Perceptions of contraceptive effectiveness and health effects of oral contraception

The Complexity of Multiple Contraceptive Method Use and the Anxiety That Informs It: Implications for Theory and Practice

Despite clinical guidelines and national data describing the use of one contraceptive method as the best and most common way to prevent unintended pregnancy, limited evidence indicates a more complex picture of actual contraceptive practice. Face-to-face in-depth interviews were conducted in November of 2013 with a sample of women from two cities in the United States (n = 52). The interviews explored the ways participants used contraception to protect themselves from unintended pregnancy over the past 12 months. Most respondents reported using multiple methods, many of which are considered to be less-effective, within this timeframe. The practice of combining methods in order to increase one's level of protection from pregnancy was prevalent, and was mainly enacted in two ways: by backing up inconsistent method use with other methods and by "buttressing" methods. These practices were found to be more common, and more complex, than previously described in the literature. These behaviors were mainly informed by a deep anxiety about both the efficacy of contraceptive methods, and about respondents' own perceived ability to prevent pregnancy. These findings challenge prevailing assumptions about women's contraceptive method use and have implications for clinical contraceptive counseling practice.

Oral contraception

Oral contraception (OC) remains a popular noninvasive, readily reversible approach for pregnancy prevention and, largely off label, for control of acne, hirsutism, dysmenorrhea, irregular menstruation, menorrhagia, and other menstrual-related symptoms. Many OC formulations exist, with generics offering lower cost and comparable efficacy. Certain medical conditions, including hypertension, migraine, breast cancer, and risk of venous thromboembolism (VTE), present contraindications. Blood pressure measurement is the only physical examination or testing needed before prescription. Although no OC is clearly superior to others, OCs containing the second-generation progestin levonorgestrel have been associated with lower VTE risk than those containing other progestins.

The influence of oral contraceptive knowledge on oral contraceptive continuation among young women

BACKGROUND

Using a multidimensional approach, we assessed young women's knowledge of oral contraceptives (OC) and its influence on OC continuation rates.

METHODS

We used data from 659 women aged 13-25 years participating in a randomized controlled trial of an educational text message OC continuation intervention. Women received 6 months of daily text messages or routine care. At baseline and 6 months, we administered a comprehensive 41-item questionnaire measuring knowledge of OC's mechanism, effectiveness, use, side effects, risks, and benefits. We ascertained OC continuation status and reasons for discontinuation at 6 months. We analyzed relationships between OC knowledge and continuation with multivariable logistic regression.

RESULTS

Young women scored, on average, 22.8 out of 41 points on the OC knowledge assessment at baseline and 24.7 points at 6 months. The 6-month OC continuation rate was 59%. OC continuers had >2-points-higher OC knowledge scores at 6 months than discontinuers (p<0.001). Those who reported discontinuing their OCs for side effects and forgetfulness scored >2 points lower than women who discontinued for other reasons (p-values<0.001). In multivariable regression models, each correct response on the baseline and 6-month knowledge assessments was associated with a 4% and 6% increased odds of OC continuation, respectively. Six-month OC knowledge scores were negatively associated with OC discontinuation due to side effects (odds ratio [OR] 0.94) and forgetfulness (OR 0.88).

CONCLUSIONS

OC knowledge, which was low among young women in our study, was associated with OC continuation and common reasons for discontinuation. Continued efforts to characterize relationships between OC knowledge and behavior and to test the effectiveness of different components of interventions aimed at increasing knowledge, addressing side effects, and improving use of OCs are warranted.

Knowledge about various contraceptive methods in young women with and without eating disorders

OBJECTIVE

To determine if young women with eating disorders (EDs) have altered views about the risks/benefits of different forms of birth control than the general population.

METHOD

Data was collected using a cross-sectional, survey-based study of postmenarchal women aged 13-25 years with a diagnosed ED (n = 50) or no history of disordered eating patterns (n =57).

RESULTS

Despite having a higher level of education (p = 0.04) and no differences in sexual history (p = 0.16), ED patients were less knowledgeable than controls about the health risks and benefits, effectiveness in preventing HIV, and effectiveness in preventing pregnancy of various methods of birth control (p≤ 0.05).

