Women who use nonpermanent birth control to prevent unwanted pregnancies now have a host of options from which to choose, and most dont require the daily vigilance that the traditional pill does, say womens health experts here.


Alternatives to a birth control pill regimen include intrauterine devices (IUDs) such as the non-hormonal ParaGard or the hormonal Mirena, a weekly skin patch, a two-inch flexible ring thats inserted into the vagina, an injection, or even the implantation of a small device in a womens upper arm.


C.J. Gribble, CEO and acting clinical services director of Planned Parenthood of the Inland Northwest, says having such choices makes it easier for women to choose a method that they find acceptable and fits their lifestyle.


Mirena, an IUD approved by the U.S. Food and Drug Administration in 2001, has grown in popularity here, says Dr. Lewis Meline, a physician at Woman Health Inc., of Spokane. He says that while a lot of his teenage patients tend to stick with the pill, there is a broad spectrum of women of all age groups who now use Mirena.


Mirena is a T shaped object thats inserted into the uterus by a doctor and works by releasing a stream of a hormone that effectively stops sperm from reaching the egg, says Dr. Traci Satterfield, a physician at OB/GYN Associates of Spokane PS. She adds that because Mirena is effective for five years after being inserted, its easy for women to use. Mirena also can make menstrual periods lighter, she says.


ParaGard is an IUD similar in shape to Mirena, but, unlike Mirena, ParaGard doesnt release a hormone, says Satterfield. Rather, she says its presence creates a hostile environment for fertilization in the uterus.


She says that she doesnt recommend the use of ParaGard to her patients because it causes heavier and more painful periods compared to Mirena. ParaGard can be used for 10 years before being removed or replaced, however.


Satterfield says that while IUDs can be used for lengthy periods of time, women can have them removed should they decide to become pregnant or if they arent happy with the side effects they can cause.


Another alternative to the pill that seems to be growing in popularity is the NuvaRing, says Meline. He says that most of his patients that try it like it.


The NuvaRing was approved by the FDA in 2001, and Gribble says its used by about 14 percent of women seeking birth control from Planned Parenthood here.


The ring is inserted into the vagina and releases estrogen and progestin over a course of three weeks, says Wendy Smith, a registered nurse practitioner and owner of Full Circle Medical Clinic, which specializes in womens health.


After three weeks, the user removes the ring, goes a week without using one, then inserts a new ring. Smith says women who use the ring must be comfortable inserting and removing it on their own.


For women who arent comfortable with those types of devices, there is Depo-Provera, the birth-control injection that protects for 90 days, says Gribble. She says that about 12 percent of women served by Planned Parenthood here choose that option.


Depo-Provera works by stopping the release of fertile eggs from a womans ovaries, says Meline, although he is beginning to see a dwindling interest in the injection due to its reputation for causing weight gain in women. He says the progestin used in Depo-Provera can cause the body to retain water and the drug seems to affect the users appetite, leading to increased snacking.


Dr. Shawn Barrong, of Northwest Ob-Gyn PS, of Spokane, says theres definitely some weight gain with Depo-Provera. He also says that coming to the doctors office to receive a shot every three months can be a deterrent to women when there are longer-lasting alternatives available.


Another choice for women is the Ortho Evra patch, which releases estrogen and progesterone into the body through the skin. The patch is placed on the womans upper arm, abdomen, upper torso, or buttocks, and is worn for one week. This cycle is repeated for three weeks, at which point the user goes a week without using the patch. Gribble says that only about 5 percent of women served by Planned Parenthood here choose the Ortho Evra patch.


Meline believes the patch has fallen out of popularity since it first was approved in the U.S. in 2001. Women complained about having it on for so long, he says.


Barrong says, Women didnt like the sticky-ring residue that remained after removing the patch. Also, he says, there is an increased risk of developing blood clots associated with the patch.


One of the newest birth control methods, called Implanon, was approved by the FDA in 2006.


Implanon is a matchstick-sized rod that is inserted into the inside of a womans upper arm by a health care provider using a local anesthetic, and can remain there for up to three years. The rod contains etonogestrel, a synthetic form of progesterone, and slowly releases it into the users body, causing the ovaries to stop the release of fertile eggs.


Barrong says that its an effective choice and a huge improvement over Norplant, which was similar to Implanon but no longer is used in the U.S. due to the intense side effects it caused. Barrong says that competition among varying types of birth control in the marketplace may be one reason Implanon hasnt really caught on here.


Meline says that Implanon hasnt caught on with his patients and that they seem to be adverse to the way its put in.


The traditional pillDespite the other choices, The pill is still the gold standard, says Smith, of Full Circle Medical Clinic. The pill has been around the longest, its the easiest to start, and its the easiest to stop, she says.


Satterfield agrees with Smith and says that she sees a lot of younger patients and feels its best to start them off with the pill. By doing so, she says, she can take a little bit of time to see if people like it.


If the patient decides the pill is not for them, its easy to move on to something else, she says. She adds that there are more options with the pill in terms of brands and dosage levels than there are with other birth-control products.


Gribble says women still really like the pill, and that 66 percent of women served by Planned Parenthood here choose to use the pill as their form of contraception.


She says women like the pill because they have a lot of control over their menstrual cycles, unlike with some other birth-control options, and women who wish to eliminate their periods altogether can do so by skipping the placebo pills that are placed in a pill pack.


Gribble warns that women have to be vigilant when taking the pill. She says a lot of the pills on the market have lower levels of estrogen, which reduces side effects but means that missing a day can reduce the products effectiveness. The less a method depends on the patient, the more effective it is, she says.


The pill also is commonly prescribed to women who may not be sexually active, but use the medication to subdue painful periods, says Barrong, adding, The pill still has the majority of the market, but other forms (of birth control) are starting to creep in.


Contact Ben Rascoff at (509) 344-1260 or via e-mail at benr@spokanejournal.com.