By Peggy O'Farrell
The Cincinnati Enquirer

New products and a returning favorite give women today more options than ever for birth control.

"The perfect contraceptive is one that's easily used and easily reversible with few, if any, side effects," says Dr. Michael Thomas, co-director of the Alliance Center for Reproductive Health.

"Unfortunately," he adds, "there isn't any."

Sterilization remains Americans' first choice for contraception, with birth control pills running a close second, according to the American College of Obstetrics and Gynecology. But patches, rings and a newly manufactured sponge are among the latest choices for women seeking contraception.

The Ortho Evra patch is probably the best known of the new options, thanks to its advertising campaign.

The first contraceptive patch, Evra, delivers estrogen and progestin - the same hormones used in birth control pills - directly through the skin.

"It's kind of a pill in a different form," Thomas says.

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To learn more about birth control options, check out these Web sites: Birth Control Basics National Women's Health Information Center Emory University Planned Parenthood

Like birth control pills, the prescription-only patch works by preventing ovulation. Unlike birth control pills, users apply one patch a week for three weeks of the month. During the fourth week, they're "patch-free."

Kelli Goerler, 24, of Fairfield switched from the pill to the patch in November.

"It's easier than remembering to take the pill every day," she says.

There are minor drawbacks: Sometimes the patch slips during bathing, and the adhesive can attract lint from clothing.

"But that's the only bad thing," Goerler says.

There are some weight restrictions with the patch, Thomas says. It might not be as effective in women who are very heavy.

Side effects are similar to those caused by the pill: increased risk of blood clots, stroke and heart attack. Women who smoke or have a history of heart disease, stroke, blood clots or certain cancers should not use the patch.

The patch can be worn on the buttocks, abdomen, upper torso (front and back, excluding the breasts) or upper outer arm.

The patch works for women who want options to the pill, doctors say. Some women can't remember to take the pill every day, and others worry about the hormones in birth control pills, especially after the debate over the safety of hormone replacement therapy. Other women can't tolerate oral estrogens or some of the side effects associated with birth control pills.

"The pill has gotten a bad rap, so trying to make the pill in a different form, whether it's a patch or a ring or an injection, is another option," Thomas says.

Patches that can be changed weekly or rings that are changed every three weeks are also easier for patients to use, says Dr. Jennifer Thie, a fertility expert in Blue Ash.

"If someone is forgetful, it's much easier to put in a ring for three weeks or put a patch on once a week or take a shot once a month than to take the pill every day," she says.

To be effective, the pill should be taken at about the same time every day.

"If you don't take it and you don't want to get pregnant, that's a problem," Thie says.

A woman's lifestyle is an important factor in choosing a birth control method, Thomas says. So are health concerns. The pill can cause heavy bleeding and worsen fibroids in some women. Lower-dose pills and hormone-based contraceptives in new formats, like the patch, can ease those issues.

Other new birth control options:

• The Today Sponge: Initially launched in 1983, the sponge was withdrawn from the market in 1995 after the Food and Drug Administration found problems at a plant where it was manufactured. Rather than upgrade the plant, the manufacturer, Whitehall Laboratories (a division of American Home Products, now known as Wyeth) stopped making the product.

The sponge was reintroduced earlier this year in Canada, and the new manufacturer, Allendale Pharmaceuticals Inc. of Allendale, N.J., hopes to make it available in the United States by the end of this year or early in 2004.

The sponge prevents pregnancy by blocking sperm from entering the cervix, and by emitting the spermicide nonoxynol-9.

The Today Sponge, which does not require a prescription, can be ordered online through two Canadian pharmacies.

• The Nuva Ring: The clear plastic ring measures about 2 inches in diameter and contains estrogen and progestogen.

The patient inserts the ring into the vagina and leaves it in place for three weeks. It's removed for a week during menstruation and a new ring is inserted after the menstrual cycle.

Like the pill and the patch, the ring works by preventing ovulation. It is manufactured by Organon.

• The Mirena IUD (intrauterine device): The Mirena must be inserted into the vagina by a physician. It can be left in place for up to five years.

The Mirena contains a progesterone-like hormone found in the progesterone-only birth control pill and some combined pills.

The hormone thickens the plug of mucus at the cervix, which prevents sperm from entering the uterus, and reduces sperm motility. It also thins the lining of the uterus.

Women who haven't had children shouldn't use IUDs for several reasons, experts say. The device can be expelled from the uterus more easily in women who haven't given birth, and it's more likely to cause cramping. There's also a small risk that it can cause infection which could lead to infertility.

• Yasmin: Some women call Yasmin, a newer birth-control pill, "the weight-loss pill" because the form of progestin it uses helps ease monthly bloating.

It's also reported to cause fewer headaches and less breakthrough bleeding than other oral contraceptives.

Yasmin has been linked to at least two blood clot-related deaths in Europe. It might increase potassium levels, which means women with kidney, liver or adrenal disease shouldn't take it.

• Ortho Tri-Cyclen LO is a new low-dose version of Ortho Tri-Cyclen, the most-prescribed birth control pill.

The LO contains 25 micrograms of estrogen and the hormones progestin and norgestimate. It is reported to cause less breakthrough bleeding and spotting than other oral contraceptives and helps control acne.

• Women who choose natural family planning might consider CycleBeads, color-coded beads that help a woman keep track of the days during the menstrual cycle when a woman is most - and least - likely to get pregnant.

The beads are used with the Standard Days Method of controlling fertility, which is similar to the old rhythm method.

E-mail pofarrell@enquirer.com