Updated Cochrane Review Compares Three Hormonal Methods of Contraception

An updated Cochrane review, conducted with partial support from USAID, highlights similarities and differences between combined oral contraceptives and some newer contraceptive alternatives.

The authors specifically reviewed randomized controlled trials comparing combined oral contraceptives with either the skin patch or the vaginal ring. They identified three trials involving the skin patch and eight involving the vaginal ring. Analyses compared data on contraceptive effectiveness, cycle control, compliance, and safety.

Contraceptive effectiveness was similar for all three forms of contraception. Although women reported more consistent use of the patch than of pills, patch users were more likely than either pill or ring users to discontinue the trials early. This may have been due to side effects.

Compared to pill users, 1) patch users noted an increased incidence of breast discomfort, painful periods, nausea, and vomiting; 2) ring users noted less nausea, irritability, and depression; and 3) ring users had fewer bleeding problems but more vaginal irritation and discharge.

All three of the hormonal methods studied here are considered safe and effective. According to a separate review of the literature, the first-year failure rate for each method is only 0.3 percent if a woman uses it perfectly. During more "typical" use, for example when a woman forgets to take her pills or change her patch, the first-year failure rate for each method is about 8 percent.

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Source
López LM, Grimes DA, Gallo MF, Schulz KF. Skin patch and vaginal ring versus combined oral contraceptives for contraception. Cochrane Database Syst Rev 2008;23(1):CD003552.