THE VIRGINIAN-PILOT
Copyright (c) 1995, Landmark Communications, Inc.
DATE: Sunday, January 22, 1995 TAG: 9501250662
SECTION: HAMPTON ROADS WOMAN PAGE: 04 EDITION: FINAL
TYPE: Cover story
SOURCE: Stories by DEBRA GORDON
LENGTH: Long : 249 lines
NORPLANT. DEPO-Provera. The female condom. If you look at these recent advances in contraception, you might think there's a contraceptive revolution afoot.
You'd be wrong.
``It appears we have a revolution because of these methods, but they aren't new and better methods. They've been available in other countries for years,'' said Susan Tew, deputy director of communications for the Alan Guttmacher Institute, a reproductive health research organization in New York.
Indeed, researchers and others active in women's reproductive issues note that every new advance in contraceptive techniques - even the Today Sponge - is merely a new form of an existing type of contraception.
Several factors have stymied national research, such as an increasingly litigious society, fallout from the large class action lawsuit against A.H. Robins, makers of the Dalkon Shield IUD, and an extremely vocal pro-life group that opposes any contraception that kicks in after fertilization, such as RU-486.
But other countries and multinational organizations, like the World Health Organization, are picking up the ball.
In India, for instance, researchers recently published a paper providing the first demonstration that women can be vaccinated to prevent pregnancy.
The researchers immunized women against human chorionic gonadotropin (hCG), a hormone produced by the ball of cells that develops from a fertilized egg and is essential for implantation in the uterus. It is this hormone that is measured to confirm a woman's pregnancy.
The vaccines prevented pregnancy in nearly all the women.
Still, even that vaccine isn't as effective as oral contraceptives, said David Griffin, who manages the contraceptive vaccine task force run by the World Health Organization. ``There's a long and difficult road from the lab bench to the buttock,'' he said in the Dec. 2 issue of Science.
Other contraceptives being researched include: FOR WOMEN:
Contraceptive rings. A doughnut-shaped drug delivery device is inserted into the vagina. The ring contains estrogen and/or progestin - hormones used in oral contraceptives - which are slowly released into the vagina and then into the bloodstream. Women can insert and remove the silicone rubber ring themselves.
- Norplant II implants. A variation of the currently available Norplant method, in which six small flexible capsules containing hormones are inserted under the skin of a woman's arm. This device involves just two capsules and is easier for health-care providers to administer. It is effective for three years.
A single implant Norplant, effective for one year, is also being tested.
- Transdermal contraceptive. Scientists at the Population Council have begun research on delivering contraceptive steroids through the skin. Negotiations are in progress to locate a manufacturer and distributor.
- Medical abortifacient. Commonly known as RU-486, this drug is in the final stages of clinical trials. It would be used within days after a woman realizes her period is late.
- Intrauterine devices. A frameless IUD, which eliminates any pressure on the uterus and thus should minimize cramping, is in clinical trials in Europe.
- Biodegradable implants. Like Norplant, these would be inserted in the arm. But they would eventually be dissolved by the body, negating the need for the often-painful procedure to remove Norplant.
- Lea's Shield. A one-size-fits-all diaphragmlike device with a one-way valve to allow air to escape during placement, thus creating better retention against the cervix. Approval is expected in 1998.
- Disposable diaphragm. It is doubtful if this method will be available before the end of the century. FOR MEN:
- Antifertility vaccine. This vaccine suppresses two levels of hormones that are necessary for sperm and testosterone production. The vaccine is expected to last up to a year and could be renewed yearly for continued production. It is in early clinical trials.
- No-scalpel vasectomy. A no-scalpel method would reduce the frequency of common after-effects of vasectomy such as bleeding, swelling, pain and infection. The Population Council is helping develop a devise that would put clips on the sperm duct, and is searching for a manufacturer to produce devices for clinical trials.
FROM THE PILL TO IUD TO NORPLANT
Thousands of years ago, women believed that squeezing lemon juice into their vaginas would protect them against pregnancy.
As early as 1850 B.C., they made vaginal inserts, or pessaries, of dried crocodile dung. Hungarian women in the 19th century used beeswax to fashion disposable discs or homemade cervical caps, and prostitutes in China and Japan covered their cervixes with disks of oiled bamboo paper called misugami.
Thankfully, women have many more options for birth control today - ones proven to work.
n The Pill. Oral contraceptives (birth control pills), available by prescription, are the most popular reversible method of contraception in the United States today. Most women take the so-called combination pill. This method, based on a 28-day cycle, involves taking two synthetically produced hormones once a day for 21 days to prevent ovulation. (For the remaining seven days, women either take no pill, or a placebo).
-Effectiveness: Less than 1 percent annual failure rate when used exactly as directed. The usual failure rate is about 3 percent.
Advantages: Confers a wide range of noncontraceptive benefits, including lowered risk of ovarian and endometrium cancer. The Pill can also help to prevent or control ovarian cysts, benign breast disease and pelvic inflammatory disease.
Long-term use may also help build bone mass, which reduces the risk of osteoporosis.
Disadvantages: Must be taken every day at about the same time. Offers no protection against sexually transmitted diseases. Initial side effects include nausea and spotting between periods.
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Barrier methods, which include the diaphragm, the cervical cap and condoms, create a physical barrier between the cervix and the penis. Some require a spermicide.
One of the least used and least well-known barrier methods is the cervical cap. The thimble-shaped device, made of latex rubber, fits snugly over the cervix and is held in place by suction and support of the vaginal wall.
It's been used for years in Europe, and received FDA approval for use in this country seven years ago.
