The answer is yes....well sort of, we're working on it. This is a question I am often asked by my patients given that even the most popular methods of contraception have downsides. Let's talk about some of the most popular methods and their newer counterparts.

Oral contraceptives "The Pill": 11.7 million women chose this option in the U.S. in 2002. There are several types of pills which can be given cyclically (21 or 24 days on and 7 to 4 days of period) or newer extended regimens with 84 days on 7 days off. Most pills are combined estrogen-progestin which can improve painful, heavy periods by suppressing ovulation, improve acne and lower risk of ovarian and endometrial (uterine) cancer. People who cannot take OCPs are those with previous episodes of clot in the leg, history of breast cancer, liver disease, and women > 35 who smoke. Additionally, women with poorly controlled high blood pressure and women with migraines probably shouldn't use them. There is a progesterone only pill (the "minipill") which is associated with higher failure rates and more unscheduled bleeding but is the method of choice for new moms who are breastfeeding.

Female Sterilization "Tubes tied": 10.3 million women in the U.S. chose this method in 2002 and the permanence of it makes it not for everyone but great for some. Tubal obstruction or ligation refers to any procedure that prevents pregnancy by occluding or disrupting the tubes and includes using clips, rings, coils or plugs. The most common technique is laparoscopic coagulation. Interestingly, a reduction in the risk of ovarian cancer is seen after tubal ligation believed to be because the procedure limits the migration of carcinogens through the vagina, cervix and fallopian tubes in to the abdominal cavity...weird huh?

Male Condoms: 6.3 million women use this as their method of contraception. Male condoms are most effective when used with a vaginal spermicide. Simultaneous use of the condom and a vaginal spermicide is as effective as a hormonal method of contraception.

Vasectomy: The next most popular method in the U.S. is Male sterilization. Vasectomy (ligation of the vas deferens) can be performed in a physician's office under local anesthesia. Although the procedure should be thought of as permanent, the procedure can often be reversed with a return of fertility. Fifty to seventy percent of reversals are successful yet the chances of success decrease over time.

Injectables/Implants/Patches: This group is the next most common method with injectables alone being used by 2 million women in the U.S.

• The only injectable contraceptive available in the US is Depo-Provera (depot medroxyprogesterone). Depo shots are given once every 3 months, are highly effective, reversible and avoid the need for a pill once a day. Depo-Provera shots are also associated with a reduced risk of endometrial cancer and can cause amenorrhea (loss of periods) which some patients love.


• Progesterone releasing IUD "Mirena IUD: The levonorgestrel-releasing IUD is a good choice for women who can't take estrogen-containing birth control methods. As an example, women with migraines who are worse on oral contraceptives have no problem using the Progesterone IUD, and it has been shown to decrease the risk of endometrial (uterine) cancer. The Mirena IUD may shorten, lighten or eliminate periods making it popular with patients.  A copper IUD is still available and remains effective for 10 years. Copper IUDs are less popular because of the heavy periods and cramping that may ensue.


• Implants: A single rod progestin implant, Implanon, is available in the US and elsewhere. Protection is provided for three years and occurs within 24 hours of insertion. Fertility returns rapidly after removal of the rod. Irregular bleeding was the primary reason for discontinuation in premarketing studies. There is a two-rod device called Jadelle that has not yet been marketed for use in the US.


• Patches: Ortho-Evra is another option for providing hormonal contraception. The patch is combination estrogen and progesterone and is applied weekly. The risks and benefits of the patch are similar to oral contraceptives and it may carry slightly higher risk of blood clot in the leg than the pills.


• Vaginal Ring "NuvaRing": The NuvaRing is worn in the vagina for three weeks of each four week cycle. The ring delivers estradiol and progesterone and advantages include rapid return to ovulation after discontinuation, lower doses of hormones, ease and convenience. To insert, the sides of the ring are pressed together and then inserted in the vagina where it is left for three weeks. The exact position of the ring does not affect contraceptive efficacy.

Barrier Methods: Condoms, diaphragms, cervical caps and contraceptive sponges are the most common forms of barrier contraception. Diaphragms and cervical caps require fitting by a trained clinician and are only effective when used with a spermicide. In a recent survey only 0.4 percent of women were using diaphragms and these are definitely less popular though they remain a good choice for new mothers who are nursing. The "Lea" is an over the counter device that is a cup shaped bowl that can be inserted hours before intercourse and is left in place for 8 hours after intercourse. The "Today" sponge is also available over the counter and can be left in place and used repeatedly for 24 hours.

Your experience?

Dr O.