Ortho-Evra Kills

November 3, 2006 2:58 AM

Ortho-Evra Birth Control Patch Has Inconvenient Death Side Effect Ortho-Evra is a faddish, convenient birth control option in transdermal patch form, which has lured women by promising no-worries birth control, not to mention nice manageable periods or even no periods at all. In my local newspaper, I noticed a tiny news brief about the class-action lawsuit going on right now, and thought it was worth posting. It's not really new news--the first cases came out about a year ago. A year ago Ortho-Evra added to the list of side effects. Previously healthy women are suffering strokes--and it is well-known that doctors don't always report problems as patch-related when in fact they are. No surprises...the FDA estimated that 118/100,000 of users would experience blood clots and circulation problems related to the drug (this was double Johnson & Johnson's rate) before they approved the patch anyway back in 2001! They also estimated that the risk would increase drastically for women whose first birth control experience was with the patch See page 43 of the second Medical Review in the FDA report. Many apologies if I'm the last to know.
posted by Fisherkitty (61 comments total)

I'm confused - why are the patches being prescribed when there are IUDs and IUSs for no-fuss, constant birth control?
In Britain, they have IUS (interuterine system) which is an IUD with a small amount of hormone which counteracts the side effects of IUD (heavier periods, bad cramps). It's safe for young women and women who haven't had children, but I never even heard about it before I moved to Britain.
posted by jb at 3:09 AM on November 3, 2006

Those whores deserve it for using birth control and using their reproductive organs for sinful pleasure.
posted by Mayor Curley at 3:56 AM on November 3, 2006 [4 favorites]

Most people aren't aware that 5% of the Caucasian population has Factor V Leiden, a hereditary blood clotting disorder--most people who have it don't know about it, because it just increases your risk of blood clots a little. But while people who know they have it are strongly discouraged from using hormonal birth control, people aren't tested for it before starting the patch or the pill. I think this is probably a major factor for drug-related blood clots and strokes.
posted by Jeanne at 4:01 AM on November 3, 2006

© 2001-2006 Online Legal Marketing Ltd. All rights reserved.

Yeah, that's a balanced source, lawyers looking to drum up some business.
posted by caddis at 4:05 AM on November 3, 2006

Any treatment that includes estrogen can cause potentially fatal clotting in a small percentage of women. My mother had an embolism due to estrogen - and also needed her gall bladder removed ten years ago - which appears to be an unproven but related disorder according to Jeanne's link. There's a high chance I've got it too, since my sister has been tested positive for the same trait.
posted by talitha at 4:16 AM on November 3, 2006

and what's the rate of blood clots and circulation problems with pregnancy, again?
posted by gaspode at 4:18 AM on November 3, 2006

That's your source? Lawyers looking to drum up business for a class-action suit? The FDA link you posted is information for all oral contraceptives, not the transdermal type specifically.
posted by rxrfrx at 4:38 AM on November 3, 2006

Yeah, that's a balanced source, lawyers looking to drum up some business.

I'm shocked you would insinuate that a public-protection attorney might be anything less than scrupulously honest.
posted by The Tensor at 4:39 AM on November 3, 2006

and what's the rate of blood clots and circulation problems with pregnancy, again?

Very low, but the rate of "having a baby" is significantly higher.
posted by clevershark at 4:43 AM on November 3, 2006

The FDA link you posted is information for all oral contraceptives, not the transdermal type specifically.

Actually, no, it's not.

Regarding the comments about my using lawyer sources for news on this--it's because many links that would have been relevant were truncated because of being in archives and whatnot, and I wanted complete sources. Anyway, they are using reasonable sources. There is a case because there is a problem, not because lawyers are creating one.
posted by Fisherkitty at 4:43 AM on November 3, 2006

They also estimated that the risk would increase drastically for women whose first birth control experience was with the patch See page 43 of the second Medical Review in the FDA report

That's really not what the linked report says. It actually attributes the risk to the particular kind of hormone contained in the patch, which is not unique to the patch itself.

