There are several new forms of contraception on the market with more to come. These newer methods increase compliance, thereby decrease side effects, including unintended pregnancies. There are approximately 3.5 million unintended pregnancies and 1.6 million abortions in the United States each year. Unintended pregnancies leave a woman with difficult decisions resulting in many social, personal and financial consequences. There are several new forms of contraception to hit the market over the last several years and even more to come in the future. These newer delivery systems increase compliance, thereby decrease side effects, including unintended pregnancies.

The Nuvaring is contraceptive ring that is placed in the vagina and remains there for 21 days. It is then removed and patients will have their menstrual period, similar to dosing with birth control pills. Compliance is better, however, since there is no need to remember to take a pill every day. The Nuvaring offers excellent menstrual cycle control and is tolerated very well by patients of all ages.

The advantages of this form of contraception is that the hormone dose to the body is consistent and very low (lower than even the lowest dose birth control pill) resulting in very few side effects. The chance that either the patient or her partner feels the ring during intercourse is very low (<6%) and there is no change in the rate of vaginal infections or abnormalities in Pap smears. Finally, it even comes with a timer so that patients do not forget to remove it at the appropriate time.

The Ortho Evra patch is another alternative that is placed on the lower torso once a week for three weeks and left off for the fourth week (also similar dosing to traditional birth control pill dosing). It offers good cycle control for patients having problems with breakthrough bleeding. Patients tolerate Ortho Evra very well as the hormone dosing is more consistent and lower than birth control pills. There is also better compliance since it has a once a week dosing schedule. Studies have shown that compliance with the patch was not affected by age (important for teenagers) and was significantly better than oral contraceptives.

The Mirena IUD is a progesterone only IUD. It is effective for up to five years and has to be inserted in a physician’s office after counseling by a practitioner. It has advantages in that menstrual flow can decrease or even disappear over time. There is not a compliance issue since the IUD is left in place. The IUD is for use in only selected patients as determined by an interview by the practitioner. Since this is a progesterone only contraception, its use is not limited in the over 35 year old, smoking population – which is a direct contraindication for birth control pills.

Finally, the Implanon is an implantable progesterone only device. This is not currently available to the public, but may be by the end of the year. This is similar to the old Norplant system, but uses a different progesterone and is only a single rod compared to a six implant system. The Implanon is effective for three years after insertion and is currently being used in many other countries.

Advantages are compliance, efficacy and use during breastfeeding. One of the disadvantages, as with the Norplant system, is possible abnormal uterine bleeding and need of an office procedure for insertion and removal.

These four alternatives to the traditional oral contraceptives all have their own unique delivery system. Each offers better compliance since patients do not have to remember to take a pill every day (which I cannot do myself with my cholesterol medication), lower hormonal levels, and ease of use. Give one of them a try in the future and you may be pleasantly surprised.

Dr. Jon Yenari is a Board Certified gynecologist practicing general gynecology with a special interest in female pelvic floor defects and bladder concerns.

He also provides evaluations for many conditions, including but not limited to, abnormal pap smears, pelvic pain, endometriosis, uterine fibroids, basic infertility, contraception counseling, menopause, vaginitis and abnormal uterine bleeding.

Dr. Yenari is accepting new patients. He is located at Intercoastal Medical Group Family Practice, 3333 Cattlemen Rd., Suite #200, Sarasota. 941-379-1700.
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