Five hormonal birth control methods have been recently approved for use in the United States.

Seasonale	Birth Control Pill
Yasmin	Birth Control Pill
Lunelle	Monthly Shot (no longer available)
Mirena	Intrauterine Device (IUD)
NuvaRing	Vaginal Ring
Ortho Evra	Patch

All these individual methods have advantages and disadvantages that are characteristic of their method group.

For example, Seasonale, Yasmin, Lunelle, NuvaRing and Ortho Evra are all part of the combination hormonal group of birth control methods. One characteristic that applies to the entire group is that women who smoke should not use any of these methods.

In the review that follows, we'll only look at the particular advantages and disadvantages of each method. Please make sure to discuss each option, in detail, with your doctor. It's also important to consider how the different methods ultimately fit in with your lifestyle and future plans.

Seasonale is a dual-use combination birth control pill. You can use it for birth control, to prevent a pregnancy, and/or you can use it for menstrual management, to manage your menstrual period.

Seasonale has two hormones--an estrogen and a progestin (0.03 mg ethinyl estradiol and 0.15 mg levonorgestrel).

The type and amounts of hormones in Seasonale are similar to the ones used in regular combination birth control pill brands.

What makes Seasonale different from the other combination birth control pill brands is the way you use this pill.

Seasonale is the only dedicated menstrual management brand. It's the only one packaged and labeled for period control.

Regular combination pill brands are used on a 3 weeks on/1 week off, monthly regimen. You take one active pill every day for 21 days and then you have one week without active pills. An active pill is a pill that has hormones. An inactive, or placebo pill ("sugar" pill) doesn't have hormones.

During the off week you usually have a fake period, called withdrawal bleeding.

The menstrual period and the fake period (withdrawal bleeding) are not one and the same thing.

The monthly fake period is actually a pretend period, and there's no medical or health reason to have one. The inventors of the Pill came up with the monthly fake period because of non-medical reasons, ranging from Puritanical politicians, to dead rabbits.

From the start, a monthly fake period was, and remains, a "designer" add-on to the Pill.

In contrast, Seasonale is a continuous pill brand, used on a 12 weeks on/1 week off regimen. You take an active pill continuously for 84 days, followed by 7 days off to allow for a bleeding episode (the fake period).

As with the regular pill brands, during the off week you have a fake period. Except that Seasonale reduces the number of yearly bleeding episodes from 13 down to 4.

Seasonale does not reduce the number of yearly menstrual periods from 13 down to 4. It shifts the frequency of the fake period, from monthly to once every three months.

Regular pill brands can also be used on a continuous regimen (Levlen, Levora, Nordette, Ortho Tri-Cyclen, etc.). However, because Seasonale comes packaged and labeled for continuous use, it's easier and more convenient to use.

For more information, please visit the Seasonale site, maintained by the manufacturer, Barr Laboratories.

Yasmin is a low-dose, monophasic combination birth control pill (oral contraceptive pill, or OCP).

Low-dose refers to the low amount of hormones in the pill and monophasic means each active pill in the pack has the same amount of hormones.

Yasmin is a combination pill because it has 2 types of hormones: an estrogen and a progestin (0.03 mg ethinyl estradiol and 3.0 mg drospirenone).

The progestin drospirenone is a newly synthesized compound, and it differentiates Yasmin from other OCP brands.

One pack of Yasmin has two types of pills: active and placebo (inert). The active pills contain hormones and the placebo pills don't. You take an active tablet for 21 days, followed by 7 days of placebo pills as a "reminder".

the pills are better tolerated

less weight gain

less acne

fewer mood changes

The specific disadvantages of using Yasmin are related to drospirenone.

Drospirenone has antimineralocorticoid properties. Because of this, if you have kidney or adrenal gland insufficiency, or liver problems you should not use Yasmin.

Also, your body's levels of potassium should be checked during the first month you use this OCP brand, if you take daily drugs that can increase your potassium. Some examples of these drugs are NSAIDs (Ibuprofen, like Motrin) and ACE-inhibitors (Lotensin, Vasotec).

Because Yasmin contains a new type of hormone (drospirenone), don't assume that if you were able to use birth control pills in the past, you'll be able to use Yasmin. Please make sure to discuss this point with your doctor.

For more information, please visit the Yasmin site, maintained by the manufacturer, Berlex.

Mineralocorticoids -- A group of hormones, the most important being aldosterone, that regulate the balance of water and electrolytes (ions such as sodium and potassium) in the body. The mineralocorticoid hormones act specifically on the kidney.

Lunelle (Cyclofem/CycloProvera) is a monthly combination birth control shot.

The shot has 2 hormones: an estrogen and a progestin (5.0 mg estradiol cypionate and 25 mg medroxyprogesterone acetate).

It is given as a monthly injection (in the arm, thigh or buttock) by a medical professional.

convenient, monthly dosage

rapid return to fertility after stopping the injections (about 2 -3 months)

typically, regular monthly cycles

the need for a monthly visit to a doctor's office to receive the shot

weight gain

headache

nausea

breast pain

Please note that Lunelle is different from Depo-Provera, the only birth control shot available in the U.S.

