PRESCRIPTIONS
Contraception requires you to be well informed

By Landis Lum

Birth control can be an awkward or even objectionable topic for some people, but from a doctor's standpoint, it's important for people to know everything possible about it, especially if you are female or a parent of teenagers.

Almost 900,000 teenagers in the United States became pregnant in 1997, leading to 254,000 abortions and 134,000 miscarriages. Thus, although many people believe abstinence should be the birth-control method of choice, one must also realize that 40 percent of women ages 15 to 19 are sexually active and need effective ways to protect themselves against pregnancy.

The "morning-after" pill can prevent pregnancy after forced or unintended intercourse, or after inadvertent slipping or tearing of a condom or diaphragm. It's actually a series of pills taken exactly 12 hours apart that reduce the pregnancy risk by 80 percent if started within three days, but work much better if started less than six to 12 hours after intercourse.

The most effective, with the least side-effects, are progestin-only pills. The best is a regimen called "Plan B"; it's available only by prescription and costs $30 for the two pills, but you or your doctor may have to call around, as only some Hawai'i pharmacies carry these. Another progestin-only option is to take 20 (you read that right) Ovrette pills 12 hours apart. Effects include some cramping and bleeding, but the chance of vomiting is about 6 percent.

Slightly less effective, and with a 20 percent risk of vomiting, are estrogen/progestin combinations. Your doctor may guide you on using high doses of ordinary birth control pills. Or you could buy Preven (it's covered only by QUEST) for $21 to $26, and take two pills 12 hours apart. In either case, a doctor may recommend that you take medication to prevent the nausea. This should improve the chance of preventing pregnancy (because if you vomit up the pills, they won't work), and reduce some of the misery.

For more information, or to find a doctor in your area willing to prescribe these to you, you could go on the Internet to www.not-2-late.com or call 888-NOT-2-LATE.

However, smarter methods of birth control include doctor-guided use of birth control pills, Depo or Lunelle shots, intrauterine devices (also known as IUDs), vasectomy, or Norplant implants because they are more effective.

You might not know that there are some benefits to taking birth-control pills other than preventing pregnancy. Surveys of Yale University students in 1991 and Brown University students in 1995 found that most knew that birth control pills reduce painful menstrual cramps and bleeding. However, the great majority did not know that the pills actually reduce cancers of the ovary and endometrium (lining of the uterus). And, the longer the use, the better — using "the pill" for a shorter period decreases ovarian cancer (a deadly, difficult to detect cancer) by 40 percent, while using them for many years results in an 80 reduction.

Birth control pills also have been shown to reduce dangerous ectopic (or tubal) pregnancies, osteoporosis and benign breast disease.

What about breast cancer? The most complete analysis of this topic, by The Collaborative Group on Hormonal Factors in Breast Cancer in Oxford, England, reviewed 54 studies and showed no overall effect of birth control pills on breast cancer risk, even if family members had breast cancer.

Only pill users over 35 who smoke are at increased risk of heart attack. I would recommend that a woman use the safer monthly Lunelle shots if she were over 35, smokes less than 15 cigarettes a day and can't quit. There is no increased risk of stroke among users of our current low-dose pills, and the absolute risk for blood clots of the veins is very low.

Of course, everyone should keep in mind that pills, shots and implants will not prevent venereal diseases, so you should still use condoms or diaphragms for optimal protection.

Dr. Landis Lum is a family practice physician with Kaiser Permanente, and an associate clinical professor of family and community medicine at the University of Hawai'i's John A. Burns School of Medicine. This column is not intended to provide medical advice; you should consult your doctor.