New Contraception Update — Annovera, Phexxi, Slynd, and Twirla

Abstract

Purpose of Review In this review, we discuss the efficacy, safety, and benefits of four new contraceptive products available in the USA, specifically Annovera, Phexxi, Slynd, and Twirla. Recent Findings Annovera is a vaginal ring releasing ethinyl estradiol and segesterone acetate that can be used for up to one year (13 cycles), offering patients an effective, user-controlled option that may improve contraceptive access for those in low-resource settings or those with barriers to retrieving monthly prescriptions; however, given limited efficacy and safety data in people with body mass index (BMI) > 29 kg/m2, clinicians may consider whether Annovera is an appropriate contraceptive method for obese patients if there are other acceptable alternatives. Phexxi prescription-only vaginal gel is a user-controlled, non-hormonal, on-demand contraceptive method that represents a novel addition to the market with its additional uses as a personal lubricant and as a potential microbicide for urogenital infection prevention. Slynd, a drospirenone-only pill, provides more flexibility for delayed or missed pills while maintaining efficacy and a more favorable bleeding profile compared with previously available progestin-only pills. Lastly, Twirla is a transdermal patch releasing ethinyl estradiol and levonorgestrel that offers users an additional option for a user-controlled, combined hormonal contraceptive method without daily dosing; however, prescription is limited to patients with BMI < 30 kg/m2 due to decreased efficacy and VTE events in people with obesity. Summary The addition of these products expands the available options for pregnancy prevention to address unmet contraceptive needs.

Contraception in Medically Complex Adolescents and Young Adults

“…It can be taken so that a withdrawal bleed occurs monthly or in a continuously, similarly to CHCs. 18 …”

Non-Hormonal Contraception

“…The recently approved contraceptive gel, Phexxi, also provides a chemical barrier to conception by buffering the vaginal environment to maintain an acidic pH. It is currently available via prescription and is the only topical contraceptive alternative to N9 approved in the US [77]. With typical use, Phexxi is 86% effective at preventing pregnancy.…”

Is There a Need for a Dedicated Pharmacokinetic Trial for a Drug in Obese Populations? A Drug Prioritization Decision Tree Framework

“…The patch was shown to have decreased efficacy and increased safety risks in subjects with obesity. 74 In the pivotal trials, it was determined that the overall incidence rate of venous thromboembolism (VTE) was 28 per 10,000 women years, and of all of the subjects who experienced VTE, all but one were women who were obese. 75 This increased incidence of VTE in people with obesity could simply reflect an increase in the background rate of VTE in people with obesity, or could reveal a combined effect from the increased background rate in women who are obese and an increased rate linked to the effect of the drug.…”

“…The levonorgestrel/ethinyl estradiol patch is a combination contraceptive patch that can elucidate an area where people with obesity could be especially vulnerable. The patch was shown to have decreased efficacy and increased safety risks in subjects with obesity 74 . In the pivotal trials, it was determined that the overall incidence rate of venous thromboembolism (VTE) was 28 per 10,000 women years, and of all of the subjects who experienced VTE, all but one were women who were obese 75 .…”