After carefully picking through the garden of male humanity, rejecting the rotten and sampling the succulent, a frustrated female has finally found a plum worth plucking. It was hard work, and now she’d like to sweat for a different reason. But before the game gets too serious, she may want to find a way to prevent unwelcome pollination.

Most college women have enough trouble juggling classes, friends, boyfriends and work; a little sprout is the last thing they need or want. Often, hormonal contraceptives provide the best pregnancy prevention for those who choose sex. In the last six weeks, University Health Services has made the two newest forms of hormonal birth control–the patch and the ring–available to students.

The Ortho Evra patch and the NuvaRing options use medication similar to the more traditional birth-control pills. However, a daily commitment is no longer necessary. Instead, women must change the patch once a week and replace the ring monthly.

“The patch and the ring are not new drugs, they’re just new ways of giving drugs to people,” University of Wisconsin assistant professor of family medicine Sarina Schrager said.

Although conflicting medical studies have inspired skepticism among consumers of new medical technology, UHS nurse manager/nurse clinician Kathy Kuhnen said the new contraception techniques are simply new delivery mechanisms, not new medication.

“I know sometimes it seems that one day we say one thing, and six months later a new study comes out, and we say the exact opposite,” she said. “The only thing I can tell women is that these new methods are built on the back of the birth-control pill, and the birth-control pill is practically the most-studied medication in the [United States.]”

The pill, ring, patch and the two shots, Lunelle and Depo Provera, are all forms of hormonal birth control. This method works by preventing ovulation, meaning that the ovary does not release an egg to be fertilized each month.

Furthermore, it thickens the cervical mucus to make it more difficult for sperm to enter the uterus. Most forms, except the Depo Provera shot, combine two hormones similar to those naturally found in the female body, estrogen and progesterone. The Depo Provera shot uses only progesterone.

According to the Planned Parenthood website, combined-hormone methods are 95- to 99.5-percent effective but do not provide protection against sexually transmitted diseases.

“These are all good and all very effective, but none of them protect against STDs,” UW assistant professor of family medicine John Brill said. “They should all be combined with condoms if that’s something you should be worried about.”

While an expanded field of contraceptive choices may be positive, it can make choosing a method as difficult as choosing a mate. UW women’s studies professor Mariamne Whatley urged women and their partners to do some independent research.

“It’s not easy,” Whatley said. “They should make sure they’re asking questions and doing a little back-up reading themselves. The physicians may not have actually read the research themselves; they may have only read literature from the pharmacies’ studies. It’s not that they are deliberately giving the wrong information; sometimes, it’s not actually having it themselves.”

Comparing the patch and the ring to the most popular contraception, the pill, the newer options are more convenient and provide the same type of protection.

“It’s something you don’t have to think about every day,” Kuhnen said. “And hormonally, the doses are about the same as a low-dose birth-control pill. But studies have shown they lead to a more even release. No matter how careful a woman is with the pill, there are still some differences some days with how our metabolism is working.”

However, Kuhnen also emphasized that the pill works well for millions of women.

“In terms of day-to-day uses, the pill is very effective even if you do miss by an hour or two,” she said. “I don’t think the patch or the ring are necessarily better for good pill-users. But for bad pill-users, they’re definitely better.”

Patch control

She can swim, scrub or skydive, and it won’t come off. Ortho Evra commercials feature the patch’s adhesive easily defying all sorts of wet activities.

“They make it look so easy and comfortable and fun,” Whatley said. “You have to remember they’re hyping their product.”

However, Schrager said, the patch really does stay put.

“They did tons of studies as far as how well the patches stuck, and they didn’t seem to fall off,” she said.

Furthermore, Ortho Evra provides an extra patch for emergency situations, UHS associate director for clinical services Scott Spear said.

The beige patch, measuring 1.75 inches on all four sides, transmits a steady stream of hormones through the skin into the bloodstream. Approved by the FDA in November 2001, each patch is effective for one week. It must be changed on the same day of the week for three consecutive weeks; the fourth week is “patch-free” to permit menstruation. Women can wear the thin square on their abdomen, buttocks, upper torso or upper outer arm.

Although some women may be hesitant to wear a physical sign of their sexuality, Spear said UHS has seen the patch becoming steadily more popular. And while Madison’s Planned Parenthood clinic does not yet offer the patch, they have received “quite a few inquiries.”

“While there are still a lot of women who wouldn’t want to be changing at the SERF and have people see the little patch, a lot of women are very open about how sexually active they are–it’s no big secret,” Whatley said.

Furthermore, Kuhnen said Ortho Evra is small enough to be easily hidden.

“No one seems to be really concerned [about patch visibility,]” she said. “Even if you’re wearing a really skimpy bikini, there’s probably a place you could tuck the rascal.”

Using the ring

Although UHS has been providing the patch and the ring for about the same amount of time, the ring’s popularity has remained low.

Women using NuvaRing insert the small, flexible plastic ring into their vagina and leave it there for three weeks. After three weeks they remove the ring and menstruate during the fourth week. At the end of the fourth week, a new NuvaRing must be inserted.

“The patch is catching on more quickly than the NuvaRing,” Kuhnen said. “Although this ring is pretty small and very soft, some women just don’t like the idea.”

Besides an aversion to the concept, many women are concerned about the ring moving around in or falling out of the vagina. This apprehension, Schrager said, is unnecessary.

“It doesn’t have to be in any particular place; it just has to be inside,” she said. “Most people don’t feel anything. You don’t think about a tampon falling out, do you?”

Another NuvaRing worry, Kuhnen said, is whether a man can feel the ring during intercourse.

“In the studies, about ten percent of men said they could feel it on occasion,” she said. “But it didn’t hurt or anything or take away from sexual pleasure. Women are not staying away from the ring because of guys saying they don’t like it.”

The ring’s placement may actually give it an advantage over other forms of hormonal contraception, Brill said, because it dispenses medication locally instead of systemically.

“The ring releases hormones just locally, so you don’t get some of the benefits or side effects of medication that goes through the whole system,” he said. “It seems less likely to cause water-weight gain and to cause some of the rare side effects like blood clotting.”

While the ring and the patch take extremely different forms, Kuhnen said women should make a contraception choice based on comfort.
“In the big picture, there really isn’t a huge difference here,” she said. “If I had a woman saying, ‘Which one should I use?’ I would be more concerned with which one they felt more comfortable with.”