The problem, as I understand it, actually turned out to be different: the patch ended up delivering much more hormone than it was supposed to.
posted by footnote at 4:44 AM on November 3, 2006

As a close relative to an ambulance-chasing class-action atty, I can assure you that the presence of a lawsuit does not have any reflection on the true safety/danger of a product.

They would sue God himself if they had a shot of serving him with papers.
posted by unixrat at 4:45 AM on November 3, 2006

Those whores deserve it for using birth control and using their reproductive organs for sinful pleasure.

Supporting links?
posted by three blind mice at 4:47 AM on November 3, 2006 [1 favorite]

gaspode: Pregnancy is a well-established risk factors for venous thromboembolism (VTE), with estimates of the age-adjusted incidence of VTE ranging from 5 to 50 times higher in pregnant versus non-pregnant women.

From the FDA (to clarify the blatant hype of the title of this FPP):

Both studies were conducted using electronic health care claims data. However, the results of the two studies are different.

The first study was conducted by the Boston Collaborative Drug Surveillance Program. This study found that the risk of non-fatal VTE events associated with the use of the Ortho Evra contraceptive patch is similar to the risk associated with the use of oral contraceptive pills (OCs) containing 35 micrograms of ethinyl estradiol (an estrogen) and norgestimate (a progestin hormone).

The second study, which also included patient chart review, was conducted by another group of investigators (i3 Ingenix). Results of this second case-control study show an approximate 2-fold increase in the risk of medically verified VTE events in users of Ortho Evra compared to users of norgestimate-containing oral contraceptives containing 35 micrograms of estrogen. Longer follow-up for VTE, heart attack and stroke, has been requested by FDA. [NB: my italics]

The published BCDSP study can be read here. With regard to the second study, a doubling of the rate of an event that occurs with low frequency in a population without risk factors (such as smoking or Factor V Leiden) still gives a very low frequency event. That is, the risk of venous thrombosis is approximately 3-4 per 10,000 woman-years for the users of oral contraceptive pills (OCPs), so the risk if the second study is true is still only 6-8 per 10,000. And it is also important to note that not every DVT (deep vein thrombosis) or PE (pulmonary embolus) is fatal. Especially in young, healthy women. So once you factor in the fatality rate for DVT/PE, you're talking about a low (approximately 4 deaths per million OCP users per year) but non-zero fatality rate.

If you don't want to take a chance with DVT/PE, then use a barrier method of contraception. If you want to minimize your risk of DVT/PE, then know the risk factors: risk increases with age and smoking. Venous thromboembolism is increased among patients with protein C or S deficiency or Factor V Leiden mutation (30-fold increase in women with Factor V who take OCPs). As your doctor/nurse practitioner to use the lowest dose of estrogen possible or consider the use of a non-estrogen method (e.g., progesterone-only or Depo-Provera). Don't smoke and know your family history of thrombophilia (blood clotting).
posted by scblackman at 4:51 AM on November 3, 2006

FDA estimated that 118/100,000 of users would experience blood clots and circulation problems related to the drug

I estimate that more than 118/100,000 experience some kind of complications during pregnancy.
posted by cotterpin at 4:54 AM on November 3, 2006

The FDA link you posted is information for all oral contraceptives, not the transdermal type specifically.

Actually, no, it's not.

Actually, yes it is. "ASSESSMENT ON THE RISK OF VTES ASSOCIATED WITH SO-CALLED THIRD GENERATION COMBINATION ORAL CONTRACEPTIVES (COCS)" Refers not just to the transdermal version. Hence the "oral" part.
posted by rxrfrx at 5:09 AM on November 3, 2006

Metafilter: Actually, no, it's not. Actually, yes it is.
posted by three blind mice at 5:11 AM on November 3, 2006

Yeah, I would hardly call class-action lawyers 'unbiased' or whatever. A lot of these guys are just total sleaze looking for a payout.
posted by delmoi at 5:16 AM on November 3, 2006

Such terrible sources in this post...

Caspode and cotterpin: Of course pregnancy's riskier than hormonal birth control, this isn't about that. This is about the risk of complications from a certain type of birth control, and whether or not it was misrepresented. All contraceptives are associated with risks (and benefits), and people need to be accurately informed about what those risks are before they make their choice.

