Readers rank top oral contraceptives

While new birth control methods are attracting attention from new and established contraceptive users, family planning clinicians say many women continue to choose combined oral contraceptives (OCs) for safe, reliable pregnancy prevention.

There has been no change at the St. Clair County Health Department in Port Huron, MI; most of its clients request OCs, says Ruth Napolitan, RNC, BSN, WHNP, a nurse practitioner at the facility.

Cost can be a factor for many women when making a contraceptive choice, explains Linda Hale, MN, APRN, WHNP, ANP, a nurse practitioner at the Provo, UT-based Brigham Young University Student Health Center.

"We sell NuvaRing [the contraceptive vaginal ring marketed by Organon, West Orange, NJ] for $34, Evra [the transdermal contraceptive marketed by Ortho-McNeil Pharmaceutical, Raritan, NJ] for $22, and many of the OCs for $12," she reports. "That is often the biggest factor when a woman chooses her contraceptive here."

Ortho Tri-Cyclen, a 35-mcg ethinyl estradiol phasic pill marketed by Ortho-McNeil Pharma-ceuticals, continues its sixth year in the Contra-ceptive Technology Update Contraceptive Survey as the top nonformulary and formulary selection for a 21-year-old nonsmoking woman. About 29% of respondents in the 2003 survey say Tri-Cyclen is their top nonformulary choice, and when bound by program formularies, 23% of 2003 responses list the OC as the No. 1 choice.

These figures, however, show a decline from 2002’s responses, when about 36% of survey respondents named the pill as the top nonformulary OC, and 37% picked it as the No. 1 formulary pill.

"We began using this tablet as a first choice three to four months ago; it has had a great response with little to no initial use side effects, and many of our clients, new and returning, are requesting it." says Napolitan.

If Ortho Tri-Cyclen is seeing competition, some of it may be coming from its lower-dose version, Ortho Tri-Cyclen Lo, a triphasic pill introduced at the end of 2002. When breaking down the selections named in the "other" category in formulary and nonformulary pills, Ortho Tri-Cyclen Lo led the pills listed in that category. Ortho Tri-Cyclen Lo provides a daily dose of 25 mcg estrogen for 21 days and three different doses of the progestin norgestimate (180 mcg daily/days 1-7; 215 mcg daily/days 8-14; and 250 mcg daily/days 15-21). The last seven days contain no active ingredients. (Read more about the pill in the December 2002 article "Pill options expand with new, generic OCs," p. 140.)

Ortho Tri-Cyclen Lo represents the first-choice nonformulary and formulary OC for 21-year-old nonsmokers, says Patricia Bauer, MSN, RNC, a nurse practitioner at the Benzie Leelanau District Health Department in Benzonia, MI. The pill is an inexpensive one that many people request, she reports.

What pill would you prescribe for a 42-year-old nonsmoking woman? Once again, CTU survey respondents named Alesse as their preferred OC. About 43% of responses listed the pill as their leading choice, an increase from its 39% ranking in 2002.

Loestrin, a monophasic 20 mcg pill from Pfizer of New York City, fell from its 2002 No. 2 position; while it was named by almost 26% as their leading choice in the 2002 poll, about 16% chose it in 2003. Competition again came from Ortho Tri-Cyclen Lo, which was the leading write-in choice in the "other" category. It was selected by 6.6% of survey respondents as their No. 2 choice in 2002 and 14.29% in 2003.

When you review the Pill’s advantages and disadvantages, do you talk about its noncontraceptive benefits?

According to the 2003 CTU Contraception Survey, more providers say they are recommending pills to women specifically to reduce their risk of cancer of the ovary. A total of 40% of survey respondents indicated they prescribed pills based on patient history of ovarian cancer risk, up from 2002’s 36% figure.

How do you approach women with information on the noncontraceptive benefits of OCs?

According to Christine Peterson, MD, director of gynecology in the department of student health at the Charlottesville-based University of Virginia, the student health center’s in-house handout contains information on the noncontraceptive benefits of OCs, including the reduction in risk for ovarian and endometrial cancer.

Peer health educators provide the handout to the students with whom they discuss contraception, as well as by clinicians to all OC users, she notes.

"Only the most medically savvy medical and nursing students indicate to us that this [benefit] is important for them," says Peterson.