The first effective delivery system for hormonal contraceptives was the pill, but since then many other means have been used in the United States, from injections to inserts to IUDs to vaginal rings. Currently, other methods are also being explored or used in other countries.
Among the hormonal delivery systems used outside the United States is the Mirena lev-onorgestrel intrauterine device. This method is called an intrauterine system (IUS) by its manufacturers because it has a hormone reservoir that delivers a daily 20 mcg dose of progestin. It is currently in use by nearly one and a half million women in Europe, Asia, and Latin America. It is the single most effective method now available in the world, followed closely by the Copper T 380-A IUD. Among other things the Mirena IUS dramatically decreases menstrual blood loss, is beneficial in the management of fibroids (leiomyomata), the primary cause of hysterectomies in the United States, and may be used by women on estrogen replacement therapy as the form of progestin they need. It is also useful in the treatment of dysfunctional uterine bleeding. In the United States, Berlex Laboratories of Wayne, New Jersey, is leading the fight for Food and Drug Administration (FDA) approval.
Johnson and Johnson has also developed an intrauterine system in the form of a contraceptive patch. The Evra patch contains the same ingredients as birth control pills and is expected to work just as well. It delivers its hormones through the skin for the duration of a year.
Cygnus, Inc., a Redwood City, California, company that specializes in developing drugs delivered through the skin, is also developing a similar product. Interested readers can best keep up with these developments in contraception in the newsletter Contraceptive Technology Update.
