Recent Advances in Oral and Transdermal Contraception

Peggy Piascik, PhD

Disclosures

US Pharmacist. 2008;33(9):19-23. 

In This Article

Chewable Oral Contraceptive and Use of COCs in Older Women

Femcon Fe contains 35 mcg ethinyl estradiol and 0.4 mg norethindrone in a spearmint-flavored pill that can be swallowed or chewed. The tablet should be followed immediately by a full 8 oz. of liquid. The proposed advantage of this product is ease of administration.[20] The seven brown tablets in the HFI contain 75 mg ferrous fumarate.

Perimenopausal women commonly experience hot flashes and dysfunctional uterine bleeding. Hormone replacement therapy can treat vasomotor and menstrual symptoms, but does not prevent ovulation. A patient taking COCs who experiences hot flashes during the HFI may be switched to an extended-cycle product. The use of COCs in older women confers both effective birth control and noncontraceptive benefits like increased bone mineral density and reduced risk of ovarian and endometrial cancer.[21]

Despite the benefits of COC use in older women, significant risks are associated with hormone use. Women over the age of 39 who take COCs have four times the risk of venous thromboembolism (VTE) compared with adolescents. The incidence in these women is 100 cases per 100,000 woman-years; obesity increases the risk.[21] COC users with a history of hypertension may have an increased risk of heart attack and stroke, and hypertension and smoking act synergistically to increase the risk of stroke and heart attack in COC users.[22] Therefore, women over 35 years of age should not take estrogen-containing contraceptives if they smoke or have diabetes, migraines, or hypertension. COC use does not appear to increase the risk of stroke or heart attack in healthy nonsmokers over age 35; oral contraceptives can be continued in these women until age 55.[22] Depot medroxyprogesterone acetate or the levonorgestrel intrauterine device (IUD) may be appropriate for women in whom COCs are contraindicated.

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