Oral contraceptive discontinuation: a prospective evaluation of frequency and reasons

Abstract

Objectives: Our purpose was to define the frequency and reasons for oral contraceptive discontinuation and subsequent contraceptive behavior.

Study design: 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.

Results: 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.

Conclusions: 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.

PIP: Oral contraception is the most commonly used contraceptive method in the US (approximately 30% of women in reproductive ages). This nationwide prospective cohort study was conducted to define the frequency and reasons for oral contraceptive discontinuation and subsequent contraceptive behavior. The study enrolled 1657 women who were starting or switching to new methods of contraceptives from private practices, clinics, and health maintenance organizations between March 1995 and May 1996. These women were given new contraceptive prescription during their visit to the physician. There were 3 questionnaires completed by the patients regarding their compliance to oral contraceptives and the use of the prescribed contraceptives. Results of the study show that 6 months after prescription was received, 68% of starters and 48% switchers continue the use of oral contraceptives, while 46% discontinued the method because of side effects and 23% felt there was no more need for continuation. Majority of the women who discontinued the use of oral contraceptives and were at risk of unintended pregnancy failed to use or adopt another method. This study concludes that counseling is vital particularly in presenting the possibility of side effects, stressing of the facts, and the need to identify a backup method, with follow-up visits after 1-2 months after receiving prescription.