DISCUSSION

ED patients may be incorrectly presumed to be asexual while working on recovery; physicians may need to take extra time to educate ED patients about their personal risks of unintended pregnancy, sexually transmitted infections, and the benefits that different methods of contraception can provide.

The impact of an educational text message intervention on young urban women's knowledge of oral contraception

BACKGROUND

Oral contraceptive (OC) knowledge deficits may contribute to OC discontinuation. We examined the effect of an innovative educational intervention on young women's OC knowledge.

STUDY DESIGN

As part of a randomized trial evaluating the impact of text message reminders on OC continuation, we assessed OC knowledge in 659 women ages 13-25 years. Women received routine care or routine care plus 6 months of daily educational text messages. We administered a comprehensive 41-item OC knowledge survey at baseline and 6 months.

RESULTS

Mean OC knowledge scores improved over time for all women (baseline 22.8, 56% correct versus 24.7, 60% at 6 months), including knowledge of OC's mechanisms of action (p=.004), effectiveness (p<.001), side effects (p=.03) and benefits (p<.001). Mean 6-month scores were greater in the intervention (25.5) than the control group (23.7)(p<.001). In multivariable linear regression models, the text message intervention most strongly predicted OC knowledge (β=1.6, 95% confidence interval 0.9-2.2).

CONCLUSION

Daily educational text messages can modestly improve knowledge of OCs, which may promote successful contraceptive outcomes.

The Health Belief Model can guide modern contraceptive behavior research and practice

INTRODUCTION

Theory-based research is needed to understand poor contraceptive behavior and related reproductive health sequelae. The purpose of this review was to examine the Health Belief Model (HBM) as a comprehensive, well-tested social-cognitive framework suitable for explaining and predicting contraceptive behavior.

METHODS

Existing literature, including editorials and research reports, describing HBM-guided contraceptive research between January 1966 and February 2011 was retrieved from established electronic databases. After consideration of inclusion/exclusion criteria, 10 articles were included in the review.

RESULTS

Issues in original family planning applications of HBM included inconsistent conceptualizations of contraceptive behavior and limited use of all HBM constructs in research surveys, interventions, and analyses. Knowledge of contraceptive behavior has evolved, warranting more comprehensive use of the HBM for pertinent reproductive health contexts, behaviors, and methods.

DISCUSSION

With more rigorous applications, the HBM can help us understand modern contraceptive behavior determinants and facilitate strategies to prevent unintended pregnancy and promote positive family planning outcomes.

Measuring oral contraceptive knowledge: a review of research findings and limitations

OBJECTIVE

Poor oral contraceptive (OC) knowledge may contribute to premature OC discontinuation and unintended pregnancy. Yet, to understand relationships between OC knowledge and contraceptive behavior, knowledge must be adequately measured. This review evaluates the findings and methodological limitations of research in which OC knowledge has been measured.

METHODS

We performed a systematic review of primary research from January 1965 to January 2009. Studies were audited for study characteristics, purpose for measuring OC knowledge, key findings and measurement properties including administration method, knowledge domains, reliability, validity, health literacy and cultural sensitivity.

RESULTS

We reviewed 21 studies: 18 cohort studies, including one psychometric evaluation, and three randomized trials. Results on OC knowledge outcomes were variable. Measures were largely self-administered survey (n=15) and lacked assessment of all OC knowledge domains. Information on measures' characteristics, reliability, validity, health literacy and cultural sensitivity was limited.

CONCLUSION

Existing OC knowledge measures lack critical psychometric elements, leading to inconsistent and unreliable findings.

PRACTICE IMPLICATIONS

Poor OC knowledge measurement precludes identifying counseling needs and developing interventions for contraceptive behavior change. Future research considerations include: measurement information in publications, psychometric evaluations, formal reliability/validity techniques, and attention to all OC knowledge domains, health literacy and cultural sensitivity.

Adherence and acceptability of the contraceptive ring compared with the pill among students: a randomized controlled trial

OBJECTIVES

To compare satisfaction with and adherence to the contraceptive vaginal ring and a daily low-dose oral contraceptive pill (OCP) among college and graduate students using a novel method of electronic data collection.

METHODS

We randomly assigned 273 women to the contraceptive vaginal ring (n=136) or OCP (n=137) for three consecutive menstrual cycles. Participants completed daily Internet-based, online diaries regarding method adherence and satisfaction during cycles of use. At 3 months, they completed an online survey regarding intention to continue their method and overall acceptability. At 6 months, we surveyed participants to see whether they continued using contraception and, if so, which method.

