Ovcon

If you think your biggest birth-control decision is choosing which pill to take or deciding whose condom to use--his or yours--you haven't looked into all of your options lately. A number of new methods are available, and more are expected over the next few years.

That is why it is especially important that you know what's out there and whether or not they will work with your life and love style. Take a look at our rundown of what's new and what's next.

HEALTHREPORT BIRTHCONTROL

Mirena

What is it? This intrauterine device (IUD) is made of flexible plastic and is inserted by a health-care provider.

How it works: It delivers a synthetic form of the pregnancy-blocking hormone progesterone in low, steady doses.

Pros:

* 99 percent effective.

* Lasts up to five years.

Cons:

* Side effects can include lower abdominal pain, acne, breakthrough bleeding and back pain.

* Adjustment period can last up to six months.

Who should use it? Women with fibroids. (A recent study found that it decreases some problems associated with this condition); women who weigh more than 190 pounds (it's more effective that the Pill or the patch for women who are heavier); new moms who are breast-feeding.

Who shouldn't use it? Women prone to sexually transmitted infections, because this IUD can increase the risk of pelvic inflammatory disease.

Cost: $650, generally covered by insurance. At less than $11 per month for five years, it's the most cost-effective method on the market.

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Essure

What is it? A tubal-ligation device that permanently prevents pregnancy.

How it works: In this nonsurgical procedure, a trained health-care provider guides two tiny inserts made of polyester fiber and metal through the vagina and places one into each fallopian tube. The resulting tissue growth blocks the tubes so eggs can't pass through.

Pros:

* 99.8 percent effective

* The 35-minute outpatient procedure usually requires no general anesthesia.

Cons:

* No turning back if you change your mind.

* Side effects include cramping, pain or nausea.

* In a small percentage of cases, procedure isn't effective and haste be repeated.

Who should use it? Women looking for permanent birth control without surgery.

Who shouldn't use it? Women who are not sure if they want to have more children.

Cost: $2,500, less than half that of traditional tubal-ligation and usually covered by insurance.

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Nuva Ring

What is it? This flexible, transparent ring, which came on the market two years ago, is inserted into the vaginal canal like a diaphragm but stays in place for a month. Nuva Ring functions like a long-term oral contraceptive.

How it works: Each ring releases a low dose of estrogen and progestin over a 21-day period to prevent release of an egg and movement of sperm.

Pros:

* 98 percent effective.

* Lasts for a month.

* Fewer side effects than the Pill.

* Steady dose minimizes side effects like headaches, nausea and breast tenderness.

Cons:

* May have higher blood-clot risk than some low-dose pills.

* May feel awkward to insert.

Who should use it? Women 190 pounds or more and those who don't want to worry about the Pill.

Who shouldn't use it? Smokers; women who have lupus.

Cost: $35-$40, generally covered by insurance.

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Ortho Evra

What is it? This barely-bigger-than-an-inch adhesive works along the same lines as the nicotine patch.

How it works: Delivers progestin and estrogen through the skin and into the bloodstream to suppress ovulation and thicken cervical mucus. A patch can be placed on your stomach, butt, upper torso or the outer part of your upper arm, and is replaced every week.

Pros:

* 99 percent effective.

* Stays on while swimming, bathing, exercising.

Cons:

* Can cause a skin rash.

* Less effective in women 190 pounds or more.

* Has same side effects as the Pill (breast tenderness, headaches, nausea).

Who should use it: Women who have trouble remembering to take their daily Pill.

Who shouldn't use it: Very overweight women, smokers, women with lupus.

Cost: $37 a month, and is generally covered by insurance.

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The Today Sponge

What is it? This popular, over-the-counter vaginal insert is set to be rereleased in the United States this summer. It was withdrawn in 1995 due to a problem with the manufacturer, not the product itself.

How it works: You insert the sponge yourself; it acts as a barrier and also releases spermicide to protect against pregnancy for up to 24 hours. Must be left in place for six hours after sex.

Pros:

* 90 percent effective.

* Doesn't contain hormones and therefore doesn't come will their associated risks.

* Low-cost, easy-to-buy option.

Cons:

* Small risk of toxic shock syndrome, as with tampons and other barrier contraceptives.

