Since low dose pills are already associated with no increased risk of heart disease for women under 35 (who have a low risk of heart disease anyway) how much advantage will be gained by having these women switch to these new progestins? Does raising HDL and lowering LDL in young women result in a later reduction in heart disease? For non-smoking women over 35, and women of any age starting the pill for the first time, perhaps the new progestins will prove to be advantageous.

Meanwhile, if you are looking just at the hard scientific facts, you would have to say that all the fuss over the new progestins is premature. Again, we will have to wait for well designed studies and long-term follow-up.

New Dutch Research

An entirely different approach is being taken by Dutch researchers who noted that the breeding season in animals is regulated by the hormone melatonin, which is secreted by the pineal gland in response to light. A January 1993 report in the Medical Post noted that the Dutch have been testing a completely new type of birth control pill since 1987. The new pill contains melatonin and progesterone, but no estrogen.

Dr. Michael Cohen, of Rotterdam University in Holland, reported his findings to a 1993 breast cancer symposium held in San Antonio. He said that breast cancer risk increases in direct proportion to the number of times a woman ovulates in her lifetime. The new pill has now been tested on 1221 women, with a breakthrough bleeding rate of six percent and a 93 percent ovulation inhibition rate. Dr. Cohen feels that this new pill may protect against breast cancer and other estrogen related side effects. Further studies on all aspects of this new pill are needed, but it looks promising.

Other Means Of Birth Control

The lowest risk of death is associated with barrier or fertility awareness methods of birth control backed up by abortion in the case of failure.

BARRIER METHODS OF BIRTH CONTROL:

• The condom is an excellent method of birth control and also protects both men and women from chlamydia, gonorrhea, herpes, AIDS, and other sexually transmitted diseases.

If used correctly and every time you have sex, it is 97 percent reliable. Rarely does a condom break. If a condom breaks, the morning after pill can be used to prevent pregnancy. Condoms do not have any known risks to a woman's health. Rarely, a woman may develop an allergy to the latex rubber used in the manufacture of condoms. Ultrathin condoms are now on the market, including a selection from Japan, where thinner condoms have been in use for some time.

• The diaphragm with spermicidal jelly is another excellent method that offers 97 percent reliability, if it is used correctly before every love-making session.

This time-honoured method requires that a woman be properly instructed on how to place the diaphragm and apply the jelly. This is easy to learn and the diaphragm can be put in place two hours before sex.

• The cervical cap is like a thick rubber thimble that fits snugly over the cervix.

It requires a lot less jelly than the diaphragm, and can be left in for a few days at a time. Some women find it more convenient than a diaphragm. However, it takes more time to fit and learn how to use than the diaphragm. It is just as effective as the diaphragm in preventing pregnancy (see chapter on cervical cap).

Both the diaphragm and cervical cap pose absolutely no risk to the woman's health and in addition protect a woman from cervical cancer and sexually transmitted diseases.

THE IUD: The main problem with this method is that it can cause pelvic infections that can make a woman sterile. It is not advised for women who have never had children. For some women who have had children, no history of pelvic infection, and a stable relationship, the IUD may be a satisfactory alternative. It is about 97 percent effective.