RESULTS

Rates of loss to follow-up were similar between groups. Contraceptive vaginal ring users reported more perfect use in the first 2 months (P=.05). After the 3-month study period, 52 (43%) of 121 contraceptive vaginal ring users and 65 (52%) of 126 OCP users reported plans to continue their method (P=.16). However, at 6 months, only 31 (26%) of 117 contraceptive vaginal ring users and 36 (29%) of 123 OCP users had continued their assigned study method (P=.61). Almost 50% of both groups were using condoms or no method.

CONCLUSION

Contraceptive vaginal ring users were more likely to report perfect use during the 3-month trial period than were OCP users. Despite randomization, participants were equally satisfied with their assigned hormonal contraceptive method. At 6 months, less than 30% of participants were still using their assigned method.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov, www.clinicaltrials.gov, NCT00635570.

Attitudes toward contraceptive methods among African-American men and women: similarities and differences

PURPOSE

Men's attitudes toward contraceptives are an understudied area, even though many men participate in contraceptive decision making. The purpose of this study was to examine attitudes and perceptions regarding a selection of contraceptive methods among a national sample of African Americans, with a particular focus on gender differences.

METHODS

Data come from a telephone survey of African Americans (aged 15-44 years) living in the contiguous United States. For the present analyses, the sample was restricted to 152 men and 281 women who reported having had a sexual partner of the opposite gender at some point in their lives. Bivariate analyses compared men and women's ratings of birth control pills, male condoms, female condoms, Norplant, Depo Provera, female sterilization, and male sterilization along several dimensions: bad/good, harmful/beneficial, difficult/easy, dangerous/safe, immoral/moral, and effectiveness. Multiple logistic regressions were performed to determine the association between gender and contraceptive attitudes, adjusting for sociodemographic variables.

RESULTS

Male condoms were given the most favorable ratings along most dimensions by both African-American men and women. In general, ratings of male condoms, female condoms, and Norplant did not significantly differ by gender. African-American men did, however, give female and male sterilization, birth control pills, and Depo Provera significantly poorer ratings than did African-American women.

CONCLUSION

African-American men had less favorable evaluations of some contraceptive methods than did African-American women. Further research is needed to examine how such gender differences may play a role in contraceptive decisions.

Medical Barriers to Effective Contraception

Medical barriers to contraception can prevent women from obtaining, initiating, and continuing their contraceptive method of choice. The barriers include lack of appropriate counseling, delaying initiation for menses or laboratory tests, inappropriate contraindications or mandated warnings, untrained clinicians, and financial or regulatory barriers preventing access by low-income, undocumented, or adolescent women. These barriers may partially explain why almost half of pregnancies in the United States are unintended and occur predominantly in the small proportion of sexually active women not using contraception.

Attitudes toward oral contraceptive use among women of reproductive age: a systematic review

Despite the effectiveness of oral contraceptives (OCs), their popularity differs across populations. Attitudes are a significant factor that influences OC use. This report systematically reviews 28 studies on attitudes toward OC use among women. The Matrix Method was used to review the literature. Affective, cognitive, and behavioral components of attitudes were analyzed, including satisfaction, safety, fear/anxiety, and inconvenience. In general, negative attitudes still prevail across countries. Positive attitudes are more prevalent in Europe. Effective counseling and education are needed for those negatively disposed toward OC use. For favorable users, compliance strategies for longer continuation with OC regimen must be provided.

Satisfaction among women: differences between current users of barrier (male condom) and non-barrier methods

OBJECTIVES

To determine the differences in and factors related to satisfaction between barrier (male condom) and non-barrier method users.

METHODS

A semi-structured questionnaire was used for collecting data for this cross-sectional survey. The questionnaires were completed via one-on-one interviews by the researchers. The study group was selected using stratified random sampling. Exclusion criteria were, being unmarried, pregnant, in postmenopausal status and using traditional methods. A total of 434 currently married women using modern contraceptive methods participated in the study. Contraceptive users were dichotomized into two groups as non-barrier method users and barrier method users.

