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Evidence summaries

Skin Patch and Vaginal Ring Versus Combined Oral Contraceptives for Contraception

Contraceptive skin patch, vaginal ring and combination oral contraceptives are all effective in contraception. There may be some differences in compliance, side effects, and method satisfaction. Level of evidence: "A"

A Cochrane review (abstract [Abstract], review [Abstract]) included 18 studies with a total of 6 865 women (5 studies with 11 168 women of the skin patch and 12 studies over 50 000 women of the vaginal ring). Contraceptive effectiveness was similar for the patch or ring and the comparison combination oral contraceptives (COC).

Compliance data were limited. Patch users reported more compliant cycles than COC users in 3 trials. More patch users discontinued early than COC users. Patch users also had more discontinuation due to adverse events. Compared to COC users, patch users were more likely to report breast discomfort, dysmenorrhea, nausea, and vomiting. Cycle control was generally similar for the patch and COC. The ring trials generally showed similar discontinuation for ring and COC users. Ring users reported less nausea, acne, irritability, and depression than COC users in single trials. However, ring users had more vaginitis and leukorrhea but less vaginal dryness. Cycle control was similar or better for the ring versus COC.

A systematic review and meta-analysis 2 included 13 studies. No significant difference in contraceptive efficacy (Pearl Index) was observed between oral and parenteral drug administration (MD -0.06, 95% CI -0.66 to 0.53; 6 trials, n=7251; I²=0%). Significantly better compliance was measured in patients using the patch than in the oral group (OR 2.32, 95% CI 1.31 to 4.12; 5 trials, n=5927; I²=33%), but not in the ring subgroup compared to the oral group (OR 1.01, 95% CI 0.33 to 3.03; 4 trials, n=3231; I²=74%). There was a trend towards more breast discomfort in the parenteral group compared with oral group (OR 1.78, 95% CI 0.98 to 3.25; 8 trials, n=9143; I²=80%). The parenteral group had more vaginal discharge than the oral group (OR 2.15, 95% CI 1.5 to 3.08; 4 trials, n=3443; I²=0%). There was no difference in the development of headaches (OR 0.97, 95% CI 0.81 to 1.16; 7 trials, n=8197; I²=14%) or dysmenorrhea (OR 94, 95% CI 0.55 to 1.62; 6 trials, n=7676; I²=70%) between the parenteral and the oral administration groups.

References

  • Lopez LM, Grimes DA, Gallo MF et al. Skin patch and vaginal ring versus combined oral contraceptives for contraception. Cochrane Database Syst Rev 2013;(4):CD003552. [PubMed]
  • Vleskó G, Meznerics FA, Hegyi P, et al. Comparison of Combined Parenteral and Oral Hormonal Contraceptives: A Systematic Review and Meta-Analysis of Randomized Trials. J Clin Med 2024;13(2): [PubMed]

Primary/Secondary Keywords