Ortho Evra Birth Control Patch and Diving

[Orion DM]

Hi,

In regards to the birth control patch, I was wondering whether somehow the changes in pressure while diving might cause more hormones to be released.

The question was kind of answered in this thread http://www.scubaboard.com/t10223-.html
but it referred specifically to Nicotine patches, I don't know enough about patches to know if it would apply universally so if anyone has an answer specifically related to the Ortho Evra birth control patch.... I would appreciate the info.
Thanks


scuba pirate Patch absorption and pressure
That's a good question. it turns out the patch absorption of nicotine is dependent on the concentration of nicotine at the skin surface.
Since the patch is flexible, there is no pressure gradient between the patch and the underlying skin.
At 68 fsw, the patch is at 3 ATA, and the skin beneath it is exposed to 3 ATA.
Hence, the only diffusion that occurs is due to the concentration gradient of the nicotine, and pressure cancels out of the equation.

Please don't make fun of me, the world needs nerds, too!

(I started out in 1970 to be an engineer, but couldn't write well enough, so I had to become a doctor.)


See you underwater, with or without patches!

John"

I also emailed DAN and got the following response,
"Thank you for your e-mail and membership support. There are too
many variables to accurately predict the effect of the marine
environment on the patch. The manufacturer does state that swimming is
permissible. Being submerged for the length of time that you may
potentially be is very different than swimming. Speaking with dive
physicians the pressure of the water would most likely not affect
hormone levels. Diving in colder water (70F or less) affects circulation
to the skin. With cold, blood vessels constrict. That may change the
rate of absorption. We wish we could provide a more definitive answer.
If we can be any further assistance do not hesitate to contact DAN.

The part I highlighted is the most important part to me, I appreciate the "Most likely" but as we are talking about Birth Control here, uncertainty is NOT a good thing :07:
I am talking about Puget Sound diving, sometimes in a Wetsuit, sometimes in a Drysuit.
Sorry the post is so long, wanted to include all the info I have so far.

 

[pharmguy]

I also emailed DAN and got the following response,
"Thank you for your e-mail and membership support. There are too
many variables to accurately predict the effect of the marine
environment on the patch. The manufacturer does state that swimming is
permissible. Being submerged for the length of time that you may
potentially be is very different than swimming. Speaking with dive
physicians the pressure of the water would most likely not affect
hormone levels. Diving in colder water (70F or less) affects circulation
to the skin. With cold, blood vessels constrict. That may change the
rate of absorption. We wish we could provide a more definitive answer.
If we can be any further assistance do not hesitate to contact DAN.

The part I highlighted is the most important part to me, I appreciate the "Most likely" but as we are talking about Birth Control here, uncertainty is NOT a good thing :07:
I am talking about Puget Sound diving, sometimes in a Wetsuit, sometimes in a Drysuit.
Sorry the post is so long, wanted to include all the info I have so far.

Oh how I wish more of my female clientele were concerned about contraceptive failure!!

From the monograph:

"For EE, slight increases were observed due to sauna, whirlpool and treadmill: however the Css values following these treatments were within the reference range. There was no significant effect of cold water on these parameters."

There was no change in the amount absorbed or the concentration of the progestin component of the patch in any experiement. Css is the steady state concentration of the drug and so the Css of the estrogen (EE) did not vary siginificantly with the varied treatments.

My humble conclusion:

Althougth the are a couple of factors that will vary the absorption of the patch (decreased Css with increasing age, body weight and body surface area) diving either wet or dry should not affect the overall pharmacokinetics of the system. There should be sufficient levels of hormones to prevent contraception and I would not expect any clinically significant absoprtion due to the pressure or the physical activity (i.e. increased blood flow, warm water increasing permeability of skin cells). I would caution applying the patch on a part of the body that is prone to rubbing or motion but any of the 4 sites suggested should be fine.

A possible solution would be to remove the patch during the dive and reapply - the amount of time spent without the patch is negligible compared to the overall kinetics. The patch would need to be stored securely so that it does not lose its adhesive ability and this would not be feasible for multiple applications. I would only consider this option if you were diving once per week.

I have put a call into to my Jansen-Ortho rep and will relay any relevant info as soon as they get back to me.

Regards,

Jason

 

[goodknight411]

I've worn the patch while diving for the past year. Now I'm not wearing it to prevent pregnacy so I can't say whether diving affects that. But I haven't had any breakthrough bleeding or other symptoms that could be caused by a change in hormone amounts after diving. I would figure that the relatively short amount of time spent under pressure compared to time on surface wouldn't cause a noticable effect.

