University of Michigan
Department of Pediatrics
Evidence-Based Pediatrics Web Site

Question

• In adolescent girls who desire hormonal contraception is there better compliance when using the contraceptive patch vs. birth control pills?

Clinical Bottom Lines

1. The evidence currently available suggests that compliance among adolescents using the contraceptive patch is better than with oral contraceptive pills but there is no definitive study available.
   
2. Among adult women using the contraceptive patch, 10 women need to be treated with the patch instead of OCPs to gain one additional month of perfect compliance (2)
   
3. Adolescent girls found the patch easier to use and easier to remember than OCPs (p=0.001).
   

Summary of Key Evidence

1. A longitudinal study of 50 adolescent girls who desired hormonal contraception and were willing to try the contraceptive patch was conducted over 3 months. No control group was included in the study.¹
2. Patients were ages 15-18, non-pregnant, with BP<140/90, wt <90kg, and with no contraindications to hormonal contraceptive use.
   
3. Patient compliance and attitudes about transdermal contraceptive were monitored with questionnaires at 1- and 3-month follow-up visits
   
4. 19 of 50 patients dropped out of the study or were lost to follow-up
   
5. At one month follow-up 36/39 (92.3%) of adolescents reported perfect compliance (wearing the patch daily). Two participants missed one day and one missed 2 days (mean days missed = 0.67, SD = 0.82) (1).
   
6. At three-month follow-up 27/31 (87.1%) of participants reported perfect compliance with patch use (mean days missed = 0.33, SD = 0.58) (1)
   
7. Girls in the study who had used OCPs in the past found the patch easier to use (P=0.001) and easier to remember (P=0.001) than OCPs.
   
8. In a 13 month, randomized, non-blinded study of adults the mean proportion of participants' cycles with perfect compliance was 88.2% (811 total participants, 5141 total cycles) with the patch and 77.7% (605 total participants, 4134 total cycles) with the OCP (p<0.001)(2). Number needed to treat is 10 in order to achieve one cycle with perfect complaince with the patch versus the pill..
   

Additional Comments

• Evidence to answer this question effectively is lacking in this age group
  
• Efficacy of the contraceptive patch is equal to that of OCPs when used correctly.²
  
• The Ortho-Evra patch costs $37.99/month of treatment versus $29.99/month for Triphasil OCP.
  

Citation

1. Rubinstein ML, Halpern-Felsher BL, Irwin CE. An evaluation of the use of the transdermal contraceptive patch in adolescents. J Adol Health 2004; 34(5):395-401.

2. Audet MC, Moreau M, Koltun WD, et al. Evaluation of contraceptive efficacy and cycle control of a transdermal contraceptive patch vs an oral contraceptive: a randomized controlled trial. JAMA 2001; 285(18):2347-54.
   

CAT Author: Sarah Lacy, MD

CAT Appraisers: John G. Frohna, MD

Date appraised: October 27, 2004