Adolescents' experience with the combined estrogen and progestin transdermal contraceptive method Ortho Evra.
BACKGROUND
The new combined estrogen & progestin contraceptive patch Ortho Evra was approved by the FDA in December 2001. To date, there is a paucity of data regarding its use in the adolescent age group. We examined adolescents' experience with this new contraceptive method.


METHODS
Using a questionnaire designed by the authors, care providers in a hospital based adolescent clinic interviewed and reviewed the charts of adolescent girls who had initiated Ortho Evra in 2002-2003.


RESULTS
Twenty-eight adolescent girls (age 18 +/- 1 years, gyn age 6 +/- 1 years, onset of sexual intercourse at 14 +/- 1 years, body mass index (BMI) 27.6 +/- 1.2, 57% Hispanic, 21% Caucasian, 11% African American, 7% biracial, 4% Indian American) who had used Ortho Evra for 7 +/- 1 months were enrolled. Half (50%) were adolescent mothers, and 57% had a history of irregular menstrual periods. All (100%) girls reported regular menstrual periods while using Ortho Evra, with only 14% experiencing occasional breakthrough bleeding. Half reported a shorter duration and 36% reported a lighter flow of their periods. About a third (39%) reported a decrease and 11% reported an increase in dysmenorrhea symptoms. About a third (29%) of those with a history of recurrent headaches at initiation reported decrease in headaches, and about a third (33%) of those with acne at initiation reported decrease in facial acne while on Ortho Evra. There were no significant BMI changes during Ortho Evra use. Although condom use while on Ortho Evra was poor (only 15% reporting consistent condom use), there were no pregnancies reported. A majority (93%) reported that they remembered to apply the patches on time, and 40% stated that Ortho Evra was easier than previous contraceptive methods. Two thirds (68%) were very satisfied and 29% were somewhat satisfied with the method, and 93% stated that they would recommend the method to a friend/relative. The preferred application site was the buttock (40%) followed by the lower abdomen (32%). About a fifth (21%) experienced at least one episode of complete patch detachment and 32% reported partial peeling of the patch corners. About a third (32%) would prefer another patch color, and 25% would like a fourth week placebo patch. The most common side effects were mild temporary application site reactions (64%), some discomfort on patch removal (32%), nausea (18%), and breast tenderness (18%). Eleven girls (39%) discontinued Ortho Evra (three lost health insurance, three because of application site reactions, two found patch application schedule difficult to remember, two desired pregnancy, two because of nausea, one because of perceived weight gain).


CONCLUSIONS
Ortho Evra provides excellent cycle control in adolescents. Most adolescents are satisfied with this method. Intensive efforts should be made to increase condom use by adolescents on Ortho Evra.
Harel
Zeev
Z
Division of Adolescent Medicine, Hasbro Children's Hospital, Brown University, Providence, Rhode Island 02903, USA. zharel@lifespan.org
Riggs
Suzanne
S
Vaz
Rosalind
R
Flanagan
Patricia
P
Dunn
Kimberly
K
Harel
Dalia
D
D000005:Abdomen; D000152:Acne Vulgaris / Q000517:prevention & control; D000279:Administration, Cutaneous; D000293:Adolescent; D001294:Attitude to Health; D001940:Breast / Q000187:drug effects; D002081:Buttocks; D017280:Condoms; D003277:Contraceptives, Oral, Combined / Q000008:administration & dosage* / Q000009:adverse effects; D004337:Drug Carriers; D004338:Drug Combinations; D004412:Dysmenorrhea / Q000517:prevention & control; D005003:Ethisterone / Q000031:analogs & derivatives; D005260:Female; D006261:Headache / Q000517:prevention & control; D006801:Humans; D008597:Menstrual Cycle / Q000187:drug effects; D008598:Menstruation / Q000187:drug effects; D009325:Nausea / Q000139:chemically induced; D009644:Norgestrel / Q000031:analogs & derivatives; D010091:Oximes; D010352:Patient Dropouts; D017060:Patient Satisfaction
D003277:Contraceptives, Oral, Combined; D004337:Drug Carriers; D004338:Drug Combinations; D010091:Oximes; D009644:Norgestrel; D005003:Ethisterone; C449219:norelgestromin