Recently, newer forms of contraceptives have been developed, such as contraceptive patches, vaginal rings, and injectable combination hormones. Each of these is designed to suppress ovulation and in this regard will lower the ovarian production of androgens. As of yet, these formulations have not been studied in the treatment of acne. The contraceptive patch (Ortho Evra) contains 20 mg of ethinyl estradiol and 150 mg of the progestin, norelgestromin. The patch is worn for three weeks and removed for one week, during which time menstrual bleeding will occur. The advantages of this formulation are better patient compliance, dosing that is not affected by gastrointestinal disturbances, and more consistent serum levels of estrogen serum levels compared to oral dosing (56). The vaginal ring (NuvaRing) is a contraceptive vaginal ring that releases 15 mg of ethinyl estradiol and 120 mg of the progestin, etonogestrel. It is placed within the vagina for three weeks and removed for one week. In one study, the incidence of irregular bleeding was less compared with an oral combination contraceptive (57). An injectable combination of estradiol cypionate and medroxyprogesterone acetate (Lunelle) has been developed. This is given as a monthly contraceptive injection. Contraceptive efficacy was shown to be comparable to a triphasic oral contraceptive containing ethinyl estra-diol and norethindrone (Ortho 7/7/7) (58).
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