Move over, Pill: New contraceptives expand acceptance among women

More choosing contraceptive patch and vaginal ring

When discussing contraceptive options with your female patients, what choices are available at your facility? If they include the contraceptive patch (Ortho Evra, Ortho-McNeil Pharmaceutical, Raritan, NJ) and the contraceptive vaginal ring (NuvaRing, Organon, West Orange, NJ), you join the majority of respondents to the 2003 Contraceptive Technology Update Contraception Survey.

A total of 88.3% of those surveyed say their facility now offers the contraceptive patch, up from 64.3% in 2002. About 75% say they provide the contraceptive vaginal ring, up from about 58% in 2002.

"We have noticed a decline of about 5% [in the number of oral contraceptive users]," reports Kimberly Carson, RN, clinical services supervisor at the Aberdeen, WA-based Grays Harbor County Public Health. "We are seeing a fair amount of users either switching to or trying the patch or the ring."

Evra and NuvaRing have been well received at the Marshfield Clinic, a private, multispecialty group practice in Eau Claire, WI, says Deborah Wright, OGNP, a nurse practitioner at the facility. Several of the clinic’s medical assistants use these methods, then tell patients about them, which increases their use, Wright notes.

While oral contraceptives (OCs) continue as a popular form of contraception, providers are seeing women consider other new forms of birth control. Results from the 2003 survey bear this out: About 35% of 2003 survey respondents say half or more of their patients use OCs. This continues a downward trend seen in 2002, when 42% said that 50% or more women used the Pill, and in 2001, when a 53% figure was recorded.

Each Ortho Evra patch contains 150 mcg of the progestin norelgestromin and 20 mcg of the estrogen ethinyl estradiol. Designed to be changed once a week and worn for three weeks, it consists of an adhesive medicated layer worn against the skin, protected by a waterproof polyester layer. Just as pill users take placebos or no pills during the fourth week, patch users go patch-free that week. (For tips on successful use of the contraceptive patch, see the October 2003 CTU article, "Contraceptive patch catches on with women," p. 114.)

Many of the female patients at the Charlottesville-based University of Virginia have been glad to have another birth control alternative, states Christine Peterson, MD, director of gynecology in the department of student health. Most patch users at the student health clinic are enthusiastic about it, though a few have discontinued because of breast tenderness or more breakthrough bleeding than they had experienced on the Pill, she notes.

"It is less popular than the Pill among first-time prescription contraceptive users," she observes. "I suspect this is because they have become more familiar with the Pill than with the patch through secondary school education and mass media, though I do not have data to support this notion."

Evra is well received at Provo, UT-based Brigham Young University, says Linda Hale, MN, APRN, WHNP, ANP, a nurse practitioner at the Student Health Center. "The two most common reasons for discontinuing the patch are breast tenderness/swelling and skin irritation; [however] both of these have occurred only rarely considering how many prescriptions I have written for Evra," she reports.

According to patient information supplied with the method, women can wear an Evra patch on their buttock, abdomen, upper torso (excluding the breasts), or on the outside of the upper arm.1 A different site may be chosen each week, but whichever place the woman chooses, the patch must remain there for seven days. The patch may be worn in the same location each week; however, women should try to avoid placing it in the same exact spot.

For example, if a woman prefers to wear it on her abdomen, on her next patch change day, she should switch to the opposite side. The patch should not be applied to skin that is red, irritated, or cut.1

NuvaRing releases a continuous low dose of the estrogen ethinyl estradiol and the progestin etonogestrel at an average rate of 0.120 mg etonogestrel and 0.015 mg ethinyl estradiol per day over a 21-day period of use. (Review recent research on NuvaRing; see "New research confirms efficacy of NuvaRing," CTU, June 2003, p. 68.)

The method was slow to take off at the University of Wisconsin-La Crosse Student Health Center, but it was helpful to give a month free, says Carol Burgmeier, MSN, FNP, a family nurse practitioner at the facility.

"Students would at least try it, and then found that they liked it," she notes. "That seems to be the fastest growing form of hormonal contraceptive."

NuvaRing now is available at the Klickitat County Health Department in White Salmon, WA, reports Theresa Rundell, ARNP, a nurse practitioner at the facility. Acceptance of the method was slow in starting, but now it is catching on, she states.

The contraceptive vaginal ring is a little more difficult to sell to patients, says Hale. Two recent patients have started the ring and "love" it, she says; both of these women started with OCs, had nausea, and were motivated to try another monthly contraceptive, she notes.

Samples of the contraceptive ring and patch are very helpful with women considering these newer methods, says Sharon Schnare, RN, FNP, CNM, MSN, clinician at South Kitsap Family Care Clinic in Port Orchard, WA.

"I find that having a woman insert the ring in the office increases her success with this method; once she inserts the ring or applies the patch in the office, I provide a prescription for that method," she notes. "This style of active engagement significantly improves success."

Reference

1. Ortho-McNeil Pharmaceutical. What You Should Know About Ortho Evra. Accessed at www.orthoevra.com.