New methods offer some benefits over pill

Clinical update: Contraception – In his latest Clinical Update, Gary Culliton reports on developments in the field of contraception, including how to pick the right contraceptive and the advantages and risks associated with various methods

A range of contraceptive options are on the Irish market, but how widely available are they in this country?
“In doing gynaecologic clinics, I have noticed that in Ireland, women tend to be offered chiefly either the pill or an intrauterine device [IUD],” said Dr Andrea Nugent, Community Gynaecologist at the Coombe Women and Infants University Hospital.
The Mirena coil is an efficient birth-control method with a very good Pearl Index score (0.09 per 100 women years). Also, because there are progesterone compounds impregnated on the IUD, this decreases the bulk of the endometrium that is shed.
Studies have shown that about 60 per cent of women end up temporarily amenorrheic (no periods) after three months of having the IUD in place. The Mirena coil is a treatment for menorrhagia and the device is inserted for five years at a time. It has become increasingly popular for women who have had children.
“Many of these women are in their late 30s or early 40s, when menstrual cycles might become more erratic and heavier in volume,” said Dr Nugent. “They are seeking a long-term – though not a permanent – solution for contraception as well.” The Mirena is an easy way to achieve both of these things without surgery.
There is also NuvaRing, a flexible ring about two inches in diameter that a woman inserts vaginally once a month. NuvaRing releases a low dose of hormones. “Having worked in America for many years, I have seen the advantages of NuvaRing,” Dr Nugent said. “Patients are not necessarily comfortable inserting the ring the first time on their own, however. Sometimes they need a practitioner to show them how to insert it once. In my practice, a quick explanation usually solves the problem. The majority of patients do not feel the device, after initial insertion.
“Also, studies have repeatedly shown that the majority of partners cannot feel it during sexual intercourse. Unlike with the pill, a women doesn’t have to remember to do something every day.”
The NuvaRing has the same effect as the pill. “For three weeks, hormone is assimilated to prevent ovulation. Then the ring is taken out and there is a week for menstruation,” said Dr Nugent.
The NuvaRing has fewer side effects than regular pills; it has the lowest dose of oestrogen of any of the combined forms of contraception. Only 15 micrograms of oestrogen per day are released into the system. The lowest-dose combined pill would release 20 micrograms. Quite a lot of pills release 30 micrograms. With NuvaRing, there is a transvaginal absorbtion.
Some women may find that oestrogen affects them adversely – breast-feeding mothers, for example. Progesterone-only pills are very useful in this regard. Many of the pills have to be taken at the same time every day, however. Even when such pills are missed by a very short period of time, efficacy may decrease.