Original Study
Adolescents’ Experiences Using the Contraceptive Patch versus Pills

https://doi.org/10.1016/j.jpag.2011.02.001Get rights and content

Abstract

Study Objective

To compare use of the weekly transdermal contraceptive patch (patch) with daily combined hormonal contraceptive pills (pills) in adolescents.

Design

Prospective longitudinal study of adolescents’ self-selected (non-randomized) use of the patch or pills.

Setting

Urban, university hospital-affiliated, adolescent outpatient clinic.

Participants

13–22-year-old female adolescents seeking hormonal contraception, 40 who chose the patch and 40 who chose pills.

Interventions

Data were collected via self-report on paper questionnaires at three-cycle intervals for a total of up to nine cycles.

Main Outcome Measures

Method continuation, perfect use, method satisfaction, quality of life, and side effects, including menstrual changes and perceived mood changes.

Results

After nine cycles, 38% of patch users and 60% of pill users were still using the method they had chosen at enrollment. There were no significant differences between the groups in self-reported perfect use. No differences were found in quality of life or side effects. Both patch and pill users noted menses became lighter and more predictable and reported decreased depression prior to their menses; only the pill group reported improvement in premenstrual anger. Method satisfaction was similar in both groups except patch users were more likely to report that their contraceptive method improved normal daily activities.

Conclusions

Despite apparent advantages of the patch over the pill, adolescents using both methods continue to face challenges achieving perfect and sustained contraceptive use.

Introduction

The highest teen birth rate in the developed Western world is in the United States,1 where more than three quarters of adolescent pregnancies are unintended.2 The explanation for unintended pregnancy is multifactorial, but contraceptive nonadherence plays an important role, as illustrated by the fact that the majority of adolescents obtaining abortions report using some method of contraception at the time they conceived.3 In the past decade, several new forms of hormonal contraception have been introduced in the United States, including a weekly transdermal patch. Despite the availability of methods that simplify contraceptive adherence, unintended pregnancy remains a persistent problem in the United States.

The weekly transdermal contraceptive patch was approved by the Food and Drug Administration (FDA) in November 2001. It contains norelgestromin 6.0 mg and ethinyl estradiol 0.75 mg and is used by applying one patch weekly (to the buttocks, upper outer arm, lower abdomen, or upper torso) for three consecutive weeks, followed by a patch-free week. Several studies have found that perfect use of the patch is more common than that of combined hormonal oral contraceptive pills among adults,4, 5 most notably among 18 and 19 year olds.6, 7 Smaller studies of adolescents using the patch also found high rates of self-reported perfect use, between 73 and 93%.8, 9, 10

Contraceptive effectiveness hinges not only on the feasibility of achieving perfect use outside of clinical trials, but also on the method being sufficiently well accepted to be continued over time. In a study that followed a cohort of young women at high risk for unintended pregnancy, Bakhru and Stanwood11 found that, in contrast to their initial hypothesis, those young women who had self-selected to use the patch were significantly less likely to continue their method compared to those who had chosen a pill, and thus were more likely to experience pregnancy. These findings have been replicated by Raine et al.12

To compare adolescents’ use of the patch and the pill, we designed a prospective longitudinal study of method continuation and perfect use in adolescents who self-selected their contraceptive method. Secondary goals of this study were to explore a range of side effects potentially related to method continuation, including perceived mood changes, and to assess overall satisfaction with the self-selected method.

Section snippets

Design

This study was approved by the Institutional Review Board of the University of Pittsburgh. It is a prospective longitudinal study of adolescents’ self-selected (non-randomized) use of the patch or pills. Data were collected via self-report on paper questionnaires at three-cycle intervals for a total of up to nine cycles.

Participants and Setting

Study participation was offered to all female adolescents 13–22 years old seeking hormonal contraception with either the patch or pills between May 2003 and June 2004. Potential

Results

We enrolled 40 young women who chose to use combined hormonal contraceptive pills and 40 who chose to use the patch. Comparisons between these two groups were performed with t tests for age and age at coitarche; Fisher exact tests were used for categorical participant characteristics. Among those enrolled, patch users were younger and less likely to be African American than pill users. However, the two groups were similar with regard to other factors potentially related to contraceptive choice (

Discussion

At the conclusion of our prospective longitudinal study, 15 patch users and 24 pill users were still using the method they had chosen at enrollment. This difference was not statistically significant; however, our findings are consistent with a number of other studies that have found patch users less likely to continue their method. A 2010 Cochrane review23 (based on four randomized controlled trials of adult women) concluded that patch users were more likely than pill users to discontinue study

Acknowledgments

This research was supported by the Research Advisory Committee, Children’s Hospital of Pittsburgh. We would like to acknowledge Nicole Boback, BSN, for her assistance with data management.

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