COMMENTARY

Two New Contraceptive Methods: More Choice or More Risk?

Andrew M. Kaunitz, MD

Disclosures

September 11, 2018

Hello. I am Andrew Kaunitz, professor and associate chair in the Department of Obstetrics and Gynecology at the University of Florida College of Medicine in Jacksonville.

Recently the US Food and Drug Administration (FDA) approved two new forms of birth control. The first, known as Annovera, is a vaginal ring developed by the Population Council; it releases a combination of the new progestin segesterone acetate along with ethinyl estradiol.[1] As with the currently available contraceptive vaginal ring NuvaRing, Annovera is placed vaginally for 3 weeks and then removed for 1 week. However, although a new NuvaRing is placed every 28 days, Annovera can be used for up to 1 year. Accordingly, some women will find the 1-year duration of this contraceptive to be an important advantage over existing methods, including pills, the patch, and the NuvaRing.

The second fertility control method recently approved by the FDA is more controversial. It's a mobile phone app to facilitate fertility awareness.

The Natural Cycles app helps women track their body temperature and menstrual cycle, and advises when they should avoid sexual intercourse (or use other contraceptives such as condoms) on the most fertile days.[2]

I have likened contraceptive options to a cafeteria, meaning that more choices is a good thing. However, some are concerned that FDA approval of a fertility awareness contraceptive strategy will encourage women and couples to believe that this method may be as effective as oral contraceptives and other, more effective forms of birth control.

In fact, studies have clarified that failure rates with fertility awareness methods are higher than with oral contraceptives, and much higher than with long-acting methods like IUDs and implants.[3]

In closing, it will be interesting to see whether approval of the 1-year Annovera leads to more women choosing vaginal ring contraception.

With respect to fertility awareness methods, among US women using contraception, some 3% currently use this approach.[4] It will also be interesting to see whether the availability of the Natural Cycles app increases this percentage.

The FDA's approval of these new but very different contraceptives is welcome news. However, women and couples considering use of the Natural Cycles app should be aware of how its efficacy compares with other methods. Ideal candidates for use of fertility awareness methods may be those for whom an unintended pregnancy would not represent a major concern.

Thank you for the honor of your time. I'm Andrew Kaunitz.

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