Practice Therapeutics

Newer non-oral hormonal contraception

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f341 (Published 14 February 2013) Cite this as: BMJ 2013;346:f341
  1. Deborah Bateson, medical director12,
  2. Kathleen McNamee, medical director34,
  3. Paula Briggs, clinical lead5
  1. 1Family Planning NSW, Sydney, NSW 2131, Australia
  2. 2Discipline of Obstetrics, Gynaecology and Neonatology, University of Sydney, Sydney, NSW 2006, Australia
  3. 3Family Planning Victoria, Box Hill, VIC 3128, Australia
  4. 4Monash Medical Centre, Department of Obstetrics and Gynaecology, Clayton, VIC 3168, Australia
  5. 5Community Sexual Health Service, Sefton, UK
  1. Correspondence to: D Bateson deborahb{at}fpnsw.org.au

A 24 year old nulliparous woman asks for a repeat supply of her combined oral contraception. She mentions that she sometimes forgets to take it and asks about alternatives that don’t rely on daily pill taking. She is a non-smoker, has no contraindications to combined hormonal contraception, and had heavy menstrual bleeding before using oral 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).

View this table:
Table 1

Summary of newer non-oral hormonal contraceptives

Transdermal patch (Evra). Jacek Kutyba/Dreamstime.com

Vaginal ring (NuvaRing). Permission from Family Planning NSW

Levonorgestrel intrauterine system (IUS) (Mirena). Permission from Family Planning NSW

Single rod, progestogen-only implant (Nexplanon or Implanon NXT) Permission from Family Planning NSW

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.

View this table:
Table 2

Currently …

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