Oral contraceptive discontinuation: A prospective evaluation of frequency and reasons

Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, North Carolina, United States
American Journal of Obstetrics and Gynecology (Impact Factor: 4.7). 10/1998; 179(3 Pt 1):577-82. DOI: 10.1016/S0002-9378(98)70047-X
Source: PubMed


Our purpose was to define the frequency and reasons for oral contraceptive discontinuation and subsequent contraceptive behavior.
A nationwide prospective study of 1657 women initiating or switching to the use of a new contraceptive from private practices, clinics, and a health maintenance organization was performed.
Six months after a new oral contraceptive prescription, 68% of new starts and 84% of switchers still used oral contraceptives. Of women who discontinued, 46% did so because of side effects, whereas 23% had no continuing need. More than four fifths of women who discontinued oral contraceptives but remained at risk of unintended pregnancy either failed to adopt another method or adopted a less effective method. Fifteen percent of women who discontinued oral contraceptives resumed their use within the 7-month follow-up period.
Counseling should emphasize the possibility of side effects, stressing the fact that most will be transient, and the need to identify a backup method. Follow-up visits should be scheduled for 1 to 2 months after a prescription is written.

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    • "Significant statin discontinuation rates have been reported, especially amongst younger patients and asymptomatic cases.28,29 In the case of OC users, Rosenberg and Waugh30 reported that 80% who stopped using their OCs either adopted another less effective method of contraception or completely discontinued, even though they were still at risk of unwanted pregnancy. In an Australian study,31 approximately 90% of pregnancies amongst women aged under 18 years were unintended and 80% amongst those aged 18–24 years. "
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    ABSTRACT: In Australia, "continued dispensing" (CD) is a new model for supply of prescription medications. Under specific circumstances, community pharmacists are allowed to dispense a further one month supply of prescription only medications without a valid prescription. It allows continuation and treatment adherence when patients run out of statin and/or oral contraceptive (OC) medications, when it is not practical or they fail to plan accordingly to get a new prescription.
    Full-text · Article · Aug 2014 · Patient Preference and Adherence
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    • "In addition, the physician must be able to provide an alternative method, should compliance prove difficult with the initially chosen one [28]. In this study, a recommendation for switching was made by the clinician after analyzing the reasons for noncompliance of the users, although this recommendation was made to a lower percentage of women using the vaginal ring than to the other groups (pill, 51.8%; patch, 58.2%; vaginal ring, 19.4%). "
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    ABSTRACT: Understanding contraception from the perspective of the user may help to improve compliance. The aim of this project was to determine the factors that influence the noncompliance in young women that use combined hormonal contraceptives (pill, patch or vaginal ring). A nationwide cross-sectional multicenter epidemiology study. Physicians [obstetricians/gynecologists]) recorded socio-demographic, clinical and current contraception data of 8,762 women. Women completed a self-administered questionnaire on compliance. After the assessment of self-administrated questionnaire, the physicians reported on their recommendations on the possibility of changing the contraceptive. Fifty-two percent of women were noncompliant, mainly because of simple forgetfulness (pill, 74.9%; patch, 47.8%; vaginal ring, 69.1%). The percentage of noncompliant women was lower in vaginal ring users (26.6%) than in patch users (42.4%) or pill users (65.1%) (p < 0.0001). The most common course of action after noncompliance was to take/use the contraceptive as soon as possible. In the multiple logistic regression analysis, the use of the pill increased the probability of noncompliance compared with the patch and the vaginal ring (odds ratio [IC95%]: 2.53 (2.13-3.02) and 4.17 (3.68-4.73, respectively), and using the patch compared with the vaginal ring (1.65 (1.36-1.99)). Others factors associated with noncompliance were: high treatment duration, low degree of information on the contraceptive method, understanding of instructions on the contraceptive method, indifference to becoming pregnant, lack of partner support, not participation in selecting the method, not having a routine for taking treatment and difficulties remembering use the contraceptive method. Switching contraceptive method was proposed by the physicians to 43.2% of women (51.8% of pill users, 58.2% of patch users and 19.4% of vaginal ring users). More than 50% of combined hormonal contraceptive users did not comply with the treatment regimen. The percentage of noncompliant women was lower between vaginal ring users. Understanding user's reasons for noncompliance by the clinician and encouraging a collaborative approach can go a long way to improving compliance.
    Full-text · Article · Oct 2013 · BMC Women's Health
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    • "A prospective study from the USA found that 68% of new pill users continued with the pill at 6 months [12]. Assuming a pill continuation rate of 50% at 12 months with conventional use, then 182 women in each arm of the trial would give 80% power at 5% significance to detect an absolute difference of 15% (or more) in continuation rates for the other arm, that is, over 65% or less than 35% at 12 months for either of the alternative ways of taking the pill. "
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    ABSTRACT: Background: There is growing interest from women and clinicians in extended or tailored use of the combined oral contraceptive (COC) pill. Potential advantages include less bleeding, greater contraceptive efficacy and user satisfaction. We examined the effect of a tailored pill regimen, compared with the standard regimen, on continuation and satisfaction rates at 1 year and associated bleeding patterns. Study design: This was a randomized controlled trial with 503 women aged 18-45 years. Women were randomized to either the standard regimen (21 daily pills followed by a 7-day pill-free interval) or tailored regimen (daily pills until three consecutive days bleeding triggers a 3-day pill-free interval) of Microgynon 30® (ethinyl oestradiol 30 mcg, levonorgestrel 150 mcg). Primary outcome was COC continuation at 12 months; secondary outcomes included satisfaction with pill regimen regarding contraception and bleeding pattern. Daily electronic diaries were used to record women's pill use, switching to other contraceptive methods, menstrual bleeding patterns and satisfaction levels. Results: Eighty-three percent of women were already taking the COC at recruitment, 13% were restarting the COC and 4% were first time COC users. Seventy-one percent of all women were followed up at 12 months. Continuation rates at 1 year were 82% in the tailored arm versus 80% in the standard arm [odds ratio (OR)=1.13; 95% confidence interval (CI)=0.67-1.91]. Satisfaction with contraceptive regimen was 86% (tailored) versus 94% (standard) (OR=0.37; 95% CI=0.17-0.79), and satisfaction with bleeding pattern was 79% versus 87%, respectively (OR=0.53; 95% CI=0.30-0.93). Median number of bleeding days per month was 2.4 (tailored) and 4.9 (standard). Incidence, duration and intensity of bleeding episodes were significantly lower in the tailored arm. Conclusions: In women familiar with standard use of the COC, switching to tailored COC use or continuing with standard use were both associated with high COC continuation rates and high satisfaction with contraceptive regimen and bleeding pattern. While significant differences tended to favor the standard group, tailored COC use was associated with significantly less bleeding, suited some women very well and can provide a suitable alternative to standard use.
    Full-text · Article · Apr 2013 · Contraception
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