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" Not so long ago, birth control choices were limited to the Pill and a few cumbersome barrier methods. Today, there&amp;#039;s a whole new menu of options you may not even know about, and one may be better for your life right now. If you&amp;#039;ve been taking the Pill since your 20s, but now find it a hassle, or if you are developing perimenopausal symptoms or have bad PMS, or if you&amp;#039;re absolutely sure that you don&amp;#039;t want another pregnancy, here are some choices to consider \u2014 with pros and cons for each \u2014 based on your life stage. You&amp;#039;re tired of taking a daily pill Or you find it hard to remember. You can safely forget about these methods for weeks, months, even years: \u2022 Mirena IUD An intrauterine device that&amp;#039;s 99.9 percent effective for up to five years. Your gynecologist inserts the 11/4-inch plastic T vaginally through your cervix into the uterus, where it delivers small doses of progestin (a synthetic form of progesterone); progestin prevents pregnancy by stopping ovulation. Most women find they have lighter, shorter, less painful periods when they use the Mirena. After a year or so, about 20 percent of women stop menstruating altogether. &amp;quot;Once they know that it&amp;#039;s normal, it&amp;#039;s a side effect patients love,&amp;quot; says Katharine O&amp;#039;Connell, M.D., an ob-gyn at Columbia University Medical Center.  \u2022 NuvaRing You insert this flexible two-inch ring into your vagina, where it releases the same types of hormones you find in the Pill, but in lower doses. And, as with the Pill, you&amp;#039;re likely to have lighter, shorter periods. The Ring is 99 percent effective and you only have to think about it twice a month\u2014once when you put it in, and three weeks later, when you take it out. After a week (during which you&amp;#039;ll have your period), you start the process again with a new ring. As for insertion, &amp;quot;If a woman is comfortable putting in a tampon, the ring poses no challenge,&amp;quot; says Marjorie Greenfield, M.D., an ob-gyn at University Hospitals of Cleveland. She notes that the device doesn&amp;#039;t require exact positioning (since it&amp;#039;s not a barrier method) and usually can&amp;#039;t be felt, even during intercourse.  \u2022 Implanon This matchstick-size implant, which got FDA approval last year, is 99 percent effective for up to three years. You may recall horror stories about Norplant, a six-rod implant that was difficult to remove and was finally taken off the market. &amp;quot;Implanon&amp;#039;s single rod isn&amp;#039;t causing those difficulties,&amp;quot; says Dr. Greenfield. It takes about two minutes for a doctor to place it just beneath the skin on the inside of your upper arm and not much longer to remove. The implant works by releasing a low, steady dose of progestin, which blocks ovulation and thickens cervical mucus so sperm can&amp;#039;t enter the uterus. Because it doesn&amp;#039;t contain estrogen, it&amp;#039;s safe to use Implanon when you&amp;#039;re breast-feeding. There may also be a lower risk of blood clots than with the Pill or any form of birth control that contains both estrogen and progestin. One drawback: Implanon may cause unpredictable breakthrough bleeding during the first six to nine months.  \u2022 Depo-subQ Provera 104 This is the &amp;quot;daughter&amp;quot; of the original Depo-Provera, an injection of progestin that works for three months. The subQ 104, like its older version, is more than 99 percent effective. But because it&amp;#039;s injected just under the skin, not deep into the muscle, it hurts less. The new shot also has a lower dose of progestin than the original formula, which may mean fewer side effects such as weight gain and loss of bone density (with long-term use). You may stop having your period on Depo, and it can take up to 10 months after you stop the injections for ovulation to resume\u2014something to note if you&amp;#039;re hoping to become pregnant in the future.  You want relief from perimenopausal symptoms  You still need protection from pregnancy but you are beginning to experience hot flashes, moodiness, and/or sleep disturbances. Almost all types of birth control pills can do double duty\u2014preventing ovulation while stabilizing fluctuating hormone levels\u2014but two new Pill formulas may be particularly helpful: \u2022 Seasonique With this extended-regimen oral contraceptive, approved just last year, you get your period only four times a year. And during those weeks when you do have your period, this pill continues to deliver a low dose of estrogen, which means you won&amp;#039;t experience the drop in hormone levels that can trigger perimenopausal symptoms. Note: Until your body adjusts to the formula, you may have some slight bleeding between periods.  \u2022 Yaz This is the only birth control pill approved by the FDA as treatment for premenstrual dysphoric disorder (PMDD)\u2014an extreme form of PMS. Because you take an active pill for 24 days, not the usual 21, and because of the particular form of progestin that it contains, Yaz keeps hormone levels steadier than other formulas do. This means that, in all likelihood, it will also help reduce perimenopausal hormone swings and symptoms, says Dr. O&amp;#039;Connell. (Yaz hasn&amp;#039;t been out long enough to say for certain.) You&amp;#039;re worried about taking hormones  For the most part, oral contraceptives have been proven safe, even beneficial. Taking the Pill for five years, for example, cuts your risk of ovarian cancer by 50 percent. And low-dose formulas reduce your chances even further, a recent study has found. But the Pill isn&amp;#039;t for everybody. If you&amp;#039;re over 35 and have high blood pressure\u2014or you smoke\u2014hormone-based methods increase your odds of a stroke or heart attack. And some women simply don&amp;#039;t like the idea of taking hormones, points out Dr. Greenfield. Two hormone-free choices:  \u2022 ParaGard IUD This T-shaped IUD contains copper, which kills sperm. Recently approved by the FDA as safe for all women (whether or not they&amp;#039;ve ever been pregnant), the device is 99.4 percent effective and provides protection for up to 10 years. The chief drawback of this IUD: It tends to trigger heavier menstrual bleeding and severe cramping. &amp;quot;But if you can stick it out, the bleeding usually levels off in three to six months,&amp;quot; says Dr. O&amp;#039;Connell. Meanwhile, she suggests that you try ibuprofen (Motrin, Advil) or naproxen (Aleve) to cope with the cramps and increased flow. If over-the-counter formulas don&amp;#039;t help enough, talk to your doctor\u2014these are available in prescription-strength too.  \u2022 CycleBeads At $13.95, this is the hands-down least expensive &amp;quot;method&amp;quot; around. Basically a tool to help you use the rhythm method more reliably, CycleBeads is a necklace that marks your most fertile days. Sound silly? It was developed by the Institute for Reproductive Health at Georgetown University and is 95 percent effective if used correctly, according to a study of almost 500 women. (Available at health food stores and at cyclebeads.com.)  You&amp;#039;re finished having a family Any method will see you through menopause, but if you want pregnancy to be completely out of the question, sterilization might be the right choice for you. There&amp;#039;s the traditional tubal ligation, which requires a small incision below your belly button and is typically done under general anesthesia at an outpatient surgical center, with recovery taking four to six days. Instead of having this traditional surgery, you may want to consider: \u2022 Essure This new sterilization procedure requires no general anesthesia, no incisions, and it is performed in a doctor&amp;#039;s office. On each side, a tiny coil is routed through the vagina, cervix, uterus, and into the fallopian tube, where it triggers the formation of scar tissue and blocks the passage of sperm. About 45 minutes after the coils are placed, you walk out of the doctor&amp;#039;s office, and you can resume your normal activities in a day. Downside: In a small number of patients (roughly five percent), the doctor can&amp;#039;t insert both coils successfully, so you&amp;#039;ll have to use another method. (Your gynecologist will be able to tell immediately.) And even when the coils can be inserted, you will have to use backup contraception for several months to make sure your tubes are completely closed; an X-ray will show whether they are. But based on four years of data\u2014Essure has been available since 2002\u2014it is 99.8 percent effective. What Price Protection?  To calculate what a contraceptive method will cost, consider these three factors: 1. Your Doctor&amp;#039;s Fee  Plus additional costs you might not think to include, such as a charge for a Depo-subQ Provera 104 injection every three months (about $75 per shot). It costs about $525 to have the Implanon rod inserted; then you&amp;#039;ll probably be charged at least the fee for an office visit to remove it. 2. Your Insurance  Before you dismiss any option as too expensive, find out what your plan will allow. The Essure sterilization procedure runs up to $3,000, for example, but many health insurers cover the entire cost, says Mitchell D. Crenin, M.D., an ob-gyn at the University of Pittsburgh School of Medicine. &amp;quot;So you may have no out-of-pocket expense.&amp;quot; 3. Years You&amp;#039;ll Need It  Over a one-year period, an IUD is more expensive (up to $600, including insertion) than NuvaRing ($46 per month) or most brand-name pills (about $30 monthly). But for long-term protection (five or more years), the IUD is one of the best values, found a recent study from Cedars-Sinai Medical Center in Los Angeles. "^^<http://www.w3.org/2001/XMLSchema#string>
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