Birth control

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birth control

"After years of little innovation in birth control, an assortment of new methods offering a broad variety of choices is emerging, including a skin patch that is changed weekly, a hormone-enhanced IUD and a permanent sterilization procedure that requires no anesthesia" (Berger, 2002, p.1). After reading this article in the New York Times, I became very interested in the new forms of birth control. Currently I am prescribed to an oral contraceptive, and have difficulty taking the pill at the same time everyday and on a regular basis, which lowers the effectiveness of the contraceptive. I was looking for a contraceptive that is not necessarily taken everyday and is reversible in that I am able to become pregnant at a later date in life. After completing research on the many different forms that have emerged in the last few years, I narrowed my concentration to three. An injectable form entitled Depo-Provera, a transdermal patch entitled Ortho-Evra, and a vaginal ring entitled NuvaRing. These all met the criteria that I wanted in a new form of birth control as well as presented enough information to research in making a decision.
"The new devises offer longer lasting alternatives to a daily pill and are viewed as long overdue in light of an estimated three million unplanned pregnancies in the United States each year, about half of them ending in abortion" (Berger, 2002, p.1). The overall effectiveness has increased with these new forms of birth control, which can help women and our country’s unplanned pregnancy rate. The lack of variety of birth control has been seen as a result of the length of time in developing these new forms as well as the Puritan culture our country is based on. There also have been many developments, such as Norplant, that have emerged just to be taken off the market soon after it premiered (Berger, 2002, p.1). It has been a long time since a new method has emerged, but Depo-Provera, Ortho Evra and NuvaRing are three examples that have emerged and has effectively increased the accuracy of pregnancy protection.
In order to correctly evaluate the risks and benefits of new emerging birth control methods, a basic understanding of those associated with oral contraceptives is first needed. Birth control pills use synthetic hormones that imitate those naturally produced in the body and were first introduced and approved by the FDA in 1960. There are many health benefits to birth control in addition to the decrease of incidence of unwanted pregnancy including prevention of osteoporosis by impacting bone mineral density as well as regulating the menstrual cycle and decreasing the chance on anemia by restricting blood loss. It is also used in the treatment of acne and uncomfortable cramps associated with the menstrual cycle. Like most pharmaceutical treatments, there are many health risks associated with the use of oral contraceptives. Many of these include an increase in risk for breast and cervical cancer, myocardial infarction, and stroke. There is a 5% failure rate associated with the pill (Shvarts, 2002, pgs. 11-13).
"On October 3, 2001, the FDA approved a combination vaginal ring called NuvaRing" (Likis, 2002, p.150). It is a doughnut shaped devise that is flexible, translucent and about two inches in diameter. It is self inserted into the vagina on or before the fifth day of menses. Its positioning within the vagina is not imperative to its effectiveness because it is not a barrier method. It releases either progestin or a combination of progestin and estrogen everyday for three weeks, when it is then removed from the vaginal so that the woman can experience bleeding. Rarely does the ring slip out of the vagina, but if this occurs and is noticed within three hours, it can be rinsed in lukewarm waster and re-inserted (Shvart, 2002, p.15).
     The advantages of NuvaRing compared to the traditional pill is the lack of direct effort in the woman because the ring is inserted and left alone for three weeks instead of having a constant reminder of taking the pill everyday. The failure rate compared to that of the pill is much lower, at .65%, and cycle control remains comparable to oral contraceptives. Infrequently was their irregular bleeding associated with NuvaRing, much lower than that of the pill and other contraceptives (). "In clinical trials, the most common adverse events reported by 5-14% of women using NuvaRing were, vaginitis, headache, upper respiratory tract infection, leucorrhea, sinusitis, weight gain and nausea. Other adverse reactions that have been reported are similar to those seen with other combination hormone contraceptives" (Shvart, 2002, p.15).
