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HEALTH : Updating Birth Control : Choosing the Method That Best Suits Your Health and Life Style

March 14, 1989|KATHLEEN DOHENY

Someday, foolproof contraception may be as simple as a shot in the arm. Testosterone injections for men and an anti-sperm vaccine for women are among dozens of contraceptive techniques working their way through research labs.

But someday is both a magical and maddening word for scientists and manufacturers who know that taking a birth control method from the laboratory to the market can be even more excruciating than the usual drug-approval process.

Getting a drug on the market generally takes seven to 10 years, according to the Pharmaceutical Manufacturers Assn. in Washington. Contraceptive drugs and devices tend to take even longer because they are part of a risky research area that requires long-term, costly and carefully designed studies of large populations to confirm a method's safety and effectiveness.

Less Money, Less Research

A decrease in federal funding for contraceptive research and development has also slowed progress. And some manufacturers, citing financial, political and legal challenges to their products, have cut spending as well.

That's not to say advances aren't being made. More contraceptives are available now than ever before, though many "new" methods are simply variations of old techniques. Meanwhile, a growing body of research about approved methods is making it easier for consumers and physicians to choose among the growing array of options. Here is a look at what's new on the market and an update on the old standbys, along with experts' advice about matching birth control to life style and medical history.

Oral Contraceptives: The modern-day Pill has a fraction of the hormone dose it contained when first introduced in 1960--about one-fifth the estrogen of the early Pill and 1/10th the progestin, said Rich Salem, spokesman for Ortho Pharmaceutical Corp., a Raritan, N.J., manufacturer of oral and other contraceptives.

While changes in formulation have led to the elimination or reduction of some side effects--such as facial hair and oily skin--debate about the Pill's safety continues. After reviewing three new studies, an FDA advisory committee in January concluded that the studies did not show a "cause and effect relationship" between oral contraceptives and breast cancer. "To date," the panel said, "it is now generally accepted that the Pill protects against endometrial and ovarian cancer and most studies have shown no overall increase in a woman's likelihood of developing breast cancer."

But according to the Washington-based National Women's Health Network, studies suggest risk of breast cancer increases with more than seven years of Pill use. Along with the FDA, the network is calling for another major study of oral contraceptives and breast cancer, said Victoria Leonard, executive director.

Several studies suggest women who take the Pill are at slightly greater risk for heart disease. But a study of 120,000 women, published in the New England Journal of Medicine late last year, indicates that once Pill users discontinue use, they are at no greater risk of heart disease than other women.

The Pill's effect on blood cholesterol is also being examined. Estrogens appear to have a beneficial effect on blood lipids, while progestins tend to have a deleterious effect, said Dr. Barry Schwarz, associate professor of obstetrics and gynecology at the University of Texas Southwestern Medical Center in Dallas.

Other research indicates that certain birth control pills reduce high-density lipoproteins, so-called "good cholesterol," while increasing low-density "bad cholesterol."

Though slight, such changes in blood cholesterol may be significant for certain patients but generally cause no problems, said Schwarz. Under study, too, are birth control pills designed to be "lipid-neutral."

Oral contraceptives aren't for everyone, including women with high blood pressure and other cardiovascular problems. Smokers should discontinue use at age 35, said Dr. Gerald Bernstein, a USC professor of obstetrics and gynecology. Nonsmokers with no other risk factors (such as obesity) are generally considered candidates until age 45, he said.

Use: 13.2 million.

Effectiveness: 97 % -99%.

Average first-year cost: $169, not including office fee.

Condoms: Two large versions and an abbreviated design have recently received marketing approval from the FDA. But the short version, called Microcondom, is sparking controversy even before it appears in drugstores.

Manufactured by SFT Laboratories in Chicago, Ill., the "partner-friendly" condom covers only the tip of the penis and is held in place by an adhesive, said Robert Greenwald, company vice president.

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