Depo-Provera contains only one hormone, a progestin. Also, you only get this shot once every three months rather than monthly, and the advantages and disadvantages of using it differ from those of Lunelle.

Lunelle was approved for use in the U.S. in 2000. However, in October 2002 it was voluntarily recalled from the market, due to plant manufacturing problems. The maker doesn't plan to reintroduce it in the U.S.

Since Lunelle was the only combination shot available in the U.S., once again American women are left without an alternative.

For women in the rest of the world, the alternatives to Lunelle are: Mesigyna, Perlutal, Yectames, and Chinese Injectable No.1.

Mirena is an older, frame Intrauterine Device (IUD). The newer IUDs, like FibroPlant, and GynePlant don't have a frame.

Mirena, the hormonal IUD available in the U.S., is a small, plastic, T-shaped device that also contains a progestin hormone (52 mg levonorgestrel) in its frame.

Mirena is inserted into the uterus by a medical professional, in a matter of minutes. Once in place, it releases a very low dose of the hormone locally, for up to 5 years.

Of course, if you don't want to use it for the full 5 years, you can have it taken out at any time. The removal is also done by a medical professional and lasts even less than the insertion.

you can use it continuously for up to 5 years

lighter, shorter and less painful periods

the hormone mostly acts inside the uterus, so there are no wide-spread body effects

quick return to fertility

effectiveness rate comparable to sterilization

irregular periods, during the first few months of use

headaches

nausea

breast pain

mood changes

Like with the other methods discussed, because Mirena is part of the IUD group of birth control methods, there are certain general characteristics associated with the use of any IUD that you need to discuss with your doctor. Some of these characteristics are: the risk of Pelvic Inflammatory Disease, ectopic pregnancy, and infertility.

Using Mirena is very safe. It has been used in Europe for over 10 years, with no serious problems reported.

For more information, please visit the Mirena site, maintained by the manufacturer, Berlex.

NuvaRing is a flexible, doughnut-shaped vaginal ring that contains two hormones--an estrogen and a progestin (2.7 mg ethinyl estradiol and 11.7 mg etonogestrel).

You insert the ring into the vagina yourself; because it's not a barrier method, you don't need to place it exactly over the cervix.

You leave NuvaRing in for 3 weeks after which you remove it for a fourth, ring-free week.

convenient, once-a-month dosing

the ring doesn't need to be fitted by a doctor

you can use it to control the timing and start of your periods

headaches

vaginal irritation, discharge, or infection

the ring may accidentally slip out during sex

you, or your partner may feel the ring during sex

For more information, please visit the NuvaRing site, maintained by the manufacturer, Organon.

Ortho Evra is a birth control patch about the size of a half-dollar. It contains both an estrogen and a progestin (0.75 mg ethinyl estradiol and 6.0 mg norelgestromin).

You wear the patch on the arm, abdomen or buttock for 7 days in a row. Then you exchange it for a new patch, which you wear for another week, and so on. After three weeks (and three patches), the fourth week is patch-free.

convenient, once-a-week dosing

you can use it to control the timing and start of your periods

it does not stick in about 5% of women

it can become partially or completely detached

it may cause an allergic skin reaction or irritation

more severe menstrual cramps and breast pain vs. pill users

the patch is less effective in women who weigh more than 90 kg (198 lbs)

For more information, please visit the OrthoEvra site, maintained by the manufacturer, Ortho-McNeil.

Implanon is a small, implantable rod, about the size of a matchstick. The rod contains only one hormone--a progestin (68 mg etonogestrel).

The rod is implanted by your doctor under the skin of the inner upper arm and you can use it for up to 3 years. Of course, if you decide you don't want to use it anymore, it can be removed at any time. Your doctor will need to remove it for you.

Both the insertion and the removal are done during short office visits.

more effective than the older implant brands

insertion and removal are faster, with fewer complications

Implanon is available in the U.S., Australia, Indonesia, and 11 European countries, including The Netherlands and the UK.

For more information, please visit the Implanon site, maintained by the manufacturer, Organon.

Jadelle consists of two implantable rods that also contain only one hormone--a progestin (140 mg levonorgestrel). In the U.S. it is called Norplant II.

The rods are implanted by your doctor under the skin of the inner upper arm and can be left in place for up to 5 years.

its effectiveness is not affected by the user's weight

fewer removal complications

Jadelle is available in Europe. It has also received FDA approval in 1996, but it's not currently being marketed in the U.S.

Uniplant is a single-rod implant that contains only one hormone--a progestin (nomegestrol acetate). It may be left in place for up to one year.

Norplant, the original 6-rod implant, was first introduced in the U.S. in 1990. In December 2002, citing limitations in component supplies, the manufacturer withdrew Norplant from the American market.

At this time only one implant brand, Implanon, is available in the U.S.

* FibroPlant-LNG picture courtesy of Dr. D. Wildemeersch, Contrel Research, Technology Park, Ghent, Belgium


Implanon	Implant
Jadelle	Implant
Uniplant	Implant