The freedom of women to use the form of birth control that best suits their individual needs is something most young women in this country take for granted. In yesterday’s post I commented that access to birth control is a relatively recent “right”. As I mused about how reproductive rights helped women move their careers forward, I remembered an article written last fall by Katie McBeth and published in a college online newspaper, the cavalierdaily.com. Originally I had it filed in the, “My, my, my, how things have changed” category. McBeth wrote  a wonderful, observational piece that demonstrates just how young women view birth control today.

Forty-five years ago birth control activist were jailed for distributing birth control information and products on college campuses. Today, breezy, informative, well-written articles about birth control options are considered normal fare in college newspapers.  I’ve included the article below.

Bra-shopping for birth control

Katie McBeth
Published: Wednesday, October 29 2008, cavalierdaily.com

Shopping for birth control can feel a lot like bra shopping — you have to choose the right fit, amount of padding, support, color, style — the options can overwhelm you. Of course, once you find the perfect fit, you swear by it and end up with multiples of the same bra. A similar phenomenon occurs with birth control — like the episode of “Seinfeld” where Elaine buys all the “Today Sponges” she can get her hands on after finding out they will no longer be made because she swears by them as birth control. Most women agree with that sentiment and are often reluctant to change the method they use.

There are methods of birth control we’re all fairly familiar with, such as condoms and the Pill. Condoms are easily available over the counter, are fairly inexpensive and are accessible to all. When used properly, they are considered 98-percent effective and, compared to non-barrier methods of contraception, have the added benefit of helping to protect against sexually transmitted infections. Condoms are often considered inconvenient, though, because they require partners to interrupt their activities. Also, many people do not use condoms correctly, which diminishes their effectiveness at preventing pregnancy to about 85 percent. And condoms do have the possibility of tearing, especially if they are expired. Remember when using condoms that you should only use one — so-called “double bagging” actually increases the risk that condoms will tear.

Historically, there was only one method of oral contraception, which became known as the Pill, but today, there are several options. The different options vary by the amount of hormones, length of menstruation, number of periods per year and whether the dose varies each week. We’ve all seen commercials for Yaz and Seasonale, two newer options that shorten menstrual cycles and decrease the number of periods per year, respectively. Choosing a birth control pill depends on your personal preferences and what you and your health care provider decide is the best option for you. When used correctly, pills can be more than 99-percent effective in preventing pregnancy, but they do not protect against STIs.

In addition to these two methods of contraception, there are many others, including things like the ring (NuvaRing), implantable method (Implanon), the Shot (Depo-Provera), the Patch (Ortho Evra), intrauterine devices and emergency contraception.

The ring is a flexible plastic ring that a woman inserts in her vagina around her cervix and leaves in place for three weeks. The ring is removed for one week, similar to the week of inactive pills in oral contraceptives. The ring works by releasing the hormones estrogen and progestin to prevent ovulation and because it releases hormones similar to the Pill, it is similarly as effective. Because the ring has to be inserted and removed from the vagina by hand, many people feel uncomfortable with it. Because it is inserted for three weeks at a time though, many enjoy the freedom of not having to remember to take a daily pill. In my opinion, this option is not for the faint of heart and definitely works best for women who are extremely comfortable with themselves.

Implanon is a small, match-stick size rod inserted underneath the skin of the upper arm for up to three years. It works by releasing the hormone progestin to prevent ovulation. This option is great for women who are looking for more long-term methods of contraception and aren’t planning to become pregnant for at least three years, although it can be removed if a woman changes her mind. Similar to other methods, it’s about 99-percent effective when used correctly. While convenient, it’s not yet widely available.

Depo-Provera shots are given every 12 weeks to prevent pregnancy by releasing the hormone progestin to prevent ovulation and is more than 99-percent effective. It is also convenient for women who do not want to remember to take a daily pill and is helpful at reducing the frequency and heaviness of periods to the point that some women do not have periods after one year of use. The disadvantage is that injections cost between $30 and $75 each and are often not covered by insurance policies. It’s also not a good option for people who are terrified of getting shots.

The Patch is a small beige patch, similar in size to Nicotine patches. It is placed on the skin of the butt, upper arm or lower abdomen for one week at a time for up to three consecutive weeks, followed by an off-week to allow for menstruation. When used correctly, it is more than 99-percent effective. It has the advantage of not being a daily medication and being very inconspicuous, but it is slightly more expensive than pills. About three years ago, however, the patch was discovered to have a 60-percent higher dose of estrogen than birth control pills and it increases the risk of developing life-threatening blood clots. If the patch is an option you are considering, it is very important to discuss these risks with your doctor.

