Women stick with contraceptive pill over patch

NEW YORK (Reuters Health) – Women who are considered to be
at high risk of pregnancy appear more likely to continue with
use of oral contraceptive pills than with a transdermal
contraceptive patch, doctors have observed.

In their study, despite apparent ease of use and
simplicity, the patch was considerably less effective than the
pill.

“What we found,” Dr. Arvind Bakhru told Reuters Health, “is
that those using the contraceptive patch were more likely to
become pregnant and more likely to discontinue usage.”

In the journal Obstetrics and Gynecology, Bakhru of the
University of Maryland School of Medicine in Baltimore, and Dr.
Nancy Stanwood of the University of Rochester, New York note
that half of all unintended pregnancies in the US occur in the
10 percent of fertile women who use no contraception.

However, about half of these women report that the
conceived while practicing contraception.

This led Bakhru and Stanwood to determine if a
contraceptive patch might do better than an oral contraceptive
in reducing such consequences. They studied information on
1,230 women that underwent contraceptive counseling at Planned
Parenthood centers.

The women had never before used hormonal contraception.
Most were considered at high risk of unintended pregnancy. In
all, 579 started on oral contraceptives and the remaining 651
began with the contraceptive patch.

A total of 468 women (38 percent) had no further contact
with the clinic after their initial visit. Initial loss to
follow-up was higher in patch (45.2 percent) than in pill users
(29.5 percent).

Continued use of contraception beyond the first three
cycles was significantly higher in the pill users (89 percent)
than was the case in patch users. Moreover, only 3.3 percent of
patch users found skin irritation to be a treatment-limiting
factor.

The researchers also found that the pregnancy rate was
markedly lower for pill users than for patch users.

“Further research,” the investigators conclude, “should
investigate factors contributing to poorer real-world
performance by the patch.”

However, Bakhru added that “the patch users in this study
were more likely to have been pregnant or to have had pregnancy
terminations in the past and may therefore be more likely to
fail any hormonal contraceptive therapy. This may explain the
lower continuation and effectiveness of the patch in this
population.”

SOURCE: Obstetrics and Gynecology August 2006.