New Contraceptives: Your Guide to Slynd, Phexxi, Nextellis, Anoverra, and Twirla - Kamm McKenzie OBGYN

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New Contraceptives: Your Guide to Slynd, Phexxi, Nextellis, Anoverra, and Twirla

There is a lot more out there when it comes to contraception than “The Pill.” Did you know that five new contraceptives have been approved by the Food and Drug Administration (FDA) in the past five years!? In this blog post, we’ll delve into these new contraceptives—Slynd, Phexxi, Nextellis, Anoverra, and Twirla—each offering unique features and benefits. These effective methods expand birth control access and acceptability, so that more patients can take control of their family planning.

Slynd: The new and improved progestin-only pill

Slynd, a progestin-only pill FDA approved in May of 2019, has gained attention for its unique formulation. Unlike traditional progestin pills which contain norethindrone, Slynd utilizes drospirenone. Drosperinone offers several advantages over norethindrone including a longer half life and more reliable ovulation suppression. These differences set Slynd apart, reducing side effects common with other progestin-only pills, like irregular bleeding. With a 24/4 active-to-inactive pill ratio, Slynd offers improved efficacy and flexibility. It’s a great option for those who want a reliable, estrogen-free, daily birth control pill.

Phexxi: On-demand and hormone-free contraceptive gel

For individuals looking to avoid hormonal contraception, Phexxi offers a unique, non-hormonal approach. Phexxi, FDA approved in May of 2020, is a vaginal pH regulator that maintains the naturally acidic environment of the vagina. Unlike other vaginal contraceptive options (spermacides), which contain the cell membrane disruptor nonoxynol-9—Phexxi simply maintains an acidic vaginal pH, which immobilizes sperm and enhances anti-microbial defenses. In fact, the gel is currently being studied for use in preventing sexually transmitted infections! In terms of effectiveness at preventing pregnancy, Phexxi is 93% effective with perfect use, and 86% effective with typical use. The gel comes in pre-filled, single-use applicators for convenient, on-demand use.

Nextellis: A new type of estrogen for your birth control pill

Nextellis represents a breakthrough in oral contraceptive pills, combining a native estrogen “estetrol” with drospirenone. Estetrol is naturally produced by the human fetal liver during pregnancy. It has greater tissue selectivity than ethinyl estradiol (the estrogen in traditional oral contraceptive pills) which can reduce side effects commonly associated with the pill, like breast tenderness. For individuals seeking effective oral contraception with potentially fewer estrogen-related side effects, Nextellis stands out as a compelling choice. Nextellis was FDA approved April 2021.

Anoverra: Procedure-free, long-acting, reversible contraceptive

Anoverra offers a long-acting reversible contraceptive (LARC) option, without an uncomfortable office procedure (like IUD or implant insertion). This small, flexible ring combines etonogestrel and ethinyl estradiol to provide effective contraception, and was FDA approved in August of 2018. The ring is inserted into the vaginal canal, providing three weeks of continuous protection. After three weeks, the ring is removed for seven days to allow for a withdrawal bleed. The same ring is then replaced and this process can be repeated for a whole year! The convenience of Anoverra, coupled with its reversible nature, makes it an attractive choice for those seeking a low-maintenance contraceptive method with the option for quick, procedure-free discontinuation when planning for pregnancy.

Twirla: A weekly patch for your convenience

Birth control patches, although not nearly as popular as their pill counterparts, also deliver combination estrogen/progestin contraception—just through the skin. Twirla was FDA approved in February of 2020, and delivers a combination of levonorgestrel and ethinyl estradiol. This weekly patch can be applied to the abdomen, buttock, or upper torso, and offers a convenient alternative for individuals who may forget to take a daily pill. With its once-weekly application, Twirla provides a reliable and discreet birth control option. Twirla differentiates itself from the earlier patch, Xulane (which contains ethinyl estradiol and norelgestromin) with lower peak and steady-state estrogen and progestin levels. Similar to Xulane, efficacy is reduced in users with overweight and obese BMI.

The landscape of new contraceptives has expanded within the past five years to accommodate diverse preferences and needs. Whether you prioritize non-hormonal methods, monthly convenience, long-acting solutions, or the ease of a patch, these new contraceptives—Slynd, Phexxi, Nextellis, Anoverra, and Twirla—offer a range of choices. As always, consulting with your women’s healthcare provider is crucial to finding the most suitable birth control method based on individual health considerations and lifestyle.

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