Jason suggested taking the patch off while diving. I doubt this would work. In my experience once the patch comes off there aint no putting it back on. I do agree however to avoid areas that rub. I've found the best spot to be on my stomach just inside the rim of my hip. When I wore the patch on my butt it tended to come off easily and move around while doing anything physical.

I would like to hear a physiological/chemical explination of the effects on the release of hormones while diving though. Wouldn't want to end up with a suprise someday.

 

[opiniongirl]

I tried it and my tongue swelled to 3x....any weirdo side effects, I'm sure to get it...sigh...

 

[Orion DM]

Althougth the are a couple of factors that will vary the absorption of the patch (decreased Css with increasing age, body weight and body surface area) diving either wet or dry should not affect the overall pharmacokinetics of the system. There should be sufficient levels of hormones to prevent contraception and I would not expect any clinically significant absoprtion due to the pressure or the physical activity (i.e. increased blood flow, warm water increasing permeability of skin cells).

A possible solution would be to remove the patch during the dive and reapply - the amount of time spent without the patch is negligible compared to the overall kinetics. The patch would need to be stored securely so that it does not lose its adhesive ability and this would not be feasible for multiple applications. I would only consider this option if you were diving once per week.

Please tell me you meant "provide contraception"? :10:

Good suggestion, unfortunately as a DM I am doing sometimes 3 days a day for a weekend plus whatever fun diving I squeeze in during the week. I have also found that they don't want to go back on once you take them off.

Now I am wondering, in the hypothetical that there is an increase in hormones emitted (probably not the right word but...) is there enough extra in the patch to compensate for a few dives a week? I am going to go back and read the fine print in the prescribing info package and see if I turn anything up.

Thanks for answering, I appreciate it.

Orion DM

 

[pharmguy]

Please tell me you meant "provide contraception"?

Yes. I am surfing while at work so I had just finished a Plan B counsel and had that in my wee little brain while I was typing.

Now I am wondering, in the hypothetical that there is an increase in hormones emitted (probably not the right word but...) is there enough extra in the patch to compensate for a few dives a week? I am going to go back and read the fine print in the prescribing info package and see if I turn anything up.

All patches have a reservoir of medication which is the driving force behind the release into the skin. Each Canadian Evra patch has a total of 6.0 mg of norelgestromin (NEG) and 0.75 mg of ethinyl estradiol (EE) that is supposed to release 0.150 mg NEG and 0.02 mg EE every 24 hours. Even after 7 days there should be a pretty siginificant reservoir left.

Of course the Jansen medical rep has pleaded lack of information and won't propose any answers without a specific study. He agrees that pressure should not affect the release of the medication as it is should not be siginificantly different at the skin vs at the patch . He would not hypothesize at the exercise/water issues though.

I suggested that he supply you and several other SB ladies with the patch for free as a clinical trial. I got a good laugh but that was all.

Take care

Jason

 

[goodknight411]

Thanks for the info. Too bad about the study

 

[Orion DM]

Yes. I am surfing while at work so I had just finished a Plan B counsel and had that in my wee little brain while I was typing.

All patches have a reservoir of medication which is the driving force behind the release into the skin. Each Canadian Evra patch has a total of 6.0 mg of norelgestromin (NEG) and 0.75 mg of ethinyl estradiol (EE) that is supposed to release 0.150 mg NEG and 0.02 mg EE every 24 hours. Even after 7 days there should be a pretty siginificant reservoir left.

Of course the Jansen medical rep has pleaded lack of information and won't propose any answers without a specific study. He agrees that pressure should not affect the release of the medication as it is should not be siginificantly different at the skin vs at the patch . He would not hypothesize at the exercise/water issues though.

I suggested that he supply you and several other SB ladies with the patch for free as a clinical trial. I got a good laugh but that was all.

Take care

Jason

Free patches, heck, if they'll do the trial I'll supply my own!
Anyway, thank you for all your answers and help, they are very much appreciated.
Orion DM

 

[AmyJ]

I had a terrible time keeping mine on... I was diving wet.... maybe the salt water affected it, becuase I hadn't had any problems previously in other conditions. I finally gave it up for any diving trips. I just switch back to the pill for the week or whatever, then back on when I'm out of the salt water.

 

[MookieMoose]

I had a terrible time keeping mine on... I was diving wet.... maybe the salt water affected it, becuase I hadn't had any problems previously in other conditions. I finally gave it up for any diving trips. I just switch back to the pill for the week or whatever, then back on when I'm out of the salt water.

If you're not bothered by a little more adhesive on your skin one thing you could try is puting a piece of saran wrap over the patch site and taping it in place with some waterproof medical tape. It probably won't keep things 100% dry, but would keep most of the water off the site. The tape can usually be found in most large drug stores, just make sure it's the waterproof kind - usually it's a pink/flesh-coloured plastic tape.