormone, but not enough to have an affect on the effectiveness of the pill. However, if you are very sensitive to the amount of hormone in the pill, you may notice a difference between generic and brand name.

MEMBER QUESTION: I took emergency contraception and five days later had heavy bleeding for two full days. Does this count as a period because I want to start my regular prescription for birth control and am confused where I am in my cycle.

MINKIN: It probably is your period, and I would go ahead and start the birth control pill. What I would recommend is to use backup contraception (i.e., use a condom as backup) for the first cycle, to be safe.

MEMBER QUESTION: What do you think about Seasonale? Does it help to relieve symptoms of endometriosis?

MINKIN: Yes, Seasonale is an excellent pill, and the concept of getting four periods a year is fine. Indeed, for many years, when birth control pills were the mainstay of endometriosis therapy, we would actually recommend that the patient go for six months without a period. So yes, indeed, Seasonale usually does help for endometriosis patients.

MEMBER QUESTION: Can you discuss alternatives to latex condoms for those allergic? What is the effectiveness of lambskin and polyeurethane condoms?

MINKIN: Another excellent question, and the answer is not really known for sure. They certainly afford some protection and are definitely better than using nothing. But I would certainly recommend that the couple also use a contraceptive cream or gel with these because they are not as effective as latex. But certainly they're better than not using a condom at all.

MEMBER QUESTION: Would you recommend Yasmin or Ortho Tri-Cyclen Lo? I have a tendency to gain weight easily, and would like to take the pill least likely to do that.

MINKIN: I think that Ortho Tri-Cyclen Lo is an excellent pill. However, the progestin in Ortho Tri-Cyclen or Ortho Tri-Cyclen Lo does not have diuretic properties like the Yasmin. So I would think that you'd probably do better with the Yasmin. But it's also perfectly fine to try a month or two of each pill and compare, and it is totally safe to switch from one pill brand to another at the end of a cycle.

"The pill, if taken faithfully, is 99% plus effective for contraception, so why bother going through sterilization if you like the pill?"

MEMBER QUESTION: I've been on the pill since age 18, now, five years later, would like something permanent, but still retain the benefit of period skipping. Essure seems to be the least invasive method. An ablation would also be requested. If both of these were done, could I still stay on the pill just because I like it? Clear skin, hormone balance, no periods, further contraceptive value, an old habit required me to ask. Thank you!

MINKIN: I'm not sure that I understand the question completely. For example, if somebody wanted to stay on the pill because she liked it, that's fine. But why go through any of the other procedures?

The pill, if taken faithfully, is 99% plus effective for contraception, so why bother going through sterilization if you like the pill? And as long as the pill keeps your periods nice, why bother going through an ablation procedure? Most pill periods are really OK. So I certainly have many patients who use the pill for cycle control who aren't relying on it for contraception and they feel well with it.

The Essure method of sterilization is fairly new and what this is for readers who aren't familiar with it, is contraception into the fallopian tubes, basically plugging off the fallopian tubes, but done through the uterus and the vagina, not through the belly. Unfortunately, it has a higher failure rate than the traditional tubal ligation. Actually statistically, you're better taking the birth control pill than relying on the Essure method of sterilization.

MEMBER QUESTION: I had a tubal ligation 14 years ago and now would like to get the Depo-Provera injection to regulate my period, so I wouldn't have it in the month of July for my 20 th anniversary/vacation, is this possible and what are there side effects? I do not smoke nor am I overweight; is there a certain time of the month to get the injection?

MINKIN: Depo-Provera is a very good method of contraception. We usually give the injection about the second day of a period. However, many women will get spotting and staining, particularly the first month they are using the shot. So in general, if somebody wants to specifically delay one period, I would tend to put her on birth control pills the cycle before and regulate her period by taking continuous birth control pills, sort of in the Seasonale method, until her event is over and then stop taking her pills and let her get her period. My only concern with the Depo-Provera is she might get considerable spotting or staining when she would like to be free of bleeding.

MEMBER QUESTION: I went off the pill last month and my husband and I have been trying to conceive. Now my period is late and I'm not sure if it's just because my body's adjusting or because I'm actually -- hopefully -- pregnant. How can I find out soon?

MINKIN: Indeed, sometimes after stopping birth control pills cycles can be a little wacky. So it is possible you're just late, not pregnant.

One thing that I would like to make sure of is that if you are trying for pregnancy that you are taking some folic acid while trying to conceive. If you want to use a home pregnancy test, that's just fine.

There are some very sensitive tests available. For example, the First Response test actually will turn positive several days before the missed menstrual period. So it's fine to try something like that to get some information. But don't be disappointed if you're not pregnant. Keep having fun and trying.

