Since technology and fashion are always evolving and changing, are you wondering if your contraceptive options have evolved too? The answer is a resounding yes … but at a much more conservative pace. Read on for an update on what’s new, what’s changed, what is having a revival, and how this can benefit you.
What’s New?
A new electronic reminder for the daily combined oral contraceptive pill (COCP) (1,2).
The oral contraceptive pill is now also available in a palm sized digital tablet dispenser (containing 120 tablets) that is programable to your preferred time to sound an alert to remind you to take the daily pill. It also notices if a pill has been missed, and provides an alert on the screen to use additional contraception if required. Women tell me that this has made their lives easier, as they are much less likely to miss a pill (which of course makes it more effective), and that they are led through the process without panicking if they do miss one.
It is also the first oral contraceptive pill in Australia approved for continuous use without a break (or sugar pills) for up to 120 days, which means that women can choose when to have a period and how many to have in a year (between 3-13 periods), which can be programmed into the device. Medical studies (1,2) have shown that skipping cycles is safe and still effective in terms of contraception, and this regime may be suitable to help avoid severe premenstrual syndrome or painful or heavy periods that some women experience every month.
Contraindications to women using any combined oestrogen and progestogen containing pills (COCP) include a previous cancer, previous blood clots in the legs or lungs, severe liver disease, a previous stroke, or if a smoker, using combined contraception after the age of 35. The side effects of the COCP and the associated risks can be explained by your GP.
The contraceptive vaginal ring (1,3) has been available in Australia for more than 10 years, and more than double that in Europe and North America, but many women have never heard of it, so I will explain.
It is a soft flexible plastic ring containing similar hormones oestrogen and progestogen to the combined (COCP) pill. It is inserted into the vagina for 3 weeks and removed for 7 days when there will be a withdrawal bleed. Less hormone is required than with the oral COCP, as it is absorbed directly by the vaginal mucosa. This may be useful for women who have experienced hormonal side effects such as nausea, breast tenderness or mood changes on the oral pill. In my practice, I have seen it increase in popularity for the reasons that it is effective (99%), no pills are required, it does not need to be specifically fitted, provides good cycle control with the ability to ‘skip a bleed’ if required, and that fertility quickly returns to normal when taken out.
The downside is overcoming the idea of putting something in the vagina and leaving it there, and becoming familiar with inserting and removing it. Many women tell me that they feel it is easy to use, set their phones to remind them to remove it monthly, and that it has no adverse affect on sexual activity. In terms of staying in place, the elasticity of the vaginal mucosa keeps it in place during both normal activity and intense physical exercise, and women generally decide in the first couple of months if this is the contraception for them and their lifestyle.
What’s changed?
A new (COCP) pill (1,4) that contains the oestrogen oestradiol, identical to the one our ovaries make, which is perhaps considered more ‘natural’. The progestogen component has a mild ‘ anti-androgen’ action making it a potential choice for women with polycystic ovarian syndrome and insulin resistance and acne. The active pills are taken for 24 days of the cycle, with four hormone free pills. These combined factors result in a lighter, shorter withdrawal bleed after taking it for a few months, and may also reduce the hormonal symptoms such as headaches and pelvic pain in the pill free break. Some women find that the period vanishes altogether after 4- 6 months of use, which is unacceptable for some, and may advocate changing to another COCP or form of contraception.
What is having a revival ?
The IUD (Inter Uterine Device)
IUD’s have been around since the 1960’s and whilst the copper IUD was plagued by a cluster of negative health effects due to its flawed design (in terms of shape and amount of copper), things have dramatically changed, especially with the introduction of a soft plastic IUD containing the hormone levonorgestrel (1,5), and they are becoming more popular.
Why? As a contraception, they are long acting (3-10 years), convenient, and quickly reversed by removal, with a return to fertility in months. In peri menopausal woman, the hormonal IUD has proven highly effective in successfully treating heavy dysfunctional bleeding, whilst still being an effective (99%) contraception. Depending on the time of menopause, if the device is inserted after the ages of 45 years, it can generally be removed at the menopause.
Now days, many younger women are hearing the benefits from their sisters and friends and requesting one. The flip side is that the device needs to be inserted by a doctor with special training, and there is bleeding and cramping initially that usually settles down within a few months. The insertion may be more difficult in someone that hasn’t had children via vaginal delivery, in which case an anaesthetic or light sedation may be used. You will be able to check if the IUD is in place as it has thin plastic strings (that feel like fishing line) attached that are a few centimetres long that sit in the vagina. During sexual intercourse, your partner may feel the strings, but there should not be any discomfort from the IUD, and the strings also makes it easier for your health care provider to remove the IUD when it’s time to take it out. After the IUD is in place in your uterus, you can swim, exercise, use tampons, and have sex as soon as you want to. With the hormonal IUD, you tend to still have a regular periods, but are likely be lighter and shorter than previously.
Many ask about the differences between the hormone containing IUD containing and the current copper IUDs (1,6). The copper IUD is suitable for women who can not use hormones (for example previous uterine, cervical or breast cancers, or prefer not to), and can be used up to 10 years depending on the device. There is often more heavy and prolonged bleeding with the copper IUD when first fitted, and during regular periods, and it is more expensive ($150 for the copper IUD compared to $40 for the hormonal device in Australia which is on thePharmaceutical Benefits Scheme (PBS).
Watch this space – As studies show that women under 21 not using long acting contraceptive options were up to twice as likely to have an unintended pregnancy than older women on all forms of contraception, it is interesting to know that there is a new IUD on it’s way (1,7) registered with the TGA but not yet marketed in Australia. It has been designed to be better suited for a smaller uterine cavity and is indicated for under 20 year olds. It contains the same type of hormone levonorgestrel, except in lower amounts (13.5 ugm/day compared with 20 ugm/day), and is effective for 3 years. Of course doctors trained in insertion are required, and women must be well counselled as to the benefits and risks (as per all forms of contraception) prior to it’s insertion.
Thus yes, like everything else, the field of contraception is also evolving and women can feel more empowered by being more aware of what is available. And, as everyone is different, it is important that women investigate and talk to their doctors about the most appropriate contraceptive option for them and their lifestyle.
(1) Australian Register of Therapeutic Goods (ARTG) search, available at www.tga.gov.au/industry/artg-searching.htm
(2) YAZ® Flex Approved product Information, April 2012
https://www.tga.gov.au/file/6491/download
(3) NuvaRing®
www.nuvaring.com/
secure.healthlinks.net.au/content/msd/pi.cfm?product=mkpnuvar
(4) Zoely®
www.msdproduct.co.uk/api/zoely.pdf
(5) Mirena®
www.mirena-us.com/about-mirena/see-mirena-up-close.php
www.fpq.com.au/pdf/Fs_Mirena.pdf
(6) Paraguard
www.paragard.com/
(7) Jaydess®
www.fsrh.org/pdfs/CEUProductReviewJaydess.pdf
https://www.tga.gov.au/file/1234/download
The Australian Family Planning NSW Website
www.fpnsw.org.au and Talk line 1300 658 886
Dr Lee is not paid to endorse any of the products referred to in the article and it is important to note that readers seek medical advice as to what may be appropriate to their particular circumstances.
