Modern Contraception Options

Hormonal Contraception: A Brief History and Modern Options

The Last 50 Years of Hormonal Contraception in America

The first birth control pill was introduced in the United States in 1960, and since then, millions and millions of women have used this method of contraception. We won’t go into the timeline of its development here, but this subject is a fascinating read, especially if you’re one of these women. Please see this interesting account at www.pbs.org/wgbh/amex/pill/timeline/timeline2.html to learn more.

Until “the pill” was developed and marketed, birth control consisted primarily of the rhythm method, the withdrawal method, inserting sea sponges or cone devices into the vagina, and various postcoital exercises. None were as effective as the pill, nor did they give women the type of control offered by the pill.

The birth control pill is at its best 99.7% effective. Moreover, it does nothing to protect against sexually transmitted diseases or HIV/AIDS. In fact, birth control pills themselves can promote or potentiate diseases such as blood clots and cardiovascular illnesses, which is why it is vital that anyone considering this type of birth control review her medical history with her physician before beginning a regimen.

Further, because of the various choices on the market today, it is also important to do some research before deciding which method is best for you. In the 50 years since the birth control pill appeared on the market, there have been many improvements and innovations. In addition to different hormone ratios and dosage strengths, there are now multiple forms that birth control can take.

For the most part, these options contain synthetic levels of hormones, mostly progesterone and estrogen. Your age, lifestyle, personal preference, and the advice of your physician are all factors that will guide your decision. According to James E. Clark, MD, Medical Director of Altamonte Springs Gynecology in Orlando, Florida, “Contraceptive choices have to be tailored to each woman’s situation. General health issues like high blood pressure, diabetes, and blood clotting disorders need to be considered. Also very important is to consider if the woman is certain that she is done with childbearing.”

For example, Dr. Clark notes, “Most teenage girls will choose birth control pills as their contraceptive. They are the most popular form of contraception in the United States. [Other] teenagers, who have a difficult time remembering to take the pill daily, will choose Depo-Provera. Depo-Provera is given as an injection once every three months.” Dr. Clark adds that an IUD, however, might not be the best choice for a teenager because “…young women who have never had a baby will have a difficult time using an intrauterine device (IUD). This is because the uterine cavity is small in these women and the IUD might not fit easily inside the uterus, leading to annoying cramping and spotting.”

Regarding women who are married but perhaps not yet ready for a family, Dr. Clark has this to note: “For newly married women who are contemplating having a baby in the next few years, most prefer a contraceptive choice that is quickly reversible. If they are not using barrier methods (condoms, diaphragm), the next best choice is the birth control pill. Most women resume ovulation within two months after discontinuing the pill, and thus are ready to attempt conceiving.” But for women who have suspended childbearing indefinitely, or at least a considerable time, he says, “In this situation, a birth control pill or the IUD are excellent choices. Both offer safe and reliable contraception and can be discontinued quickly should the woman change her mind about wanting to have a baby.”

In continuing through the various stages of a woman’s reproductive lifecycle, Dr. Clark notes that for the “perimenopausal woman, contraception is still necessary. A high percentage of the unwanted pregnancies in the United States occur in this group. These women often have irregular cycles and hot flashes. A low-dose birth control pill often is a great option that will address all of their needs. It will provide contraception, regulate her cycles, and eliminate most hot flashes.” However, he emphasizes, “There is no place for the use of birth control pills in the treatment of menopausal symptoms. Menopausal symptoms can be controlled with much lower doses of estrogen than is found in birth control pills.”

You can see how important it is to take into consideration the many factors regarding your current age, situation, and reproductive goals when determining what type of contraception is right for you. Here is a list to help further guide your understanding of this important choice.

Hormonal Contraception Options

Oral Contraceptives

  • Birth control pills taken daily.
  • Combination estrogen/progesterone pills and progestin-only pills are the two types available.
  • The combination pills prevent ovulation; the progestin-only pills work to thicken uterine lining and cervical mucus.

21- and 28-day Pills

Some of the more popular combinations include:

  • Monophasic: Regimen contains one combination of estrogen and progestin for all 21 active days.
    • Loestrin
    • Alesse
    • Norinyl
    • Brevicon
    • Ortho-Cyclen
    • Demulen
    • Ortho-Novum
    • Desogen
    • Yasmin
    • Ortho-Cept
    • Yaz
    • Beyaz
  • Lo Loestrin fe   24 day regimen with lowest dose of estrogen available at 10mcg.
  • Biphasic: Regimen contains two different levels of estrogen and progestin for the 21 active days.
    • Jenest-28
    • Mircette
    • Necon  10/11
    • Ortho-Novum 10/11
  • Triphasic: Regimen contains three different hormone and progestin combinations for 21 days of active pills.
    • Ortho-Novum 7/7/7
    • Ortho Tri-Cyclen
    • Tri-Levlen
    • Tri-Norinyl
    • Triphasil
  • Quadraphasic:  28 day regimen contains four different hormone and progestin combinations for 26 days of active pills
    • Natazia  estradiol valerate and estradiol valerate/dienogest
  • “Mini-Pills,” or progestin-only pills:
    • Ortho Micronor
    • Nor-QD
    • Ovrette

Extended Cycle Combination (Estrogen/Progestin) Pills

Each regimen results in about four periods a year.

  • Seasonale: 81 days of active tablets (0.15 mg levonorgestrel/0.03 mg ethinyl estradiol) followed by 7 days of inactive pills with no hormones.
  • Seasonique: 84 days of active tablets (0.15 mg levonorgestrel/0.03 mg ethinyl estradiol)  followed by 7 days of 0.01 mg of ethinyl estradiol tablets.
  • Lo Seasonique: 84 days of active tablets (0.10 mg levonorgestrel/0.02 mg of ethinyl estradiol) followed by 7 days of 0.01 mg of ethinyl estradiol tablets.

Continuous Cycle Combination Pills

This program results in a cessation of periods.

  • Lybrel, which is a 365-day active pill regimen.

Alternate Methods of Hormonal Contraception

  • NuvaRing: This monthly vaginal ring releases a low-dose combination of estrogen and progestin. NuvaRing is inserted into the vagina and removed after three weeks; seven days later, a new NuvaRing is inserted. www.nuvaring.com
  • Ortho Evra: This combination estrogen and progestin patch is put on for a three-week duration and then removed for a hormone-free week until a new patch is applied. www.orthoevra.com
  • Mirena: This progestin-only regimen consists of an intrauterine device (IUD) that is inserted to remain effective for up to five years. One benefit is that it is immediately effective upon implantation. www.mirena-us.com
  • Depo-Provera: This birth control method involves an injection of medroxyprogesterone, a synthetic form of progesterone, and lasts up to 13 weeks. It works by preventing ovulation and thickening cervical mucus to deter sperm from entering the uterus. www.depoprovera.com
  • Implanon: This progestin hormone rod is inserted under the skin and lasts up to three years. www.Implanon-usa.com
  • Paragard: The only hormone free intrauterine contraceptive device that requires no daily or weekly dosing and is completely reversible.   Can be used for 2, 5, or 10 years. www.paragard.com