Drs Jenna Beckham and Thomas Kimble review the benefits of newly approved contraceptive systems, such as use in women with higher BMIs and ease of access.
Jenna Beckham, MD, MSPH, FACOG: We've already talked a little bit about the differences in these newer methods, but are there any other specific additional benefits that you think of that these specific newer methods or delivery systems might provide to patients?
Thomas Kimble, MD: Yes. I think there are several benefits. One, we talked about the longer pill intake window with the 2 pills that are new that we discussed, the drospirenone-only pill and the drospirenone/estetrol pill. Now, again, comparing it to norethindrone, which is what's in the mini-pill, which has an 8- to 9-hour half-life, the progestin has a 30-hour half-life in the drospirenone-only pill. And then in the drospirenone and estetrol pill, the estetrol has a 28-hour half-life. That is great. Now, patients have a wider pill intake window if they happen to miss a pill. As you also mentioned, you can cycle patients now, whereas the mini-pill, they have to take it continuously because of the short half-life. Now, they can take it in an extended cycle regimen. And that provides our patients with a regular, scheduled period, which is convenient for more people. And then with the patch, we've got better adherence system; we've got lower hormone levels, and nowadays, less is more when it comes to the dosing of hormones; and other delivery methods, like the new vaginal gel.
Jenna Beckham, MD, MSPH, FACOG: In your practice and experience, how satisfied do you think patients are with currently what's available for contraceptive options?
Thomas Kimble, MD: I do see a higher satisfaction. Historically, when we used to prescribe birth control pills for our patients, there was about a 50% continuation at 6 months. With increased tolerability, with lower hormones, people are having less adverse effects, they're having less risks and concerns, with the different options as well, that continuation rates have really increased.
Jenna Beckham, MD, MSPH, FACOG: Like you said, the first pills which we've thought about for a long time as being, quote-unquote, "birth control," people think those are better tolerated. But as you said, and as we've discussed here today, there are more and more options available. We do still- I know you surely see them- there are those patients who have tried everything and have had an adverse reaction to pretty much everything that's available on the market, and those still are puzzling conundrums, and there are some patients who struggle still to find a satisfying option. But as you said, we've seen more and more satisfaction and people continuing to use their method, although still, some people do change. What do you see in your practice in terms of any kind of trend of when or how patients maybe switch from one method to another?
Thomas Kimble, MD: Yes, I do, although again, I'm not seeing people switch as often as I used to years ago. And this is just anecdotally in my own clinical practice. But you've got the group who were prescribed birth control pills because, as you mentioned, that was just "birth control." And I still talk to other providers, my resident doctors, my medical students. Sometimes, when they want to say, "birth control," they say "OCPs." And I must correct them. "Well, let's get away from saying 'OCPs' when you really want to say 'contraception' because there are so many other options." We have that group that the person they saw, their prior provider, that's primarily what they prescribed. And they come to us, and then they hear about some of the other newer things, and I think we see a little bit more of that because of direct-to-consumer marketing. And they want to switch to this other thing that they've heard of or this other thing that their girlfriend or their sister is taking. We have some people who are on a LARC method, but again, they're reaching a milestone, and they want to either start or extend their family, and they know, maybe in 3, 4 months, they want to start trying for a pregnancy. And they want to get off their LARC method, use something temporary in the meantime, until they're ready to start. I see that group as well. But for the most part, I think people tend to be more satisfied than they were historically.
Jenna Beckham, MD, MSPH, FACOG: I agree. I think sometimes, for those patients who are using contraception not only for pregnancy prevention, but we talked about it earlier, about bleeding control, or if they have dysmenorrhea, some of those patients maybe struggle a little bit more to find just the right method because it's not just about preventing pregnancy, but it's controlling some of those other symptoms. And they may switch around a little bit more. We are still seeing, I think at least in our patient population, patients who have certain government insurances that only cover them through pregnancy, and then for a certain period of time after pregnancy, that may get a LARC, but then no longer have the coverage. And they are more expensive if you're paying out of pocket compared to buying birth control, OCPs, pills, over the counter- or not over the counter, but prescribed, buying them from a pharmacy, out-of-pocket cost. There are still some socioeconomic factors that may cause a shift or a change in method that perhaps might not be that patient's choice. But as you said, if it's just purely, I think, satisfaction with the method, it does seem that patients tend to find that and stick with it a little bit more, I think likely attributed to the fact that we have more options available, so they can find one that works better for them.
Transcript edited for clarity