Women can leave it in place for up to 48 hours, regardless of the number of times they have intercourse.
One of the few practitioners in Hampton Roads who fits women for the cap, certified nurse midwife Laurie MacPherson-Smith, calls the cap: ``The best-kept secret in family planning.
``It's a good method for a woman who has had a child, is in a stable relationship and if you're fairly comfortable with your anatomy.''
Its failure rate is similar to that of the diaphragm, about 6 percent.
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Female condom: Called Reality, the female condom consists of a polyurethane pouch with two flexible rings at either end. The condom's inner ring holds it in place inside the vagina; the outer ring covers the outer lips.
-Effectiveness of barrier methods: Failure rates vary, depending on the specific method, and how consistently and correctly it's used. Male condoms have the lowest failure; the female condom has the highest.
Advantages: All barrier methods offer some protection against STDs, but the male condom is more effective than others.
Disadvantages: Barrier methods must be used with every act of intercourse and be put on or inserted prior to genital contact. Male condoms made of natural membrane are not as effective as latex condoms in preventing transmission of STDs.
Depo-Provera. Depo-Provera is an injectable contraceptive containing a synthetic hormone (a progestin), which prevents pregnancy primarily by inhibiting ovulation. One injection provides reliable protection for three months, at a cost of about $40 to $60, including the exam.
Effectiveness: Less than 1 percent annual failure rate.
Advantages: Privacy, effectiveness and only requires attention once every few months.
Disadvantages: Initially, the most common side effect is irregular and unpredictable bleeding.
Other, less common, side effects are headaches, mood changes and weight gain. Does not protect against STDs.
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Norplant. Norplant is a contraceptive system made up of six match-stick-size, flexible capsules containing progestin. The capsules are inserted under the skin of the upper arm in a simple surgical procedure. For up to five years, the implants slowly release a steady dose of progestin.
Effectiveness: Less than 1 percent annual failure rate.
Advantages: No worries about taking a daily pill. The initial cost of Norplant is high - about $500 to $700 including an exam and insertion - but it is cost-effective for women who intend to keep it in place for three to five years.
Disadvantages: Side effects are the same as those for Depo-Provera, but periods are likely to return to normal over time. A few women have experienced problems with removal. Norplant offers no protection against STDs.
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The IUD. The two types of intrauterine devices available in the United States today - the ParaGard and the Progestasert - are widely regarded as safe and effective. But less than 1 percent of women who use contraception choose the IUD, compared with numbers as high as 40 percent in other countries. (This may be because of lingering bad memories of the Dalkon Shield, which was found to cause pelvic infection and was taken off the market in 1975.)
The ParaGard is a copper-coated device that probably prevents pregnancy by creating a hostile environment for sperm. It is effective for at least 10 years.
The Progestasert releases the hormone progesterone, which thickens cervical mucus to prevent sperm from entering the uterus. This IUD must be replaced every year.
Effectiveness: ParaGard has a less than 1 percent annual failure rate. Progestasert is is about 2 percent.
Advantages: It is long-term, completely reversible and there's no need to remember to take a pill every day. Surveys show that the IUD has the highest user satisfaction rating of any contraceptive.
Disadvantages: There is an increased risk of pelvic infection in the few weeks after insertion, when microorganisms in the vagina may be pushed up into the uterus. Experts only recommend IUDs for women who are in stable, mutually monogamous relationships.
The major side effect of ParaGard is increased menstrual bleeding and cramps, so women who already have heavy bleeding or severe cramps are advised to use the Progestasert, which causes less bleeding and cramping. Because the Progestasert must be replaced every year, there is an increased risk of infection. IUDs do not protect against STDs.
Morning-After Pill: If your birth control method breaks or dislodges, or you have unprotected sex, your doctor can prescribe emergency contraception. This consists of taking two larger-than-normal doses of oral contraceptives. Treatment must begin within 72 hours after intercourse. If fertilization has occurred, the hormones in the Pill inhibit the establishment of a pregnancy.
- Source: Good Housekeeping magazine, October 1994 ILLUSTRATION: BETH BERGMAN/Staff color photos
The cervical cap is one of the least used and least well-known
barrier methods that has been used for years in Europe before coming
to the U.S.
Nurse midwife Laurie MacPherson-Smith speaks highly of the cervical
cap.
Graphics
CONTRACEPTIVE FACTS
Method Number of Users Percent of users
Sterilization 13,686,000 39.2
Tubal 9,617,000 27.5
Vasectomy 4,069,000 11.7
Pill 10,734,000 30.7
Condom 5,093,000 14.6
Diaphragm 2,000,000 5.7
Periodic abstinence 806,000 2.3
Withdrawal 778,000 2.2
IUD 703,000 2.0
Spermicides 637,000 1.8
Other methods 76,000 0.4
PAST TRENDS
Here are some trends in contraceptive use during the 1980s:
Female sterilization increased from 23 percent to 28 percent.
Increased use occurred among the formerly married, the less educated
and among low-income, Hispanic and African-American women.
Pill use increased from 28 percent to 31 percent. Increased use
occurred among better educated women, whites and those with higher
incomes. Declines in its use occurred only among teenagers.
Of the 39 million women at risk of unintended pregnancy, nine
in 10 use a contraceptive method.
Two-thirds of teenage women use a contraceptive the first time
they have intercourse; use at first intercourse increased during the
1980s almost entirely because condom use doubled.
- Source: Alan Guttmacher Institute, a not-for-profit corporation
for reproductive health research, policy analysis and public
education.
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KEYWORDS: CONTRACEPTIVE DEVICES by CNB