Oral contraceptives hold top position as leading choice for women
DMPA use gaining in women, teens, 1997 survey results show
Women may love it, or they may leave it, but when it comes to recommending a reliable form of contraception, they will tell their friends, "try the pill." The birth control pill shows no evidence of relinquishing its position as the leading form of reversible contraception, according to results of the latest Contraceptive Technology Update survey. With minimal side effects and attractive pricing, family planners find that more than 85% of adult women and 78% of teen-agers choose oral contraceptives. (See chart, p. 134, bottom.)
Contraceptive choices are apt to change as women move through different phases in their lives. More young mothers at the South Austin (TX) Women’s Clinic are choosing injections of Depo-Provera (DMPA), instead of struggling with the pill’s daily regimen, says Kathryn Lloyd-Watkins, BSN, NP, a women’s health care nurse practitioner. Seventeen percent of teens and 11% of adults use DMPA, according to CTU readers, reflecting an increase from 1996 levels of 11% and 6% for the two populations.
"We have a maternity clinic, and DMPA seems to be the big choice because they realize it doesn’t harm the baby and it promotes breast-feeding," Lloyd-Watkins notes. "We also point out that when you have a new kid, life is pretty disruptive, and it may be hard to remember to take a pill."
DMPA has been well-accepted by teens, who also prefer the convenience of quarterly shots, says Corinne Rovetti, RNC, MSN, a family nurse practitioner at the Knoxville (TN) Center for Reproductive Health. Rovetti estimates 35% of the facility’s patients use DMPA.
Whether women remain on the pill or go with another contraceptive, they show a high level of satisfaction with the method, reveals a recent study commissioned by the Washington, DC-based Association of Reproductive Health Professionals (ARHP).1
Eighty percent of women using the pill are very satisfied with their choice, and 50% of women no longer taking the pill still prefer it to other forms of contraception, the study shows. (See chart, p. 4 of insert.) Almost 75% of respondents to the ARHP survey would advise a young woman to use oral contraceptives for birth control.
Increase in DMPA affirmed
The CTU survey responses on DMPA use fall in line with national trends, says Jacqueline E. Darroch, PhD, senior vice president and vice president for research with the Alan Guttmacher Institute in New York City.
According to statistics from the 1995 National Survey of Family Growth, DMPA is used by 3% of the population and Norplant by 1.3%.2 Norplant use appears to be on the wane, say those who responded to the CTU survey. Several clinics do not carry it or find a call for it, due to the upfront cost to the patient. With few traditional insurance or managed care plans currently covering reversible contraception, many women are unable to pay Norplant’s insertion cost, say clinicians.
There are few, if any, Norplant users at Reproductive Health Care Center at Platteville, WI, says nurse practitioner Robin Timm, WHNP. The nonprofit family planning clinic logs about 35 patients a month for DMPA injections, most in their teens and 20s. About 10% stop DMPA use due to irregular bleeding and weight gain, Timm says.
While there has been little call lately for Norplant insertions at San Miguel County Public Health Nursing in Telluride, CO, the majority of patients who have them have kept them, says June Nepsky, FNP, MSN, the facility’s director of nursing. "I think a lot of that has to do with really good education and giving the patient all the information that they need," Nepsky notes. "They actually had a desire for that method."
Whether they use DMPA or Norplant, many women often return to birth control pills. Fewer women discontinue pills due to significant side effects than either DMPA or Norplant. Weight gain, severe headaches, and mood swings may affect users of all three methods, but OCs continue to offer the best fit for many patients. (See charts, below left, p. 136, and p. 3 of insert.)
Ortho Tri-Cyclen moves to No. 1
Ortho Tri-Cyclen, manufactured by Ortho-McNeil Pharmaceutical in Raritan, NJ, leads the 1997 survey’s first-choice selections. With minimal side effects, attractive cost, and high level of patient satisfaction, Ortho Tri-Cyclen captured 34% of the responses. (See chart, p. 1 of insert.)
