Pills are still popular with many women
When selecting from the cafeteria of current contraception options, what do women choose? According to results from the 2013 Contraceptive Technology Update Contraception Survey, while many women continue to pick combined oral contraceptives (OCs), other options are making inroads on the popular choice. In 2013, about 27% of survey respondents said more than 50% of their patients left using pills, down from 40% in 2012. In contrast, in 2013 about 85% of respondents said use of intrauterine devices and the contraceptive implant had increased.
"I actually do think the number of pill users has gone down," says Susan Kilburn, RN, APRN-BC, a clinician at Southern Nevada Health District Family Planning Clinic - East Las Vegas and Henderson. "Most are moving toward Depo-Provera (Pfizer, New York City) or the intrauterine device for more convenience."
However, the Pill continues to be a popular choice for many patients. Many younger women still want to try oral contraceptives, even with counseling about long-acting reversible contraceptive methods, says Karen Albright, WHNP-BC, lead clinician at Planned Parenthood Southeastern Virginia in Virginia Beach. These women look to setting an alarm on their cell phones to take their pill on time, she says. (The Bedsider web site, www.bedsider.org, operated by The National Campaign to Prevent Teen and Unplanned Pregnancy, offers a text reminder to help women successfully use their chosen methods. Visit http://bit.ly/1h8TO42 to set up reminders for the vaginal ring, patch, Pill, or shot.)
The Pill is still the most requested method at Wood County Community Health & Wellness Center in Bowling Green, OH, says clinician Caroline Strzesynski, WHNP-BC. The method is considered affordable to patients, because some generics are $9 at Wal-Mart, Rite-Aid or Kroger. At 100% on the center's sliding-fee scale, a pack of pills is $15, making the method generally affordable for women, whether insurance covers it or not, she notes.
The impact of generic oral contraceptives is making an impact on the choices named by clinicians in the annual survey. For the first time in survey history, "other" was named by more respondents than any branded pill for the top pill for young women, whether or not formulary dictates prescribing practice. About 22% named generic choices such as Sprintec, a 35 mcg pill, as well as Apri and Portia, two 30 mcg pill, all from Teva Pharmaceuticals, North Wales, PA, for formulary and non-formulary options.
Loestrin from Teva Pharmaceuticals edged Ortho Tri-Cyclen Lo (Ortho-McNeil Pharmaceutical; Raritan, NJ) as the leading branded pill when it comes to the top non-formulary pill for young women. It also takes the first spot in branded pills when formulary rules dictate which OC to use for this age category.
When it comes to the pill of choice for older women, Alesse (Wyeth, Philadelphia) was named by 29% of readers, dropping its 45% share in 2012. Loestrin 24 FE (Actavis, Parsippany, NJ) was named as second choice; this pill has been replaced by Actavis with Minastrin 24 Fe, a bioequivalent.
Alesse also dominates as the leading option for women who have experienced nausea when using previous pills. About 44% named it as top pill, compared to 55% in 2012.
When it comes to oral contraceptives, budget constraints are leading many clinics to stock more generic pills instead of branded OCs. About 58% say their facilities are using more generic drugs, compared to 2012's 62% reading.
Clinicians continue to hold the line when it comes to prescribing combined pills to older women (40 and above) who smoke 10 cigarettes a day. About 97% said they would withhold OCs from such patients, which is comparable to 2012's 95% statistic. Readers are less emphatic when it comes to women smokers ages 35-39. About 78% said they would not prescribe combined pills to those who smoke 10 cigarettes a day, similar to 2012's 77% figure.
According to the U.S. Medical Eligibility Guidelines for Contraceptive Use, use of combined hormonal contraceptives for smokers under age 35 as a "2," which is a condition for which the advantages of using the method generally outweigh the theoretical or proven risks. When it comes to combined OC use for women age 35 or older who smoke less than 15 cigarettes per day, the guidelines list it as a "3," which is a condition for which the theoretical or proven risks usually outweigh the advantages of using the method. For women in the same age range who smoke 15 cigarettes or more per day, the guidelines give a "4" ranking, because the condition represents an unacceptable health risk if the method is used.1
- Centers for Disease Control and Prevention. U.S. Medical Eligibility Criteria for Contraceptive Use. MMWR 2010; 59(RR04):1-6.