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Expert Perspectives on Contraception Options: Where Are We Today? - Episode 10

Hormonal Patch and Vaginal Gel Contraceptives

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Drs Jenna Beckham and Thomas Kimble comment on hormonal patch and vaginal gel contraceptives.

Jenna Beckham, MD, MSPH, FACOG: There's a couple more that are still kind of new in the last few years. There's a new formulation of the contraceptive patch. What do you think about that one?

Thomas Kimble, MD: That's a good one also. Transdermal birth control, the first one that was introduced, it was great. It was a game changer. It became extremely popular when it was first launched, but then there were some concerns. There were some concerns about increased cardiovascular risks with it. That is also an example of when statisticians went back and looked at the data, and they controlled for other risk factors. That risk was not as exaggerated as we initially thought. However, levonorgestrel is the progestin. That is a tried-and-true progestin. It's been around for decades. It's what we would consider a second-generation progestin. And then there's our ethinyl estradiol; we're also very familiar with that. That was one change. The other change is that the adherence system is a little different. When the initial contraceptive patch was launched, some people had issues with it coming off. Didn't like it. It got a little sticky. This one has an adherence system that is improved, and we think that increases the tolerability for patients more.

Jenna Beckham, MD, MSPH, FACOG: And although we said estrogen is relatively safe for most patients, this does have a slightly lower dose of that, so maybe if you have a patient who is sensitive to it, or particularly concerned about it, it's just another option for those patients.

Thomas Kimble, MD: And that is absolutely a counseling point for me. This has a lower estrogen than the other patches on the market.

Jenna Beckham, MD, MSPH, FACOG: So those are all the hormonal methods that have been released recently. And then there's this new vaginal gel that does not have hormones but is another option for patients to use.

Thomas Kimble, MD: That gel has been around for a while in development. My disclaimer for all the other 4- I was an investigator in their development. This one, on the very early phases, I was involved with it. It is great to have another option. Some of us get maybe a little too focused on, "Everybody needs a LARC." Well, they're not for everybody, and we need a variety of different types of birth control. It was great that we got this option. It is effective as a barrier method of birth control, as barriers are. One of the best things is the commercials, right?

Jenna Beckham, MD, MSPH, FACOG: Yes. They're advertising that a lot.

Thomas Kimble, MD: I really love some of the commercials for it. But it's a great option. It does require a prescription for use, as opposed to other spermicides. I've run into a barrier with getting coverage for it, and then we learned a little trick that when you're writing it for your patients, if you get any bounce back from their carrier, say that she's tried other spermicides and didn't tolerate them well. And if you can document that, then they do tend to cover it more often.

Jenna Beckham, MD, MSPH, FACOG: You're right. We, certainly, especially with our OB/GYN doctor hats on, are fans of LARCs. I tell all my patients it's my personal and professional favorite. But they're not for everyone, and the contraceptive method that works for a particular patient is the one that they like and that they're going to use. It is good to have those other options. The struggle with it- I always think about, as we already talked about, sometimes it's hard to remember to take a pill every single day. This has some of those similar adherence barriers or challenges, that you must use it with every act of sexual intercourse, and that may not always be either feasible or just something that patients may not remember to do. But for those who are motivated to use it, it is nice to have another non-hormonal option available.

Thomas Kimble, MD: It is, and it's a great temporary option as well, I think. I had mentioned earlier, some people, they plan on getting that degree soon, or the promotion, and they are timing their pregnancies, and they know within a couple or a few months that they may want to attempt a pregnancy. And so LARCs aren't for everybody. I think they're great. That is what I try to encourage usually. But there is a need for some of these temporary and daily options.

Transcript edited for clarity