Transdermal Contraceptive Patch for a 29-Year-Old Woman
The Ortho Evra transdermal contraceptive patch (containing 0.6 mg norelgestromin and 0.75 mg ethinyl estradiol) is a good cost-effective birth control option for a 29-year-old woman without contraindications. 1
Efficacy and Mechanism
- Typical use failure rate is approximately 9%, similar to combined oral contraceptives (COCs) 2
- Perfect use failure rate is less than 1% 2, 3
- Contains combination hormones (estrogen and progestin) that work similarly to COCs 2
- Transdermal delivery eliminates:
- Variability in gastrointestinal absorption
- Hepatic first-pass metabolism
- Peaks and troughs in serum concentrations seen with oral contraceptives 4
Application and Usage
- Applied to abdomen, upper torso, upper outer arm, or buttocks 2
- Simple regimen: one patch weekly for three consecutive weeks, followed by one patch-free week 2
- Each patch contains sufficient medication for 7 days 5
- Can be used in extended cycling regimens (12 weeks of continuous use followed by 1 patch-free week) for fewer periods per year 1
Advantages for a 29-Year-Old Woman
- Weekly application improves compliance compared to daily pills 4, 3
- Studies show better adherence than COCs, with 90% perfect compliance in clinical trials 4, 3
- Simplified regimen (once weekly vs. daily for pills) 2
- Cost-effective due to decreased costs related to unwanted pregnancy from better compliance 4
Important Considerations and Risks
- FDA has identified increased estrogen exposure (1.6 times higher than with low-dose COCs) 2
- Potential increased risk of venous thromboembolism compared to some COCs (odds ratios 1.2-2.2) 2, 6
- Less effective in women who weigh more than 198 pounds (0.9% vs 0.3% failure rate in first 12 months) 2
- Common side effects include:
Alternative Options to Consider
- If venous thromboembolism risk is a concern, consider:
- If weight is >198 pounds, consider more effective methods like IUDs or implants
Follow-up Recommendations
- Schedule follow-up 1-3 months after initiation to assess tolerance, compliance, and side effects 1
- Monitor for breakthrough bleeding, which may occur but is typically not concerning
- Provide education on proper application and what to do if a patch becomes partially or fully detached
The transdermal patch offers a good balance of efficacy, convenience, and cost-effectiveness for a 29-year-old woman without contraindications, with the primary advantage being improved compliance due to weekly rather than daily administration.