If you read the FDA's recommendations for EVRA labelling and then go and read the labelling itself, you'll see the manufacturer does have something to answer for. While they do note the cases of pulmonary embolism from their clinical trials, they don't put it in context (in this case, context would have been unfavourable). They then say that the risk of VTE for EVRA compared with other OCPs is unknown, despite reliable analyses and the FDA reviewer's recommendations suggesting otherwise. For the manufacturer to say the risk with EVRA compared with other hormonal contraceptives is unknown is a lie.

Scblackman: Sure, the increased risk doesn't = loads more lives affected, but as minimal as the implications may be they happen in the real world to real people.
posted by teem at 5:20 AM on November 3, 2006

I'm confused - why are the patches being prescribed when there are IUDs and IUSs for no-fuss, constant birth control?

"Intrauterine" remains a bad word in the US after the Dalkon Shield debacle.
posted by ROU_Xenophobe at 5:37 AM on November 3, 2006

I don't see whats so wrong with pulling out. Its a proven technique through the ages.
posted by rsanheim at 5:50 AM on November 3, 2006

teem: Believe me, I deal with rare diseases on a daily basis and fully understand the impact of marginal increases in risk on individual lives. My point is simply that the risk of fatal DVT/PE from exogenous estrogen use (in either OCPs or patches) is miniscule compared to the actual things that cause death in the same age population (adolescent and young adult females). Look at the death summary information by age in NY State for 2003 (it was the thing I could find fastest using The Google): the topic causes of death for the most relevant age groups (20-24 and 25-34 combined) were: 1. accidents, 2. cancer, and 3. heart disease, and 4. AIDS.

Similarly (that is, beating the horse a bit more), the risk of dying from OCP-related venous thrombosis (0.4/100,000) is less than the odds of dying from a bee sting, being struck by lighting or being accidentally shot. My original comment was not intended to minimize the tragedy of the rare death by OCP-induced clot, rather it was to de-hype Fisherkitty's post and provide some real numbers and context.
posted by scblackman at 5:55 AM on November 3, 2006

I'm confused - why are the patches being prescribed when there are IUDs and IUSs for no-fuss, constant birth control?

Because they are incredibly expensive, and a lot of insurance plans don't cover them.
posted by ThePinkSuperhero at 5:56 AM on November 3, 2006 [1 favorite]

Wait, so do you also consider Synthroid to be "faddish?" And Albuterol inhalers? Those are also on that list of the top 300 prescriptions. I better warn my friends with thyroid disease and asthma that their doctors have been prescribing faddish drugs!
posted by needs more cowbell at 6:17 AM on November 3, 2006

I found one source that said that summer heat, sweat, etc., can deliver more of the hormone than the already super-high constant dose, which is a potential problem. The problem was always that the dosage was too high, but events like heat can exasperate that problem. There were cases with pain patches when heat caused increased delivery, for example, and in some cases, people died of an overdose. You all can look it up, because I am not going to post any more sources, there are enough problems with the ones I did post. Anyway. Delivering hormones this way seems intuitively unsafe, but then, apparently it's not. All of you go ahead and use the patch if you think it's safe. It will be fun. I didn't mention that a friend of mine who uses the patch has constant migranes in their "week off" ---well, that's not a reliable source, just one I know about. I guess I should "balance" that with stories of my friend who vomits every month around her period and is not on birth control. The problem must be that women are prone to illness anyway, as people are suggesting. Not irresponsible drug companies who know there is a problem with the product, but also know how wildly popular it will be with people uneducated about the risks. I'm sorry I posted this and even sorrier this is my first FPP.
posted by Fisherkitty at 6:18 AM on November 3, 2006

Oh stop being such a wet hanky Fisherkitty. Nobody here is saying that it's just that women are prone to dying at random. They're pulling out the actual statistics on rate of adverse event and death and comparing it to other causes of such problems.

Whining does not help your case.
posted by Karmakaze at 6:41 AM on November 3, 2006

All of you go ahead and use the patch if you think it's safe. It will be fun.

Oh come on.

Scblackman: Fair point, and there's no question that this was an alarmist post.

