By Anna Merlan
By Keegan Hamilton
By Albert Samaha
By Darwin BondGraham
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With the Beatles' "Revolution" playing quietly behind her, Candace Bushnell recently welcomed the new birth control pill designed to limit menstruation. "So anyway, I'm like loving the idea of four periods a year," Bushnell, author of the original "Sex and the City" columns and celebrity spokesperson for the new drug Seasonale, told a crowd of reporters two weeks ago. "I've probably had like two guys break up with me when I was in premenstrual mode."
The first pill that officially allows women to menstruate once every three months, Seasonale is being positioned as a medical breakthrough. (Framed by four giant, reddish dots, Bushnell trumpeted "a whole new way" for women.) But similar combinations of estrogen and progesterone have long been marketed under other brand names. Women have been avoiding bleeding by staying on traditional birth control pills for months or even years, skipping each month's placebo doses. Even Seasonale's makers say having a period at the end of the product's three-month cycle serves no health purpose, but bleeding remains part of the package. It's as if too big an advance might overwhelm women used to a narrow range of birth control options.
Nevertheless, women are grateful for the baby step forwardif not for bringing down their breakup rates, then because Seasonale is reassuring proof that the pharmaceutical industry is finally coming up with new options. After more than 40 years of traditional pills, condoms, diaphragms, and sterilization dominating the stagnant landscape of pregnancy prevention, several recently approved methods have hit the marketa chewable, spearmint-flavored birth control pill, a range of new hormonal devices, and improvements on the IUD and cervical cap. Meanwhile, the backup pills known as emergency contraception are becoming more widely available. You might even call it a revolution, if it weren't a decade or two late in coming.
Women are embracing the advances, delayed and inadequate though they may be. "Our patients are happy with the new methods, but there's a long way to go," says Susan Sosa, director of clinical/surgical services at Planned Parenthood of New York City. "People are interested in easier, more convenient methods. They'd be happier if they fit their lifestyles better."
While the pill remains the most common reversible method, especially for women in their twenties, Sosa says her young patients are still excited about a wearable patch, approved last year, which releases hormones into the blood through the skin. Once a week for three weeks, women stick a fresh square, slightly bigger than a postage stamp, on their skin (butt or stomach placement would make it least visible, though Sosa says most of her patients put it on their shoulders). While it's more convenient than the pill, which has to be taken daily, Sosa says some complain that the patch slips around on their skin. And it comes in only one skin tone so fara pale, peachy color that stands out on darker skin.
A new vaginal ring, introduced last summer, is also growing in popularity. The roughly two-inch ring is 99 percent effective (which means that in clinical trials, one out of 100 women who used it for a year got pregnant). Like the patch, the ring releases hormones that make the body inhospitable to a pregnancy, but you have to put a new ring in only once a month.
Meanwhile, an improved IUD that lasts for five years and is less likely to cause side effects like cramps and bleeding has come to market. In March 2002, the FDA approved a one-size-fits-all, reusable cervical cap known as Lea's Shield. And a new hormonal implant, Implanon, is due out at the beginning of the year. Unlike the old Norplant system, Implanon contains only one tube and will stay implanted for three, rather than five, years.
Then there's the Today sponge, whose story speaks volumes about the desperation of birth control users. The sponge is known to get stuck inside, and its spermicide can irritate the vaginal lining. Even if women follow the several steps necessary to use itfirst running it under water and then leaving it in at least six hours after having sexthe sponge has a less than stellar success rate of about 90 percent.
Still, when the manufacturer of Today stopped making the over-the-counter method in 1995 because of factory problems (which apparently didn't seem worth correcting, given relatively modest sales) many women felt bereft. There was even a Seinfeld episode about the vanishing devices, with Elaine screening out guys who weren't "sponge-worthy." Not due back on U.S. shelves until at least February, the sponge went back on sale in Canada in March, and since then U.S. sponge fans have bought thousands online at around three American dollars apiece.
"The response we've had is incredible," says Barbara Bell, administrative manager of the Canadian website birthcontrol.com, which sells as many as 200 sponges a week to women in the U.S. and started an e-mail newsletter, The Spongeworthy Watch, catering to women pining for the device.
All these new options should cut into the unintended pregnancy rate, which now hovers at 49 percent of all conceptions. And with women terminating half of these unplanned pregnancies, a wider range of birth control methods could also lower the abortion rate, already at its lowest point since 1974. Indeed, emergency contraception, which can prevent pregnancy up to five days after unprotected sex, has been credited with preventing an estimated 51,000 abortions in 2000, according to the Alan Guttmacher Institute, a reproductive think tank.
As with adjusting the pill to skip or delay their periods, some women have crafted their own emergency contraception by taking several birth control pills at once. An FDA-approved "morning after" pill became available in 1997, but too often those who need it still don't get it. While the FDA is weighing whether to make the pills available over the counter throughout the country, a bill pending in Albany would allow registered nurses and pharmacists in a voluntary state program to supply them to women without a prescription. The Unintended Pregnancy Prevention Act can seem like a no-brainer; if it passes, the state could save $913.3 million dollars on abortions and health care for unintended pregnancies, according to a report last month by State Comptroller Alan Hevesi. But the bill faces an uphill battle in the state senate.
Why aren't all legislators jumping to make contraception easier to get? Unease with anything that has to do with sex and fear of opposition from religious groups are major factors. Worried that emergency contraception might be construed as abortion, some have responded to the advance with the enthusiasm a woman might reserve for an unplanned pregnancy. Just requiring insurers to pay for the stuff makes them squirmy. Though New York State has mandated coverage for FDA-approved contraception since the beginning of the year, most states still do not.
Similar forces are responsible for slowing birth control research. While liability concerns have put off some drug companies, political controversy has also dampened interest in developing more contraceptive products. Although some 38.6 million women use birth control, only two of the 20 biggest pharmaceutical companies are committed to researching contraception. "After the big push in the 1960s, a number of companies have dropped out of the field," explains Jacqueline Darroch, vice president for science at the Alan Guttmacher Institute.
You could say the field of pregnancy prevention became a minefield and that, at least for a while, people stopped walking in it. Viewed that way, the recent progress in contraceptive development can look like bold leaps rather than timid baby steps. Almost a revolution.