MEMBER QUESTION: I was taking birth control pill for about one year and I was not gaining weight, but I quit and I noticed that the past few months I am gaining weight. Why is that?

MINKIN: Unfortunately, all of us tend to gain weight over time if you look at general statistics for adults. I encourage everyone to eat a good, healthy diet and get lots of regular exercise. If you seem to be gaining more weight than you think you should by your eating and exercise patterns, I would talk to your health care provider about checking some thyroid function tests because thyroid dysfunction can lead to unexplained weight gain.

MEMBER QUESTION: Is there any future effect of only having four periods a year with the method you mentioned earlier? Does it change onset of menopause or lower your eggs' quality if you decide to conceive later?

MINKIN: No, it does seem to have any long-term adverse effects. It does not either push up or delay menopause, so it does not have an effect on total eggs remaining. As far as pregnancies afterwards, it does not seem to have any adverse effects there. I think it's quite reasonable for someone who wants to have kids in the future to use it quite safely.

MEMBER QUESTION: Has anything changed over the years in regards to breast cancer and the pill? My mother had breast cancer and I have been on and off the pill for about 12 years.

MINKIN: There actually really is no data linking birth control usage to breast cancer. I know there's a lot of anxiety out there, but there really is no data saying using birth control pills increases the risk of breast cancer. Indeed, there is some data to show that birth control pills actually lower the risk of ovarian cancer and uterine cancer, which is, obviously, a good thing.

"I know there's a lot of anxiety out there, but there really is no data saying using birth control pills increases the risk of breast cancer."

MEMBER QUESTION: Is Norplant still around? Is it a viable option for those who have trouble remembering to take the pill?

MINKIN: The answer is, unfortunately, Norplant is not around. It was an excellent form of contraception you didn't have to think about. The good news is there is a newer version coming out. I believe it may be available in Europe, but it's supposed to be coming to this country soon. This is a single rod, sort of like one little matchstick that goes under the skin, where Norplant was six little rods. I can't say when it's coming, but it is supposed to be soon.

In the meanwhile, what I would suggest for people who like the Norplant concept, that either an every three-month injection of Depo-Provera, or something like the Mirena intrauterine system, which lasts for five years, is a reasonable alternative.

MEMBER QUESTION: I know you must hear this a lot, but do you think women will always be the one's responsible for this stuff? Will there ever be "equal rights" in the birth control field?

MINKIN: The answer is, I'm a realist and it certainly won't be in my lifetime, I don't think. Guys make a lot more sperm than we make eggs. So it's harder to stop the sperm production than to limit the egg production.

The other issue I think has some political connotations, and that's the fact that since we carry the baby, and then raise the baby, we are going to always be the ones ultimately responsible for keeping ourselves from getting pregnant.

MODERATOR: We are almost out of time, Dr. Minkin. Do you have any final words on contraception choices for us?

MINKIN: Contraception is very important. However, we need to always consider, when involved in sexual activity, both contraception and infection protection. I would be remiss in not reminding everyone that in any sexual encounter, presuming we don't want to become pregnant, we need to protect ourselves against pregnancy and protect ourselves from infectious diseases. We see way too many younger and older women with sexually transmitted diseases that could have been prevented by barrier method use, as well as using birth control pills or IUDs to prevent pregnancy. These are problems that can continue to haunt us our entire lives. So infection protection is something we should all be thinking about, as well as contraception.

The other thing that I would like to mention is that although we tend to think of women in the perimenopausal range as having diminished fertility, perimenopausal women still have some fertility. I have personally delivered three 47-year-olds who thought they were perimenopausal. So I just would like to remind our participants that if you're still having some periods, you're still at risk for pregnancy. One of the other good uses of low dose birth control pills is management of perimenopausal women with symptoms who are at risk for pregnancy.

Again, we alluded to this before, but if you are sexually active and not using contraception, you should be taking a vitamin pill with folic acid. Because if you are not using contraception, you are at risk for pregnancy, and we certainly have good data that shows that babies who are conceived when mom is taking folic acid, do better. So either you should be using contraception or be on folic acid.

Half of the pregnancies conceived in the U.S. every year are unplanned. We actually do worse than any other developed country in the world, as far as unplanned pregnancies.

MODERATOR: We are out of time. Thanks to Mary Jane Minkin, MD, for sharing her expertise with us today. For more information please read her book, The Yale Guide to Women's Reproductive Health . And also be sure to visit our message boards to talk with others and ask questions of our in-house experts. You'll be welcomed warmly!

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