Nondaily hormonal contraceptives: Establishing a fit between product characteristics and patient preferences

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Applied Evidence

Nondaily hormonal contraceptives: Establishing a fit between product characteristics and patient preferences

J Fam Pract. 2004 November;53(11):904-913

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References

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Use of progestin-only DMPA-IM particularly raises concern regarding effects on BMD. However, no increased incidence of fractures has been noted in more than 30 years of DMPA-IM use worldwide.

In a recent meta-analysis that compared data from 10 cross-sectional and 7 longitudinal studies of BMD in 1039 women exposed to DMPA-IM with that of 2086 controls,⁵² average BMD was decreased in current users of DMPA-IM compared with nonusers, but was within 1 standard deviation of the mean in nonusers.⁵² Reductions in BMD tended to be greater as the duration of use of DMPA-IM increased, but stabilized after 3 to 5 years of use.^52,53 Notably, the loss of BMD seen among current users of DMPA-IM is reversible following cessation of use.

Cross-sectional studies in both postmenopausal women^52,54 and reproductive-age women,^52,55 showed that BMD in former users of DMPA-IM was not significantly different from that of never-users at any site, and a recent prospective study also confirmed the reversibility of bone loss after cessation of DMPA-IM use.⁵⁶

Establishing a good contraceptive fit

Overall, clinicians can prescribe nondaily hormonal contraceptives with confidence. Primary considerations in selecting a contraceptive method are its efficacy during typical use and its suitability for the medical needs and lifestyle preferences of the individual.

DMPA-IM and L-IUS. Consider the progestin-only nondaily methods DMPA-IM and L-IUS for women who want highly effective, nondaily, reversible contraception and who regard amenorrhea is a desirable side effect. These methods are also suitable when estrogen therapy is contraindicated.

L-IUS, unlike DMPA-IM, is not recommended for teens, nulliparous women, or those who are not in a stable, mutually monogamous relationship. L-IUS should also be avoided when there is a history of pelvic inflammatory disease or ectopic pregnancy.⁵

Because of its 5-year efficacy, L-IUS should be offered only to those desiring contraception for several years. Likewise, DMPA-IM is not recommended for those who wish to become pregnant within 1 to 2 years, because suppression of ovulation may persist beyond the 3-month dosing interval.

NE-patch and EE-ring. These products containing both estrogen and progestin are effective alternatives for women who would be candidates for combined oral contraceptives, including those desiring shorter-term or more rapidly reversible contraception and regular bleeding cycles.

When discussing contraceptive choices with a patient, review each method’s route and schedule of administration, efficacy in typical and nontypical use, potential noncontraceptive health benefits, reversibility, side effects, and long-term safety profile. The availability of a broader array of contraceptive choices should help women and their clinicians find a method that will fit individual medical needs as well as lifestyle preferences.

Correspondence
Jeffrey P. Levine, MD, MPH, Associate Professor, Departments of Family Medicine and Obstetrics, Gynecology & Reproductive Sciences, UMDNJ–Robert Wood Johnson Medical School, 1 RWJ Place, CN19, New Brunswick, NJ 08903-0019. E-mail: JeffZoo@aol.com.