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Women's Health

The Pregnancy Issue Birth control options include this one. By Dr. Lisa KaramardianPublished: February, 2003

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It is a well-known fact that unintended pregnancy is a serious problem in the United States. As a gynecologist, it saddens me to know that nearly half of all pregnancies in this country are unintended, and that half of these unintended pregnancies end in abortion. An interesting finding is that despite the availability of safe and effective hormonal birth control options, 53 percent of the unintended pregnancies occur in women who were using contraception during the month of conception - albeit incorrectly or inconsistently. Birth control pills remain the most commonly selected method of reversible contraception in the U.S.; however, inherent difficulties associated with remembering to take a pill every day, as well as the occurrence of nuisance side effects, preclude the consistent and correct use of birth control pills. As a gynecologist, I wonder what more can be done to improve effectiveness and compliance. The answer is here because this year we have made great advances in hormonal contraception. For the first time in a long while, we have new methods of birth control to offer women. The good news is that these methods are safe, effective and reversible. We can say that because we are not learning new things about new hormones. We are just changing the system of delivery of some female hormones that we have used for years. A novel, new idea is the vaginal ring. The NuvaRing, manufactured by Organon, is an innovative, new type of birth control that is effective and convenient all month long. It is a transparent ring, made from polyethylene vinyl acetate, and it is flexible. This odorless, non-absorbent ring has an outer diameter of 54mm (about as big around as a silver dollar). NuvaRing is easy to self-insert. This flexible ring is worn in the vagina for three weeks and then removed for the fourth week of the cycle, during which you should have your period. Exactly one week later you insert a new ring. This method is both personal and private. You insert NuvaRing yourself, once a month, and no one else knows that you are taking birth control. For women who lead busy lives and have to worry about work, travel, family and social obligations, the NuvaRing is something that they don't have to think about. The item is a combination hormonal contraceptive because it contains both female hormones, estrogen and progesterone, similar to combination birth control pills. Among all available combinations of hormonal contraceptives, it delivers the lowest dose of estrogen. The ring releases 15 mcg of ethinyl estradiol (the type of estrogen common in birth control pills) and 120 mcg of etonogestrel (the metabolite of a well-known progesterone) per day. This sustained release system provides very low peak serum concentrations and offers a more steady release of hormones. Ovulation is completely inhibited during the use of the ring, thus making it highly effective. Controlled, steady release of hormone levels means that the ring provides excellent cycle control, with extremely low incidences of breakthrough bleeding, spotting, or problems withabsence of withdrawal bleeding. NuvaRing probably has the same risk profile seen with birth control pills. However, this unique delivery system also allows you to bypass any effect on the liver that you would see when you take any hormones orally. It is easy to see that NuvaRing is discreet and easy to use. The important point to note is that the ring is effective when placed anywhere in the vagina, because the hormones diffuse across the vaginal mucosa as long as the device is in contact with the vagina. Like tampons, there is no special fit required. If it is inserted, it is working. You only have to place the device far enough in the vagina to be comfortable. There is no danger of it being pushed too far up in the vagina or getting lost. It sounds great, but do women really like using it? The NuvaRing in large studies was proven highly acceptable to women. Studies showed favorable safety and tolerability. Some 85 percent of women were highly satisfied with this method of contraception. Probably because 97 percent of women found the NuvaRing easy to insert and 96 percent of women found it easy to remove. Most women studied found neither discomfort nor distraction during their day-to-day activities. And if you are wondering - the NuvaRing was found to be comfortable for women and their partners during sex. Some 83 percent of women said they usually could not feel the ring during intercourse, and 91 percent of their partners did not object to the ring. With all the new options available, better counseling is the key to help patients select the right method for them. Better choices will hopefully lead to better compliance. You owe it to yourself to ask your physician about these new options. Dr. Lisa M. Karamardian is a board-certified OB/GYN and Fellow of the American College of Obstetricians and Gynecologists. She can be reached at 949.644.2722.

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