What are the equivalent contraceptives to switch to from norelgestromin (a progestin)-containing contraceptives, such as Ortho Evra (norelgestromin and ethinyl estradiol) patch?

Equivalent Contraceptives When Switching from Norelgestromin-Containing Products

When switching from norelgestromin-containing contraceptives like the Ortho Evra patch, equivalent options include combined hormonal contraceptives containing levonorgestrel or norgestimate, particularly those with similar estrogen content (20-35 μg ethinyl estradiol). 1, 2

Understanding Norelgestromin Contraceptives

Norelgestromin is a progestin used in the Ortho Evra/Evra transdermal patch, which delivers:

• 150 μg norelgestromin daily
• 20 μg ethinyl estradiol daily 3

Norelgestromin is the active metabolite of norgestimate, and both have similar physiologic effects at the progesterone receptor with minimal androgenic activity 4.

Equivalent Contraceptive Options

Combined Oral Contraceptives (COCs)

• First-line equivalent options:

  • COCs containing norgestimate (30-35 μg ethinyl estradiol) 1
  • COCs containing levonorgestrel (30-40 μg ethinyl estradiol) 1, 5

• These progestins have similar clinical profiles to norelgestromin, with comparable efficacy and side effect profiles 5

Other Transdermal Options

• Transdermal patches containing levonorgestrel with similar ethinyl estradiol content (20 μg) 1

Vaginal Ring

• NuvaRing (15 μg ethinyl estradiol/120 μg etonogestrel) provides similar efficacy and convenience with weekly administration 1, 2

Considerations When Switching Contraceptives

Stroke Risk Assessment

According to the 2024 American Heart Association/American Stroke Association guidelines:

• Transdermal patches containing 20 μg ethinyl estradiol with norelgestromin or levonorgestrel have a mild increase in stroke risk
• COCs with ≤20 μg ethinyl estradiol have a similar mild risk profile
• COCs with 30-40 μg ethinyl estradiol and second/third-generation progestins have a higher risk profile 1

Efficacy Considerations

• All combined hormonal contraceptives have similar typical failure rates (5-9%) 2
• Perfect compliance is higher with the patch compared to daily oral contraceptives 4
• Consider long-acting reversible contraception (LARCs) like IUDs or implants for highest efficacy (<1% failure rate) 2

Non-Contraceptive Benefits

When switching, consider maintaining these benefits of combined hormonal methods:

• Protection against endometrial and ovarian cancers with >3 years of use
• Management of menstrual symptoms
• No negative effect on long-term fertility 2

Practical Switching Protocol

1. For immediate switching:

   • Start the new method the day after removing the last patch
   • No need for backup contraception if switched correctly

2. For patients with risk factors for thrombosis:

   • Consider progestin-only methods (pills, injections, implants, or IUDs) which have no increased stroke risk 1

3. For patients concerned about compliance:

   • Consider longer-acting methods like the vaginal ring (weekly/monthly) or LARCs 2

Common Pitfalls to Avoid

• Avoid increasing estrogen content when switching from norelgestromin patch (20 μg ethinyl estradiol) to higher-dose COCs, as higher estrogen content is directly linked to increased stroke risk 1
• Don't overlook the importance of administration route preferences - patients who chose the patch initially may prefer non-daily dosing options 4
• Beware of drug interactions that may affect contraceptive efficacy when switching methods

By selecting an equivalent contraceptive with similar hormonal components and dosing, patients can maintain contraceptive efficacy while addressing individual needs or concerns that prompted the switch from norelgestromin-containing products.