Original StudyAdolescents’ Experiences Using the Contraceptive Patch versus Pills
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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What's Known and What's Next: Contraceptive Counseling and Support for Adolescents and Young Adult Women
2021, Journal of Pediatric and Adolescent GynecologyCitation Excerpt :Only 8.2% of young women use long acting reversible contraceptive methods (LARC), such as intrauterine devices (IUDs) and the subdermal implant, despite the fact that LARCs are estimated to be 20 times more effective at preventing an unintended pregnancy compared to SARCs.9,19–21 Regardless of method selected, young women are more likely to discontinue contraceptive use compared to adults.22–29 A population-based study among 10,000 women in St. Louis found young women were 1.4 times more likely to discontinue contraception in the first 12 months of use compared to older adult women.30
Progesterone – Friend or foe?
2020, Frontiers in NeuroendocrinologyCitation Excerpt :Furthermore, there is no biological reason for why the vaginal ring or patch CHC would confer an increased risk compared to an oral CHC. They result in similar, or even lower, serum concentrations of the steroid hormones (Kerns and Darney, 2011; Duke et al., 2007), and comparative RCTs noted no difference in depressive symptoms or well-being between these preparations (Urdl et al., 2005; Sucato et al., 2011). Finally, researchers have also pointed to the absence of dose-response relationships for the POPs, where the low dose hormonal IUD seems associated with higher risks than the higher dosed progestogen implant or injection (Worly et al., 2018).
Use of Short Acting Reversible Contraception in Adolescents: The Pill, Patch, Ring and Emergency Contraception
2018, Current Problems in Pediatric and Adolescent Health CareCitation Excerpt :They found that the majority of adolescents were satisfied with the patch and 93% would recommend it to a friend.36 In a prospective study of 80 adolescents using either the patch or COC, Sucato et al found that after nine cycles of use 38% of patch users were still using the patch as compared to 60% of COC users despite patch users being equally satisfied as COC users.37 One important problem with the patch is that there has been concern that the risk of venous thrombolic events (VTE) with patch use may be higher than that of other methods of combined hormonal contraception, because the patch emits a continuous dose of estrogen that is higher than the total dose that is provided by COC use.
Effectiveness and use of hormonal contraceptives (except for intrauterine devices): CNGOF Contraception Guidelines
2018, Gynecologie Obstetrique Fertilite et SenologiePredictors of Early Discontinuation of Effective Contraception by Teens at High Risk of Pregnancy
2016, Journal of Pediatric and Adolescent GynecologyCitation Excerpt :However, despite their high theoretical effectiveness, short-acting hormonal contraceptives are known to be less effective in typical use,6 in part, because of early discontinuation. In clinical samples of adolescents, 6- to 9-month continuation rates that range from 29% to 70% have been reported for hormonal contraceptives including depot medroxyprogesterone acetate (DMPA) and combination oral contraceptives (COCs).7–10 Information on continuation rates for intrauterine devices (IUDs) in typical use by US teens is limited but 1 large study found a 12-month rate of more than 80%.5
Providing Contraception to Adolescents
2015, Obstetrics and Gynecology Clinics of North AmericaCitation Excerpt :The contraceptive patch consists of a transdermal adhesive patch applied to the skin and is replaced every 7 days for 3 weeks, followed by a patch-free interval of 3 to 7 days for a withdrawal bleed. The patch is associated with high rates of satisfaction in adolescents, although it has a higher rate of discontinuation in comparison with COCs.78 The most common reasons for discontinuation among adolescents are cost, skin irritation, and detachment of the adhesive patch.78,79
There are no conflicts of interest.