Wednesday, August 25, 1999
Birth control options
Next wave for American couples includes weekly patch, updated sponge
BY SUE MacDONALD
The Cincinnati Enquirer
Deciding on birth control is always a very personal decision for women, and as a new millennium approaches, American women are being offered more options than ever.
A weekly birth-control patch is expected in a year or two, the Today contraceptive sponge is returning to drugstore shelves this fall and a new emergency contraception kit called Plan B was just approved by the U.S. Food & Drug Administration (FDA).
Low-dose birth-control pills continue to hit the market, and a monthly birth-control shot is in the works. So are Cincinnati-based Duramed Pharmaceutical's generic birth-control pills, OK'd last week by the FDA and expected to cost less than brand-name counterparts. Meanwhile, drug companies are researching a non-latex condom, new spermicides, a new implant and IUDs containing progestin.
“When a woman finds a form of birth control that she really likes, she tends to stick with it,” says Dr. Arthur Ollendorff, obstetrician-gynecologist at the University of Cincinnati Medical Center. “When you're talking about birth control, the ultimate goal is to find a method that women are happy with and that works.”
The most-used forms of birth control in the U.S. are sterilization (also referred to as “tying the tubes”) and the birth-control pill. But the new methods hitting the market soon or in the final stages of research, and testing will give women even more reliable options.
“The real effort today is to provide individuals with as many choices as possible,” says Dr. Robert Rebar, director of obstetrics-gynecology at the University of Cincinnati Medical Center and also medical director for Planned Parenthood.
Angela Chaney, education and training specialist with Planned Parenthood of Southwestern Ohio and Northern Kentucky, finds that many women have no idea that so many devices and products — at least a dozen — are available until she opens an educational kit to demonstrate and explain contraceptives to women's groups or classes.
“Women are constantly surprised that there as many options as there are,” she says, rattling off everything from the odd-looking female condom to the little-known but effective vaginal contraceptive film.
New developments
Among the newest contraceptives available to women or in stages of development and testing:
• The birth-control patch. For the woman who can't remember to take a pill every day, this Johnson & Johnson product would deliver the same birth-control hormones in an adhesive patch that's changed once a week. Johnson & Johnson may be ready to submit its paperwork for patch approval to the FDA sometime in 2000.
• Low-dose birth-control pills. The amount of estrogen in birth-control pills has dropped from a high of 150-300 micrograms (mcg) in the early 1960s to 20 mcg today, Dr. Ollendorff says. The newest pills on the market are Alesse, Levlite and Mircette. Low-dose pills prevent pregnancy just as effectively as older-generation pills without many of the side effects — headache, nausea, breast tenderness.
• Lunelle. Lunelle is a monthly shot that contains estrogen and progestin, similar to a birth-control pill. It is an alternative to Depo-Provera, another injectable contraceptive that lasts for three months. Lunelle is FDA approved.
• Plan B. The newest emergency contraception kit joins Preven, another kit containing birth-control progestin pills that must be taken within 72 hours of unprotected sex. These products put into an easy-to-use kit a combination of existing pills long known to prevent pregnancy. The problem: not all pharmacies stock the kits, and special-ordering it means missing the 72-hour window of opportunity in which the pills work.
• The sponge. Remember the Seinfeld episode when Elaine stockpiled the no-longer-available Today contraceptive sponge? It is expected to return to over-the-counter shelves this fall for the first time since 1995.
Several options being studied by drug companies likely are coming down the road, according to Dr. Rebar. They are:
• A non-latex condom, made of polyvinylchloride and already used in the Netherlands, is being studied but not yet available in the United States. It is geared to the growing number of people allergic to latex. Avanti, a polyurethane condom, already is available in the United States.
• New spermicides that would kill both infectious germs and sperm also are being studied and tested. Currently, nonoxynol-9 is the only spermicide available on the U.S. market. Spermicides can be used separately or can enhance the contraceptive effectiveness when combined with other methods, such as the condom or diaphragm.
• Implanon, a single implant device made by Organon, already is available outside the United States and is being tested for the U.S. market for release perhaps within a year. It is based on Norplant, the contraceptive rods that are surgically implanted under the skin of a woman's arm. Both implants release a steady stream of hormones that prevent pregnancy.
• Progestin-containing IUDs already are available for other health problems, including heavy menstrual bleeding in women who do not want a hysterectomy. Other types are being tested as contraceptives and must be replaced every one to seven years.
Foreign testing
There's still much to be done, says Dr. Jill Huppert, also an obstetrician-gynecologist at UC Medical Center.
“There are lots of options now, but there are fewer options in the U.S. than anywhere else in the world,” she says.
Fear of lawsuits, federal guidelines that favor abstinence as the mainstay of sexual education programs as well as liability issues have kept many drug companies and manufacturers out of the contraceptive testing business altogether.
The upshot is that many new birth-control products and devices are tested in foreign countries and available elsewhere for years before they make it to the U.S. market.
Dr. Huppert and other reproductive health experts cite the intrauterine device (IUD) as an example: a cheap, convenient, highly effective and fairly safe form of birth-control that's extremely popular around the world but rarely used in the United States. Two IUD's — the ParaGard and Progestasert — are approved for use and still available on the U.S. market, but many doctors don't recommend it and many women don't know to ask for it, she says.
The IUD is a small copper or plastic wire that's inserted into the uterus for spans of one to 10 years, depending on the type. The copper IUD is thought to stimulate an inflammatory reaction in the uterus that kills sperm, while the plastic version releases the hormone progesterone to prevent pregnancy.
But in the 1970s and '80s, lawsuits over the Dalkon Shield, an IUD made by A.H. Robins that caused pelvic disease and miscarriages in women, scared many women away from IUDs altogether. All IUDs got a bad rap simply because the Dalkon shield was a bad IUD, Ms. Chaney says.
“The IUD is incredibly underutilized in this country,” she explains. “It's a sad fact when women have to undergo sterilization — which is major surgery — as the major form of birth-control when cheaper, safer methods are available.”
But several contraceptive devices now being used elsewhere in the world are slowly making their way to the United States, perhaps in the next few years, mostly because of the efforts of a consortium of family planning clinics that are willing and able to undertake studies.
Dr. Rebar, who participates in contraceptive research through the National Institutes of Health's Clinical Contraceptives Network, says he is encouraged by the federal government's renewed interest in effective contraceptive methods that not only prevent pregnancy but also reduce the risk and spread of sexual diseases.
So is Judy Norsigian, one of the founders of the Boston Women's Health Book Collective, which produces Our Bodies, Ourselves for the New Century (Simon & Schuster; $24).
“There are some areas where there are encouraging signs,” Ms. Norsigian says. “One is in the area of antimicrobial spermicides, where we will soon have something that will protect both against pregnancy and (sexually transmitted diseases). The trick is to get something that's not irritating and doesn't have any negative aspects.”
Antimicrobial spermicides are substances that would kill sperm and the germs that cause sexually transmitted diseases, such as HIV, chlamydia, genital warts, herpes, lice, scabies and gonorrhea.
“Foams and jellies and creams tend to be unattractive,” she explains, “but with the right texture and approach and application of these new products, the hope is that more women would find it an acceptable method.”
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