When it comes to birth control, Olivia Haeberle and Alicia Mokwa stand on opposite ends of an expanding spectrum.
Haeberle uses CycleBeads --- a string of color-coded plastic beads that help women practice natural family planning. White beads, symbolizing peak fertility days, even glow in the dark.
Mokwa relies on NuvaRing --- a nickel-sized plastic ring inserted into the vagina that stays there for three weeks, releasing a low, constant stream of hormones into the body to stave off pregnancy.
They reflect two different camps. One group of women is clamoring for chemical-free alternatives to the pill and barrier methods. Yet, another set of women doesn't mind --- even likes --- hormones and is demanding longer-lasting protection. They desire a contraception they only need to think about once a month, not once a day.
Together, CycleBeads and NuvaRing, which have emerged in the past couple of years, are part of a wave of burgeoning birth control options that include everything from flesh-colored weekly skin patches to a revamped plastic intrauterine device that is effective for up to five years.
Even birth control pills are getting a makeover. Today's pills contain less hormones, including a progestin-only pill known as the "mini-pill." On the flip side, one manufacturer designed an oral contraception that, when taken for three consecutive months, eliminates all but four menstrual cycles a year.
Three-quarters of married couples use some form of birth control. But about half of all pregnancies are unplanned, with accidents still commonplace.
Mokwa wants something easy and sure.
"I just want to be safe and lazy," said Mokwa, who lives with her longtime boyfriend and their 2-year-old son. "With the pill, I would sometimes forget and I would double up or not feel like taking it. Nuva-Ring is so easy." Natural family planning
Even before CycleBeads, developed by Georgetown University's Institute for Reproductive Health, hit the market, an uptick of women of all different faiths and lifestyles have moved toward natural family planning, or NFP.
In the past, NFP has been almost exclusively linked to the Catholic Church. And it's unclear how many couples use NFP methods today. In 1995, the most recent year surveyed by the National Institutes of Health, the number of married couples practicing periodic abstinence was only 1.8 percent --- of that, 0.4 percent was natural family planning.
But two trends, experts say, have caused a renewed interest in NFP: > Fertility monitors, like the Atlanta-based Ovuscope, a lipstick-sized metal microscope, and Clear Plan, which tests urine, make it easy to identify when a woman is ovulating. Although they aren't designed to prevent pregnancy, they can be used to double-check NFP methods. > The lingering controversy around hormone replacement therapy. Although HRT applies to menopausal women, the fallout has made some younger women hesitant to take chemical therapies.
"In the last few years, we are seeing for the first time, Protestants coming to the class," said Tracy Stringer of Roswell, one of a handful of NFP teachers in metro Atlanta affiliated with the Couple to Couple League, an NFP teacher-training institute based in Ohio with local affiliates across the country. "They want something completely natural."
In 2003, 7,314 couples across the nation learned NFP through the Couple to Couple League, up from 4,755 couples in 1995.
Many local NFP teachers subscribe to the Sympto-Thermal method, which requires a daily check of three fertility signs: morning basal temperature, the consistency of cervical mucus and the position of the cervix. Still, traditional NFP methods are seen as too cumbersome for many women, a situation that buoys CycleBeads. About 30,000 CycleBeads have been purchased in the United States during the past couple of years. The number is expected to grow when it hits pharmacy shelves in coming months.
Haeberle's husband, an attorney, surprised his wife by buying the $12.95 color-coded beads off the Internet after his wife complained about their birth control.
"I tried the pill. I tried the patch but it would fall off; I tried Depo-Provera shot and I tried NuvaRing," she said. "I wanted to get away from the hormones because of the mood swings."
The beads rest on their night table by their bed. Every day, she slides the black rubber band one bead over.
The beads, based on more than 7,500 menstrual cycles compiled by the World Health Organization and designed only for women with regular menstrual cycles, have a 12-day stretch (white beads) requiring either abstinence or another form of contraception.
"NFP has had a bad reputation because of the assumption that it is ineffective and difficult to use. So we thought, 'Let's break out of this and make a method that is very simple to use,' " said Dr. Victoria Jennings, director of Georgetown's Institute for Reproductive Health.
Many local OB-GYNs give the CycleBeads a thumbs up but are careful to point out that NFP methods require discipline.
If used correctly, the method has a first-year pregnancy rate of about 5 percent. The birth control pill is more effective, with a less than 1 percent failure rate. However, when the human factor is included, such as forgetting to move the band or having sex at the wrong time --- the actual failure rate for CycleBeads is about 12 percent. Comparatively, women sometimes forget to take the pill, making the actual failure rate of oral contraception between 5 percent and 8 percent.
NFP has its other drawbacks.
"What is not so natural is having to plan [sex] around the beads," said Dr. Michael Randell, a gynecologist in Sandy Springs, "because the whole psyche of sexuality is being spontaneous." 'Convenient, discreet'
Most women still want a low-fuss, low-risk birth control.
"They are looking for something convenient, discreet and something that is very effective," Randell said.
NuvaRing appeals to women who want a lower dose of hormones, Randell said. Since the ring is directly inside a woman's vagina, the dose of hormone needed is less than a birth control pill.
Some women prefer the beige-colored patch because it is noninvasive, but others don't like this form of birth control because it is clearly visible due to its placement on either the arm, hip, torso or buttocks.
Two new IUDs --- Mirena and the ParaGard --- are also on the market. They're a good option for women who already have children and believe they don't want more --- but are not comfortable with sterilization, according to several Atlanta OB-GYNS.
Unlike the controversial Dalkon Shield, the newer IUDs are not associated with pelvic infections, scar tissue or death. IUDs are now the most popular option in the world, with more than 85 million women using them, according to Planned Parenthood. ParaGard is made of a soft, flexible material in the shape of a "T" that has copper on the arms and stems and is inserted in the uterus. IUDs are designed to interfere with conception.
Birth control pills --- the No. 1 choice for most American couples --- are also being revamped.
Dr. Carrie Cwiak, an assistant professor in the family planning department at Emory University, said many women are interested in Seasonale --- taken for three months at a stretch instead of three weeks --- so they can reduce their menstrual cycles from one a month to one a season.
"Some women have unpleasant side effects from their period," Cwiak said, such as cramping or pain with ovulation. She said Seasonale can eliminate these problems.
Other pills are expected to be released soon as well. At Johnson & Johnson, a birth control pill combined with the vitamin folic acid is under development. And last fall, the Food and Drug Administration approved a chewable spearmint-flavored version of Ovcon-35.
And the emergency contraceptive pill, effective for up to 72 hours after unprotected sexual intercourse, is now available over-the-counter in a few states --- but not Georgia.
Even men will have more options in the future, according to Planned Parenthood.
Studies have shown promise in a men's once-a-week injection of testosterone enanthate, or TE, a synthetic hormone. And researchers are exploring battery-powered capsules, implanted into each vas deferens --- the tube that transports sperm from the testis --- that emit low-level electrical currents that immobilize sperm.
Finally, some studies are evaluating the effectiveness of a sperm "vaccine" for men. Once the vaccine wears off, men would return to their normal fertility.
"We have many new options today," said Randell. "And we will soon have a birth control pill for men; I am just not sure society is ready for that."
Copyright 2004 The Atlanta Journal-Constitution