 Sept. 30 - Oct. 3, 2003 |
| ASSEMBLY EDITION • NEW ORLEANS |
Newly available or soon-to-be-available contraceptive methods offer women many more choices for birth control that suit their individual needs and that could help them comply with directions for use. Among the new options are a progestogen intrauterine system, vaginal contraceptive ring, combined hormone contraceptive patch and new oral contraceptives.
Two family physicians who help patients find the best contraceptives for their needs explained the pros and cons of the new methods in a seminar Wednesday. The speakers said the options could help improve compliance and thereby lower unwanted pregnancy rates.
"Some really good studies have shown compliance is even worse than we expected," said Cathryn Heath, M.D., clinical associate professor of family medicine and director of maternity care at the University of Medicine & Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick.
"One study showed that at least 36 percent of people skipped three or more contraceptive pills ... a month," said Heath. "The premise behind a lot of the new methods is, 'Let's make this more foolproof than what we have with the pill.'"
Heath and Sandra Sulik, M.D., associate professor of family practice at the Upstate Medical Center in Syracuse, N.Y., presented "New Contraceptive Methods: A Case Based Approach to Helping Your Patients Choose." They will offer the two-hour seminar today from 8:30 to 10:30 a.m. Check on ticket availability at the registration area of Morial Convention Center; the course location is on the ticket.
Contraceptive patch
The new patch has been widely advertised, and a lot of patients are asking about it, Heath said. The Ortho EvraTM combined hormone contraceptive patch is a transcutaneous system that provides 20 micrograms of ethinyl estradiol and 150 micrograms of norelgestromin per day. Each patch lasts seven days. A new patch must be applied each week for three weeks, with one patch-free week afterwards.
Initial compliance with the patch is better than with the pill. The patch gives less estrogen 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 three months of use, and the need for it to be used with caution in women heavier than 198 pounds, Heath said.
Vaginal ring
The NuvaRingTM vaginal contraceptive ring is made of flexible silicone encoated with 15 micrograms of ethinyl estradiol and 120 micrograms of etonorgestrel. The hormones gradually diffuse through the vaginal mucosa. The ring can be inserted and removed by the patient and lasts 21 days, to be followed by seven ring-free days.
The pros are that it is easy to use, delivers continuous low-dose estrogen, and does not commonly induce breakthrough bleeding and spotting, Heath said. However, it is expensive ($40 per ring), some women are squeamish about inserting the ring, 97 percent of women who use it experience some withdrawal bleeding, and it cannot be used by women who are allergic to silicone.
Intrauterine system
The MirenaTM progestogen intrauterine system consists of a T-shaped frame with a hormone reservoir around a vertical stem that releases 20 micrograms of levonorgestrel a day. A physician needs to insert the intrauterine device, but once it is inserted, it lasts for five years.
The system is very effective in preventing pregnancies, Heath said. It decreases menses for most users and carries a low risk of causing pelvic inflammatory disease. Its five-year usefulness is a definite plus. On the negative side, spotting is common in the first three 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 pills
"Two new types of low-dose oral contraceptive pills are available," said Sulik. The new pills offer greater cycle control than other contraceptive pills, she said.
One new pill is a monophasic oral contraceptive containing 30 milligrams of ethinyl estradiol and 3 milligrams 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, Sulik said.
Its major drawback is that it has potential drug interactions with certain medications, such as ACE inhibitors, potassium-sparing diuretics and heparin, she said.
Out at the end of October will be an extended-cycle oral contraceptive that lasts for 91 days (Seasonale®). It is comparable in efficacy to traditional oral contraceptives, but it causes more spotting and bleeding and commonly causes nasopharyngitis, Sulik said.
In addition, an implantable rod that replaces Norplant® is expected to be approved for use in the United States next year, Sulik said.
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by American Academy of Family Physicians.