Preventing unplanned pregnancies is a complicated business. About half of all pregnancies in the United States each year are unplanned, and it's estimated that about half of these occur despite the use of a birth control method.

So, it's obvious that birth control is not completely reliable. Most birth control failures are a result of human error: condoms put on incorrectly can slip off or tear; women forget to take birth control pills at the same time each day; diaphragms and cervical caps can be placed incorrectly.

The most reliable birth control methods are the ones that require little or no action on the part of the user. For example, once an IUD (intrauterine device) is placed, there is nothing a woman has to do to make sure it is working. Once a man has a vasectomy, no further action is needed.

Women's health researchers have learned the best birth control methods are highly effective, simple to use, do not require daily attention, do not require the user to take action right before intercourse and have minimal side effects. Also, they should be easily reversible so that if a pregnancy is desired, fertility returns quickly after discontinuing the birth control method.

Two newer birth control methods fit these criteria quite well.

The contraceptive patch, known by the trade name Ortho Evra©, is a 13/4-inch square beige patch. It is placed on the skin of the upper arm, upper chest, abdomen, back or buttock and left in place for seven days. Then, it is removed and a new patch is placed in different location. After 21 days (three consecutive patches), no patch is worn for seven days and the menstrual period will begin during this patch-free week.

The contraceptive patch continuously releases small amounts of the female hormones estrogen and progestin, just like birth control pills. The possible side effects are the same: breast tenderness, nausea, headache and mood changes. Also, some women with sensitive skin may develop a rash where the patch is placed.

Most women who have used both birth control pills and the contraceptive patch find the patch easier to use and just as effective. The cost is about the same.

The contraceptive patch is probably not as effective for women who weigh more than 198 pounds.

Another newer birth control method is the contraceptive vaginal ring, known by the trade name NuvaRing©. This is a flexible soft ring, about 2 inches in diameter that is placed inside the vagina once a month. It is left in place for three weeks, then removed for one week. During the ring-free week, the menstrual period begins.

The ring releases a small amount of estrogen and progestin, so it works in the same way as birth control pills or the patch. There is a lower occurrence of side effects with the ring because the estrogen level is much lower. The effectiveness is not affected by body weight.

The contraceptive vaginal ring is easier to use than either pills or patches, since it is replaced just once every four weeks. If it is placed in the vagina correctly, women and their partners will usually not notice it is there.

Women over 35 who smoke cigarettes should not use hormonal contraception such as birth control pills, the contraceptive patch or vaginal ring because of their increased risk of blood clots, stroke or heart attack.

Both of these newer birth control methods are about 99 percent effective if used correctly. If you decide to get pregnant, your natural menstrual cycles and fertility are likely to return quickly after discontinuing the patch or the ring.

Kathryn B. Brown is a family nurse practitioner with a master's degree in nursing from OHSU. Is there a health topic you would like to read about? Send ideas to You can find more local health news and information in the Health section at

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