The pill, with a graduated dose of the progestin norgestimate and a constant 35 mcg dose of ethinyl estradiol, has been available in America since 1992. With the U.S. Food and Drug Administration’s approval this year for treatment of acne, Ortho Tri-Cyclen is the first low-dose birth control pill to be indicated for noncontraceptive use. (For details, see CTU, March 1997, p. 25.)
Nurse practitioners at Family Planning Services of SUN (Snyder, Union, and Northum-berland counties) in Selinsgrove, PA, have used Tri-Cyclen since it made its debut on the U.S. market, says Karen Borusiewicz, RNC, CRNP, medical manager.
Clinicians have recommended Tri-Cyclen for acne all along, but patients have been requesting it following the new acne indication, Borusiewicz says. "Cost, as always, plays a role in our decisions, and Ortho-McNeil Pharmaceuticals offers the lowest prices," she explains. "Luckily, both the cost and the pill acceptability make Tri-Cyclen a viable alternative for our patients."
Many of the low-dose pills offer good acne control, notes Marilyn Joseph, MD, FACOG, medical director of Boynton Health Service in Minneapolis, the student health center for the University of Minnesota. Since Ortho was the first to obtain the acne indication, though, many patients now come in requesting "the acne pill," she says.
Other pills named as first-choice selections include Ortho Cyclen (19%); Triphasil, manufactured by Wyeth-Ayerst of Philadelphia (14%); Ortho-Novum 7/7/7 (11%); and Ortho-Cept (5%). Eight other OCs were included in the first-choice list: Ortho-Novum 1/35, Nordette (Wyeth-Ayerst), Ovcon (Bristol-Myers Squibb, New York City), and Loestrin (Parke-Davis, Morris Plains, NJ), all with 3%; Desogen (Organon, West Orange, NJ), with 2%; and Lo-Ovral (Wyeth-Ayerst), Tri-Levlen (Berlex, Wayne, NJ), and Modicon (Ortho-McNeil Pharmaceuticals), all with 1%.
Ortho-Cyclen is second choice
What do family planners say is their second-choice pill? Although preferences were more evenly matched in this category, 23% of those participating in the CTU survey selected Ortho-Cyclen, followed by Triphasil with 22%, Ortho Tri-Cyclen with 12%, Ortho-Novum 7/7/7 with 10%, and Lo-Ovral at 7%. (See chart, p. 2 of insert.)
Other selections included Loestrin, with 5%; Ortho-Novum 1/35, Ortho-Cept, and Nordette, with 4%; Tri-Levlen, Desogen, Ovcon, Modicon, Levlen (Berlex), Demulen (Searle), Genora (Rugby), and Alesse (Wyeth-Ayerst), all with 1%.
Triphasil led the No. 2 list in the 1996 survey, with Loestrin and Ortho-Novum 7/7/7 tied for second. Ortho-Cyclen followed, with Ortho Tri-Cyclen and Lo-Ovral tied for the remaining spots.
Nepsky says Ortho Tri-Cyclen’s and Ortho-Cyclen’s progestin, which minimizes spotting and breakthrough bleeding, led her to select the two for her top choices. For Suzanne Presson, RNC, WHCNP, a nurse practitioner with Columbia Family Healthcare Center of Pampa (TX), pill availability is a factor.
"Tri-Cyclen is my first choice because it is what I have the most of from my state-funded program, but I would use it anyway," she notes. "I include the education about acne, especially with my teens."
References
1. Association of Reproductive Health Professionals. The Paradox of the Pill: Oral Contraceptives and Today’s Woman. Washington, DC; February 1997.
2. Abma JC, Chandra A, Mosher WD, et al. Fertility, family planning, and women’s health: new data from the 1995 National Survey of Family Growth. National Center for Health Statistics. Vital Health Stat 1997; 23(19).
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