Treatments in Endocrinology

, Volume 5, Issue 6, pp 359–365 | Cite as

A Review of Transdermal Hormonal Contraception

Focus on the Ethinylestradiol/Norelgestromin Contraceptive Patch
Review Article


Imperfect use of contraceptive methods notably increases the likelihood of pregnancy. One means of improving user adherence with hormonal contraception is to minimize the dosing schedule. Two forms of hormonal contraceptive have currently achieved this goal: the transdermal patch and the vaginal ring. The first and only transdermal contraceptive patch to receive worldwide regulatory approval (ethinylestradiol/norelgestromin) is a convenient approach to contraception that has a similar efficacy to oral contraceptives (OCs), but with the benefit of once-weekly administration. In addition, transdermal delivery of contraceptive hormones eliminates variability in gastrointestinal absorption, avoids hepatic first-pass metabolism, and prevents the peaks and troughs in serum concentrations that are seen with OCs. Norelgestromin, the progestin contained in the patch, is the active metabolite of norgestimate and is structurally related to 19-nortestosterone. Norgestimate and norelgestromin mimic the physiologic effects of progesterone at the progesterone receptor; however, norelgestromin has negligible direct or indirect androgenic activity, suggesting that it may be suitable for women with disorders related to androgen excess (such as hirsutism, acne, and lipid disorders).

Contraceptive effectiveness is usually a function of the efficacy of a contraceptive in combination with compliance with its dosing regimen. The efficacy of the contraceptive patch has been clearly demonstrated in three phase III trials, two of which were randomized comparisons with an OC. The likelihood of pregnancy was similar between these contraceptive methods; however, compliance with the patch was notably better, particularly in younger women. The safety and tolerability profile of the patch was similar to that of the OC. A cost-effectiveness analysis has suggested that the contraceptive patch is more cost effective than the OC, due to decreased costs related to unwanted pregnancy.


