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Department of Pediatrics
University of Arizona
September 16, 2010
Androgenic Potency: Medroxyprogesterone acetate > (Norgestrel ≈ Levo-norgestrel) > (Norethindrone ≈ Ethynodiol) >
(Desogestrel ≈ Norgestimate = non-androgenic) > (Drospirenone = anti-androgenic)
Triphasic OCPs
Progestin-Only Pills
Mirena IUD (or IUS) Levo-norgestrel 0 +++ ++/+++ IUD cost: ∼ $500
20 mcg/day x 5 years Insertion: ∼ $300
ParaGard (Copper T 380A) IUD No Hormone, x 10 years 0 0 0
Norplant “rods” --- Levo-norgestrel 36 mg 0 ++ ++ No longer available in U.S.
x 6 rods = 216 mg; Over 5
years = 0.12 mg/day.
Implanon --- Etonogestrel 0.06 0 ++/+++ 0 Active form of desogestrel.
“implant” mg/day x 3 years DVT concern.
NuvaRing EE 15 Etonogestrel 0.12 ++? +++ 0 Vaginal ring x 3 weeks.
Vaginal insert mcg/day mg/day x 3 weeks Increased vaginal discharge.
DVT concern.
Ortho Evra Patch EE 20 Norelgestromin +++ + 0 1 patch weekly x 3 weeks.
mcg/day (Norgestimate) Poor cycle control.
150 mcg/day “Tricycle” with 9 patches.
Increased DVT risk.
Emergency Contraception
Plan B --- Levo-norgestrel +++ +++ Initial dose < 72 – 120 Hrs. May
Next Choice 0.75 mg each tablet
- take both tabs together. Check HCG
Plan B One Step Levo-norgestrel +++ +++ Take pill < 72 – 120 Hr of
1.5 mg
- unprotected sex. Check HCG
ellaOne or ella Ulipristal acetate Selective progesterone receptor modulator. 1 dose given < 72 – 120 Hr of
(New Aug 2010) 30 mg unprotected sex. (cf. RU-486/mifepristone). More effective than Plan B.
Missed Contraceptive Doses (See Ref. 7: Society of Ob-Gyn of Canada, November 2008)
References:
1. Gupta N, Corrado S, Goldstein M: Hormonal contraception for the adolescent. Pediatr Rev 2008, 29(11):386-396
2. Hatcher RA. Contraceptive Technology, 19th edition. 2008, Thomson Reuters, New York
3. Petitti DB. Clinical practice. Combination estrogen-progestin oral contraceptives. N Engl J Med 2003;349(15):1443-1450.
4. Comparison of oral contraceptives: a summary. Prescriber's Letter 2010;26(7):231207 (Updated June 2010)
5. Natazia (Estradiol Valerate and Dienogest). Prescriber's Letter 2010;26(7): 260706
6. Missed doses of hormonal contraceptives. Prescriber’s Letter 2009;25(1):250120
7. Guilbert, E, et al. Missed hormonal contraceptives: new recommendations. J Obst Gyn Can 2008;30(11): 1050-62.
8. Fine P, Mathe H, et al. Ulipristal acetate taken 48-120 hours after intercourse for emergency contraception. Obstet Gynecol.
2010;115(2 Pt 1):257-263.
9. Glasier AF, Cameron ST, Fine PM, et al. Ulipristal acetate versus levonorgestrel for emergency contraception: a randomised
non-inferiority trial and meta-analysis. Lancet. 2010;375(9714):555-562.