A quick-start protocol, similar to that used for oral contraceptives (OCs), can be used for transdermal (patch) and vaginal ring contraceptives. If either contraceptive method is started at any time other than the first 5 days of menses, a backup contraceptive method should be used concurrently for 7 days.
A 20-cm2 transdermal patch delivers 150 mcg of the progestin norelgestromin (the active metabolite of norgestimate) and 20 mcg of ethinyl estradiol daily into the systemic circulation for 7 days. After 1 week, the patch is removed, and a new patch is applied to a different area of the skin. After 3 patches are used, no patch is used for the 4th week to allow for withdrawal bleeding.
Hormone blood levels of estrogen and progestin are much more constant with the patch than with OCs. Overall, contraceptive efficacy, incidence of bleeding, and adverse effects with the patch are similar to those with OCs, but patient adherence may be better with the patch because it is applied weekly rather than taken daily. The patch may be less effective in obese women who weigh > 90 kg.
Women should be advised to use a backup contraceptive method concurrently for 7 days if > 2 days have elapsed since a new patch was to be applied.
Vaginal rings are flexible, soft, and transparent. Two types of rings are available:
A month-long ring that releases 15 mcg of ethinyl estradiol (estrogen) and 120 mcg of etonogestrel (progestin) a day and must be replaced each month
A year-long ring that releases 13 mcg ethinyl estradiol (estrogen) and 150 mcg segesterone acetate (a progestin) a day and must be replaced only once a year
Both types of rings are typically left in place for 3 weeks, then removed for 1 week to allow for withdrawal bleeding.
The hormones released by vaginal rings are absorbed through the vaginal epithelium. When a vaginal ring is used, hormone blood levels are relatively constant.
Women insert and remove the ring themselves; no fitting by a physician is required.
Contraceptive efficacy and adverse effects with vaginal rings are similar to those of OCs, but adherence may be better with rings because they are inserted monthly rather than taken daily.
Women may wish to remove the vaginal ring at times other than the week for withdrawal bleeding. However, if the ring is removed for > 3 hours, women should be advised to use a backup contraceptive method concurrently for 7 days.