(not directed at you scblackman, just general horse beating) The risks are small. But with 9 million prescriptions in 2005 alone, it's likely that people have been affected by this medication. I couldn't say if different labelling would have prevented these patients choosing EVRA, but that's not a decision the manufacturer gets to make.
posted by teem at 6:44 AM on November 3, 2006

It can be hard to get an IUD - you should hear the trials and tribulations of many friends of mine who want one. Many doctors won't give them to young women who haven't spawned, because it can be harder to insert them past the cervix, and because of a slight risk of complications that might damage future fertility.

I personally don't want one because I have a problem with foreign objects floating around in my uterus. So it's hormones (pill) now for me until hubby can get snipped.
posted by agregoli at 6:48 AM on November 3, 2006

This is a non-post. Every single successful (in monetary terms) drug has a class action lawsuit. If a side effect is "elevated stroke risk" and someone who is on the pill also gets a stroke regardless of whether the stroke would have happened without the drug, a lawsuit gets filed. That doesn't mean they win, it just means one gets filed.
posted by Pastabagel at 6:49 AM on November 3, 2006

I, for one, welcome our shuffling slurred-speech sexually adventurous Overlords.
posted by CynicalKnight at 7:02 AM on November 3, 2006

J&J is anxious to settle all of these suits quickly and quietly* for the reason that young women generally do not get strokes. Some already have been settled, but more cases continue to spring up. The patch is extremely lucrative, so they will continue to settle as many cases as they have to...not pull the patch off the market.

I actually do believe that most popular drugs are "fads" but that is just my belief. Some would say that natural remedies exist for almost everything, and with far, far fewer side effects. Is the doctor who was posting before still around? What say you about the effectiveness of non-prescription drugs?

*re: my lack of good sources on this...the AP might have reported a lot of this action, but many papers didn't. Could this be for any reason other than journalistic oversight? I heart conspiracies.
posted by Fisherkitty at 7:02 AM on November 3, 2006

Drugs have possible side effects! Story at 11!

(Actually this is exactly the kind of alarmist crap that makes the local news unbearable).

Everyone who's ever even considered taking hormonal birth control knows there's a higher risk of stroke, blood clots, heart attacks, all that stuff. I honestly thought it was common knowledge. It's not? They say it on TV all the time, like in those commercials for NuvaRing and all that.

If you find a safe, natural "remedy" that stops my ovaries from producing eggs, you let me know.
posted by lampoil at 7:13 AM on November 3, 2006

As Talitha mentioned, the most reliable information suggests that estrogen therapy increases the risk of abnormal blood clots (thrombosis) in women. Exhibit A is the HERS study, which slashed the market for menopausal hormone replacement therapy. A consequence of this study seems to have been the popularization of bisphosphonates for the prevention of bone loss/osteoporosis in post-menopausal women.

The reason that the FDA estimate is higher than the reported event rate from the trials probably has something to do with the trial patient population - they are probably younger and healthier, statistically, than the "real world" population who went on to use the patch; I will have to look for more info on the pivotal clinical studies later.

The important thing to remember here is that all medications carry risks, and that patients and doctors must perform a careful risk-benefit analysis before deciding on any medication. For example, if you are a 41-yr-old smoker who is 50 pounds overweight, the benefits of Ortho Evra probably do not outweigh the risks.

The problem that I see is that medical care in general, and prescription medication in particular, has been commoditized . Ortho Evra is sold as a "lifestyle" product, like an iPod or something, with flashy TV commercials that imply that life will be wonderful if you get on this patch. Older techniques do not have the burnish of newness like Evra, and consequently, people think that they are not the "best" medical care. THe truth is that Evra is probably a good choice - and good medicine - for a small number of women, but there is enormous pressure to make it the first choice of ALL women. This is similar to what happened with the COX-2 inhibitors, Vioxx and Celebrex. These were useful niche drugs that became blockbusters because of some cleverly implied (but never demonstrated) superiority. Most of the people who took Vioxx and had heart attacks should never have taken the drugs, because they were no more effective or safer than older, cheaper products. Merck was a little slimier about hiding their safety data, though.
posted by Mister_A at 7:25 AM on November 3, 2006

"Those whores deserve it for using birth control and using their reproductive organs for sinful pleasure."

