Alternative Methods of Hormonal Administration

Transdermal patch (Ortho-Evra)

Transdermal patches are an alternative method for administering combined estrogen and progestin that increases the compliance of the patient and might lower the user-failure rate of combination hormonal contraception. The transdermal patch (Ortho-Evra) are patches that are changed weekly. They are administered for 3 weeks with one week off. The use of transdermal patches has decreased since recent studies suggest they lead to an increase in cardiovascular events when compared to traditional COCs.

Vaginal ring (Nuvaring) 

A contraceptive vaginal ring (Nuvaring) is an intravaginal ring that releases continuous progestin and estrogen. They are changed monthly with three weeks of ring use and one week off. The hormones that are released from the contraceptive vaginal ring are absorbed through the vaginal epithelium.

Only Progestin Administration

Progestin administration works by inhibiting ovulation, thickening the cervical mucous, and causing atrophy of the endometrial lining. Progestin can be administered in oral, injectable, or subdermal implants on a continuous basis. Women have to be compulsive for the maximum efficiency as there is no pill-free interval. The implantable or injectable forms are effective and lack the requirement of responsibility.

Progestin administration is less effective and is associated with more breakthrough bleeding than the combination of estrogen and progestin. It does have fewer serious side effects, as progestin does not promote clotting, which would not cause a risk of heart attacks or stroke regardless of age or smoking status. Progestin administration also lowers HDL but has not been shown to contribute clinically to heart disease. Although there are fewer serious side effects, the FDA requires the same thrombosis precautions on all hormonal contraceptives.


Depo-Provera is 150 mg of a medroxyprogesterone acetate in a sustained release suspension that is administered every three months. This method is extremely effective, with a failure rate of 0.3% during the first year of use. Ammenorrhea is experienced in 50% of women who use depo-provera after one year of use. The most common side effects are irregular bleeding and an increase in weight. When depo-provera is no longer being used, the average return to fertility is 9-10 months.

Subdermal Implant

Implanon is a subdermal implant that is a single rod that releases etonogestrel. Implanon is very effective for three years. The mechanisms of action in this subdermal implant are very similar to the other progestin-only methods. The most common reason for discontinuation of the implant is irregular bleeding.


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Human Reproduction: A Clinical Approach Copyright © 2023 by Dr. Hala Bastawros, M.D is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, except where otherwise noted.