'You mean you take a pill just to fend off pregnancy – how primitive!" exclaims Kate to a colleague who is clearly behind the times. Kate is taking a contraceptive pill, but it's no ordinary pill, for it has the added effect of improving her complexion. Her friend Liz is also taking the Pill, but hers is designed to reduce water retention, giving her a slimmer look. Finding a monthly period a nuisance, Jo simply takes a "no-period pill" which reduces hers to four per year.
Welcome to the era of the designer contraceptive. For while these pills are not yet available in Britain, they are on the way. Designed not just for contraception but for lifestyle and convenience, they aim to improve specific aspects of health and appearance.
Yasmin, a combined contraceptive pill developed by Schering, counters water retention, helping to stabilise or even decrease body weight. It could be available as soon as April. Meanwhile, Estrostep, a contraceptive pill that claims to combat acne, is already available in the United States and could be here in a few years. Others, such as Seasonale, which is due to arrive in 2005, reduce periods to four a year.
The good news does not stop there: scientists are developing a contraceptive pill that needs to be taken only once a month, and researchers in Australia are designing a morning-before pill that, taken three to 24 hours before sex, protects against pregnancy.
Within five years, though, the concept of taking a pill for hormonal contraception may be considered completely passé. Approval is being sought through the Medicines Control Agency for Evra, a contraceptive patch worn on the abdomen for three weeks of each month, which may become a contraceptive option for thousands of women in three years. Around that time, another option is set to hit the pharmacy shelves. NuvaRing is a flexible plastic ring that sits in the vagina, releasing oestrogen and progestogen for a month. Both are expected to be hugely popular, mainly because they eliminate the bother of taking a daily pill.
The way these new hormonal contraceptives work, explains Tony Belfield of the Family Planning Association, is very similar to those currently available. The main difference is that the hormones used mimic natural hormones more accurately and their method of delivery is becoming ever more refined.
"All these pills and contraceptive devices are variations on a theme," says Belfield. "Different oestrogens or progestogens and their dosages affect women's biology in different ways. One progestogen may improve complexion; another may reduce water retention, mood-swings or irritability."
Take Yasmin, the pill that counteracts water retention. This is the first birth-control pill to contain drospirenone, a new synthetic hormone that mimics the body's natural progesterone levels more accurately than current versions. Drospirenone cuts water retention because it mirrors natural progesterone in the way it eliminates water.
Estrostep, on the other hand, relies on the action of oestrogen to fight acne and improve the complexion. "Estrostep releases step-by-step doses of oestrogen into the body and combats hormone-related acne by fighting the effects of male hormones which trigger the condition," explains Jodie Norton of Pfizer, the manufacturers. "It also combats anaemia as the last seven pills in the pack contain iron."
Seasonale, an 84-day pill that reduces periods to just four a year, works on the same principle as taking two or three packs of pills back to back.
"Many women, particularly those who suffer heavy bleeding, period pain or premenstrual syndrome, take pills continuously for several months to cut out periods," says Belfield. "And while some women may have reservations about this, the method is in fact perfectly safe."
Other pills in development aim to take advantage of the specific effects of female hormones on reproductive organs. The once-a-month pill, in which one pill would offer protection for an entire cycle, would rely on being taken at a highly specific time each month to interfere with ovulation. The morning-before pill, under development at Monash University in Australia, uses progestogen's effects on a woman's cervical mucus. Taken between 24 and three hours before sex, it would prevent fertilisation by thickening cervical mucus so that the sperm cannot reach the egg.
But is there any point to these pills when they could be so readily superseded by more convenient contraceptive methods such as patches, implants and IUDs? The contraceptive device Mirena, which fits into the uterus and releases progestogen for five years, and Implanon, a contraceptive three-year implant, have already proved extremely popular.
Demand for contraceptive patches, though, could be even greater. For while implants last several years, Evra patches last a week, making them the most flexible non-pill option so far. The contraceptive patch is stuck on the abdomen where it releases oestrogen and progestogen. As it is very adhesive, you can swim and bathe safely. You use one new patch every week, taking every fourth week off. Then, if you change your mind and want to get pregnant, you just throw your patches away. It couldn't be simpler.
The other advantage is that the patches, as well as other non-oral methods such as the NuvaRing, are likely to have fewer nausea-like side-effects than the oral pill because the hormones are delivered to the body in a more sustained way.
But are all these options too good to be true? Since tomorrow's pills will contain more refined versions of today's synthetic hormones, they are likely to have fewer side-effects than those now on offer. Nonetheless Yasmin, containing drospirenone, may raise potassium levels, so it is not suitable if you have kidney, liver or adrenal disease.
Meanwhile, some women may worry that pills such as Seasonale may expose the body to excess oestrogen. "It's well known that taking oestrogen increases your risk of suffering a blood clot or stroke, particularly if you smoke or have high blood pressure," says Marianne Smith, a London-based GP who specialises in women's health. However, since Seasonale contains less oestrogen than conventional pills, she concedes that this risk is probably minimal.
Tony Belfield points out that the advantages of hormonal contraceptives are so great that they dwarf many of their lesser side-effects. "Hormonal contraceptives can cause headaches, nausea and a degree of weight gain but they also protect women from serious illnesses," he says. "Oestrogen and progesterone substantially reduce the risk of ovarian and endometrial cancers and also greatly reduce the pain of conditions such as endometriosis."
But with such a mind-boggling choice of contraceptives hitting the pharmacy shelves, just how are women to choose? "Finding a contraceptive should be like buying a car," says Belfield. "Even if you have a specific aim in mind like cutting down on periods or acne, you should always try a few options before deciding. Women react to different pills in different ways. If one gives you a headache or makes you a little nauseous, switching brand can solve the problem.
"Ask your doctor what's on offer and let them know if you're worried about any particular side-effects. With more than 33 types of pill available and more on the way, you're bound to find something that fits."
For more information on current contraceptive methods go to fpa.org.uk or call 0845 310 1334
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