Supporting links?
posted by three blind mice at 4:47 AM PST on November 3

http://www.christiananswers.net/
posted by Optimus Chyme at 7:49 AM on November 3, 2006

fisherkitty, you might want to look into this evolution fraud that's being perpetrated on unwitting school students. You seem like just the kind of person who would think that Intelligent Design makes "intuitive" sense.
posted by OmieWise at 7:58 AM on November 3, 2006

JB: The IUD is available in America, as well. However, it occasionally causes problems leading to sterilization, so it's not always used for women who may choose to have children in the future. That particular chain of side-effects is rare, though.

Fisherkitty: 118-in-100,000 having 'circulation problems' isn't the same as 'stroke'. And as a larger note, the risk of circulation problems is something like four to ten times more likely in women who smoke while on birth control. It's a well known risk, and the real problem lies with physicians not making their patients aware of said risk.
posted by talldean at 8:02 AM on November 3, 2006

Talldean wrote: and the real problem lies with physicians not making their patients aware of said risk.

Since the advent of DTC advertising and the attendant commoditization of prescription drugs, patients have become much more likely to march in with their minds already made up about what (medical) treatment they expect to receive. Well-meaning primary care physicians (or in this case, gynecologists) may accede to a patient's request in order to preserve the physician-patient relationship that they have established over many years. The relationship between a patient and his/her GP is crucial to "good" healthcare, and many docs don't want to jeopardize this relationship by not giving the patient what he/she thinks is the "best" medicine, even though something else would do the job as well or better.

The physician has to perform a risk-benefit analysis, comparing the risks of seeming unaccomodating and obdurate to a patient with the benefit of preserving the relationship with the patient. It is unfair to suggest that doctors bear all the responsibility for the over-use of this new and expensive medication.

I should also point out that primary care doctors and gynecologists, as "health managers", are really very good about describing the risks of using various medications or procedures. For Ortho Evra, they will rely on the published, peer-reviewed data about the risk of thrombosis, rather than the FDA estimate. Any primary care provider or gynecologist who fails to inform women about the well-know risks associated with hormone treatments, and the exacerbation of these risks by factors including smoking, deserves to lose his/her license. However, that's just not what's happening.
posted by Mister_A at 8:34 AM on November 3, 2006

Wow, what remarkable timing. I just had my yearly woman's exam by my new on-campus gynocologist yesterday and got a lovely lecture about how taking Ortho Evra is going to kill me, even though I'm young, physically active and fit, have low blood pressure, and don't smoke. Oh, and shouldn't I consider abstinence?

All I have to say is that I've been taking Ortho Evra for well over a year now, and it's one of the best things to ever happen to me. I went from monthly periods with cramps so painful I would vomit to painless periods four times a year--and I get to control when they start. On top of that, my acne cleared up, I experienced a slight weight loss, and my libido increased, all very good things. This is all anecdotal and maybe not all of that can be entirely attributed to the Ortho Evra, but I would gladly accept an increase in an already miniscule stroke risk for that much improvement in my daily life, and the same holds true for many other women I know.

And fisherkitty, if it's this lifestyle comfort that makes the drug a "fad", I have news for you: people will pay money for more comfort in their lives. That's why air-conditioning is such a lucrative business.

And as far as Ortho Evra not being a natural enough option for you, have you looked at what's in it? Estrogen and progesterone (albeit synthetic). I don't know if you ever studied hormones in biology class, but what the patch does is essentially simulate a pregnancy, hormonally speaking. It's hardly a case of science-y voodoo magic, and sounds pretty darn "natural" to me. It's not like there's a hemp alternative for controlling your hormonal cycles.

Also, everyone needs to remember that not all women are on Ortho Evra to keep from getting pregnant. I was on the patch before I was even sexually active, and I still use barrier contraception, too. So to both sides of the fight, the people saying that women have better contraceptive options and the people saying that the health risk is worse with pregnancy, there are other reasons to be on the patch.
posted by internet!Hannah at 8:36 AM on November 3, 2006

"Intrauterine" remains a bad word in the US after the Dalkon Shield debacle.

