Between taking care of her baby and tending to her work schedule, Trina Pullie sometimes forgot to take her daily birth control pills. When she did take them, the 28-year-old Penn Hills resident sometimes became nauseated.
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Alison Bodenhemier of Oakland uses the new Ortho Evra contraceptive patch. (Andy Starnes, Post-Gazette) |
For those reasons, Pullie is thankful for one of two new birth control methods available to women this summer, neither of which requires daily attention.
In late May, Pullie started using Ortho Evra, a contraceptive patch that is worn for one week at a time. It's changed on the same day of the week for three consecutive weeks. A woman is patch-free for the fourth week during her menstrual period.
"If you're one of those people who's very forgetful, this is much better," said Pullie, adding that she has not had side effects with the patch. "Once a week, you can't go wrong."
The other method, called NuvaRing, is expected to arrive in local pharmacies this week.
The flexible, transparent ring with an outer diameter of 2 inches and a cross-sectional diameter of 1/8-inch, is squeezed between fingers and gently pushed into the vagina. Twenty-one days later, it is removed. The exact positioning of the ring is not critical because, unlike barrier contraceptives, NuvaRing works by releasing hormones that prevent pregnancy.
Dr. Bryna Harwood, an assistant professor in the department of obstetrics, gynecology and reproductive science at Magee-Womens Hospital, was one of 6,500 physicians allowed to provide NuvaRing to some patients this spring.
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Coverage for the patch and the ring
Most local health plans have decided to cover the costs of the contraceptive patch, but are taking a wait-and-see approach on the NuvaRing.
UPMC Health Plan, Aetna U.S. Healthcare and HealthAmerica have added the patch to the lists of medicines covered under their pharmacy benefit.
Women covered by Highmark Blue Cross Blue Shield health plans that have "open formularies" -- meaning a relatively large list of covered medicines -- will have access to the patch, albeit at the highest co-pay levels. There is no coverage for women in Highmark health plans that have closed formularies.
Employers buying health plans from any of the four insurance companies can elect not to extend contraceptive benefits. But representatives from all four insurers say most local employers cover the costs of contraceptives.
Because the ring is newer than the patch, coverage decisions haven't yet been made and pricing information isn't available. The patch is being sold at pharmacies for between $30 and $35 -- slightly higher than the price of a one month's supply of the pill.
-- Christopher Snowbeck
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"Patients have been finding it very acceptable," said Harwood, who is also involved with studies of patch contraceptives.
The two methods make this an exciting time for reproductive health researchers, Harwood said.
"For women who have liked the birth control pill for its efficacy and cycle control, the main design flaw has been that it has to be taken every day," she said. "Most of us, no matter how attentive we are to our daily routines, can't do anything every single day. ... We're just happy that there are options now that don't require daily attention."
The Ortho Evra patch, which first became available in pharmacies at the end of April, can be worn on the buttocks, abdomen, upper torso or upper outer arm. It uses a transdermal system to deliver progestin and estrogen through the skin and into the bloodstream. Like birth control pills, the patch prevents pregnancy by suppressing ovulation, meaning the ovary does not release an egg to be fertilized.
Dr. Stephen Hasley, an obstetrician at The Western Pennsylvania Hospital, is cautiously optimistic that the patch will be effective and popular. Even so, he questions whether patches will fall off or irritate the skin.
Other doctors, however, including Dr. Aurora Miranda, director of West Penn's obstetrics and gynecology clinic, said they aren't so worried. Miranda said the detachment rate in studies was only 2 percent and that was in a group of health club members who were highly active.
Harwood said that women worried about irritation could simply alternate where they place the patch.
Like the patch, the NuvaRing releases hormones that prevent pregnancy by suppressing ovulation. Women begin using the ring on or before the fifth day of their menstrual period.
During studies of the ring, 3 percent of women removed the device for sex, bathing or douching, said Nancy Alexander, director of contraception at Organon Pharmaceuticals in West Orange, N.J. Removing the ring is unnecessary, but can be done safely so long as it is re-inserted within three hours.
Harwood said most couples didn't notice the ring during intercourse. If they did, they didn't mind it.
"Even a smaller minority took it out, so I have a feeling that it's not going to be an enormous issue," she said. "In studies across the world where sexual practices vary ... it was highly acceptable to leave the ring in."
It's no more difficult to insert the ring than to put in a tampon, Harwood said, although it doesn't have a string for removal.
"You put it in as far as is comfortable, so it's not sitting at the opening of the vagina," she said. "In every part of the country I've practiced in, I've been told women won't like a product they have to put in their vagina. Yet in every community I've found evidence to the contrary."
The patch and the ring aren't the only birth control methods that don't require daily attention. IUDs and a contraceptive injection called Depo Provera provide protection that last from three months to several years.
But both methods require a visit to the doctor. For that reason, Claire Keyes, executive director of the Allegheny Reproductive Health Center in East Liberty, believes the new methods are the most consumer-friendly options on the market.
"The consumer herself will have more control over the administration of the patch and it's not going to have the negative association of an injection" she said. "The enthusiastic response that we have seen from women at this facility leads me to believe that the patch is really a viable option for women of all ages.
"Many women become pregnant because they have skipped a pill or forgotten to take a pill, so the patch could eliminate that problem, which can result in unplanned pregnancies," Keyes said.
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