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Two New Approaches to Hormonal Contraception for Women: Patches and Vaginal Rings

Among women who use hormonal contraception for family planning, poor adherence to pill regimens remains a significant problem. These 2 new hormonal contraceptives may provide women with effective alternatives.

In a randomized, open-label, manufacturer-sponsored trial conducted at 45 centers in the U.S. and Canada, investigators compared 20-cm², 7-day, combination contraceptive patches with triphasic combination oral contraceptives (OCs). Healthy women (age range, 18 to 45) were assigned to receive patches (812 participants) or OCs (605) for 6 or 13 cycles (21-day hormone plus 7-day hormone-free phases). Failure rates were comparable: Among patch users, there were 4 method-failure pregnancies and 1 user-failure pregnancy; among OC users, there were 4 method failures and 3 user failures. Breakthrough bleeding was significantly higher for patch users only during the first 2 cycles; incidence was comparable when all cycles were analyzed. Perfect adherence was noted in more patch cycles (88.2 percent) than OC cycles (77.7 percent). Application-site reactions occurred in 20 percent of patch users; breast discomfort and dysmenorrhea occurred in significantly more patch users than OC users.

In another randomized, open-label, crossover, manufacturer-sponsored study, Dutch researchers compared contraceptive vaginal rings (outer diameter, 54 mm) and combination OCs. The rings were used continuously by 16 subjects (age range, 18 to 35) for 5 weeks (2 weeks beyond the recommended 3 weeks of use) and were compared with 1 cycle of OC use. The rings could be removed for intercourse (as long as 3 hours), if desired. Ovarian suppression, documented by ultrasound follicular diameter and absence of ovulation hormones, was maintained in all women during ring and OC use.

Comment: The results of these and other studies indicate that contraceptive patches and rings are both likely to be as effective as OCs in preventing unwanted pregnancies. Moreover, some women may find these methods more acceptable, leading to improved adherence. These products currently are undergoing FDA review in the U.S.

— RW Rebar

Published in Journal Watch General Medicine May 25, 2001

Citation(s):

Audet M-C et al. Evaluation of contraceptive efficacy and cycle control of a transdermal contraceptive patch vs an oral contraceptive: A randomized controlled trial. JAMA 2001 May 9 285 2347-2354.

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• Medline abstract (Free)

Mulders TMT and Dieben TOM. Use of the novel combined contraceptive vaginal ring NuvaRing for ovulation inhibition. Fertil Steril 2001 May 75 865-870.

• Medline abstract (Free)