Get ready to add new contraceptive options
The next few months will be exciting ones for family planning providers as two new contraceptive methods, the contraceptive vaginal ring and the birth control patch, are set to hit pharmacy shelves.
The first half of 2002 is the projected entry date for the Ortho Evra transdermal contraceptive from Ortho-McNeil Pharmaceutical of Raritan, NJ, according to Kellie McLaughlin, director of global pharmaceutical communications for New Brunswick, NJ-based Johnson & Johnson, Ortho-McNeil’s parent company.
Organon of West Orange, NJ, anticipates the launch of the NuvaRing combined contraceptive vaginal ring by July 2002, says Nancy Alexander, PhD, Organon’s director of contraception.
There are some fast facts that providers will need to know to incorporate these methods in their practices.
The NuvaRing and the Ortho Evra offer the convenience of effective birth control in a nonpill form, which may be desirable for those patients who have trouble with daily pill-taking. Cost for both methods is expected to be comparable to that of oral contraceptives.
The Ortho Evra is a thin, beige patch that delivers continuous levels of the progestin norelgestromin and the estrogen ethinyl estradiol through the skin and into the bloodstream. It is worn for one week at a time and is replaced on the same day of the week for three consecutive weeks. The fourth week is patch-free.
The NuvaRing is a small, flexible, transparent ring that releases a continuous low dose of the progestin etonogestrel and ethinyl estradiol. It is inserted in the vagina, where it remains for three weeks, and then is removed for one week. (Get in-depth information on the NuvaRing; read the Contraceptive Technology Reports "The Vaginal Contraceptive Ring — Efficacy, Caution, and Instructions" inserted in the February 2002 issue of CTU.)
Points for discussion
McLaughlin suggests including the following talking points about Ortho Evra in your contraceptive options discussion:
- It combines the effectiveness of the Pill with convenient once-a-week dosing.
- Ortho Evra offers women an easy-to-use, weekly, noninvasive form of reversible birth control that does not require frequent trips to the doctor, surgical procedures, or daily dosing.
- The birth control patch allows the hormones to enter into the bloodstream through the skin, which may help loss of doses due to vomiting and diarrhea.
- Ortho Evra allows a slow, steady stream of hormones to enter the body over time.
Patch systems are widely used and efficient methods for delivering a variety of drugs and hormones, notes McLaughlin. While Ortho Evra represents the first contraceptive transdermal system, other medications that are available in patch form include hormone replacement therapy, smoking cessation, motion sickness treatment, chronic pain alleviation, hypertension treatment, and angina prophylaxis.
A hormone-releasing vaginal ring has been used for hormone replacement therapy, but the NuvaRing represents the first contraceptive vaginal ring. It has an outer diameter of 2 inches and a cross-sectional diameter of 1/8 inch. Women can easily insert and remove NuvaRing by using their fingers to press the sides of the ring together and gently push it into or remove it from the vagina. The exact positioning of the NuvaRing within the vagina is not critical for it to work since it is not a barrier contraceptive; therefore, it cannot be incorrectly inserted. Although some women may be aware of the ring in the vagina, most women do not feel it once it is in place.
Support material on way
A variety of tools, such as brochures, posters, and other printed materials, will be made available to clinicians once Ortho Evra and the NuvaRing are launched. Until materials are ready, providers and consumers are directed to product web sites, www.orthoevra.com and www.nuvaring.com.
About 7,000 health care providers have had the opportunity to provide a small number of patients with free NuvaRings up until the official product launch, reports Alexander. The Premier Program has proven successful in introducing the new method; however, enrollment now is closed, says Alexander.
Samples, whether medicated or not, can be used as effective teaching tools in the office when introducing new methods, says Andrew Kaunitz, MD, professor and assistant chair in the obstetrics and gynecology department at the University of Florida Health Science Center/Jacksonville.
With a transdermal system, Kaunitz works with the patient by allowing her to apply a patch and ask questions about the method. With the vaginal ring, his routine is to insert a ring in the office. He then allows the medical assistant to remain in the exam room with the patient to review inserting and removing the ring until the patient reaches a comfort level with the method.
"Hopefully, wide availability of sample patches and rings will facilitate this approach to patient education regarding these important new contraceptives," states Kaunitz.
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