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New Contraceptive Methods Offer Many Options for Women: Presented at AAFP

By Mike Fillon

NEW ORLEANS, LA -- October 12, 2003 -- Women have many new contraceptive methods to choose from, among them a progestogen intrauterine system, vaginal contraceptive ring, combined hormone contraceptive patch and new oral contraceptives.

Cathryn Heath, MD, and Sandra Sulik, MD, described the options, and explained the pros and cons of each during a seminar held here October 1^st at the American Academy of Family Physicians 55^th Annual Scientific Assembly.

One big advantage of the new options, they said, is that they could help improve compliance and thereby lower unwanted pregnancy rates. "Some really good studies have shown compliance [with conventional contraceptives] is even worse than we expected," said Dr. Heath, clinical associate professor of family medicine and director of maternity care, University of Medicine & Dentistry of New Jersey - Robert Wood Johnson Medical School, New Brunswick, New Jersey. "One study showed that at least 36% of people skipped three or more contraceptive pills... a month."

"The premise behind a lot of the new methods is, 'Let's make this more foolproof than what we have with the pill'," she said.

The new patch has been widely advertised, and a lot of patients are asking about it, Dr. Heath said. The Ortho Evra combined hormone contraceptive patch is a transcutaneous system that provides 20 mcg of ethinyl oestradiol and 150 mcg of norelgestromin per day. Each patch lasts 7 days. A new patch must be applied each week for 3 weeks, with one patch-free week afterwards.

Initial compliance with the patch is better than with the pill. The patch delivers less oestrogen than the pill because the patch is absorbed continuously. It is easy to use and highly accepted. The disadvantages include its expense ($35 to $40 a month), the breakthrough bleeding and spotting that are common in the first 3 months of use, and the need for it to be used with caution in women heavier than 198 lbs, Heath said.

The NuvaRing vaginal contraceptive ring is made of ethylene vinylacetate copolymers (28% and 9% vinylacetate) and magnesium stearate, also known as EVA, coated with 15 mcg of ethinyl oestradiol and 120 mcg of etonorgestrel, which are gradually diffused through the vaginal mucosa. The ring can be inserted and removed by the patient and lasts 21 days, followed by 7 ring-free days.

The pros of the vaginal ring are that it is easy to use, delivers continuous low-dose oestrogen, and does not commonly induce breakthrough bleeding and spotting, said Dr. Heath said. However, it is expensive ($40 per ring), some women are squeamish about inserting the ring, 97% of women who use it experience some withdrawal bleeding, and it cannot be used by women who are allergic to silicone.

The Mirena progestogen intrauterine system consists of a T-shaped frame with a hormone reservoir around a vertical stem that releases 20 mcg of levonorgestrel a day. A physician needs to insert the intrauterine device, but once it is inserted, it can stay in place for 5 years. Dr. Heath said the system is very effective in preventing pregnancies. It decreases menses for most users and carries a low risk of causing pelvic inflammatory disease. Its 5-year usefulness is a definite plus, she said. However, spotting is common in the first 3 months of use. The initial upfront cost is high, at $650 for the system, in addition to a typical $200 insertion charge; and insurance coverage is not always available.

"Two new types of low-dose oral contraceptive pills are available," said Dr. Sulik, associate professor of family practice, Upstate Medical Center, Syracuse, New York. The new pills offer greater cycle control than other contraceptive pills, she said. One new pill is a monophasic oral contraceptive containing 30 mg of ethinyl oestradiol and 3 mg of progestogen drospirenone. With this new pill, the occurrence of breakthrough bleeding and spotting is low, and it may reduce the occurrence of acne and hirsutism, said Dr. Sulik. Its major drawback is that it has potential drug interactions with certain medications, such as angiotensin-converting enzyme inhibitors, potassium-sparing diuretics and heparin, she said.

Late in October 2003, an extended-cycle oral contraceptive that lasts for 91 days, Seasonale (ethinyl oestradiol and levonorgestrel) will be on the market. It is comparable in efficacy to traditional oral contraceptives, but it causes more spotting and bleeding and commonly causes nasopharyngitis, Dr. Sulik said. She added that an implantable rod that replaces Norplant is expected to be approved for use in the United States next year.


[Study title: "New Contraceptive Methods: A Case Based Approach to Helping Your Patients Choose." Abstract 563]

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