title: Performance of contraceptive patch compared with oral contraceptive pill in a high-risk population.
abstract: OBJECTIVE
  To evaluate the potential benefit of the transdermal contraceptive patch compared with the oral contraceptive pill for its acceptability and compliance in a population at high risk for future unintended pregnancies and abortions.
  
  
  METHODS
  Assessment of the contraceptive patch and pill was prospective. We gathered information on women undergoing contraceptive counseling at three Planned Parenthood clinics. Discontinuation, adverse effects, and pregnancy outcomes were catalogued. The primary outcome was time to discontinuation of the patch or pill. Survival analyses with life tables and Cox proportional hazards were used to assess acceptability and compliance. Pearl indices were calculated for both the pill and patch.
  
  
  RESULTS
  A total of 1,230 contraceptive-naïve women were identified. Subjects were a racially diverse group of primarily single women. Eighty-nine percent of the study population met our definition of being at high risk for a future unintended pregnancy or pregnancy termination. Loss to follow-up was higher among patch users (45.2% versus 29.5%, P<.001). Verified continued use beyond the first three cycles was lower with a patch (67% versus 89%, P<.001). Skin irritation and site reactions were the treatment-limiting factor for 3.3% of patch users. The 3,206 cycles captured in this study resulted in a Pearl index of 3.62 for the pill and 14.84 for the patch. Differences in the baseline demographic and contraceptive practices may account for this discrepancy although, in multivariate analysis, patch users continued to do worse.
  
  
  CONCLUSIONS
  In this high-risk population, we found the contraceptive patch to have lower continuation and effectiveness rates. Further research should investigate factors contributing to poorer real-world performance by the patch.
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland, Baltimore, 21201, USA. abakh001@umaryland.edu
authors.forename: Arvind
authors.initials: A
authors.lastname: Bakhru
authors.forename: Nancy
authors.initials: N
authors.lastname: Stanwood
mesh_terms: D000279:Administration, Cutaneous; D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D002648:Child; D015331:Cohort Studies; D003268:Contraception Behavior; D003271:Contraceptive Agents, Female / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D003277:Contraceptives, Oral, Combined / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D009518:New York; D016016:Proportional Hazards Models; D011446:Prospective Studies; D016312:Treatment Refusal
chemical_list: D003271:Contraceptive Agents, Female; D003277:Contraceptives, Oral, Combined