Dr. Swiner’s Medical Note of the Month-May 2010-Updates on birth control

In a recent “Ask Dr. Swiner” segment on my Facebook page, I had a number of interesting questions about what’s new in birth control. I deal with this issue frequently in my practice, and even I have to make sure I’m up-to-date with the information that comes out.

f levels of estrogen and progesterone that balance one another and allow a woman to have monthly, regular menstrual cycles. Some pills, if taken without taking the placebo pill (the ones at the end of the pack that are usually a different color), allow a woman to have only three menses a year.

We’ve had the patch, the ring, the shot, the implant and the pill for a number of years. Most recently, IUDs have become all the rage. Intrauterine devices such as the Mirena and the Paragard are one of the “hands-off” methods, in that the woman doesn’t have to do anything except wear a condom to prevent STDs, of course.

A doctor places the plastic device into the uterus during an office visit, and that’s it essentially. When the woman is ready to have it removed at five years (Mirena) or 10 years (Paragard), the doctor takes it out. Recently, the complaint I’ve heard from women about the IUD is that it appeared to thin their hair, which might, theoretically, occur with any hormonal option or for other reasons if they’re postpartum.

What can be unpredictable about Mirena IUDs is the way a woman’s cycle might change once it’s placed. Because it’s made primarily of progesterone and does not have estrogen – like most pills – to balance it out, it can change the timing of menstrual cycles. What I tell most women is the rule of thirds: approximately one-third of women with the IUD may have their normal, monthly cycles; one-third may have no cycles, which is usually what the majority of women hope for; and one-third may have variable, unpredictable cycles. We don’t know which group you’ll end up in until we place the device. In most cases, however, women are pleased with this method of birth control.

Norplant was put out a couple of years ago, and it is known as the implant that is placed under the skin of the arm and lasts for up to five years. It was a five-rod method made primarily of a progesterone-related hormone like the IUD, meaning it may have the same effect on bleeding.

It was taken off the market about four years ago, and now we have Implanon, the “new and improved” version. This one lasts for up to three years and has to be removed after this point. Instead of five rods, Implanon only has one and appears to have less bleeding variability, less bone loss concern and less weight gain than some of its counterparts. I was recently trained to place this method, and it seems to be a good alternative to the Depo-Provera injection for women who may want to try something different.

The newest contraception I’ve heard about is Essure. Instead of going into an operating room and having a bilateral tubal ligation, or getting your tubes tied, this is an outpatient version of the procedure. It involves the release of small metal coils into the fallopian tubes to block fertilization. It is irreversible. The usual surgery that is done to have a tubal ligation is now possibly reversible, depending on how the surgery was done and who performed it. And finally, there is another type of outpatient surgery; one that doesn’t involve any female anatomy, and that’s a vasectomy.

  1. Nicole Price Swiner, M.D., works for the Durham Family Practice in Durham. Contact her at 220-9800.

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