The right to choose
Monday, March 01, 2004
Contraceptives, that is By Kimberly StraubOrtho Evra is a patch that is worn directly on the body.
She followed her doctor's recommendation for forgetting pills: "Take two the day you remember and two the next day." But Stacey Hunter found it impossible to keep up with her birth control regimen.
She calls it "playing catch up." And like many women who constantly struggle to stay on top of their birth control pills, Hunter was through with the game. Fed up, Hunter's last resort, tubal ligation, was looking more and more enticing. But her doctor told her to try one last option, a new semi-permanent intrauterine device (IUD) called Mirena. And the Lansing mother of two found her troubles solved.
Experts say the best indication of a woman's ability to use contraception and use it correctly is how well the method accommodates her lifestyle. Ten years ago, the predominantly prescribed pill was widely considered the "one-size-fits-all" solution to every woman's contraceptive wants.
"Now we're able to fit contraception to the people," says Dr. Tracy Vera, a Chicago obstetrician-gynecologist.
Today there are a variety of contraceptive options. And now, a woman's accessibility to those options has never been better, with the prospect of an over-the-counter morning-after pill and a new Illinois law requiring insurance providers to cover the cost of contraceptives.
But still, one in four unintended pregnancies occur in women who use contraception, according to statistics from the Alan Guttmacher Institute.
"I always say there's always two numbers quoted when it comes to birth control-actual use and intended use," says Vera. Women actually use their preferred methods of contraception far less than they intend to. The problem, she says, are all the women, such as Hunter, on the wrong contraceptive method for their lifestyle.
"Contraception needs to be tailored to each person's needs," says Vera. "I think the most important thing about contraception is that women be honest about what they can do."
Chicago single mother Shataika Head values variety as one of the best advantages in birth control today. Since the birth of her son five years ago, Head has used four different methods of birth control. "Every woman responds differently," she says. "At least now you have the option to choose."
An array of options Several new brands of hormonal contraceptives are making it easier for women to tailor birth control to their lifestyle. The following products are more than 99 percent effective and significantly reduce human error:
• Ortho Evra: a birth-control patch placed on the skin weekly for three weeks. It can be worn discreetly on the outer arm, chest, back, buttocks or abdomen. Advantages include less nausea, less estrogen and a rapid return to fertility. Disadvantages include possible skin irritation and decreased effectiveness in overweight women.
• NuvaRing: a flexible plastic ring inserted in the vagina by the user once a month. Advantages include less menstrual bleeding and a low and steady dosage of hormones and less nausea. Disadvantages include the possibility of vaginal discharge and headaches.
• Mirena: a T-shaped IUD that prevents pregnancy for five years. It is inserted close to the uterine lining by a health care practitioner. Advantages include less or no menstrual bleeding, a rapid return to fertility and a high success rate for women who are in or approaching menopause, breastfeeding or have histories of breast cancer, endometriosis, heart disease or certain bleeding disorders. Disadvantages include the possibility of vaginal discharge and the fact that it cannot be used by women at risk for sexually transmitted diseases.
• Seasonale: the latest brand of oral contraceptive on the market (approved in October). The product reduces the number of periods a woman has to just four per year. Besides the obvious convenience, experts say it is perfectly safe and in many ways healthier for women.
"It's better not to have all that bleeding," says Dr. Edward Linn, chairman of the department of obstetrics and gynecology at Advocate Lutheran General Hospital in Park Ridge. "There is no scientific reason you need a period. And if you're on the pill, the periods you have are not from your body's own natural cycle."
Women who bleed heavily or suffer from the effects of cramping, bloating or painful migraines right around the time of their period each month will benefit most from this product. The most common complaint is breakthrough bleeding or spotting between periods.
Debra Slater, mom of one in Itasca, has been suppressing her periods through continuous use of oral contraceptives for 12 years on the advice of a doctor. Every month, she starts a new pack of her prescription oral contraceptives at the point when the inactive pills begin, thus preventing a period. She says it has changed her life.
"You don't have any mood swings. I've been able to maintain my weight. There's no cramping. It's just been wonderful," she says.
A timely Plan B Access to the morning-after pill could become as easy as a trip to the drugstore.
In December, an advisory board to the Food and Drug Administration (FDA) recommended that Plan B, the safest emergency contraceptive on the market, become available as an over-the-counter product. Expected to rule at the end of February, the FDA announced it will delay its decision until May. Marketers of the product say the drug meets all the specifications for over-the-counter status.
"Women who use emergency contraceptives have big challenges," says Linn. "Whether it's [that] they can't find a doctor who will write out a prescription without seeing the patient, or more realistic, the women can't call their doctor for a prescription on the weekend, or most likely, the woman doesn't even have a doctor to call."
FDA-approved in 1999, Plan B emergency contraceptive pills-not to be confused with the abortion pill (RU-486) that terminates a pregnancy-is a high-dose oral contraceptive that prevents pregnancy in three ways: It prevents ovulation, or the release of an egg into the uterus; it thickens the cervical mucus so the sperm is less likely to penetrate and, if those two efforts fail, it may thin the lining of the uterine wall so a fertilized egg cannot implant. Since Plan B contains no estrogen, it produces less nausea and vomiting than other emergency contraceptives available by prescription.
Tests show Plan B is 95 percent effective if taken within 24 hours of a contraceptive accident or unprotected intercourse. But effectiveness diminishes after that, says Dr. Carole Ben-Maimon, president and chief operating officer of Barr Research, the company that is acquiring marketing rights to the product.
"Even a woman who uses birth control on a regular basis encounters problems-the condom slips or breaks. ... The importance of Plan B is that it is there as a form of secondary defense," she says. "Timing can mean the difference in preventing an unwanted pregnancy."
According to the American College of Obstetricians and Gynecologists, making the morning-after pill available without a prescription could prevent half the unintended pregnancies and half the abortions in the United States each year.
Insurance will pay For many women who pay out-of-pocket for contraceptive costs, the best form of contraception for their particular needs is not always an option. The good news is Illinois state law now requires health insurance companies that provide prescription drug coverage to also cover the cost of contraceptives.
"It [the law] will help you make sure you get on the right form of contraception, not just the cheapest," says Judy Appelbaum, vice president and legal director of the National Women's Law Center.
Illinois joins 19 other states in mandating contraceptive coverage. That means "literally tens of thousands of women in the state of Illinois who have historically paid out-of-pocket for those expenses are now going to be covered," according to Tracy Fischman, vice president for public policy at Planned Parenthood Chicago Area.
Religiously affiliated insurance companies and self-insured employers are exempt. But other companies that amend, issue or renew employee health plans after Jan. 1, 2004, must include contraceptive coverage. With the exception of sterilization and abortion procedures, the mandate covers all FDA-approved contraceptive services, drugs and devices.
"We are in need of a federal law that would mandate contraceptive coverage across the board [and hold all businesses accountable]," says Fischman. "But I don't want to understate what a huge stride this is for women living in Illinois."
"This is great news," says Head, about the contraceptive coverage mandate. "A lot has changed. It should be this way though, where everyone has the option to be on some sort of form of contraception."
Kimberly Straub is a student at Northwestern University's Medill School of Journalism and a Chicago Parent intern.