Depo Now: preventing unintended pregnancies among adolescents and young adults

Initiation of Oral Contraceptives Using a Quick Start Compared With a Conventional Start

OBJECTIVE

To estimate whether young women taking the first pill on the day of prescription had higher continuation rates and lower pregnancy rates than women who waited until menses to start the oral contraceptive pill (OCP).

METHODS

We recruited 1,716 women aged younger than 25 years seeking to initiate the oral contraceptive at three publicly funded family planning clinics, and randomly assigned them to conventional initiation of the pill (conventional start) or immediate, directly observed ingestion of the first pill (quick start) during the clinic visit. Women underwent follow-up interviews at 3 and 6 months.

RESULTS

Sixty percent of participants discontinued the pill, and 8% became pregnant during follow-up. Women who took the first pill in the clinic were more likely to continue to the second OCP pack (odds ratio 1.5, 95% confidence interval 1.0-2.1.); however, the Quick Start approach did not improve OCP continuation rates at 3 and 6 months. Those assigned to Quick Start were slightly less likely to become pregnant within 6 months from the time they started the pill (hazard ratio 0.90, 95% confidence interval 0.64-1.25). Eighty-one percent of women rated the Quick Start approach as acceptable or preferable to waiting. Rates of serious adverse events were low and similar in the two groups.

CONCLUSION

Protocols that require a woman to wait until the next menses to start hormonal contraceptives are an obstacle to contraceptive initiation. Directly observed, immediate initiation of the pill improves short-term continuation.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov, www.clinicaltrials.gov, NCT00068848

How do health care professionals respond to advice on adverse side effects of contraceptive methods? The case of Depo Provera

CONTEXT

Depomedroxyprogesterone acetate (DMPA) (Depo Provera) is a long-acting contraceptive popular in the United Kingdom, particularly among young women. In the United States, use of DMPA has been instrumental in reducing teenage pregnancy rates. Evidence for a detrimental effect of DMPA on bone mineral density led to advice from drug regulatory authorities in the United Kingdom and the United States, recommending caution in prescribing DMPA, particularly for young people.

OBJECTIVE

The study was conducted to explore changes in practice in response to prescribing advice about DMPA among primary care doctors and nurses working in the UK.

METHODS

A self-completed questionnaire sent to 420 primary care health professionals.

RESULTS

In response to the advice, 16% of practitioners would deter all women, and one third would deter young women, from using DMPA. One in five practitioners would limit use of DMPA to 2 years. Fewer than one in 10 would suggest contraceptive implants as an alternative contraceptive.

CONCLUSIONS

The response of primary care professionals in their prescribing advice about DMPA risks increasing rates of unintended pregnancy in the UK, particularly among teenagers. The findings demonstrate an urgent need for a clear, balanced approach to advising health professionals on how to respond to new findings about adverse effects of contraceptives.