Contraceptive patch catches on with women
When a patient discusses possible switches in birth control, what contraceptive options can you offer her?
One method that may stick with her is the transdermal contraceptive Evra. Since manufacturer Ortho-McNeil Pharmaceutical of Raritan, NJ, released the contraceptive patch in 2002, it has become the fastest-growing hormonal contraceptive in the United States. In a survey of more than 8,000 women conducted by the company, nine out of 10 patch users said they preferred the transdermal contraceptive over their former birth control method, and 95% of women said they were satisfied with the patch as a discreet form of birth control.1
As with any form of contraception, careful counseling is an important aspect in ensuring patient satisfaction with the method, says Lee Shulman, MD, professor of obstetrics and gynecology at the Feinberg School of Medicine, Northwestern University, Chicago.
"With issues particular to the patch, there are unique events that are specific to patch use," says Shulman. "Since it is a patch, there needs to be a clear description of the best way to use it."
Make it stick
Each Evra patch should be worn continuously for one week and then be replaced with a new patch on the same day of the week for a total of three weeks of patch wear.
The fourth week, which is patch-free, allows a woman to have her menstrual period, which is similar to the regimen for oral contraceptives (OCs).
In order for the patch to adhere to the patient, it must be applied to clean, dry skin, with no oils, emollients, perfumes or other ointments on the skin surface, says Shulman. Researchers analyzed performance of patch adhesion in women participating in contraceptive studies, a subset of women in warm and humid climates, and a study of women in a crossover exercise study.2 In the contraceptive studies, 4.7% of patches were replaced because they fell off or became loose; patch replacement rates in centers from a warm, humid climate were 1.7%; only one of 87 patches completely detached in the exercise study.2
"Detachment rates are very low, but they do occur, and clear instructions need to be given if the patch does detach," says Shulman. According to the product literature, if a patch seems loose, partially lifts up off the skin, or falls off, instruct the woman to try to reapply it or apply a new birth control patch immediately, using the following directions:
• Press down firmly on the patch with the palm of the hand for 10 seconds, making sure that the edges stick well, then run your fingers around the edge of the patch.
• Do not use tapes or wraps to keep the birth control patch in place.
• Do not try to reapply a patch if it is no longer sticky, if it has been stuck to itself or another surface, if it has other material stuck to it, or if it has become loose or has fallen off before. If the birth control patch does not stick well, remove it, and then apply a replacement birth control patch. This patch should be replaced on the original "patch-change day." Single replacement patches are available.
If the detached patch is reapplied in less than 24 hours, no backup contraception is needed and the patient’s "patch change day" will remain the same. If detachment has occurred for more than 24 hours, or if the patient is unsure of the time span, instruct her to start a new four-week cycle immediately by applying a new patch. This will begin a new "day one" and a new "patch change day" for her. Counsel the patient to use backup birth control, such as a condom, spermicide or diaphragm, for the first week of her new cycle.3
Another counseling item to include is expected side effects. Self-limited, mild breast tenderness has been noted with initial use of the patch with some women, so it is important to counsel on it prior to Evra use,4 states Shulman.
"It’s not associated with any problems, and for the vast majority of women who do experience this mild to moderate breast discomfort, it is gone by the end of the second cycle," he states. "Then it is no different from what we find with oral contraceptives."
Is it more forgiving?
A new study suggests that the contraceptive patch is more effective than birth control pill in suppressing ovulation in normal cycles and after dosing errors. In the study, scientists compared three OCs to the patch in terms of follicle size and incidence of ovulation in normal cycles and after a dosing error, such as would be caused by a patient not changing a patch when indicated.5 Researchers found that during normal cycles and after the dosing errors, the women using the contraceptive patch had smaller follicle size and were much less likely to ovulate than the women who used OCs.
"The recent findings of less follicular development compared to oral contraceptives with ultrasound imaging is intriguing," states study co-author David Archer, MD, professor of obstetrics and gynecology and director of the Clinical Research Center at the Eastern Virginia Medical Center in Norfolk. "A possible explanation is that the consistent delivery of the transdermal steroids have better suppression of serum FSH [follicle-stimulating hormone] than oral steroids."
References
1. Ortho-McNeil Pharmaceutical. Women prefer the patch: In one year Ortho Evra becomes the fastest growing hormonal contraceptive on the market. Press release. July 16, 2003.
2. Zacur HA, Hedon B, Mansour D, et al. Integrated summary of Ortho Evra/Evra contraceptive patch adhesion in varied climates and conditions. Fertil Steril 2002; 77(2 Suppl 2):S32-5.
3. Ortho-McNeil Pharmaceutical. What You Should Know About Ortho Evra. Accessed at www.orthoevra.com.
4. Audet MC, Moreau M, Koltun WD, et al. Evaluation of contraceptive efficacy and cycle control of a transdermal contraceptive patch vs. an oral contraceptive: A randomized controlled trial. JAMA 2001; 285:2,347-2,354.
5. Pierson RA, Archer DF, Moreau M, et al. Ortho Evra/ Evra versus oral contraceptives: Follicular development and ovulation in normal cycles and after an intentional dosing error. Fertil Steril 2003; 80:34-42.
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