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Hormonal Methods of Birth Control (cont.)

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Contraceptive patch: Ortho-Evra

An adhesive patch has been developed that provides hormonal contraception through the skin, which is known as a transdermal (through the skin) delivery system. The patch is about the size of a half-dollar and can be worn on the arm, abdomen, or buttocks. A woman wears the patch for a week and then replaces it with a new patch.

These patches are called Ortho-Evra (ethinyl estradiol/norelgestromin patch-topical), and are similar to the pill in that they contain both estrogen and progesterone. Ortho-Evra should be just as effective in preventing pregnancy as the pill. Ortho-Evra is similar to the pill in that it suppresses ovulation and has the advantage of improved compliance and convenience due to weekly administration. A woman only needs to remember to replace the patch once a week instead of being required to remember taking a pill every day. However, some studies have shown that the contraceptive patch may be associated with a greater risk of negative side effects, such as blood-clotting problems, than oral contraceptive pills.

Women who have medical reasons why oral contraceptives are not recommended (such as already having an underlying tendency toward blood clotting) may find that their prescribing physician also recommends against Ortho-Evra because of the similarity in the hormone ingredients of both types of contraceptives.

It is important to ensure that the patch makes good contact with the skin. The patch could be a problem for those women who perspire heavily, swim, and/or take frequent showers because moisture can interfere with the patch's contact with the skin. Some women may also experience skin irritation at the site of the patch. Furthermore, contraceptive failure may be a risk in heavier women (those who weigh over 198 pounds, or 90 kilograms).

As with all other hormonal methods of birth control, the patch will not protect a woman against sexually transmitted infections.

Contraceptive implants

A contraceptive implant known as Implanon is available in the U.S. Implanon provides contraception by the slow release of the progestin etonogestrel over a period of three years. Implanon is a thin rod that is inserted in the upper arm under local anesthesia. Protection from pregnancy occurs within 24 hours of insertion of the rod, and the failure rate is comparable with surgical sterilization (tubal ligations). One advantage of the Implanon rod is that fertility rapidly returns after removal of the rod.

A two-rod implant containing the progestin levonorgestrel (Jadelle) was approved by the FDA for 5 years of use, although it has not been marketed in the United States. Similarly, the Sino-Implant II contraceptive implant is similar to Jadelle, but is designed to remain in place for 4 years.

Preliminary studies of the product showed that it was generally well tolerated and effective in preventing pregnancy. However, these studies showed that irregular bleeding is a possible side effect of the product.

As with all other hormonal methods of birth control, Implanon will not protect a woman against sexually transmitted infections.

Vaginal ring: NuvaRing

A ring-shaped device that contains the hormones estradiol and etonogestrel (a progestin) can be placed in the vagina. It remains in place for three weeks continuously, then it is removed for one week to allow for a menstrual period. It continuously releases low levels of the hormone into the bloodstream for the entire three weeks.

There is currently one brand available in the U.S., NuvaRing (etonogestrel/ethinyl estradiol-vaginal ring). It is about 99% effective in preventing pregnancy, having the same high effectiveness as the other hormonal methods of contraception. The incidence of hormone-related side effects is similar to those seen with other hormonal contraceptive methods such as the pill and the patch. Vaginal discharge can sometimes occur as a side effect of the ring preparation.

NuvaRing does not protect against sexually transmitted infections.


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