Contraception trends feature rings, patches and skin implants

The contraception arena has seen some significant activity in recent years. New products,such as vaginal rings and transdermal patches, have joined refined and reformulated versions of oralcontraceptives, intrauterine devices, and subdermal implants, as well as familiar methods, such asdiaphragms and condoms.

"Developments in contraception are important because unintended pregnancy continues to besuch a huge problem in this country," said Edward Bope, MD, director of family medicine residency atRiverside Methodist Hospital in Columbus.

"There are 6 million pregnancies in the United States every year and one-half of them areunintended. An awful lot of them are people who had absolutely no interest in becoming pregnant andabsolutely did not want to become pregnant."

The effectiveness of contraceptive devices and products varies widely. Male condoms have apregnancy rate of 2% in perfect use and 15% in the real world of improper use that results in condomsripping, tearing, or coming off, according to Dr Bope.

Other traditional devices are even less effective. Withdrawal has a 4% pregnancy rate inperfect use and 27% in reality. The diaphragm allows 6% pregnancy in perfect use and 16% in real use. Any of these methods that take away from spontaneity and get in the way of sex run into realhuman error," Dr Bope noted.

Oral contraceptives (OC) also suffer from user error. OCs have a 0.3% pregnancy rate inperfect use versus 8% in real use where women can miss pills or take a pill at the wrong time. Thenew contraceptive patch and vaginal ring have similar pregnancy rates in perfect use and inreality.

One of the most effective means of contraception is Implanon, a newly developed subdermalimplant. It has a pregnancy rate of 0.05% in perfect use and in real use. The new progestin IUD alsohas a low injectable contraception 0.2% pregnancy rate in perfect use and in real use.

"It really is not subject to human error like most other methods," Dr Bope explained. "Oncethey're implanted, they're in. That's a significant advantage."

Dr Bope also offered quick reviews of the major contraceptive choices that women and theirphysicians can choose.

OrthoEvra, a transdermal patch, is easy to apply and offers good menstrual control. It uses200 mcg of ethinyl estradiol (EE) and 150 mcg of norgestrel. On the negative side, it poses potentialrisk for VTE, is less effective in women who weigh more than 198 pounds, and the patch adhesive cancause mild skin reactions. It is also available only in a single Caucasian tint.

"The patch only comes in one color, but we come in many colors," Dr Bope said. "Thatdiscourages many women."

NuvaRing, a new vaginal ring, has become an extremely popular choice, he continued. Itcontains 15 mcg of EE plus 120 MCG of etonegestrel and is left in place for three weeks.

"It has great compliance because it lasts for three weeks," Dr Bope reported. "And it's easyto use. Unlike a diaphragm, one size really does fit all."

Implanon contains 68 mg of etonogestrel and is effective for three years. The small, 4 cm rodis implanted just above the elbow between the bicep and tricep muscles. Implanon is effectiveimmediately after implantation and, because it is a progestin-only product, has no estrogenic sideeffects.

"I think this will be very popular as more physicians learn to use it," Dr Bope said.Like other progestin products, Implanon can produce irregular bleeding. The manufacturer alsorequires a three-hour training course.

Mirena, an IUD that contains progestin, is another new choice. The IUD can be left in place for fiveyears and carries no additional risk of pelvic inflammatory disease, unlike IUDs that were marketedin past decades. It does carry a risk of perforation or expulsion, Dr Bope cautioned, and can causeinitial pain, cramps, and bleeding.

New on the oral contraceptive side is Lybrel, a 365-day pill. It contains 20 mcg of EE and 90 mcg oflevonorgestrel. A similar product, Seasonale, offers a 91-day cycle for women who prefer fourmenstrual periods annually to just one. Also new are Mircette, a low dose pill, and Femcon Fe, achewable birth control pill with added iron.

"Compliance is really important with almost all of these products," Dr Bope said. "Motivation is abig part of success in contraception."