For Valentine's Day: A Field Guide to Contaceptives

The single greatest threat to wildlife and wild places in the world today is unrestrained population growth and the poverty that is maintained by that population growth.

For far too long, environmentalists have wrung their hands and talked too vaguely about "development," "industry," "mining," "drilling,' "over-fishing," "factory-farming" and "consumption."

All of these are symptoms of the same disease: too many people.

Even as environmentalists have shied away from naming the problem, too many others remain entirely ignorant about the mechanics of the solution.

Here's a hint: it's not bio-diesel or backyard chickens, grass-fed beef or nuclear energy.

It's contraception.

The litany of birth control methods that follow is a thumbnail guide to some of the options women and men have today ... and might have tomorrow.

The good news is that today women have more birth control options than ever before.

The bad news is that there are precious few male contraceptive methods available, other than condoms and vasectomies, and many tried and true contraceptive methods, such as Norplant, are being taken away from U.S. women.

Research into male contraception is simply NOT getting the funding it deserves, and clinical trials are too small even when they produce promising results.

Please be advised that the list below is NOT comprehensive, nor is it designed to endorse any particular method of birth control. This list is simply a 'field guide' to some of the contraceptive options out there, and should not serve as a substitute for a physician's advice or your own research.


A FIELD GUIDE TO CONTRACEPTIVE OPTIONS

• Male and Female Surgical Sterilization: Surgical sterilization is the most common form of birth control, both in the United States and overseas. In the U.S., among ever-married women ages 15-44 years, 41 percent now rely on surgical sterilization for contraception. Of this 41 percent, 26 percent report having had a tubal ligation, 7 percent had a hysterectomy, and 12 percent were currently living with a husband or partner who had a vasectomy. The above numbers do not quite add up, as some couples were double-covered, i.e. one partner had a vasectomy and the other had a hysterectomy or tubal ligation. Click here for more data showing the increase in surgical sterilization over the last 20 years. This trend is likely to continue as the population ages and as easier methods of sterilization are made available (see Essure and Quinacrine in the list below).
  
  
• Essure: Essure is a type of permanent, FDA-approved contraception that does not require any incisions, and is inserted into a woman's fallopian tubes in less than 30 minutes in a doctor's office with only local anesthesia. Most women are able to resume their normal activities the next day. How does Essure work? Basically, a net-like sleeve is inserted into each fallopian tube, and the fallopian tubes, aided by the micro-insert, seal shut over the course of a three-month period during which time other types of birth control are used. The Essure inserts do not contain hormones, and are made out of the same nickel-titanium metal and polyethylene fibers that hold open Dick Cheney's heart vessels. Data from clinical testing shows that Essure is 99.8% effective in preventing pregnancy after two years of follow-up (the same as for a vasectomy or tubal ligation). 98% of women who relied on Essure rated their long-term satisfaction with the method was "good" to "excellent". Essure is not reversible. Essure was FDA approved in November of 2002.
  
  
• FemCap and Lea's Shield: the FDA approved FemCap in April of 2003; it's been available in Europe for years. FemCap is a cervical cap used in conjunction with spermicide and it can be left in place for up to 48 hours. FemCap is not as reliable as an intrauterine device or hormonal methods of contraception and is reported to have a one-year failure rate of 20%. Lea's Shield, another barrier method, was approved by the FDA in March of 2002. Lea's Shield is a reusable, vaginal contraceptive made of medical-grade silicone rubber. One size fits all, and failure rates are reported to be about 15 percent over 12 months. Lea's shield has been in use in Germany, Austria, Switzerland, and Canada since 1983.
  
  
• Ortho Evra Patch: The Ortho Evra patch was FDA approved in November of 2001, and is 99% effective in women that weigh less than 198 pounds. The patch is 1.75 inches square and is to be placed on the buttocks, abdomen, upper torso or outer part of a woman's arm. The patch releases progestin and estrogen hormones into the bloodstream to stop a woman from getting pregnant. A new patch in applied every week for three weeks, and the woman is supposed to go patch-free during the fourth week. The patch can withstand bathing, showering and exercising, and comes in a beige color that looks very much like a band-aid.
  
  
• NuvaRing: The NuvaRing is a soft, flexible ring, about 2 inches in diameter that slowly releases estrogen and progestin after a woman inserts it into her vagina. The product is left in place for three weeks, and the woman is supposed to then go ring-free for the fourth week. NuvaRing was FDA approved in October of 2001, and is about as effective as hormonal oral contraceptive.
  
