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Contraception - Management
What are the advantages, disadvantages, and risks of the combined contraceptive patch?

  • In general, the advantages, disadvantages, and risks of the combined contraceptive patch are similar to those of the combined oral contraceptive (COC).
  • Advantages of the patch compared with COCs:
    • The user does not have to think about it every day, only having to remember to replace the patch once a week.
    • The patch does not become less effective if the user vomits or has diarrhoea (because the hormones are absorbed through the skin, not through the gastrointestinal tract).
  • Disadvantages of the patch compared with COCs:
    • It can be seen.
    • It irritates the skin in some women.
    • It may be detached (partially or fully) from the skin, compromising efficacy.
    • It is less effective in women who weigh more than 90 kg.
  • The risks of rare but serious adverse effects for users of the patch are similar to those for users of COCs.
  • The patch is as effective as COCs at preventing pregnancy — see Effectiveness of contraceptives.
  • There is some evidence that, although compliance is improved in patch users compared to those using COC, the use of the patch did not have a significant effect on reducing failure rates.
Basis for recommendation
  • A Cochrane systematic review concluded that self-reported compliance was better with the combined contraceptive patch than with combined oral contraceptives (COCs) [Gallo et al, 2003].
  • Adverse effects of the combined contraceptive patch compared with COCs [FFPRHC, 2004c]:
    • Breast discomfort:
      • Breast discomfort was more common with the combined contraceptive patch than with COCs but was significant only in the first two cycles of use: 15.4% compared with 3.5% in cycle one and 6.6% compared with 1.5% in cycle two.
      • Most women (85%) who described breast tenderness had only mild to moderate discomfort, and the symptom led to discontinuation in only 1.0% of patch users.
    • Site reactions occurred with combined contraceptive patch use in 20.2% of women but led to discontinuation in only 2.6% of women.
    • Body weight increased similarly for users of the combined contraceptive patch and users of COCs: +0.4 kg.
    • Disruption of bleeding pattern:
      • Breakthrough bleeding and spotting with the combined contraceptive patch was similar to that with triphasic COCs.
      • Breakthrough bleeding and spotting were more common in cycles one and two with patch use than with COC use. In cycle one, 18.3% of patch users reported breakthrough bleeding and spotting compared with 11.4% of COC users. In cycle three, 10.0% of patch users reported breakthrough bleeding compared with 8.8% of COC users.
      • An open-label, non-randomized trial identified good cycle control in 1164 women recruited to use the combined contraceptive patch. Breakthrough bleeding and spotting were reported by 17.5% of women in cycle one; this proportion decreased to 9.2% by cycle 13.
    • Metabolic effects:
      • Pulmonary embolism was reported in one combined contraceptive patch user, but the patch had been used up until the time of major surgery.
      • No clinically significant alterations in laboratory values have been identified with combined contraceptive patch use.

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