RESULTS

About half of the participants (n = 191, 44%) were barrier method users. Their mean age was 33.7 +/- 7.3 years, 66.6% (n = 131) were well educated and reported significantly less pregnancies, given births, living children and abortions (reproductive history events) than non-barrier users. Barrier method users were significantly more likely to be satisfied with their contraceptive method of choice (OR: 2.4; 95% CI 1.2-5.2). Among barrier method users, deciding the type of the contraceptive method themselves had significant effect on satisfaction.

CONCLUSION

In our study, satisfaction was mostly affected by heavy side effects and health risks of the methods resulting in less satisfaction with the contraceptive method among non-barrier method users. Other factors which may influence satisfaction deserve further investigation.

Challenges of conducting a placebo-controlled trial for dysmenorrhea in adolescents

We recruited adolescents to study oral contraceptives versus placebo for dysmenorrhea. We anticipated high discontinuation and concerns about safety, side effects, and sexual behavior. Treatment discontinuation (11%) and loss to follow-up (1%) were lower than expected. The most common reason for nonenrollment was logistical issues (63%). Most participants remained abstinent.

Concerns about contraceptive side effects among young Latinas: a focus-group approach

To identify perceptions and attitudes about contraceptive side effects in young, low-income Latina adolescents through focus-group conversations. We conducted seven focus-group discussions with Latino females in an outpatient clinic and community setting. Qualitative methodology was used to analyze data. Participants were recruited from the outpatient gynecology clinic at the University of Illinois at Chicago, and from the Easter Seals Day Care Center. Women were recruited if they were Latino and between the ages of 18 and 26 years (N = 40). Participants cited both perceptions of side effects as well as personal experience with side effects as reasons for not using or discontinuing the use of contraception. Women also demonstrated incorrect knowledge about contraception, and tended to value anecdotal information over information from health professionals. These factors led to reliance on less-effective methods of contraception, placing participants at risk for unintended pregnancy. Concern about side effects, fear of health consequences and misinformation were identified as barriers to effective contraceptive use in young, low-income Latinas. Providers caring for this population should address potential concerns about side effects of contraception as well as assess patients' understanding in light of cultural and language barriers.

[Non contraceptive benefits of oral contraception]

Both women and the medical profession underrate the non-contraceptive benefits of oral contraception, imbued as they are with its sole deleterious effects, such as thromboembolic ones, in particular. However, the pill is quite an efficient means of preventing against troubles of the menstrual cycle, with a betterment of cycle regularity, a diminishing of menstrual flux and a lowering of the frequency and the severity of primary dismenorrhoea. A review of the literature also demonstrates that oral contraception reduce by 40-50% the incidence of endometrial and ovarian cancer, inclusive of women with a previous history, or genetic predispositions. This effect is correlated with time of use and continues until 10 years or more after stopping taking the pill. Also, the positive part of the pill may well be considered as far as colorectal cancer is concerned, with a 40% or so reduction in risk, by means of decreasing bile acids in the colon. Other benefits of oral contraception have been documented, such as prevention of postmenopausal osteopenia when used during perimenopause, decrease in the incidence of adenofibromas, uterine fibromyomas, fibrocystic mastosis and uterine adnexial infections, and, finally, a favourable effect on acne. Preventive action of the pill on rheumatoid arthritis is debatable, the current feeling being that it diminishes severity as well as symptomatology more than risk of occurrence.

Communication about contraception and knowledge of oral contraceptives amongst Norwegian high school students

Communication about contraception and specific knowledge of oral contraceptives (OCs) were examined in a sample (n = 4,650) of Norwegian high school students. Data were collected through a 44-item questionnaire especially developed for the study. The response rate was 73% and data from a total of 1,714 girls and 1,389 boys were eligible for analyses. More females (83%) than males (54%) discussed contraception at least monthly. Discussions were predominantly held with peers and not adults. Females were far more knowledgeable about OCs than males. Respondents knew more about side effects and the pill's relative efficacy than about risks of cancer and tromboembolism. The most significant predictors of high knowledge scores were gender and OC use (females). Also predictive of high knowledge scores were frequent discussions about contraception with peers. Talks about contraception with health workers were unrelated to knowledge scores.

