The Latest On Birth Control

It was made famous in a "Seinfeld" episode and, after eight years off the market, the Today sponge is back.

Well, sort of. The Today Sponge can now be purchased through Canadian Web sites and may get FDA approval by year's end. Dr. Michael Silverstein of NYU's School of Medicine talks about the sponge and a number of new contraceptives available to women that are safe.

• The Today Sponge was introduced in 1983 and, before it was taken off the market in 1995, it was one of the largest-selling over-the-counter (OTC) female contraceptives in the United States. It is a soft, disposable polyurethane foam that feels like natural vaginal tissue. The Today Sponge contains the widely used spermicide nonoxynol-9. After it is moistened with water and inserted into the vagina, the Today Sponge becomes effective immediately and protects against pregnancy for the next 24 hours without the need to add spermicidal cream or jelly - even with repeated acts of intercourse.

  In 1995, the sponge was taken off the market because its original owner (now called Wyeth) didn't want to pay for upgrades at the plant that manufactured the sponge.

  The sponge is between 89 and 91 percent effective at preventing pregnancy, but it offers no protection against sexually transmitted diseases. It is currently not available on U.S. store shelves. However, women can buy it via Canadian Internet sites and have it shipped. An individual sponge costs about $2.90 and its new maker, Allendale Pharmaceuticals, hopes to have FDA approval by the end of the year.

  Besided the sponge, there is the Ortho Evra Patch, which is applied to the skin and contains hormones similar to those found in birth control pills. The NuvaRing, which prevents pregnancy by suppressing ovulation (about 99 percent effective). And Essure, which is a non-invasive replacement for tubal ligation.

• Ortho Evra is the first birth control patch. It has FDA approval and has been available since April 2002. It is available for prescription from your doctor or healthcare professional.

  The patch is a once-a-week birth control option that, if used correctly, is about 99 percent effective, which is about the same as the pill.

  Ortho Evra is worn on the body (many women prefer the arm or back). It contains hormones similar to those in birth control pills.

  Hormonal contraceptives are not for everybody. Most side effects of the contraceptive patch are not serious and those that are, occur infrequently. Serious risks, which can be life threatening, include blood clots, stroke or heart attacks and are increased if you smoke cigarettes. Some women should not use the contraceptive patch, including women who have blood clots, certain cancers, a history of heart attack or stroke, as well as those who are or may be pregnant.

  The contraceptive patch does not protect against HIV or other sexually transmitted diseases. The cost on a Web site was about $35 for three patches.

• The NuvaRing is a small, flexible ring that delivers low doses of two female hormones, estrogen and progestin, into your body. This helps prevent pregnancy by suppressing ovulation. It also causes the mucus on the cervix to thicken, which helps prevent sperm from reaching the egg

  To use it, a woman inserts the NuvaRing into her vagina and leaves it there for three weeks. She then removes it for a week (during which she has her period). After the week is up, she may insert a new ring, and she will be protected for another full month.

  If used properly, the ring is about 99 percent effective. However, it does not protect against sexually transmitted diseases.

  Many women like it because it allows for spontaneity.

  In clinical trials of NuvaRing, some women experienced vaginitis, headache, upper respiratory tract infection, leukorrhea, sinusitis and nausea.

• Essure received FDA approval in November 2002. It is permanent and claims to be the first alternative to tubal ligation. Essure is a small spring-like coil made of polyester fibers and nickel titanium alloy, which is the same material used to make artificial heart valves.

  Unlike tubal ligation, which requires an abdominal incision and is typically done under general anesthesia, Essure requires no incisions and can be performed without general anesthesia.

  Like all birth control methods, Essure is not expected to be 100 percent effective, and pregnancies are expected. There is a three-month waiting period after the procedure during which women must use another form of birth control.

  The most common side effect is cramping and some women experienced vaginal discharge.