  
• Mirena: Mirena is a hormone-releasing intrauterine device that can prevent pregnancy for up to five years. Marketed as "birth control for moms" Mirena is a plastic-T design, and like other intrauterine devices is a reversible form of contraception. Mirena was FDA approved in December of 2000.
  
  
• ParaGard: ParaGard is a "Copper-T" intrauterine device that does not contain hormones and can be left in place for up to 10 years. A copper-T IUD can be used as emergency contraception if inserted within 5 days of having sex, and is a reversible but long-lasting form of birth control. Copper-T IUDS have been in use for more than 20 years, and more than 50 million have been distributed in over 70 countries around the world. The FDA first approved the marketing of the Copper T in the United States in 1984.
  
  
• Seasonale is a series of active birth control pills taken for 84 straight days instead of the usual 21. The result of this regime is that a woman on Seasonale has periods only four times a year. FDA approval of Seasonale is expected within the next few months. A continuous regime of active birth control pills is expected to help women who suffer from heavy periods, bad cramps or endometriosis. Many women already use standard birth control pills in an "off-label" protocol to achieve these same results.
  
  
• Depo-Provera and Lunelle: Depo-Provera is injectable progestin that inhibits ovulation, prevents sperm from reaching the egg, and prevents the fertilized egg from implanting in the uterus. It is effective for up to 12 weeks. Depo-Provera was FDA approved in 1992, and is now used all over the world. A similar product, Lunelle, provides contraception for one month, and is a combination of progestin and estrogen.
  
  
• Norplant: Norplant consists of six silicone implants that continuously release synthetic progestin in order to provide contraceptive coverage for up to 5 years. First used in Finland in 1983, Norplant was approved for use in the U.S. in December of 1990 and is now used in over 44 countries around the world. U.S. sales of Norplant were discontinued in 2000 due to threats of litigation by a small number of women who claimed hair loss and depression caused by Norplant use. Though this litigation never came to fruition, in July of 2002 "due to limitations in component supplies" the manufacturer of Norplant decided to permanently discontinue the sale of this very effective reversible form of contraception in the U.S.
  
  
• Today Sponge: The Today sponge prevents pregnancy by covering the cervix with a sponge containing a spermicide. The Today sponge was taken off the market in 1995 due to manufacturing problems at the plant. The Today sponge is now available again in Canada (it is now made in a new factory in New Jersey) and is expected to be available in the U.S. without a prescription in 2004. With a failure rate of about 10 percent, the Today sponge is not as reliable as an intrauterine device or hormonal methods of contraception, but is inexpensive (about $36 for a dozen) and women can use it only when they intend to have sex.
  
  
• Implanon and Jadelle: Implanon is an implant placed into the under side of the upper arm and it protects against pregnancy for two to three years. Implanon works very much like Norplant, but has only one rod instead of six. Implanon has not always been injected correctly by inexperienced doctors. A minor change in the manufacturing process and delivery method is expected fix this. Not yet available in the U.S., FDA approval of Implanon is expected in 2004. Note that FDA approval does not mean the product will ever reach our shores. A similar product, called Jadelle, is a two-rod levonorgestrel implant that has been approved for use up to 5 years by the FDA, but is not yet on the market in the U.S.
  
  
• Emergency Contraception: Two dedicated emergency contraceptive products are available: Preven and Plan B. Both work by delaying or inhibiting ovulation, inhibiting fertilization or inhibiting implantation of a fertilized egg. Preven and Plan B are little more than high-doses of normal birth control pills. Plan B is a progestin-only pill, while Preven is a progestin-estrogen combination. In California, Alaska, and Washington State, some pharmacies will provide emergency contraceptive pills without requiring you to see anyone except the pharmacist. In addition, emergency contraception is available over the counter in Quebec. If Preven or Plan B are not available, women can get the same results by taking several active birth control pills at once (see here for protocols). In addition to hormone-base methods of emergency contraception, the insertion of an IUD within 5 days of having sex, can also work.
  
  
• Female Condom: The female condom is a lubricated polyurethane sheath with a flexible ring on the closed end, which is inserted into the vagina. The female condom is difficult to use and not very popular; the FDA reports a 22% failure rate (i.e. number of pregnancies expected per 100 women per year) as compared to 11% for male condoms.
  
  
• Male Condoms: The male condom and the female condom, are the only two barrier methods which prevent the transmission of the HIV virus. Latex or polyurethane condoms do not allow the HIV virus to pass through. Breakage and slippage rates for latex condoms range from 2 to 6 percent, and may be higher among inexperienced users or those unable to read the directions. Condom breakage is related to how packages are open, how they are rolled on, whether and what types of lubricants are used, and the age and storage of the product. Due to slippage, breakage and inconsistent use, couples typically report a 10 to 15% annualized pregnancy rate with condoms.
  
