By Richard Harkness
Knight Ridder Newspapers

Q: My daughter has been using the Ortho Evra patch for birth control. I’m concerned about the recent warning that it can increase the risk for blood clots. What would you advise?

A: Ortho Evra is a contraceptive in patch form that became available in 2002. It’s placed on the skin for a period of one week and then replaced with a new patch. The patch releases its hormonal ingredients into the bloodstream steadily over that time period.

On Nov. 10, the FDA warned that Ortho Evra exposes users to about 60 percent more estrogen than a low-dose oral contraceptive pill containing 35 mcg of estrogen.

It’s well-established that hormone pills such as oral contraceptives and menopausal hormone replacement therapy are associated with some degree of increased risk for abnormal blood clots.

Generally, you want to use the lowest effective dose of estrogen, as the risk appears to escalate as the dose increases.

Life-threatening blood clots can lodge in the veins of the legs or lungs, and less frequently, in the arteries of the heart (heart attack) or brain (ischemic stroke).

It should be said that the absolute risk of these serious complications appears to be small.

Generally, hormonal contraceptives are most risky in women who have cardiovascular risk factors such as high blood pressure, diabetes, high cholesterol, obesity, or a history of severe migraine headaches. Women older than 35 who smoke also are at higher risk.

In regard to the Ortho Evra patch, however, a recent analysis by the Associated Press gives pause for extra concern.

The AP reported that patch users die and suffer blood clots at a three-times-higher rate than women taking the pill.

Especially worrisome is the finding that most of about a dozen users who died of clot-related complications in 2004 were young — in their late teens and early 20s.

Patch-delivery systems have an advantage over pills in maintaining consistent levels of drug in the blood.

It’s possible that the higher than expected levels of estrogen maintained by the Ortho Evra patch might ratchet up the risk.

If so, retooling it to deliver less estrogen could be an option.

If your daughter wants to get off the patch, she might consider switching to a low-dose oral contraceptive pill containing 35 mcg or less of estrogen (ethinyl estradiol).

Another alternative is the NuvaRing, a contraceptive ring designed to be inserted into the vagina and left in place for three weeks.

She could finish her current cycle of Ortho Evra, then start the new contraceptive product when she would normally start a new cycle.

If she wishes to discontinue the patch prior to the end of the cycle, she should use a backup method of contraception until breakthrough bleeding occurs.

She should check with her doctor or pharmacist for specific instructions on starting the contraceptive product she switches to.

Caution: Don’t try to cut the patch in half to get less estrogen. This distorts the release of drug and may make it less effective or unsafe.

login to post comments