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Obstetrics & Gynecology:
doi: 10.1097/AOG.0000000000000095
Contents: Original Research

Low-Dose Levonorgestrel and Ethinyl Estradiol Patch and Pill: A Randomized Controlled Trial

Kaunitz, Andrew M. MD; Portman, David MD; Westhoff, Carolyn L. MD; Archer, David F. MD; Mishell, Daniel R. Jr MD; Rubin, Arkady PhD; Foegh, Marie MD

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Abstract

OBJECTIVE: To compare a new low-dose levonorgestrel and ethinyl estradiol contraceptive patch (Patch) with a combination oral contraceptive (Pill; 100 micrograms levonorgestrel, 20 micrograms ethinyl estradiol) regarding efficacy, safety, compliance, and unscheduled uterine bleeding.

METHODS: Women (17–40 years; body mass index 16–60) were randomized in a 3:1 ratio to one of two groups: Patch only (13 cycles) or Pill (six cycles) followed by Patch (seven cycles). Investigators evaluated adverse events during cycles 2, 4, 6, 9, and 13. Participants recorded drug administration and uterine bleeding on daily diary cards. Compliance was assessed by measuring levonorgestrel and ethinyl estradiol plasma levels. Pearl Index (pregnancies per 100 woman-years) was calculated to evaluate efficacy.

RESULTS: Participants (N=1,504) were randomized to Patch (n=1,129) or Pill (n=375). Approximately 30% were obese, more than 40% were racial or ethnic minorities, and more than 55% were new users of hormonal contraceptives. Laboratory-verified noncompliance (undetectable plasma drug levels) was 11% of Patch and 12.6% of Pill users at cycle 6. Pearl Indices (95% confidence intervals) for the intention-to-treat population (cycles 1–6) were 4.45 (2.34–6.57) for Patch and 4.02 (0.50–7.53) for Pill; excluding laboratory-verified noncompliant participants, Pearl Indices were 2.82 (0.98–4.67) for Patch and 3.80 (0.08–7.52) for Pill (differences not statistically significant). Incidence of unscheduled bleeding and incidence and severity of adverse events were similar for both contraceptives (no statistically significant difference).

CONCLUSIONS: Efficacy and safety of the new contraceptive Patch are comparable to those of a Pill. Laboratory-verified noncompliance and bleeding profile are similar between the two treatments. The Patch was well tolerated.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT01181479.

LEVEL OF EVIDENCE: I

© 2014 by The American College of Obstetricians and Gynecologists.

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