Newer non-oral hormonal contraception

What newer non-oral hormonal contraceptive methods are available?

This article concentrates on the newer non-oral hormonal methods of contraception (table 1⇓):

• Medium acting combined hormonal contraception—the transdermal patch (Evra) (fig 1⇓) and the vaginal ring (NuvaRing) (fig 2⇓)

• Long acting reversible methods—the levonorgestrel intrauterine system (IUS) (Mirena) (fig 3⇓) and the single rod, progestogen-only implant (Nexplanon or Implanon NXT) (fig 4⇓).

How well do these methods work?

User errors are more common with methods that rely on frequent activity—for example, taking a pill daily. Table 2⇓ summarises failure rates for different contraceptive methods (and for a useful counselling tool to use with patients, see the Web Extra figure on bmj.com). The efficacy of the patch (weekly activity) and the vaginal ring (monthly activity) is similar to that of the combined pill.2 An analysis of US data estimated that the combined pill has a failure rate of 0.3% for perfect use (achieved under research conditions) and 9% for typical use (which includes user error) in the first year of use.3 Long acting methods, including the progestogen-only implant and IUS, do not rely on ongoing user administration; they are thus more effective than shorter acting methods, and are sometimes referred to as “fit and forget” methods.