I don’t like the pill. What else is super-effective?

Q: If I don’t want to take the pill every day, but want equally effective contraception, what are my choices?

A: There are three effective ways to suppress ovulation with the same hormones as in birth control pills — but you don’t take them by mouth.

The patch
The patch, marketed under the name Ortho Evra, is a popular choice for those who dislike oral contraceptives. Its adhesive contains estrogen and progestin that are absorbed through the skin.

You can stick the patch in one of several places: buttocks or abdomen (most of my patients choose one of these) or the upper arm or torso (excluding breasts).

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The patch should be changed once a week for three weeks. Each patch contains an identical formulation. On the fourth week, you take a break. This is when you get your period, as if you were on the placebo week of the pill.

“Fall-off” rates are low; the patch sticks with you through showering, swimming and sweating. Studies show that less than 2 percent of patches fall off entirely and less than 3 percent become partially lifted.

To reduce the chance of the patch becoming loose, keep the application site clean and dry, and don’t rub use cream, lotion, oil or powder before you apply it. Once the patch is on, keep those creams away from the immediate area.

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If a patch should fall off, you can get a single replacement from your pharmacist. To ensure ongoing protection against pregnancy, stick the new one on within 24 hours, and remove it on the original removal date. Because the hormones are in the adhesive, trying to reattach a dried-out patch on with a Band-Aid won’t work.

The chief complaint I hear from my patients is that the edge gets dirty — and that, after removal, a bit of adhesive remains. This can be rubbed off with baby oil.

The ring
Another non-pill alternative — and one that gives no visible sign of contraception — is the vaginal ring, which releases estrogen and progestin in amounts similar to those of a low-dose birth control pill.

Sold under the brand name NuvaRung, it resembles a hollow diaphragm. The hormones are absorbed through the vaginal lining. You insert it yourself, wear it for three weeks, and remove it for a week (when you get your period). Then you insert a new one.

The IUD
If you want discreet, long-term birth control, consider the intrauterine system. Marketed under the brand name Mirena, it is inserted like an IUD by a health-care provider. It slowly releases progestin, which inhibits the release of an egg, and it also dissuades sperm from swimming up.

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Unlike older IUDs, Mirena doesn’t contain copper. In addition, aside from being wonderfully effective it “calms” the uterine lining, reducing blood loss and cramps, which makes it a good choice for women with heavy periods.

Once inserted, it will keep working for five years. You can have it removed if you want to get pregnant before its expiration date.

Dr. Reichman’s Bottom Line: If taking a pill the same time every day is problematic, you don’t have to give up on effective hormonal suppression of ovulation. Talk to your doctor about these alternatives. And remember: None of these methods will protect against sexually-transmitted diseases. For that you need to use a condom and choose your partner wisely.

Dr. Judith Reichman, the “Today” show's medical contributor on women's health, has practiced obstetrics and gynecology for more than 20 years. You willl find many answers to your questions in her latest book, "Slow Your Clock Down: The Complete Guide to a Healthy, Younger You," published by William Morrow, a division of HarperCollins.

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