  
• Diaphragms with Spermicides: Diaphragm use has fallen off rapidly in recent years due to the product's high failure rate as a contraceptive (17% according to the FDA) and the fact that it also offers no protection from sexually transmitted diseases.
  
  
• Quinacrine Sterilization: Quinacrine sterilization is achieved using quinine tablets (the same quinine tablets used for Malaria). Two quinine insertions, made one month apart, result in a chemical reaction which leads to a sealing over of the fallopian tubes, very much like what occurs with the FDA-approved Essure (see above). While Essure is fairly expensive, quinacrine sterilization can be done for very little money and few negative side effects have been reported. Over 100,000 women in 20 countries have been sterilized using quinacrine without a single fatality. With surgical sterilization, several deaths from general anesthesia or from surgical complication would have been expected in this number of procedures. Because quinacrine is such a cheap and easy method of achieving sterility, some human rights activists have raised the specter of mass sterilizations of the uninformed. In fact, quinacrine is much more likely to liberate women: female sterilization is the most common form of birth control in many countries, and would probably be even more popular if women were not incapacitated from work and did not have to notify their husbands before getting the procedure. An alternative to quinacrine sterilization, using erythromycin as a method of transcervical sterilization, is being researched by Family Health International which patented this methodology in March of 1999.
  
  
• Abstinence: Periodic abstinence is the least effective method of birth control available. According to the FDA, the failure rate (number of pregnancies expected per 100 women per year) is at least 20 percent.
  
  
• RISUG or SMA: RISUG stands for Reversible Inhibition of Sperm Under Guidance. In essence this is a method that coats the male vas deferans glands with styrene malic anhydride (SMA) mixed with the solvent DMSO (think of it as glue). RISUG does not completely close the vas deferens, but when sperm passes through the coated walls, an ionic charge is created that ruptures the sperm membranes causing them to be incapable of fertilizing an egg. RISUG has completed some small clinical trials, but it unlikely to be seen in the U.S. any time soon. A single injection of 60 milligrams of RISUG is thought to be able to provide contraception for up to 10 years, and the method is reportedly reversible.
  
  
• Birth Control Pills: Birth control pill are safer and more effective today than ever before, and are available in a dizzying array of brands. Birth control pills, also called oral contraceptives (OCs), come in two basic forms: a combined pill consisting of two synthetic hormones, estrogen and progestin; and, the "minipill," which consists solely of progestin. The combination pill works by suppressing the natural hormones in the body that stimulate ovulation; the progestin-only pill works by thickening the cervical mucus and preventing the egg from implantation in the uterus. If taken consistently, both forms of birth control pills are very effective forms of contraception, with combination pills being somewhat more effective than progestin-only pills. The failure rate of combination pills is less than 1 per one hundred women using this method of contraception for a year. "The pill" is the most popular reversible contraceptive in use in the United States, with about 27 percent of all women that are having sex and using contraception choosing the Pill as their contraceptive option.
  
  
• Vas Deferens Plugs: In China over 500,000 men have received polyurethane or silicone injections into their vas deferens. These injections harden to form a plug. Tests show a 98% effectiveness rate, and all the men who have had their plugs removed for at least four years have fathered children, most within the first year. Another kind of plug is the "shug," which is a made up of two non-injectible silicone plugs with nylon tails to help anchor the plugs to the vas. The Shug is also reversible, and is in clinical trials in China. Neither method is FDA approved in the U.S.
  
  
• Male Hormonal Contraceptives: Several types of hormonal pills for men are currently being tested with mixed results. It appears that about 10% of all men simply do not respond to hormonal pills, and researchers are not sure why. Another problem is delivery: the male hormone pill has to be taken 3 times a day to keep androgen levels consistent, and if delivered as a shot it must be given as often as every 10 days. Male hormonal contraceptives have also produce some unpleasant side effects (such as nausea and weight gain). Contraceptive patches for men have yet to deliver enough hormones to be effective. Research is ongoing, but underfunded.
  
  
• Gossypoll / Cottonseed Oil: Gossypoll is a substance derived from cottonseed oil. Large-scale studies done in China in the 1970s showed gossypol provided reliable contraception, could be taken orally as a tablet, and did not upset men's hormonal balance. Unfortunately, between 5 and 25 percent of the men who took Gossypoll for long periods of time remained infertile for up to a year after stopping treatment. In addition, gossypoll lowered potassium levels and strained kidney functions. Due to a combination of high infertility rates and renal interactions, research into gossypoll has largely been abandoned.
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