Transdermal contraceptive patch

1. Ortho Evra is a transdermal contraceptive patch, which is as effective as oral contraceptives. Orfho Evra delivers 20 :g of ethinyl estradiol and 150 :g of norelgestromin daily for 6 to 13 months. Compliance is better with the patch. The patch is applied at the beginning of the menstrual cycle. A new patch is applied each week for 3 weeks; week 4 is patch-free. It is sold in packages of 3 patches. Effectiveness is similar to oral contraceptives.

2. Breakthrough bleeding during the first two cycles, dysmenorrhea, and breast discomfort are more common in women using the patch. A reaction at the site of application of the patch occurs in 1.9 percent of the women. Contraceptive efficacy may be slightly lower in women weighing more than 90 kg.

C. Depot medroxyprogesterone acetate (DMPA, Depo-Provera) is an injectable contraceptive. Deep intramuscular injection of 150 mg results in effective contraception for three to four months. Effectiveness is 99.7 percent.

D. Women who receive the first injection after the seventh day of the menstrual cycle should use a second method of contraception for seven days. The first injection should be administered within five days after the onset of menses, in which case alternative contraception is not necessary.

E. Ovulation is suppressed for at least 14 weeks after injection of a 150 mg dose of DMPA. Therefore, injections should repeated every three months. A pregnancy test must be administered to women who are more than two weeks late for an injection.

F. Return of fertility can be delayed for up to 18 months after cessation of DMPA. DMPA is not ideal for women who may wish to become pregnant soon after cessation of contraception.

G. Amenorrhea, irregular bleeding, and weight gain (typically 1 to 3 kg) are the most common adverse effects of DMPA. Adverse effects also include acne, headache, and depression. Fifty percent of women report amenorrhea by one year. Persistent bleeding may be treated with 50 :g of ethinyl estradiol for 14 days. H. Medroxyprogesterone acetate/estradiol cypionate (MPA/E2C, Lunelle) is a combined (25 mg MPA and 5 mg E2C), injectable contraceptive.

1. Although monthly IM injections are required, MPA/E2C has several desirable features:

a. It has nearly 100 percent effectiveness in preventing pregnancy.

b. Fertility returns within three to four months after it is discontinued.

c. Irregular bleeding is less common than in women given MPA alone.

2. Weight gain, hypertension, headache, mastalgia, or other nonmenstrual complaints are common.

3. Lunelle should be considered for women who forget to take their birth control pills or those who want a discreet method of contraception. The initial injection should be given during the first 5 days of the menstrual cycle or within 7 days of stopping oral contraceptives. Lunelle injections should be given every 28 to 30 days; 33 days at the most.

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