Advantages and Disadvantages of the Contraceptive Patch

The oral contraceptive pill was used widely because of its high efficacy. However, poor patient compliance inevitably led to higher-than-ideal pregnancy rates, as users often forgot to take the pill at the right time, to take it every day, or had gastrointestinal conditions which interfered with its digestion and absorption.

The contraceptive patch was one of the alternatives designed to address this issue.

Advantages of the patch

• It is simple to use
• Can be used by just one partner
• Highly effective if used properly, with almost 100 percent protection
• Needs to be applied only once a week and not in relation to intercourse, improving patient compliance
• Its presence can be verified by sight
• Does not detach with exposure to water or sweat
• May improve menorrhagia and dysmenorrhea not due to organic conditions
• May improve acne in many cases
• May improve bone strength due to the estrogen content
• May reduce the risk of benign breast disease, as well as uterine endometrial and ovarian cancers

Disadvantages

The patch is not a perfect means of contraception, because of some drawbacks listed below:

• It does not provide protection against sexually transmitted infections (STIs), including HIV
• Must be prescribed by a health care provider
• The estrogen levels are higher with the patch than with other hormonal methods
• Interacts with some medications such as rifampin (an anti-tuberculosis antibiotic), corticosteroids, anticonvulsants, and herbal supplements such as St. John's Wort. These induce greater activity of the liver enzymes which metabolize the hormones, and may therefore lead to a shorter term of activity than expected.
• The return of fertility may be delayed by up to two months after stopping the use of the patch
• Skin irritation may occur in some women
• It can be seen by the partner
• It is sometimes felt inside the vagina by the partner

Minor side effects

Minor side effects may occur for the first few months, such as:

• Headaches
• Hypertension
• Nausea
• Breast tenderness
• Depressive mood changes
• Intermenstrual spotting or bleeding
• Breast tenderness
• Vaginal pruritus or discharge

Serious side effects

Estrogen and progesterone may produce some life-threatening complications, such as:

• Thromboembolic episodes including events such as pulmonary embolism, myocardial infarction, calf venous thrombosis, or cerebrovascular accidents
• A somewhat increased risk of breast cancer and cervical cancer with long-term use

Contraindications

Women with the following conditions should not use the patch for fear of thromboembolism:

• Severe obesity
• Smoking, current or quit within the last year
• Age over 35 years
• Family or personal history of thromboembolic events, especially if the relative was under 45 years at the time
• Immobilization following surgery, trauma, or other conditions
• Severe varicose veins
• Hepatitis or benign liver tumors
• Gallbladder disease
• Diabetes with complications or of more than 20 years duration
• Migraines with aura on a regular basis

The patch is also not suitable for women who are exclusively breastfeeding their infants and are less than six months postpartum.

References

1. http://www.nhs.uk/Conditions/contraception-guide/Pages/contraceptive-patch.aspx
2. https://medlineplus.gov/druginfo/meds/a602006.html
3. https://www.hhs.gov/opa/pregnancy-prevention/hormonal-methods/patch/index.html