The acceptability of combined oral hormonal contraceptives in Shanghai, People's Republic of China

Although combined oral hormonal contraceptives have been described as the most significant medical advance of the 20th century, the usage rate in the People's Republic of China is considerably lower than in developed countries. This survey aimed to explore the acceptability of combined oral hormonal contraceptives (COC) amongst women aged 18-35 years who attended the family planning clinic in the International Peace Maternity and Child Health Hospital in Shanghai, as well as amongst gynecologists who worked in the same hospital. In total, 500 clients and 89 gynecologists were recruited. Only 12% of the clients had ever used COC. Women with a lower educational level or parous women were more likely to use COC (p < 0.05). COC was the third most popular method recommended by the gynecologists (85.4%). Both groups were concerned about the risks and side effects of COC, especially younger doctors and doctors with fewer years of experience (p < 0.01). The results of the survey suggest that it is necessary to provide improved training about COC to reproductive-aged women and professionals to dispel misunderstandings of the pill.

Oral contraceptives: an update on health benefits and risks

OBJECTIVE

To review the health benefits and risks of oral contraceptives, with an emphasis on emerging noncontraceptive benefits and the pharmacist's role in promoting safe and effective use of these widely prescribed medications.

DATA SOURCES

Published articles identified through MEDLINE (1995-2001) using the search terms oral contraception, neoplasms, cardiovascular disease, menstrual cycle, and other pertinent subject headings. Additional articles and books were identified from the bibliographies of the retrieved articles.

DATA SYNTHESIS

Combined oral contraceptives (COCs), which contain synthetic estrogen and progestin, are the second most common form of birth control for women after sterilization. When taken properly, COCs are highly effective, with a pregnancy rate of 0.1% among perfect users. Also, a growing body of evidence points to multiple noncontraceptive benefits of COCs, including protection from several types of cancer and a variety of gynecologic benefits, such as reduced menstrual bleeding irregularities and fewer ectopic pregnancies. COCs are one of the most studied classes of medications, and they have been found to have an excellent safety profile in nonsmoking healthy women. They may be used continuously until menopause. For women with coexisting medical conditions or other special circumstances, the risks and benefits of COCs must be carefully evaluated before use.

CONCLUSION

More than 40 years after their introduction, COCs remain the leading form of hormonal contraception. By assessing patients' contraceptive needs, evaluating their risk factors, and providing sensitive and thorough counseling, pharmacists can help ensure the safe and effective use of these medications.

Selection of oral contraceptives or hormone replacement therapy: patient communication and counseling issues

Oral contraceptives and combination hormone replacement therapy are underused by most women. Among users, lack of compliance/adherence to oral contraceptive or hormone replacement therapy regimens can lead to discontinuation and deprive women of the full range of benefits achieved through hormone continuity. To prevent unintended pregnancy and to improve the health outcomes of women of all ages and the overall quality of life, adherence and continuation rates need to be improved for oral contraceptive and hormone replacement therapy use. Effective communication and counseling during the oral contraceptive and hormone replacement therapy regimen selection process and subsequent follow-up interactions are essential. Patients need to be informed in a clear and concise manner that, for most women, the benefits of oral contraceptives and hormone replacement therapy outweigh any associated health risks. Data should be presented without epidemiologic jargon and in terms that are easily understood. It is recommended that realistic expectations concerning the possible side effects, especially during the initial use of hormones, are established before use; furthermore, the selection of a formulation should take into account the unique needs of each patient.

Knowledge of the risks and benefits associated with oral contraception in a university-aged sample of users and non-users

As research has shown that knowledge concerning the health risks and benefits of oral contraceptive (OC) use is a contributor to OC compliance, the following study examined an educated sample of young women to determine the level of knowledge concerning the risks and benefits of OC use. A 28-item questionnaire was developed by the research team and distributed to female undergraduate students. Five questions were designed to assess the respondent's knowledge of OC. Overall, it found that OC users answered 71.9% of the questions correctly, whereas non-users answered significantly fewer questions correctly. As well, the number of correct responses increased with academic year, indicating that younger women were less knowledgeable about OC. The results of this study indicate that despite increased efforts to educate women, knowledge of OC remains a major problem, even in a sample of women with relatively high socio-economic status.

Perceptions of hormonal contraceptive safety and side effects among low-income Latina and non-Latina women

OBJECTIVES

We explored perceptions of the safety and side effects of oral and injectable hormonal contraceptives among low-income women at high risk of unintended pregnancy.

