Contraceptive Methods: Options, Side Effects & Effectiveness

Introduction

What type of contraceptive device would be appropriate for a woman who says she is too forgetful to be trusted to take birth control pills or use a diaphragm? This is also a woman who does not trust the so-called "rhythm method," nor does she ever want to have an abortion. What is the best advice one could give her? This paper reviews alternatives to the methods mentioned above and examines possible side effects as well as the effectiveness of each option in providing reliable protection from pregnancy. There are in fact several workable and reasonably dependable methods available, and those will be reviewed here. The conclusion of this paper will make a specific recommendation for the contraceptive device best suited to a woman who fears she may forget to take a daily pill.

Some background facts about pregnancy and contraception help set the context for the information to be presented. According to an article in The New York Times, six million women become pregnant each year in the United States (Brody, 2006). Of those six million pregnancies, about half are unplanned. Among teenage pregnancies, more than three-fourths are unexpected, and the same is true of half of the pregnancies among women approaching menopause.

Pregnancy and Contraception: Background Facts

Brody also points out that "a shocking 60 percent of the unplanned pregnancies" occur in women who were using contraception at the time, and that almost half of all unplanned pregnancies end in abortion. Why are so many women becoming pregnant each year when there is such a wide variety of contraceptive options available? Brody raises this question and attributes much of the problem to contraceptive methods that "often fail because couples are unprepared or unwilling to interrupt a moment of passion." These include condoms, diaphragms, sponges, cervical caps, and spermicidal jellies and creams — items that must be applied at the time of sexual activity and are therefore sometimes forgotten or ignored.

Rather than relying on those devices, Brody suggests that a safe and effective way to reduce the number of abortions and unwanted births is to ensure that every sexually active woman is "always protected" by a method that suits her individual health needs and circumstances.

Among the options reviewed in Brody's article are oral contraceptives, which are far safer and have fewer side effects than the original birth control pills. Information from the Mayo Clinic Proceedings cited in the article notes a dramatic reduction in the amount of estrogen used in oral contraceptives in recent years. Rather than 150 micrograms per pill, today's formulations contain only 25, 30, or 35 micrograms, substantially reducing concerns about serious health problems previously associated with older versions, such as blood clots, strokes, and masculinizing effects.

For women who have difficulty remembering to take a daily pill, there are hormonal contraception alternatives such as injections, transdermal patches, vaginal rings, implantable devices, and intrauterine devices (IUDs). The injection method, known as Depo-Provera, does work, but it is not widely recommended. Women who use these injections are known to experience altered menstrual bleeding, bone loss, and mood disorders, and once the injections are discontinued, there is a prolonged delay before fertility returns.

The contraceptive patch delivers continuous daily doses of estrogen through the skin. A woman applies a new patch each week for three weeks, then goes one week without a patch, during which time menstruation occurs. The U.S. Food and Drug Administration (FDA) warns that women using the patch receive higher doses of estrogen than those taking oral contraceptives. Because the patch must be replaced weekly, it may not be ideal for a woman who tends to be forgetful.

Hormonal and Long-Acting Contraceptive Options

Another option is the vaginal ring, which is easily inserted and remains in place for three weeks. The woman removes it after three weeks, goes one week without it, and then inserts a new ring for another three weeks.

A further option is an implantable device that prevents pregnancy by inhibiting ovulation and altering the consistency of cervical mucus. This option holds appeal for absent-minded women because it remains effective for three years — though only two years in women who are significantly overweight. Its primary side effect is the potential for prolonged irregular bleeding.

The Mirena IUD, approved by the FDA in 2000, is effective for up to five years and must be implanted and removed by a physician. According to Brody's article, the Mirena IUD is 99.7% effective, though it can produce side effects such as acne, headaches, breast tenderness, dizziness, and weight gain. Notably, the article also states that fewer than 1 percent of American women of childbearing age use IUDs.

Meanwhile, according to an article in U.S. News & World Report (Fields, 2006), a forgetful woman whose first daughter was born while she was on the pill later chose an IUD to prevent a third pregnancy after having her second child intentionally. Although Fields' article appears to contradict some figures in the Times article, she asserts that while only 2 percent of women using contraception had IUDs in 2002, the number sold nearly tripled between 2002 and 2005.

Fields describes the Mirena IUD as a T-shaped plastic device that stays inside the uterus for up to ten years, preventing pregnancy by releasing progestin or copper ions. The American College of Obstetricians and Gynecologists endorses the IUD as a safe and effective option for women at low risk for sexually transmitted diseases. Regarding its mechanism of action: doctors once believed that IUDs made the lining of the uterus inhospitable to fertilized eggs — a view that some people equated with abortion. Today, however, many doctors and medical researchers believe that IUDs primarily prevent fertilization. The copper in the Mirena IUD creates a uterine environment that is toxic to sperm and also slows or damages eggs.

Conclusion and Recommendation

Fields, Helen. "Perhaps a 10-year Solution?" U.S. News & World Report 141.5 (August 2006): p. 66. Retrieved from Thompson Gale, Document #A148869827.

MacRae, Fiona. "One in five women using longer-lasting contraception." Daily Mail (October 2006). Retrieved 9 Nov. 2006 from