Pill won’t budge from No. 1 spot: Half of women leave exams with OCs
Pill won’t budge from No. 1 spot: Half of women leave exams with OCs
Low-dose pills gain favor for use in younger and older women
When it comes to safe, effective, and convenient birth control, women continue to turn to the Pill, say participants in Contraceptive Technology Update’s 2000 Contraception Survey. Almost half of survey respondents say more than 50 of the women who enter their exam rooms leave with pills in hand each month. Thirty-six percent say 26 to 50 women receive pills each month, while 11.2% place that number at 11 to 25. Another 3.4% say one to 10 women receive pills each month. Just 1.1% say no women receive pills.
The Alan Guttmacher Institute in New York City reports 61% of American reproductive-age women who practice contraception use reversible methods such as oral contraceptives (OCs) or condoms. The rest rely on female or male sterilization (28% and 11%, respectively).1
The number of women who use OCs has remained consistent, although use of depot medroxyprogesterone acetate (Depo-Provera or DMPA) also is popular, says Barbara Kremer, CNM, MPH, a clinician at Planned Parenthood of Southern Arizona in Tucson.
Pamela Porter, PA-C, CRN, FNP, MSN, a clinician at Woodland (CA) Healthcare, a multispecialty clinic, frequently prescribes oral birth control pills for her patients, as well as shots, intrauterine devices, and barriers such as diaphragms. Porter says she is looking forward to the availability of Lunelle, the monthly contraceptive injectable by Pharmacia & Upjohn of Bridgewater, NJ. The method is now under review for market release by the Food and Drug Administration (FDA). (For a discussion of the research on this effective method, see CTU, November 1999, p. 125.)
What is the first choice among OCs when it comes to providing contraception for 21-year-old nonsmoking women? CTU survey respondents again pick Ortho Tri-Cyclen, a 35-mcg triphasic pill from Ortho-McNeil Pharmaceuticals of Raritan, NJ. The pill leads the choices in formulary and nonformulary categories, with about 33% of survey respondents naming it as their first choice when not under formulary restrictions, and about 37% selecting it as the top choice in formulary plans. (See chart on first-choice nonformulary OC for a 21-year- old nonsmoker, p. 103.)
Competition from 20 mcg pills appears to be affecting Ortho Tri-Cyclen’s command of the top spot, according to survey results. Almost half (47%) of 1999 responses listed the pill as the top nonformulary choice. This year’s results show that two 20 mcg pills — Alesse from Wyeth-Ayerst Laboratories of Philadelphia and Mircette, a 20 mcg pill with a shortened hormone-free interval from Organon of West Orange, NJ — moved up to capture more than 21% of top-choice selections. The two pills accounted for less than 10% of 1999 responses in the same category. (CTU covered this trend in an article on 20 mcg pills in June 2000; see p. 72.)
Pills for older women?
Contraception in the perimenopausal years is an important issue for many women, note authors of Contraceptive Technology.2 Women over age 40 have the second highest proportion of unintended pregnancies, a proportion exceeded only by adolescents ages 13 and 14.3
About half of the participants in the 2000 Contraception Survey named Alesse as their leading OC selection for 42-year-old nonsmoking healthy women. That’s an increase over 1999, when 28% chose the brand as their No. 1 selection. Loestrin, offered in 20 and 30 mcg strengths from Parke-Davis of Morris Plains, NJ, was named by almost 20%, compared with 26% in 1999. (See chart on first-choice nonformulary OC for a 42-year-old nonsmoker, p. 104.)
Mircette was named as a first-choice pill by 13.4% of providers, and a second-choice pill by nearly 18%. Those results represent gains over Mircette’s 1999 figures, when it was ranked by 7% of respondents in both first- and second-choice categories for older nonsmoking women.
Check OC benefits
When discussing the risks and benefits of oral contraceptives with your patients, do you note the Pill’s noncontraceptive benefits? One important dividend to mention is the Pill’s protective effect against ovarian cancer. This protection extends not only to healthy women, but to those who carry an inherited risk, as well.4 (According to findings from a 1998 study, OC use can halve the risk of ovarian cancer among women who inherit a faulty gene that puts them at high risk for the disease. For details, see CTU, November 1998, p. 146.)
Responses to the 2000 survey show that about 31% of survey participants recommended pills to women specifically to decrease risk of cancer of the ovary. That figure is consistent with 1999’s finding.
Deborah Mathis, MSN, CRNP, women’s health coordinator at the University of Pennsylvania Student Health Service in Philadelphia, says information about the Pill’s protective effects is on her facility’s bulletin board and in the patient handout about birth control pills.
Many women are afraid of the possibility of ovarian cancer and believe that OCs actually may cause them, Porter says. Patient education plays an important role in alleviating such misconceptions, she notes.
Keep pills under Rx
Family planning providers promote access to safe, effective birth control for both men and women. When it comes to making oral contraceptives over-the-counter (OTC) items, however, the majority of respondents to the 2000 Contraception Survey say pills should remain prescription-only.(See chart on whether OCs should be available OTC, p. 104.) About 72% say pills should not go OTC, which is consistent with the 1999 survey.
Some providers believe pills should be readily available. Diana Lithgow, RN, FNP, a family nurse practitioner at Laguna Beach (CA) Community Clinic, says low-dose pills should be provided over the counter, with strong warning labels regarding the absolute contraindications and the smoking concerns.
While Mathis says she agrees that there is limited rationale to keeping pills prescription-only, she says it brings women into the health care system who may not otherwise come in. Women would miss out on the additional teaching about their general health, as well as the instructions on how to take pills correctly, if pills were sold over the counter, she adds.
The FDA is considering whether many types of drugs, including birth control pills, should be made available without a provider’s prescription. Public hearings this summer launched the drug agency’s re-examination of the way it regulates over-the-counter drugs, the first such review in nearly 30 years. Its last review in 1972 created a new system for approving over-the-counter drugs that allowed more than 600 drugs to switch from prescription to nonprescription status.5
Many patients, even longtime OC users, are not always good pill users, observes Kremer. If the Pill were available over the counter, women would not have adequate information on use and side effects, she says, and those with strong or absolute contraindications to OC use would be able to use them without any medical oversight. However, she would like to see emergency contraceptive pills (ECPs) available OTC. (See article, p. 112, on the movement seeking OTC status for ECPs.)
References
1. Alan Guttmacher Institute. Facts in Brief. Contraceptive Use. New York City; 1998.
2. Hatcher RA, Trussell J, Stewart F, et al. Contraceptive Technology. 17th ed. New York City: Ardent Media; 1998.
3. Forrest JD. Epidemiology of unintended pregnancy and contraceptive use. Am J Obstet Gynecol 1994; 170:1,485-1,489.
4. Narod SA, Risch H, Moslehi R, et al. Oral contraceptives and the risk of hereditary ovarian cancer. N Engl J Med 1998; 339:424-428.
5. Stolberg SG. FDA considers switching some prescription drugs to over-the-counter status. New York Times, June 28, 2000. Web: www10.nytimes.com/library/national/ science/health/062800hth-fda-otcdrugs.html.
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