An IUD is a small T-shaped device inserted into the uterus by your doctor. They primarily work by interfering with the movement of sperm and preventing them from joining with an egg. There are two main varieties — one is made of copper and lasts for up to 12 years, and the other releases the hormone progestin and lasts for five years. Many consider IUDs to be one of the most effective methods of birth control because they are 99-percent effective and do not introduce any variability in effectiveness based on how correctly you use them. It’s also a one-time expenditure for more than 5 years of contraception, depending on which specific device you choose. A major risk of IUDs is that they can essentially “trap” bacteria, such as chlamydia and gonorrhea and increase the risk of developing pelvic inflammatory disease, so they are not encouraged for use in people who have multiple sexual partners and who are not using barrier contraception in addition to the IUD to prevent STIs.

And, when all else fails, there’s always “Plan B” or emergency contraception. The morning-after pill is a super-dose of the same hormones in birth control pills. It can be started up to five days after intercourse, although most recommend that it is started within 72 hours for maximum effectiveness. Some mistakenly think that Plan B is an abortion pill, but it is not; it works by thickening cervical mucus to prevent sperm from entering the uterus and joining with the egg and also by lessening the likelihood that an egg will implant in the uterine wall. It should not be used as a primary method of birth control under any circumstances, but accidents happen and it is a very effective backup method if you’re worried that your primary method may have failed.

Remember that there are even more options out there than these; if considering the use of birth control, you should discuss various options with your physician to determine which method is the best for you.

Katie is a University Medical student. She can be reached at k.mcbeth@cavalierdaily.com.

©2012 An Inconvenient Woman. All Rights Reserved.

Levine filed a lawsuit against Wyeth in state court in Vermont over alleged problems with the Phenergan label, and a jury ruled in her favor. The Vermont Supreme Court upheld the decision. In an appeal to the U.S. Supreme Court, Wyeth argued that FDA approval of medication labels precludes lawsuits in state courts filed over alleged problems with the labels (Kaiser Daily Health Policy Report, 10/3).

The current Supreme Court — “one of the most pro-business ones in 50 years,” according to the Journal — in February ruled in favor of pre-emption in a case involving the medical device company Medtronic. In addition, Justice Stephen Breyer in a “testy burst” during a recent drug-related case asked the plaintiff’s lawyer whom she would rather have in charge of whether drugs should be allowed on the market: “an expert agency, on the one hand — or 12 people pulled randomly for a jury role who see before them only the people whom the drug hurt, and don’t see those who need the drug to cure them?” According to the Journal, the Bush administration “has long promoted the idea that federal law pre-empts state lawsuits.”

Comments

Wyeth officials noted that the suit does not allege that the firm knowingly sold a dangerous product and that it complied with FDA guidelines for the drug’s label. In addition, Wyeth officials said that strengthening the label to comply with stricter Vermont law would have been a violation of federal law. Bert Rein, lead outside attorney for Wyeth, said, “It would be a chaotic system if you can relabel anything as long as you mumble safety.” However, Rein said he did not know of any instances where FDA had punished a firm for increasing the emphasis of a warning label.

Levine’s lawyers say federal law is not intended to prevent drugmakers from taking proactive steps to enhance warnings to doctors and consumers. According to the Journal, they say FDA guidelines “are the floor, not the ceiling, when it comes to safety standards.”

Consumer advocates say patients’ ability to sue in state courts is their only defense against corporate misbehavior, such as instances where FDA reviewers make a mistake or firms hide information. The New England Journal of Medicine in August published an editorial in favor of Levine that made similar arguments. Rein said that a ruling in favor of pre-emption would make it more difficult for people harmed by drugs to obtain compensation, but noted that Congress should establish a fund for such patients, as it did for vaccine-related injuries.

Implications

According to the Journal, a ruling in favor of pre-emption could heavily affect the drug industry. Recent cases that would have been affected include a $68 million settlement by Johnson & Johnson over its Ortho Evra contraceptive patch, more than $1 billion in settlements by Eli Lilly over its antipsychotic drug Zyprexa and $4 billion in payments so far by Merck over lawsuits involving its anti-cholesterol treatment Vioxx.

The Journal reports that some Democrats said that if they increase their majority in Congress this election cycle they will propose bills to undo pre-emption and guarantee the ability of patients to sue for damages (Wall Street Journal, 10/27).

Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation.

© 2008 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

©2012 An Inconvenient Woman. All Rights Reserved.