PMID- 18254023
OWN - NLM
STAT- MEDLINE
DCOM- 20080414
LR  - 20200511
IS  - 1469-493X (Electronic)
IS  - 1361-6137 (Linking)
IP  - 1
DP  - 2008 Jan 23
TI  - Skin patch and vaginal ring versus combined oral contraceptives for 
      contraception.
PG  - CD003552
LID - 10.1002/14651858.CD003552.pub2 [doi]
AB  - BACKGROUND: The delivery of combination contraceptive steroids from a skin patch 
      or vaginal ring offers potential advantages over the traditional oral route. The 
      skin patch and vaginal ring could require a lower dose due to increased 
      bioavailability and improved user compliance. OBJECTIVES: To compare the 
      contraceptive effectiveness, cycle control, compliance, and safety of the skin 
      patch or the vaginal ring versus combination oral contraceptives (COCs). SEARCH 
      STRATEGY: We searched MEDLINE, POPLINE, CENTRAL, EMBASE, and LILACS for trials of 
      the contraceptive patch or the vaginal ring. We contacted manufacturers and 
      researchers to identify other trials. SELECTION CRITERIA: All randomized 
      controlled trials comparing the skin patch or vaginal ring with a COC. DATA 
      COLLECTION AND ANALYSIS: Data were abstracted by two authors and entered into 
      RevMan. For dichotomous variables, the Peto odds ratio (OR) with 95% confidence 
      intervals (CI) was calculated. For continuous variables, the weighted mean 
      difference was computed. MAIN RESULTS: We found three trials of the skin patch 
      and eight of the vaginal ring. Contraceptive effectiveness was similar for the 
      patch or ring and the comparison COC. Patch users reported more compliant cycles 
      than COC users; ORs were 2.05 (95% CI 1.83 to 2.29) and 2.76 (95% CI 2.35 to 
      3.24) in two trials. One crossover ring trial had more noncompliance for the ring 
      users. Satisfaction with method was higher for ring users than COC users in two 
      studies. More patch users discontinued early than COC users: OR 1.58 (95% CI 1.25 
      to 1.99) and 1.45 (95% CI 1.11 to 1.90) in two trials. Patch users also had more 
      discontinuation due to adverse events (AEs). The ring trials generally showed 
      similar discontinuation for ring and COC users. Compared to COC users, patch 
      users were more likely to report breast discomfort, dysmenorrhea, nausea, and 
      vomiting. Ring users reported less nausea, irritability, and depression than COC 
      users in single trials. However, ring users had more vaginitis and leukorrhea. 
      Bleeding problems were generally similar or less common for the ring versus COC. 
      AUTHORS' CONCLUSIONS: Effectiveness rates were similar for the methods compared. 
      The patch group had better compliance than the COC group. Compared to COC users, 
      patch users had more side effects. Ring users generally had fewer adverse events 
      than COC users but more vaginal irritation and discharge. The patch could lead to 
      more discontinuation while the vaginal ring showed little difference. High losses 
      to follow up can affect the validity of the results.
FAU - Lopez, L M
AU  - Lopez LM
AD  - Family Health International, Clinical Research Department, P.O. Box 13950, 
      Research Triangle Park, North Carolina 27709, USA. llopez@fhi.org
FAU - Grimes, D A
AU  - Grimes DA
FAU - Gallo, M F
AU  - Gallo MF
FAU - Schulz, K F
AU  - Schulz KF
LA  - eng
PT  - Journal Article
PT  - Review
PT  - Systematic Review
DEP - 20080123
PL  - England
TA  - Cochrane Database Syst Rev
JT  - The Cochrane database of systematic reviews
JID - 100909747
RN  - 0 (Contraceptive Agents, Female)
RN  - 0 (Contraceptives, Oral, Combined)
RN  - 0 (Drug Implants)
SB  - IM
UOF - Cochrane Database Syst Rev. 2003;(1):CD003552. PMID: 12535478
CIN - Evid Based Nurs. 2008 Oct;11(4):108. PMID: 18815320
UIN - Cochrane Database Syst Rev. 2010;(3):CD003552. PMID: 20238323
MH  - Consumer Behavior
MH  - Contraceptive Agents, Female/*administration & dosage/adverse effects
MH  - *Contraceptive Devices, Female/adverse effects
MH  - Contraceptives, Oral, Combined/administration & dosage/adverse effects
MH  - *Drug Implants/adverse effects
MH  - Female
MH  - Humans
MH  - Pregnancy
MH  - Randomized Controlled Trials as Topic
RF  - 48
EDAT- 2008/02/07 09:00
MHDA- 2008/04/15 09:00
CRDT- 2008/02/07 09:00
PHST- 2008/02/07 09:00 [pubmed]
PHST- 2008/04/15 09:00 [medline]
PHST- 2008/02/07 09:00 [entrez]
AID - 10.1002/14651858.CD003552.pub2 [doi]
PST - epublish
SO  - Cochrane Database Syst Rev. 2008 Jan 23;(1):CD003552. doi: 
      10.1002/14651858.CD003552.pub2.