Pill still is popular family planning option

More contraceptive choices for women mean increased competition for the Pill, but the method continues to be favored by many family planning patients.

Oral contraceptives (OCs) continue to be the No. 1 choice with patients, says Karin Rohn, FNP, a nurse practitioner at Tuolumne County Health Department in Sonora, CA. She estimates 50% or more of her patients leave the office each month with pill prescriptions.

About 42% of 2002 survey respondents agree with Rohn, with half or more of their patients using OCs. While that number is significant, it represents a drop from 2001’s 53% figure and is the lowest amount in the 50% plus category since the question was first posed in 1998.

About 38% of 2002 survey responses say 26%-50% of patients use pills, and 16.7% indicate that 11%-25% of patients choose OCs. About 3% of responses note pill use in 10% or less of their patient population.

"All of our methods have been slowly increasing, including OC users, due to gradual increases in the number of clients we are seeing," states Michele Van Vranken, MD, medical director of the Annex Teen Clinic and West Suburban Teen Clinic in Minneapolis.

Pill use has stayed about the same for patients of Carrie Hrubala, CNM, a certified nurse-midwife at Women’s Health Care of Trumbull, CT. She estimates half of her patients are using birth control pills.

While Helen Cook, ARNP, a nurse practitioner at Franklin County Health Department in Appalachicola, FL, says half of her patients leave each month with pill prescriptions, that number has not increased in the past year.

"A few more are requesting intrauterine devices," says Cook. "The newer methods are not available in our clinics yet."

Tri-Cyclen top choice

Ortho Tri-Cyclen, a 35-mcg ethinyl estradiol phasic pill marketed by Ortho-McNeil Pharmaceuticals of Raritan, NJ, continues as the leading choice as the top nonformulary and formulary selections for a 21-year-old nonsmoking woman, which marks five years of dominance in the survey responses. (See chart on first-choice nonformulary OC for a 21-year-old nonsmoker.) About 36% of respondents in the 2002 survey say Tri-Cyclen is their top nonformulary choice, and when bound by program formularies, 37.2% of 2002 responses list the OC as the No. 1 choice. The findings showed a slight decrease from 2001’s responses, where 37.4% chose the pill as the top nonformulary OC, and 39.5% named it the leading formulary selection.

"Ortho Tri-Cyclen is on our formulary and is popular with the teens because of the company’s marketing to that group of clients," says Cook. "Teens often come in requesting that particular OC, especially the ones with acne problems."

What OC for older women?

For the second year, CTU survey respondents named Alesse, a monophasic 20-mcg pill from Wyeth-Ayerst Laboratories of Philadelphia, as the preferred OC for older nonsmoking women. About 39% of responses listed the pill as their leading choice, a drop from its 52% ranking in 2001.

Loestrin, a monophasic 20-mcg pill from Pfizer of New York City, was named by almost 26% as their leading choice in the 2002 poll, up from 14.5% in 2001. About 15% named Mircette from Organon of West Orange, NJ, as their top choice, a slight increase from 12.1% in 2001. The pill offers 21 days of 150-mcg desogestrel/20-mcg ethinyl estradiol, two days of placebo pill, followed by five days of 10-mcg ethinyl estradiol. (See chart on first-choice nonformulary OC for a 42-year-old nonsmoker.)

When discussing OC use with women, you discuss the side effects, such as spotting, breast tenderness, and headaches, but do you mention the noncontraceptive benefits? The Pill provides protection against benign breast disease, ectopic pregnancy, salpingitis, dysmenorrhea, and iron deficiency anemia, in addition to its effectiveness in pregnancy prevention.1

According to the 2002 CTU Contraception Survey, more providers say they are recommending pills to women specifically to reduce their risk of cancer of the ovary. Almost 36% of survey respondents indicated they prescribed pills based on patient history of ovarian cancer risk, up from 2001’s 33.9% figure.

Such noncontraceptive benefits are included as a part of the general discussion with every OC patient, says Maria Mangini, PhD, CNM, FNP, a nurse practitioner in private practice in Berkeley, CA.

Julie O’Neill, CNM, a certified nurse midwife at Mount Timpano-gos Women’s Healthcare in Pleasant Grove, UT, says she uses pills for a number of noncontra-ceptive indications, including perimenopausal symptoms; heavy, painful menstrual periods; and premenstrual syndrome.

"When women ask for birth control, we mention the added benefits of OCs, and we have a handout on lowering the risk of ovarian cancer," says O’Neill. "We also mention it specifically to women who have family history of ovarian cancer."

Reference

1. Grimes DA, Chaney EJ, Connell EB, et al. Health benefits of oral contraceptives. The Contraception Report 1997; 8:4-14.