Power of the Pill: Readers speak out

The upswing of use of long-acting reversible contraception is making an impact on the use of combined oral contraceptives (oCs), according to responses to the 2012 Contraceptive Technology Update Contraception Survey. While about 40% of respondents to the 2012 survey said more than half of their patients use OCs (a slight rise from 2011’s 38% mark), reports from clinicians in the field underscore the increasing acceptance of other methods.

Fewer women are using the Pill, observes Jocelyn Stowell, CNM, ARNP, nurse practitioner at Liberty and Calhoun County Health Departments in Bristol and Blountstown, FL. She says fellow clinicians are promoting the use of LARC methods because of ease of use and low failure rates.

“More women seem to be opting for the contraceptive vaginal ring (NuvaRing, Merck & Co., Whitehouse Station, NJ) than ever before,” notes Sharon Carlisle, CNM, lead clinician at Planned Parenthood of Southwest and Central Florida in Tampa. “Typically these women were former combined OC users.”

Pill use is a “little down” at the University of Wisconsin — Eau Claire Student Health Center, confirms Debbie Wright, MSN, OGNP, nurse practitioner at the facility. So many patients go on and off oral contraceptives, she notes. “We need to change the name for ‘birth control pills.’ because so many young women are now using pills for non-contraceptive reasons, such as acne and premenstrual dysphoric disorder,” Wright states. “Many virgins are looking at contraception for ‘just in case.’”

When talking about the Pill, take time to educate women about its noncontraceptive benefits. Use the following talking points:

  • Dysmenorrhea can be treated successfully with combined oral contraceptives.
  • Combined oral contraceptives have been shown to reduce and regulate menstrual bleeding.
  • Combined oral contraceptives can treat acne in women also desiring contraception.
  • Severe premenstrual syndrome might respond to drospirenone-containing combined oral contraceptives.
  • Use of combined oral contraceptives decreases the risk of endometrial and ovarian cancer.1

Ortho Tri-Cyclen Lo (Ortho-McNeil Pharmaceutical; Raritan, NJ) once again is named as the leading choice as the top non-formulary pill for young women, a spot it has maintained since 2008. (See graphic below.) It also takes the first spot when formulary rules dictate which pill to use for this age category. Respondents to the 2011 survey named Loestrin from Teva Pharmaceuticals as the leading formulary choice for 21 year olds.

Alesse (45%) remains in its top spot as the pill of choice for older women, followed by Loestrin 24 FE (Warner Chilcott, LLC, Rockaway, NJ). About 40% of 2011 respondents named Alesse, a 20-mcg pill from Wyeth, as top pill in this category. (See graphic below.)

Survey Profile

Results of the 2012 Contraceptive Technology Update (CTU) Contraception Survey were tallied and analyzed by AHC Media, publisher of CTU. The survey was mailed in December 2012 to 800 subscribers with 43 responses, for a response rate of 5.4%.

Ninety-three percent of responses came from nurse practitioners or registered nurses. Physicians represented about 5%. About 88% of respondents identified themselves as care providers, with some 9% involved in administration, and about 2% identifying themselves as faculty/teachers/students.

About 77% said they worked in public health facilities, with about 12% listing student health centers or academic institutions as their employer. About 2% reported working in hospitals, with some 9% employed in other settings.

More than half (51%) said they worked in a rural areas. About 29% said they were employed in an urban area, while about 17% listed a suburban setting.

Alesse also dominates as the leading option for women who have experienced nausea when using previous pills. More than half (55%) selected it in the current survey, with 49% naming it as top pill in the 2011 poll. The pill has consistently held the no. 1 position in this category since 1999.

When it comes to oral contraceptives, budget constraints are leading many clinics to stock more generic pills instead of branded OCs. About 62% say their facilities are using more generic drugs, compared to 2011’s 75% 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 95% said they would withhold OCs from such patients, declining from 2011’s 98% statistic. Readers are less emphatic when it comes to women smokers ages 35-39. About 77% said they would not prescribe combined pills to those who smoke 10 cigarettes a day, a sharp decline from 2011’s 90% figure.

Clinicians likely are now adhering to the U.S. Medical Eligibility Guidelines for Contraceptive Use, which ranks 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.2

References

  1. Carey MS, Allen RH. Non-contraceptive uses and benefits of combined oral contraception. Obstetrician & Gynaecologist 2012; 14(4):223-228.
  2. Centers for Disease Control and Prevention. U.S. Medical Eligibility Criteria for Contraceptive Use. MMWR 2010; 59(RR04):1-6.