The less a woman has to worry about procreation when she’s having sex, say some, the better. It would be nice to think that the prevention of pregnancy was easy, but there is always some kind of compromise. For those women who choose to use hormonal contraception methods, emotional and physical risks to a woman’s body are part of the burden. Unfortunately, those risks are sometimes difficult to assess.

Ortho Evra , the drug known as “the Patch,” is one of the newest developments in contraception. Manufactured by Ortho-McNeil, a subsidiary of Johnson and Johnson, the Patch has attracted nearly 500,000 women in the United States since it was released on the U.S. market early in 2002. While the drug has attracted women because it only requires weekly tending, Ortho Evra has also received more than a handful of negative reviews and is currently facing a lawsuit from Parker & Waichman, LLP.

The patch is a beige-colored square, about one and three quarters inches wide, that can be worn on a woman’s upper torso, abdomen, upper arm, or buttocks. Once she chooses a start day—either the first day of her period or the Sunday after her period starts—she must continue to use that same start day of the week throughout her use of the Patch. She replaces the Patch each week on that same day. When she has used three patches, the fourth week she wears no patch and she has her period.

The Patch delivers two synthetic hormones—norelgestromin (progestin) and ethinyl estradiol (estrogen) that prevent ovulation, and thus, pregnancy. These hormones also help to thicken the cervical mucus so that it is more difficult for sperm to reach the eggs.

The Patch is seemingly a step in the right direction for women who desire the most freedom in their birth-control method. A woman on the Patch doesn’t have to remember to take the Pill every single day or insert a diaphragm right before sex and “interrupt the vibe” (though she should always have her partner use a condom to prevent STDs). Nor does she have to have it surgically implanted and removed, as is the case with the IUD. And unlike Depo-Provera, she can simply apply the Patch herself and “forget” about it for a week, as opposed to visiting the doctor every three months for an injection.

But the relative freedom of the patch has recently been overshadowed by rumors that it carries increased health risks for even young and healthy women.

Some of the common side effects of the Patch, such as nausea, breast tenderness, headaches, and “emotional liability” are clearly outlined on the Ortho Evrawebsite.

Also noted are the more serious risks that “ can be life threatening.” These include “blood clots, stroke or heart attacks and are increased if you smoke cigarettes. ”

Unlike the Pill, which is ingested and absorbed through the lining of the stomach, the Patch releases hormones directly into the bloodstream. For this reason, it is believed that the Patch is more likely to cause blood clots than the Pill. Deep Vein Thrombosis (DVT) is a condition resulting from a blood clot that forms deep in the leg or pelvis. If the blood clot travels to other parts of the body it can potentially cause pulmonary embolism, blocking the lung, heart, or brain.

Parker & Waichman, LLP, the lawyers who have filed a lawsuit against Ortho-McNeil, argue that the serious risks associated with the Patch are too high. Moreover, they claim, Ortho-McNeil knew just how high those risks were during clinical trials, but nevertheless failed to properly notify potential consumers.

According to an Associated Press article published last July, about a dozen women died during 2004 from complications believed to be a result of the birth control Patch.

Now three years on the market, word about the Patch is beginning to get out, and women have to weigh the risks against the advantages. One woman currently using the Patch says her doctor notified her about the increased risk of blood clots.

“I’ve read a few articles,” she says, “That’s one more reason to go off … but the risk of dying from a blood clot because of the birth control Patch are so low … I could die suddenly for any other reason, too.”

For many women like her, the search for the perfect birth control has meant years of experimentation. This is inevitably an emotional journey, not only because of the emotional effects that occur when introducing synthetic hormones into a woman’s body. With each new method, a woman’s body makes physical adjustments to new hormones, new levels of hormones, or the absence of hormones when she takes a break. All of this is complicated by insurance companies that stop covering a particular drug or partners who may be unwilling to share the costs of contraception—generally $25 to $45 a month.

One 26-year-old woman has been using the Patch for nearly two years and has no complaints. After being on the Pill for many years, she began to feel nauseous every time she took it. She then switched to Depo-Provera and the result was that she “flat-lined” emotionally. She only noticed that she wasn’t feeling the same emotional highs and lows until after she’d discontinued use of the drug: “I realized I hadn’t cried in a year.”

Another woman now on the Patch experienced a similarly rocky road towards finding the right birth control: “Although I didn't typically have problems forgetting to take the Pill, one of the major side-effects of hormonal birth control I've faced is that it raises my blood pressure. Thus, my doctors and I have tried switching to pills with less and less hormones. Even Alesse [a low-estrogen Pill] raised my blood pressure. So, when the Patch came out and I was ready to try something new, my doctor recommended it. Since its continuous feed, it's a lower dose overall, I was told. Although I haven't been monitoring my blood pressure very religiously, it does seem to be better than when I was on other pills.”

While these users are overall fairly happy, they still do experience some side effects.

“ I get headaches,” says one woman, “mostly on my 'no patch' week, during which I have my period. My hypothesis is that my body's saying 'hey, where'd those hormones go?' but I really don't know what it is. I take ibuprofen if I don't feel like dealing with it, and that helps. Headaches have been a common problem with me and hormonal birth control overall, but before I was on the patch it wasn't this pronounced.”

Another woman experienced a hard first three months on the Patch, full of a lot of emotional lows. At the advice of her doctor she “stuck with it,” and gave her body a chance to acclimate. Since then, she hasn’t experienced any major side effects. On the contrary, she has light, regular periods. And while on Depo-Provera she had noticed a lowered libido, on the Patch, she says, “I feel like my sex drive is still there.”

Some women wonder if the Patch looks ugly or if it itches. Says one Patch user, “It does itch sometimes … I wear it on my back so I don't have to see it, but I feel it and I know my partner sees it. I feel like it maybe makes me less sexy with this gross 'band-aid' on my skin. It gets that black lint ring around it which takes some work to remove even after taking off the Patch.”

However, another Patch user doesn’t feel that it’s been such a hindrance to her sex life. “Partners I’ve had just think it’s a nicotine patch.” The only problem has been that, “It’s fallen off during really sweaty sex.”

Fortunately, for many women like these, the side effects of the Patch are minimal. But, not all women have had such positive experiences. And this is what is perhaps most frustrating about experimenting with hormonal contraception methods. Synthetic hormones affect every woman differently, and the results are difficult to predict.

But while many women express reservations about putting synthetic hormones into their bodies when they don’t necessarily “have to,” nevertheless, for them, the advantages continue to outweigh the disadvantages.

“I keep on thinking I should go off it because I don’t have a regular partner right now … One of the reasons I stay on is because it’s so hard to get back on after you stop hormones for awhile … I’m also scared because I have no cramps, my period is light, and I’m happy with where my weight is right now.”

How much risk is too much and are hormonal contraception methods “worth it,” especially in an age when STD prevention should demand the religious use of condoms? Every woman considering the Patch will have to decide for herself.