What do women want? The answer is simple: Convenient birth control
What do women want? The answer is simple: Convenient birth control
Survey indicates desire for simpler methods; 2002 offers new options
What do women want when it comes to birth control? Results of a national survey of women and OB/GYNs indicate a desire for contraceptive methods that simplify women’s lives.1
Look to 2002 to deliver such options. Changes on the reproductive health scene that began more than a year ago will come into full play as two new contraceptive methods hit the U.S. market, and two more become fully integrated in routine practice.
The last 14 months have witnessed federal Food and Drug Administration (FDA) approval of four new contraceptive methods: the monthly combination injectable (Lunelle, Pharmacia Corp., Peapack, NJ), the levonorgestrel-releasing intrauterine system (Mirena IUS, Berlex Laboratories, Montville, NJ), the contraceptive vaginal ring (NuvaRing, Organon, West Orange, NJ), and the transdermal contraceptive (Ortho Evra, Ortho-McNeil Pharmaceutical, Raritan, NJ). Lunelle entered the U.S. marketplace in late fall 2000, with the Mirena IUS introduced in the first quarter of 2001. Providers can expect the rollout of NuvaRing and Ortho Evra this year. (Announcement of FDA approval was reported in the following issues of Contraceptive Technology Update: Lunelle, November, 2000; Mirena, February 2001; NuvaRing, December 2001; Ortho Evra, January 2002. These stories can be accessed from the CTU web site: www.contraceptiveupdate.com.)
Make options available
Women generally are satisfied with their current birth control method, according to the results of the recent national survey.1 However, women are not very satisfied with the simplicity of remembering to use their current form of birth control. Providers should keep this fact in mind when presenting options to their patients.
"The Pill remains an excellent method of contraception with a extensive record of safety and noncontraceptive benefits," notes Andrew Kaunitz, MD, professor and assistant chair in the obstetrics and gynecology department at the University of Florida Health Science Center/Jacksonville. "Nonetheless, many of our patients would prefer a longer-acting method that doesn’t require daily attention."
What each of these new methods has in common is that they represent new, longer-acting, patient-friendly delivery systems for steroids for which providers already have a wealth of experience, says Kaunitz.
"Two challenges we and our patients face as these new convenient and effective birth control options become available are ensuring that clinicians, particularly primary care providers, are up to date regarding these new methods, and [securing] insurance coverage that will facilitate our patients’ access to them," says Kaunitz.
Snapshot: What’s in use?
The Mirena IUS and Lunelle injections are available at Kaiser Permanente in Northern California, reports Ruth Shaber, MD, women’s health leader at the Oakland-based organization. In fact, Kaiser’s health plan expanded its contraceptive benefits to include no copay for these two products after January 2002; the zero-copay benefit already included Depo-Provera (depot medroxy-progesterone acetate or DMPA, Pharmacia Corp.) and emergency contraception, says Shaber.
Kaiser Permanente staff members have developed protocols for Mirena and Lunelle to be directly dispensed from its clinics and are educating providers about the products, notes Shaber. According to Shaber, the greatest challenge with introducing Mirena to the provider staff was in the interpretation of the FDA/Berlex requirements for certification and documentation of provider training; the greatest challenge with Lunelle was in establishing injection protocols that were not too labor-intensive for clinic nursing staffs.
"Lunelle has not been prescribed very often, mainly because providers are not used to thinking about it as an option," Shaber observes. "However, our Mirena utilization is increasing rapidly."
Jeffrey Maurus, MD, is a Rock Island, IL, OB/ GYN who is active in private practice, the Rock Island County Health Department family planning program, and a hospital-based collaborative practice with certified nurse-midwives. He says that Lunelle shots have been very well received and outnumber DMPA for new injectable starts.
"We have put in several Mirena with good results, but many candidates are discouraged by lack of insurance coverage and high upfront costs," Maurus notes. The unit cost for the Mirena IUS is approximately $355.
In Illinois, the state department of public aid and the department of human services are now making Mirena available, says Maurus.
"However, high cost is a problem with Title X because fewer patients can be served if you use a lot of Mirena," says Maurus. "Likewise, you can serve more Title X clients with Triphasil [an oral contraceptive, Wyeth-Ayerst Laboratories, Philadelphia] at 30 cents a cycle than you can with Lunelle."
When it comes to the emerging methods, Maurus says he is planning to get on board early with the NuvaRing contraceptive ring and the Ortho Evra patch in his private practice. Shaber says she cannot be sure if Kaiser Permanente will offer the contraceptive ring or the transdermal patch. As with all new pharmaceutical products, a physician-led formulary committee will evaluate the literature and safety profiles of the devices and make a recommendation to the medical group, she notes.
"The OB/GYN chiefs also will have an opportunity to make a recommendation," Shaber reports. "If these products represent unique and safe contraceptive options for women, then more than likely they will be approved and available."
Get informed on methods
Look to national provider organizations to provide a wide variety of educational opportunities on the new methods. The Washington, DC-based National Association of Nurse Practitioners in Women’s Health (NPWH) is eyeing the dates for four regional daylong symposia this year to update providers on the new options, particularly transdermal contraception, as well as the Pill and intrauterine contraception.
"We anticipate that the proceedings from these symposia will be published in a new publication to be premiered by NPWH this year," says Susan Wysocki, RNC, NP, NPWH president and chief executive officer. "The new publication also will cover information and updates on injectable contraception."
NPWH and the Washington, DC-based American College of Nurse-Midwives (ACNM) are presenting a joint symposium, "Blending Traditions in the 21st Century," Feb. 13-16 in Honolulu. The event, cosponsored by the family planning services section of the Hawaii State Department of Health and Center for Health Training, will offer information on the transdermal contraceptive, new concepts in intrauterine contraception, and an update on birth control methods. Expect NPWH to further address contraceptive advances at its annual meeting, scheduled for Sept. 25-28, says Wysocki.
Clinicians who just attended the rescheduled annual meeting of the Washington, DC-based Association of Reproductive Health Professionals (ARHP) got an overview of the contraceptive landscape, with presentations made on contraceptive injectables, the Mirena IUS, NuvaRing, and Ortho Evra. The organization offered continuing education sessions throughout 2001 on the Mirena IUS; look for similar educational opportunities in 2002, say ARHP officials.
Contraceptive Technology conferences always carry the latest information on birth control, and the Washington, DC, March 13-16 session and San Francisco March 20-23 session will follow suit. Insertion training will be offered on the Mirena IUS, and presentations will be made on Lunelle, Mirena, and the upcoming NuvaRing and Ortho Evra. (See the January 2002 issue of CTU for more information on the conference sessions.)
Reference
- American Medical Women’s Association. Women Want Birth Control That Simplifies Their Lives. Press release. Alexandria, VA; Nov. 1, 2001.
Resources
For more information on the Feb. 13-16 joint symposium presented by the Washington, DC-based National Association of Nurse Practitioners in Women’s Health (NPWH) and American College of Nurse-Midwives (ACNM), download the brochure and registration form at the ACNM web site, www.acnm.org. Click on link under "Upcoming Events." Also, contact Katrina Roux at NPWH: e-mail: [email protected]; telephone: (202) 543-9693. Continue to check the NPWH web site, www.npwh.org, for further details and registration information on the NPWH Sept. 25-28 annual meeting.
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