METHODS

Overall safety perceptions, specific health concerns, and the relationship between these safety perceptions and contraceptive choices were determined by focus groups and questionnaires obtained from white non-Latina (n = 19), English-speaking (n = 21), and Spanish-speaking Latina women (n = 19).

RESULTS

Uncertainty or ambivalence about the safety of oral and injectable contraceptives was reported by 41% and 70% of respondents respectively, while 20% considered these methods to be mostly harmful. Personal experiences and stories from social networks proved to be more salient than medical opinions in shaping safety perceptions. Side effects and concerns about long-term health effects were common themes. While white non-Latina women focused predominantly on physical side effects, emotional side effects also contributed to Latinas' decisions about contraceptive switching. Spanish-speaking Latinas differed from English-speaking Latinas in other attitudinal dimensions, contraceptive use prevalence, and access to contraceptive services.

CONCLUSION

Low-income mothers lacked confidence in method safety and had many concerns about the side effects of oral and injectable contraceptives. Because such concerns can be a barrier to contraceptive use, these perceptions need to be corrected to encourage more effective use of hormonal methods and to prevent unintended pregnancies. Culturally appropriate interventions should focus on client-provider interactions, social networks, and access to care.

Oral contraceptives. Risks

The modern combination oral contraceptive (OC) has become a mainstay in the effort to provide safe, reliable, and effective contraception. Safety concerns with OC use have largely been laid to rest as a result of multiple and extensive studies. Even so, misperceptions about the risks of OC use and a relative lack of recognition concerning the numerous and important noncontraceptive benefits limit their use, thus putting women in needless danger for unintended pregnancy. Indeed, even fears concerning breast cancer risk and OC use have been unsubstantiated by an abundance of data. Clinicians should be aware of the safety of low-dose OCs so that they can provide accurate and individualized counseling concerning the applicability of OCs and other contraceptive methods.

Health benefits of oral contraceptives

A sizeable literature corroborates the multiple health benefits of oral contraceptive use. The first estrogen/progestin combination pills were marketed to treat a variety of menstrual disorders. Although currently used oral contraceptives no longer carry FDA-approved labeling for these indications, they remain important therapeutic options for a variety of gynecologic conditions. Well-established gynecologic benefits include a reduction in dysmenorrhea and menorrhagia, iron-deficiency anemia, ectopic pregnancy, and PID. Although older, higher-dose pills reduced the incidence of ovarian cysts, low-dose pills suppress follicular activity less consistently. Nevertheless, cycle-related symptoms, including functional cysts, dysmenorrhea, chronic pelvic pain, and ovulation pain (mittelschmerz), generally improve. Women with polycystic ovary syndrome note improvement in bleeding patterns and a reduction in acne and hirsutism. Symptoms from endometriosis also improve with oral contraceptive therapy. Current data suggest that oral contraceptive therapy increases bone density and that past use decreases fracture risk. Oral contraceptives also improve acne, a major health concern of young women. Oral contraceptives provide lasting reduction in the risk of two serious gynecologic malignancies--ovarian and endometrial cancer. The data with respect to ovarian cancer are compelling enough to recommend the use of oral contraceptives to women at high risk by virtue of family history, positive carrier status of the BRCA mutations, or nulliparity, even if contraception is not required. Health care providers must counsel women regarding these benefits to counteract deeply held public attitudes and misconceptions regarding oral contraceptive use. Messages should focus on topics of interest to particular groups of women. The fact that oral contraceptives increase bone mineral density and reduce ovarian cancer is of great interest to women in their forties and helps influence use and compliance in this group. In contrast, the beneficial effects of oral contraceptives on acne resonates with younger women. Getting the good news out about the benefits of oral contraceptives will enable more women to take advantage of their positive health effects.