     "The Ortho Evra patch was approved by the FDA in November 2001 and is expected to be available to the public in winter 2002" (Shvart, 2002, P.20). This was the first transdermal system used in birth control and introduced to the public. It is beige in color and is the size of a matchbook. It is first applied on the first day of menses to clean and dry skin. It may be placed on the buttocks, abdomen, upper arm or torso. There are no restrictions on usual activity like showering or swimming, but lotions and other ointments should not be placed on the area of the patch (Likis, 2002, p.151). Ortho Evra is applied and left on the skin for seven days. After seven days the patch is removed and replaced by a new patch. This continues for three weeks and is followed by a patch free week in which bleeding occurs. While it is on the skin, continuous hormones of estrogen and progestin are releases through the skin and into the blood stream. Because the patch consists of three layers, a clear liner removed before fixation to the skin, a medicated middle layer, and a polyester protective outer layer, it is rarely detached from the skin. If it happens to detach, a new patch must be reapplied immediately (Shvarts, 2002, 20).
     "The combination transdermal contraceptive patch is very effective with estimated failure rates of 0.4% and 0.7% for perfect and typical use respectively" (Likis, 2002, p.151). It is much more effective than the traditional pill, and eliminates the annoyance of daily contraceptive use. Because it is a transdermal process, lower serum levels are seen which reduces nausea. "Although breast symptoms were more common with the contraceptive patch than with oral contraceptive, most cases were mild or moderate, occurred only once or twice, and generally were not treatment limiting" (Sibai, 2002, p.S24). Other negative side effects include higher incidence of breakthrough bleeding, skin reactions at or near the application site, and a higher incidence of cramps. In women with body weight greater than 198, failures of the contraceptive increased because of the increase in body mass (Zieman, 2002, p.S18).
     Progestogen injectables have been available for consumers since 1992. Depo-Provera is one of the main injectable forms of contraceptives on the market. It is dispensed into the deep intramuscular tissue every 12 weeks. "The first injection should be given on day 1-5 of the menstrual cycle, on the day of the abortion or miscarriage, on the day the last pill is taken if switching over from a progestogen only pill or a combined oral contraceptive pill or at 6 weeks after childbirth" (Gupta, 2003, p.30). It works by keeping the ovaries in a resting state so that eggs are not released, and therefore the sperm has nothing to fertilize. Each shot suppresses ovulation for three months; therefore the shot is administered four times a year. By suppressing ovulation, Depo-Provera gradually reduces menstrual bleeding and eventually stops menstruation all together. This happens because during the monthly cycle, the uterus builds up and is shed when the egg is not fertilized. Depo-Provera causes less and less buildup in the uterus, and usually after a year, the buildup stops, and the monthly period ends (Gupta, 2003, p.30).
     Depo-Provera is one of the most favorable new forms of birth control on the market. This is most likely because of the convenience of the dosage as well as the privacy in utilizing it. Those who have trouble with pills seem to find great use in the injectable. "Endometriosis, painful heavy periods, iron deficiency anemia, and premenstrual syndrome improve with the use of injectables, possible due to the suppressant effect on ovulation and the resultant amenorrhoea in long term Depo-Provera users" (Gupta, 2003, p.30). This is benefit similar to most other contraceptives including the pill. There have been many recent studies that say it reduces seizures in epileptic women. Unlike the pill, there is no increase risk of myocardial infarction or stroke. The rate effectiveness is 99.7% which is much higher than most other forms of contraceptives. Irregular vaginal bleeding, headaches, dizziness, and depression are common side effects (Gupta, 2003, p.30). In a study done and published in the Journal of Adolescent Health, it was concluded that an average of 9.2 pounds were gained on average every year that the injectable was used (Miller, 1996, p.132). "This may be due to modification of the hypothalamic appetite control centre, with extra weight being mainly from fat as opposed to water retention" (Gupta, 2003, p.31). All other risks and benefits are similar to that of the pill and many other forms of contraceptives.
     After finishing the research and comparison on Ortho Evra, Nuva Ring and Depo-Provera and weighing the many advantages and disadvantages of each, I believe that Ortho-Evra would be the best method for me. It seemed to have the least amount of risks because I never experienced cramps previously to taking birth control. It is much more effective than traditional oral contraceptives and in comparison to Depo-Provera, it is much easier to discontinue use because it is not internally injected. Because I do not have to worry about taking a pill every day or changing any daily habits, the transdermal patch would be an effective contraceptive for me. The research I performed fully assisted my decision and eased the worrying that the daily pill has given me in the past.

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