Yes but that was 20 years ago. Its sad that the feeling that IUD's generally are dangerous has lingered this long.

The IUD is available in America, as well. However, it occasionally causes problems leading to sterilization
posted by French Fry at 8:41 AM on November 3, 2006

"Intrauterine" remains a bad word in the US after the Dalkon Shield debacle.

Yes but that was 20 years ago. It's sad that the feeling that IUD's generally are dangerous has lingered this long.

The IUD is available in America, as well. However, it occasionally causes problems leading to sterilization
posted by French Fry at 8:42 AM on November 3, 2006

jb writes "why are the patches being prescribed when there are IUDs and IUSs for no-fuss, constant birth control?"

Dalkon Shield.

ThePinkSuperhero writes "they are incredibly expensive, and a lot of insurance plans don't cover them"

You can get an IUD in Canada for less than C$100, or about three months of birth control pills. It's an out patient procedure that takes about 5 minutes plus the exam time.
posted by Mitheral at 8:51 AM on November 3, 2006

French Fry--actually, I think a lot of it has to do with application anymore. Compare an IUD with Ortho Evra: one is a foreign body in your uterus (and I can honestly say that's a big deal breaker for me) that can come out or become imbedded (!!!) without being noticed, requires clinic visits to be put in or removed and is put in through the cervix (if you are a male, you probably don't have any idea about how unappealing that idea can be to a woman), while the other is a discreet patch that you swap out once a week, can easily keep track of, and that can have all sort of wonderful hormonal side effects. The IUD has simply been passed up by more convenient options.

Also, as I believe was most doctors aren't comfortable recommending IUDs to women who haven't children, which rules out a large portion of the population that's using these sorts of contraceptives anyways.
posted by internet!Hannah at 8:53 AM on November 3, 2006

Mitheral writes: You can get an IUD in Canada for less than C$100, or about three months of birth control pills. It's an out patient procedure that takes about 5 minutes plus the exam time.

In America, it is more. My doc told me it would be $600 for the... non-hormonal one, and the hormonal would be even more (insurance covering the appointment, but not the device). That's a lot of money if you're not going to use it for the whole 10 years. She also said she generally doesn't recommend them in women who haven't had children yet, although she will do it.
posted by mylittlehipster at 9:04 AM on November 3, 2006

The IUD has simply been passed up by more convenient options

internet!Hannah. Don't get me wrong, I'm not AT ALL saying that the idea of having a plastic (or copper) device implanted in my reproductive organs, sounds either comfortable or appealing. My Point is simply that the modern IUD/IUS is not the DALKON and does not at all present the same risks to women’s health. Although it is often perceived to.

Ortho-Evra, Ortho-Tri, and Nuva-Ring all seem a lot more convenient.
posted by French Fry at 9:12 AM on November 3, 2006

internethannah said: 'Come out without being noticed'

What, the string is for decoration? No, it's to check that it's in place, which one is supposed to do after every period. And a clinic visit every 10 years is barely inconvenient (but then again instead of waiting half an hour for a bus I walked a very cold mile this morning, so maybe I have a skewed version of 'inconvenient.')

That said, docs don't like giving them to us nulliparas for various reasons. It took begging to get my gyn to give me my Paragard instead of a diaphragm when I spontaneously developed hypertension (at 22.)

Personally, I see it like glasses versus lasers-inna-eye; I'd rather have a physical device than chemicals/lasers when it comes to things that are important to me. Depo gives you osteoporosis, this gives you strokes, research into long-term but reversable options is weak because of the penchant for people to sue because they can't make half-clones precisely when they want to, etc.

All that being said, when your headline ends in '...Kills' it seems mighy jumpy to me. Dihydrogen Monoxide kills, too.
posted by cobaltnine at 9:16 AM on November 3, 2006

My condolences to women who have died as a result of this.

.

Also, I'm very sorry this has to happen like this.