Oral Contraceptive Ethinylestradiol Hormonal Contraception Dienogest Vaginal Ring 
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  1. 1.
    Rosenberg MJ, Waugh MS, Long S. Unintended pregnancies and use, misuse and discontinuation of oral contraceptives. J Reprod Med 1995; 40(5): 355–60PubMedGoogle Scholar
  2. 2.
    Rosenberg MJ, Waugh MS, Meehan TE. Use and misuse of oral contraceptives: risk indicators for poor pill taking and discontinuation. Contraception 1995; 51(5): 283–8PubMedCrossRefGoogle Scholar
  3. 3.
    Kubba A, Guillebaud J, Anderson RA, et al. Contraception. Lancet 2000; 356(9245): 1913–9Google Scholar
  4. 4.
    Sitruk-Ware R. Vaginal delivery of contraceptives. Expert Opin Drug Deliv 2005; 2(4): 729–36PubMedCrossRefGoogle Scholar
  5. 5.
    Johansson ED, Sitruk-Ware R. New delivery systems in contraception: vaginal rings. Am J Obstet Gynecol 2004; 190(4 Suppl.): S54–9PubMedCrossRefGoogle Scholar
  6. 6.
    Smallwood GH, Meador ML, Lenihan JP, et al. Efficacy and safety of a transdermal contraceptive system. Obstet Gynecol 2001; 98 (5 Pt 1): 799–805PubMedCrossRefGoogle Scholar
  7. 7.
    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): 2347–54PubMedCrossRefGoogle Scholar
  8. 8.
    Hedon B, Helmerhorst FM, Cronje HS. Comparison of efficacy, cycle control, compliance, and safety in users of a contraceptive patch vs an oral contraceptive [abstract]. Int J Gynaecol Obstet 2000; 70 Suppl. 1: 78CrossRefGoogle Scholar
  9. 9.
    Sibai BM, Odlind V, Meador ML, et al. A comparative and pooled analysis of the safety and tolerability of the contraceptive patch (Ortho Evra/Evra). Fertil Steril 2002; 77(2 Suppl. 2): S19–26PubMedCrossRefGoogle Scholar
  10. 10.
    Prausnitz MR, Mitragotri S, Langer R. Current status and future potential of transdermal drug delivery. Nat Rev Drug Discov 2004; 3(2): 115–24PubMedCrossRefGoogle Scholar
  11. 11.Janssen-Cilag
    International N.V. Evra transdermal patch: summary of product characteristics. Beerse: Janssen-Cilag International N.V., 2002Google Scholar
  12. 12.
    Burkman RT. Pharmacologic characteristics of progestins used for contraception and hormone replacement therapy, including new transdermal technologies. Am J Manag Care 2001; 7(18 Suppl.): S571–4PubMedGoogle Scholar
  13. 13.
    Stanczyk FZ. All progestins are not created equal. Steroids 2003; 68(10–13): 879–90PubMedCrossRefGoogle Scholar
  14. 14.
    Henzl MR. Norgestimate: from the laboratory to three clinical indications. J Reprod Med 2001; 46(7): 647–61PubMedGoogle Scholar
  15. 15.
    Schindler AE, Campagnoli C, Druckmann R, et al. Classification and pharmacology of progestins. Maturitas 2003; 46 Suppl. 1: S7–16CrossRefGoogle Scholar
  16. 16.
    Abrams LS, Skee D, Natarajan J, et al. Pharmacokinetic overview of Ortho Evra/ Evra. Fertil Steril 2002; 77(2 Suppl. 2): S3–12PubMedCrossRefGoogle Scholar
  17. 17.
    Phillips A, Hahn DW, McGuire JL. Preclinical evaluation of norgestimate, a progestin with minimal androgenic activity. Am J Obstet Gynecol 1992; 167 (4Pt 2): 1191–6PubMedGoogle Scholar
  18. 18.
    White T, Jain JK, Stanczyk FZ. Effect of oral versus transdermal steroidal contraceptives on androgenic markers. Am J Obstet Gynecol 2005; 192(6): 2055–9PubMedCrossRefGoogle Scholar
  19. 19.
    Rabe T, Kowald A, Ortmann J, et al. Inhibition of skin 5 alpha-reductase by oral contraceptive progestins in vitro. Gynecol Endocrinol 2000; 14(4): 223–30PubMedCrossRefGoogle Scholar
  20. 20.
    Sator PG, Schmidt JB, Honigsmann H. Clinical evidence of the endocrinological influence of a triphasic oral contraceptive containing norgestimate and ethinyl estradiol in treating women with acne vulgaris: a pilot study. Dermatology 2003; 206(3): 241–8PubMedCrossRefGoogle Scholar
  21. 21.
    Pasqualini JR. Differential effects of progestins on breast tissue enzymes. Maturitas 2003; 46 Suppl. 1: S45–54CrossRefGoogle Scholar
  22. 22.
    Zieman M, Guillebaud J, Weisberg E, et al. Contraceptive efficacy and cycle control with the Ortho Evra/Evra transdermal system: the analysis of pooled data. Fertil Steril 2002; 77(2 Suppl. 2): S13–8PubMedCrossRefGoogle Scholar
  23. 23.
    Burkman RT. The transdermal contraceptive system. Am J Obstet Gynecol 2004; 190(4 Suppl.): S49–53PubMedCrossRefGoogle Scholar
  24. 24.
    Trussell J, Vaughan B. Contraceptive failure, method-related discontinuation and resumption of use: results from the 1995 National Survey of Family Growth. Fam Plann Perspect 1999; 31(2): 64–72, 93PubMedCrossRefGoogle Scholar
  25. 25.
    Fu H, Darroch JE, Haas T, et al. Contraceptive failure rates: new estimates from the 1995 National Survey of Family Growth. Fam Plann Perspect 1999; 31(2): 56–63PubMedCrossRefGoogle Scholar
  26. 26.
    Emans SJ, Grace E, Woods ER, et al. Adolescents’ compliance with the use of oral contraceptives. JAMA 1987; 257(24): 3377–81PubMedCrossRefGoogle Scholar
  27. 27.
    Archer DF, Cullins V, Creasy GW, et al. The impact of improved compliance with a weekly contraceptive transdermal system (Ortho Evra) on contraceptive efficacy. Contraception 2004; 69(3): 189–95PubMedCrossRefGoogle Scholar
  28. 28.
    Archer DF, Bigrigg A, Smallwood GH, et al. Assessment of compliance with a weekly contraceptive patch (Ortho Evra/Evra) among North American women. Fertil Steril 2002; 77(2 Suppl. 2): S27–31PubMedCrossRefGoogle Scholar
  29. 29.
    Rubinstein ML, Halpern-Felsher BL, Irwin Jr CE. An evaluation of the use of the transdermal contraceptive patch in adolescents. J Adolesc Health 2004; 34(5): 395–401PubMedGoogle Scholar
  30. 30.
    Logsdon S, Richards J, Omar HA. Long-term evaluation of the use of the transdermal contraceptive patch in adolescents. ScientificWorldJournal 2004; 4: 512–6PubMedCrossRefGoogle Scholar
  31. 31.
    Weisberg F, Bouchard C, Moreau M, et al. Preference for and satisfaction of Canadian women with the transdermal contraceptive patch versus previous contraceptive method: an open-label, multicentre study. J Obstet Gynaecol Can 2005; 27(4): 350–9PubMedGoogle Scholar
  32. 32.
    Lippi G, Manzato F, Brocco G, et al. Prothrombotic effects and clinical implications of third-generation oral contraceptives use. Blood Coagul Fibrinolysis 2002; 13(1): 69–72PubMedCrossRefGoogle Scholar
  33. 33.
    Lippman JS, Shangold GA. A review of post-marketing safety and surveillance data for oral contraceptives containing norgestimate and ethinyl estradiol. Int J Fertil Womens Med 1997; 42(4): 230–9PubMedGoogle Scholar
  34. 34.
    Jick SS, Kaye JA, Russman S, et al. Risk of nonfatal venous thromboembolism in women using a contraceptive transdermal patch and oral contraceptives containing norgestimate and 35 microg of ethinyl estradiol. Contraception 2006; 73(3): 223–8PubMedCrossRefGoogle Scholar
  35. 35.
    35. Council for International Organizations of Medical Sciences (CIOMS). Guidelines for preparing core clinical-safety information of drugs. 2nd ed. Geneva: CIOMS, 1998Google Scholar
  36. 36.
    Sonnenberg FA, Burkman RT, Speroff L, et al. Cost-effectiveness and contraceptive effectiveness of the transdermal contraceptive patch. Am J Obstet Gynecol 2005; 192(1): 1–9PubMedCrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2006

Authors and Affiliations

  1. 1.Center of Gynecology and Medical SexologyH. San Raffaele ResnatiMilanItaly
  2. 2.University of FlorenceFlorenceItaly

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