Contraceptive choices continue to grow

Key Points

Instead of 21 days on drug and seven days on placebo, women can choose from low-dose regimens that stretch to three months. A 365-day pill is waiting in the wings, while other hormonal methods offer five years of voluntary infertility.

Non-hormonal methods offer 10 years of pregnancy-free life, and the first male hormonal contraceptive is on the horizon. Other products in the pipeline include string-like intrauterine devices (IUDs), transdermal sprays, and nonsteroidal anti-inflammatory contraceptives.

What hasn't changed is the need for effective contraception. Despite a growing menu of contraceptive methods, 49% of all pregnancies in the United States are unplanned, according to the Guttmacher Institute.

What's available

There are more than 40 different OCs on the U.S. market, said Lawrence Finer, Ph.D., director of domestic research for Guttmacher. OCs are the method of choice for about 31% of American women, but pills aren't for everyone. Compliance has been a problem since the Pill was introduced, he continued. Poor compliance is the primary reason that OCs have a failure rate of about 8% in regular use versus the expected failure rate of 0.3%.

Other women become pregnant during gaps between contraceptive methods or due to contraceptive failures. Some women have problems getting access to contraception. And about 7% of women in their childbearing years (15 to 44) are not using contraceptives but do not want to become pregnant. The more contraceptive choices a woman has, the more likely she will find a method that meets her needs, Finer said.

The OC market reflects the greatest changes. The original 21/7 regimen has largely been replaced by a 24/4 dosing schedule. The change eases premenstrual (PMS)-like withdrawal symptoms, such as bloating and mood swings. And it lessens menstrual bleeding, explained Andrea Coffee, clinical pharmacy specialist at Scott & White Memorial Hospital and Clinic in Temple, Texas. "The shortened pill-free interval is a big move," she explained. "We are totally getting away from the 21/7 regimen."

The biggest move is toward extended-use OCs. The latest entrant is Seasonique (levonorgestrel 0.15 mg/ethinyl estradiol 0.03 mg and ethinyl estradiol 0.01 mg, Barr).

Seasonique, like its predecessor Seasonale (levonorgestrel 0.15 mg/ ethinyl estradiol 0.03 mg, Barr), has a scheduled bleeding episode every 13 weeks. But even four times a year is more than some women want.

Wyeth received an approvable letter from the Food & Drug Administration last year for a 365-day pill, Lybrel (levonorgestrel 0.09 mg/ ethinyl estradiol 0.02 mg). "There is nothing to suggest that you have to withdraw and bleed every month or every quarter or even every year," Coffee said. "We have women who have gone years without withdrawal."