.
posted by kayalovesme at 9:59 AM on November 3, 2006

Fisherkitty writes "I found one source that said that summer heat, sweat, etc., can deliver more of the hormone than the already super-high constant dose, which is a potential problem. The problem was always that the dosage was too high, but events like heat can exasperate that problem. There were cases with pain patches when heat caused increased delivery, for example, and in some cases, people died of an overdose."

Anyone who's ever used the nicotine patch to quit smoking and forgot to remove it before working out knows all too well that you can seriously mess yourself up with transdermal patches. It's convenient, but it's frankly it's just not a very good way to administer medication in a regulated manner.
posted by clevershark at 10:07 AM on November 3, 2006

French Fry--my bad, I was trying to disagree with whomever it was said that the reason women are against IUDs was over the Dalkon Shield issue. I see now that wasn't what you were saying.

cobaltnine--Yes, but checking for the string involves getting close and personal with yourself, and there will always be the woman who forgets to look for it that cycle. My point was more that with the patch, you get a visual confirmation it's there everytime you change clothes, no feeling yourself up required. And as far as inconvenience goes, I was speaking from the pespective of someone in the high school to college range, where the initial clinic visit might be more of a hassle than the monthly trips to the pharmacy required by Ortho Evra.
posted by internet!Hannah at 10:12 AM on November 3, 2006

I'm confused - why are the patches being prescribed when there are IUDs and IUSs for no-fuss, constant birth control?

I had an IUD. For about three days. Having it inserted was quite possibly the single most painful experience of my life (labour was a breeze in comparison) and afterwards... I'd never really known until that moment that turning green was not just a figure of speech. The nurse told me that I'd actually done quite well, as she'd seen women faint during the procedure. Three days later, after constant pain and cramps, I had the damn thing taken out, and went back on the pill.

I'm not saying that this is everyone's experience; my cousin liked hers just fine. But I wouldn't touch one again with a forty foot pole.
posted by jokeefe at 10:55 AM on November 3, 2006

Derail, Colbaltnine, Depo can slow absorption of calcium so you have to be sure to get your daily dose of CA. It doesn't cause osteoporosis, not getting enough calcium and genetic factors do that.
posted by stormygrey at 11:08 AM on November 3, 2006

Some would say that natural remedies exist for almost everything, and with far, far fewer side effects.

SOME WOULD SAY! May peace be upon Murdoch.
posted by rxrfrx at 11:14 AM on November 3, 2006

thank you, jokeefe!

After talking to friends and family who'd had IUDs inserted, I was so furious with my ob-gyn for describing the pain of insertion as "a pinch" that I didn't go through with getting an IUD. I'm not tough enough to handle that kind of pain. My MD really pushes IUDs, and doesn't like to prescribe oral BC at all.

Besides the pain of insertion, you have no control over an IUD. If the hormones are screwing with you, you need to make an appointment and wait out another X weeks of hormone-induced insanity before you can get someone to take it out.

Oral BC I can just quit taking when my ob-gyn drags her feet and tries to talk me into waiting "just another couple of months" for my body to adapt when another couple of months would have me committing suicide.

ugh. sorry. I just hate it when IUDs are presented as a no-brainer solution.
posted by small_ruminant at 11:59 AM on November 3, 2006

This article says, and the company's website confirms, that Agile Therapeutics is currently testing a lower-dose estrogen birth control patch. If anybody knows how to become a subject on the clinical trials, please let me know.

One thing that we haven't covered here is the differences between the patch and the pill that may affect the dose. The oral pills have to travel through the digestive tract before they are sent out into the blood stream. So the pill has added compunds and a slightly higher dose of the hormones to account for the environment in your gut. The patch, on the other hand, bypasses the digestive system altogether and deposits the hormones directly into the bloodstream. That may have something to do with the increased risks.

Even though I am a scientist and I understand how drugs are tested and how risks are determined, I am biased in this situation. I would go back on the patch in a minute, clot risks and all, because I am more depressed on the lowest dose monophasic pill than I ever have been, including the two and a half years I was on the patch.
posted by sarahnade at 12:17 PM on November 3, 2006

small_ruminant writes "Besides the pain of insertion, you have no control over an IUD. If the hormones are screwing with you, you need to make an appointment and wait out another X weeks of hormone-induced insanity before you can get someone to take it out. "

Not all IUDs have a hormone component, the cheaper ones just use copper.
posted by Mitheral at 1:40 PM on November 3, 2006

This informational webpage mentions no side-effects causing sterility with IUD/IUS.