Patient acceptability and satisfaction with Lunelle monthly contraceptive injection (medroxyprogesterone acetate and estradiol cypionate injectable suspension)

The results from a User Satisfaction Questionnaire, Treatment Assessment Questionnaire, and Global Well-Being Schedule questionnaire administered to women participating in an open-labeled, nonrandomized, parallel, controlled study comparing a new monthly injectable contraceptive containing 25 mg of medroxyprogesterone acetate (MPA) and 5 mg of estradiol cypionate (E2C) (MPA/E2C) (Lunelle Monthly Contraceptive Injection) and a triphasic norethindrone (0.5, 0.75, 1.0 mg)/0.035 mg ethinyl estradiol (NET/EE) oral contraceptive (Ortho-Novum 7/7/7) are reviewed. Approximately 85% of all 1103 women enrolled in the comparative trial completed their initial and final questionnaires. To better assess the comparison of a new and extant method of contraception, outcome data were divided among MPA/E2C users and new and previous oral contraceptive (OC) users. Despite the inherent inequalities in comparing an injectable to an oral method of contraception, few treatment assessment and satisfaction outcomes were significantly different when comparing MPA/E2C users to new OC (NET/EE) users. More women in the MPA/E2C study group reported discomfort with their method than women in either NET/EE study group; however, only 19.4% of MPA/E2C users rated the administration of their contraceptive to be moderately uncomfortable or worse, compared to 11.7% of new NET/EE users and 13.4% of previous OC users. Among MPA/E2C users, 86.3% reported no interference with social activities compared with 90.4% of new NET/EE users. MPA/E2C and new NET/EE users were also similar in their responses recommending their respective contraceptive method to friends, with > 90% of both groups stating that they had a very favorable experience and would definitely recommend their method to a friend. In general, MPA/E2C was well accepted by women in the study group. Their attitudes and perceptions are similar to those of women who were starting OCs for the first time. These data support the premise that MPA/E2C may become a well accepted, first-line contraceptive option for women in the US.

Oral contraceptive health benefits: perception versus reality

Many women remain unaware of classic oral contraceptive (OC) noncontraceptive health benefits even as new health advantages emerge from experience and research. An extensive body of evidence has established that OC protect women against dysmenorrhea and menorrhagia, menstrual cycle irregularities, iron deficiency anemia, ectopic pregnancy, pelvic inflammatory disease, ovarian cysts, benign breast disease, endometrial cancer, and ovarian cancer. In addition, the FDA has stated for the first time that an OC-triphasic norgestimate/35 micrograms ethinyl estradiol--is an effective treatment for moderate acne vulgaris. OC use also appears to prevent osteopenia in hypoestrogenic women. In addition to these noncontraceptive health benefits, OC have proven valuable in the management of a variety of gynecologic disorders, including dysfunctional uterine bleeding, persistent anovulation, premature ovarian failure, functional ovarian cysts, pelvic pain (including secondary dysmenorrhea), mittelschmerz, endometriosis, and the control of bleeding in women with blood dyscrasias. Educating healthcare providers and women about these important noncontraceptive health benefits will result in increased compliance, greater continuation, and fewer unintended pregnancies.

Oral contraception: current use and attitudes

Oral contraception (OC) has been available for almost four decades. During this time, changes in contraceptive use in general and OC in particular have occurred. Knowledge and attitudes about OC may not always reflect trends in use. Contraceptive use data from 1965-1995 show that OC continue to be the method chosen consistently by more than one-quarter of women contraceptors. Probably even more women would use the pill if they had more accurate information regarding the higher failure rates with barrier methods (especially the condom), if misperceptions about OC safety were put to rest, and if greater awareness of the noncontraceptive health benefits of OC could be achieved. Increased education and awareness of women as well as their healthcare providers has the potential to positively affect future contraceptive use.

Clinician/patient interaction: communicating the benefits and risks of oral contraceptives

Myths and misperceptions continue to influence women's opinions about oral contraceptives (OC), despite the immense body of evidence regarding OC safety and efficacy. Patient opinions about OC failure rates and health risks are often far from proven fact, and the health benefits of OC are too often unrecognized. Because successful OC use requires an informed patient, effective communication between clinicians and their patients is needed to correct misinformation, relieve unnecessary fears, and increase OC use. A variety of interactive counseling skills and attitudes can improve the process of patient counseling; they are especially crucial for adolescents, who may be reluctant or unable to easily articulate their concerns. Counseling messages can be geared specifically to the interests and concerns of particular age groups: adolescents, young adults, and perimenopausal women. With thoughtful planning and involvement of all members of the healthcare team, clinicians can create time and opportunities for the provision of consistent, appropriate counseling to all candidates for OC use.