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Other hormonal options and choices
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Mirena: Another new birth control option
Originally Published: September 12, 2003
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Dear Alice, I know that some new methods of birth control were recently put out on the market, and I was wondering how they worked. Those I have seen thus far are the patch, the Nuva Ring, and the Mirena. It looks to me like that patch and the Nuva ring work in a similar way, but I don't understand how the Mirena (or any IUD, really) works. Why might these methods be better than oral contraceptives, which have been out for a long time? — Thinking about trying a new method
Dear Thinking about trying a new method, It's important to keep up with all of the birth control options, since new ones are being developed and may be a better "fit" for you than what you are using. To answer your question, the contraceptive patch and the contraceptive ring (NuvaRing) do work similarly. The patch is essentially a sticker that is applied weekly to the surface of the skin that uses norelgestromin (a progestin) and ethinyl estradiol (an estrogen) to significantly decrease the chances of pregnancy. The contraceptive ring is a small polymer ring that is inserted into the vagina for three weeks. It uses the same hormones as the patch to prevent pregnancy. The ring must be removed for one week, when a woman menstruates — during that time, a woman is still protected. After her period has finished, a new ring can be inserted. For more specific information on these two methods, check out the Related Q&As below. Mirena, as you pointed out, is one specific product among a variety of commercially-available and U.S. Food and Drug Administration (FDA)-approved intrauterine devices (IUDs). IUDs are contraceptive devices, either coiled or T-shaped, inserted by a health care provider that sit in a woman's uterus, just past the cervix. Depending on which type a woman uses, IUDs can prevent pregnancy from one to ten years, and can be removed at any time by a health care provider, if pregnancy is desired. IUDs have proven as effective or even more effective than birth control pills (especially among women who have had a child or children), though specialists are still not certain as to precisely how they work. For more information about the various types of IUDs, see the Related Q&As listed below. Mirena differs from other IUDs in that it releases a hormone called levonorgestrel into the uterus. Levonorgesterel is a progestin hormone used in several progestin-only birth control pills, as well as in the Plan B emergency contraception method. Mirena is capable of preventing pregnancy for up to five years, and a new device can be inserted if a longer period of protection is desired. Mirena is effective. In a clinical trial, fewer than one in 100 women using Mirena became pregnant during five years of use. As with other IUDs, the jury is still out on the actual mechanics behind Mirena's effectiveness. Thickening of the cervical mucus (thereby blocking sperm from entering the uterus) and thinning of the uterine lining (making implantation less likely) have been cited as possibilities, but it is uncertain which is more responsible for pregnancy prevention. It is likely a combination of both. As far as deciding between using Mirena or birth control pills as one's method of contraception, a number of factors need to be considered. A woman using this method manually checks the strings that extend from her cervix into her vagina after every period cycle and after having sexual intercourse. Much of what makes Mirena an appealing choice is the convenience of use; a single insertion can be effective for up to five years without the necessity of strictly adhering to a daily schedule as with oral contraceptives. On the other hand, the initial insertion of Mirena is expensive, making the pill a more frugal option in the short-term. In the end, deciding between Mirena, the pill, the contraceptive ring, the contraceptive patch, or any other method is a choice you can make with your women's health care provider or gynecologist and/or partner. Your provider can discuss with you the many options available for contraception and, dependent on your medical history, lifestyle, sexual activity, and any medication you might be taking, can recommend specific choices that would best suit you. Lastly, none of the methods of contraception mentioned above prevent against sexually transmitted infections (STIs). For this kind of protection, latex condoms are still the best option.
Related Q&As
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