I did have some pain for the first few weeks I had mine. Nothing since (5 months). Which is way better than the pill (forgot them, they killed my sex drive anyways), or Depo (the worst - it gave me menopause symptoms at age 23), or diaphram (which is great, but you still have to stop, no spontenaity). The hormones in pills and Depo (three month shot) caused so many problems for me, but the IUS is working fine and not affecting my mood.

Cost is an issue - $600 USD? They are free under NHS, and I remember them being pretty cheap at a birth control clinic in Toronto.

But basically, I remember being told in health class in Canada that IUDs were for older women only, in case of sterility, and I think that was based on old information, maybe decades out of date. But because of it, I went for 7 years with either really unsafe birth control (barrier) or hormonal hell (pills or shot).
posted by jb at 5:31 PM on November 3, 2006

Obligatory link to Gladwell article about John Rock and the invention of the pill. Apparently, cutting out periods reduces the risk of ovarian cancer considerably.
posted by mrgrimm at 6:43 PM on November 3, 2006

Mitheral- true, but the copper ones give you heavy bleeding and massive cramps, which I thought were also hormone related but, now that I think about it, might not be.
posted by small_ruminant at 7:19 PM on November 3, 2006

Two doctors have told me that the reason that some doctors may be hesitant to insert IUDs in younger unmarried women is because those at a higher risk of STIs can have serious complications with infection. I presume this is where all the sterility chatter stems from. Current-day IUDs are very safe.
posted by loiseau at 9:47 PM on November 3, 2006

I'm really surprised that this entire thread has almost completely ignored the very real risk of the patch: that the delivery system turned out to give you 50% more estrogen than regular pills, which, when added to the fact that its hormones are novel, makes it comparatively riskier than older, better known oral birth control pills. Aside from the convenience factor, there's absolutely no reason to use the patch over other forms of hormonal birth control.

It's the age-old story -- pharmaceutical companies marketing new (ie still patent protected) drugs that cost more, have unknown risks, and provide no clear benefit over the old, cheaper drugs. I certainly can't understand what kind of doctor would now prescribe the patch (or ring, for that matter) over the older pills.
posted by footnote at 4:38 AM on November 4, 2006

"...give you 50% more estrogen than regular pills..."

Why did I have to read until the end of the page to find this? I knew this myself, but seriously people, it's the clinching fact.

It also took until half way down the page for someone to mention that all b/c users are very aware of the increased risks with hormonal therapy.

We know well that the synthetic estrogens in birth control are the main cause of specific side-effects such as stroke and high blood pressure. The higher the dose, the higher the risk- hands down. The only advantage of the estrogen is that it decreases incidence of breakthrough bleeding.

It is tricky to optimise a dose that will remain relatively constant while still keeping one healthy and 'spot-free'. It seems to me that a patch would not be well suited to low dosage estrogen, because while it isn't being metabolised (like oral b/c), there is great opportunity to 'lose effectiveness' through pealing, etc.

I don't know. I was happy while I used it , except for its dirty bandaid look. I only switched off of it when I started smoking again which happens to be another contributing risk factor with hormones/strokes. Wouldn't want to tempt it.

What about NuvaRing?
posted by sunshinesky at 12:15 PM on November 4, 2006

What about NuvaRing?

Well, you're not supposed to smoke with it, either.

Their website says the dose remains constant. And I think it's a fairly low level of hormones, especially compared to the patch.

My experience: The first month on NuvaRing was fine. The second I got horribly depressed, lost my libido, & got backaches so bad I could barely walk or tie my shoes. Oh yeah - and a racing heart & breathlessness. I quit after 3 months on it. One week later, all of those symptoms were gone & I felt normal again. (YMMV - I tend to be in that 1% of people with freaky reactions to meds.)
posted by belladonna at 11:05 AM on November 5, 2006