* Cannot be used during your period.

Who should use it: Women who aren't regularly sexually active.

Who shouldn't use it: Women who feel uncomfortable with the insertion and removal process.

Cost: $2 to $3 per sponge.

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The Newest Pills

Ask your doctor about these up-to-the-minute options:

Ovcon 35

What's the twist? A chewable, spearmint-flavored pill for those who have trouble swallowing medication.

Available: At press time, it's scheduled for a spring 2004 release.

Seasonable

What's the twist? This pill extends your menstrual cycle so you only have four periods per year, instead of 13. You take an "active" pill for 84 days, instead of 21 days, followed by seven days of an "inactive" one. (You menstruate during the seven inactive pill days.)

Available: Now.

Yasmin, Nordette, Ortho Tri-Cyclen Lo, Alesse, Mircette

What's the twist? These oral products offer lower amounts of estrogen and progestin than their predecessors--which can minimize side effects associated with oral contraceptives.

Available: Now.

Birth-control FAQ Solutions for your contraceptive quandaries

Q can I get pregnant during my period?

A Yes. Your period is one sign that you're not pregnant, but that doesn't mean you can't become pregnant during menstruation. Ovulation can occur during or immediately after your period. So why don't women on oral contraceptives get pregnant during their "week off"? When used properly, the Pill prevents you from ovulating. So even if you have unprotected sex during the week when you're taking the placebo, there's no egg to be fertilized by the sperm. Further, Linda Darlene Bradley, M.D., an OB-GYN at the Cleveland Clinic Foundation, notes that certain conditions (infections, fibroids and lesions on the cervix) can mimic a period, thus confusing a woman about where she is in her cycle.

Q Can I get pregnant if I'm breast-feeding?

A Maybe. While you're nursing, the body releases a chemical called prolactin, which prevents ovulation. But breast-feeding as contraception isn't foolproof: It only works within six months of having your baby, if you haven't had a period since the baby and if you're breast-feeding exclusively. "If you're breast-feeding or pumping milk every two to three hours, your risk of getting pregnant is very small," explains Hilda Hutcherson, M.D., codirector of the New York Center for Women's Sexual Health at Columbia Presbyterian Medical Center in New York.

Q Is it safe to stop my period?

A In a recent nationwide poll of more than 300 female OB-GYNs, 99 percent said they thought menstrual suppression (the technical term for stopping your period by continuously taking oral contraceptives with no time off) was safe for their patients. In fact, more than half had tried it themselves. "It's perfectly healthy not to have a period while on the Pill," states Elizabeth Onyemelukwe Garner, M.D., an instructor in obstetrics, gynecology and reproductive biology at Harvard Medical School in Boston. She notes that this is very different from having an irregular cycle or an underlying health problem that can cause irregular or missed periods. "In today's world where women are increasingly busy and budgets are tight, not having periods can be a convenience less money spent on pads and tampons, less time off from work for PMS and cramps," says Garner, who adds that, thus far, the Pill is the only method of suppression scientists have studied.

Q Why does taking birth control pills make my breasts bigger?

A "The hormone estrogen, found in the Pill, stimulates breast tissue," Garner explains. She adds that similar changes happen in women who are pregnant or those who are in certain phases of their menstrual cycle. Just so you know: Some women's busts decrease after they go off oral contraceptives, while others retain their enhanced cup size.

Q Will being on birth control for more than five years diminish my ability to conceive later on?

A "Not at all. You can be on birth control for 20 years, and it won't decrease your fertility," says Hutcherson.

When Plan A Fails: Emergency-Contraception Update

Even the savviest sister can find herself in a jam, thinking she might accidentally be pregnant. Maybe you missed a pill pulling a late night at work. Or the condom broke. Or worse, you were in a situation where you were forced to have unprotected intercourse. That's where emergency contraception pills (ECP) can help. The method, also known as the morning-after pill or Plan B, works this way: Within 72 hours of intercourse, you take a high dose of the progestin-only birth control pill. This prevents pregnancy by stopping ovulation, inhibiting sperm or hindering the implantation of a fertilized eggs in the uterus.

Lynya Floyd is a freelance writer in New York.

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