Edition 76 - Sexual Health Discontinuation of Hormonal Contraception: A Systematic Review and Metanalysis

Abstract

Introduction Around the globe, unintended pregnancy rates remain high, especially among women in low and middle-income countries. A major contributor is contraceptive discontinuation. This study aims to synthesize the rates of early hormonal contraceptive discontinuation (i.e., discontinuation prior to 12 months of use) and the impact of side effects on discontinuation. Methods A systematic review of seven databases covered articles published between 2011 and 2021. Observational studies that assessed choices about hormonal contraceptive use were included in the final review. As reported in each article reviewed, the pooled proportions of early contraceptive discontinuation rates were calculated using a random effects model. Qualitative and quantitative data about the influence of side effects on discontinuation of hormonal contraception were synthesized using a narrative approach. Results Fifty studies met the inclusion criteria. The pooled overall early discontinuation rate was 26% (95% CI: 21–32%). The pooled early discontinuation rates for short-acting hormonal methods like oral contraceptives and injectables were 42% (95% CI: 20–67%) and 21% (95% CI: 7–40%), respectively. Meanwhile, the pooled discontinuation rates for long-acting hormonal methods like implants and intrauterine devices were 22% (95% CI: 16–28%) and 17% (95% CI: 11–24%), respectively. The side effects mentioned most frequently as contributing to hormonal contraceptive discontinuation were abnormal bleeding, abdominal pain, nausea, vomiting, cramping, headaches, mood changes, and sexual and genitourinary side effects. Discussion/ Conclusion High rates of early contraceptive discontinuation persist with varying levels of discontinuation based on contraceptive type. Side effects play a major role in hormonal contraceptive discontinuation. However, there is a dearth of evidence on managing side effects, making this an important area for future research.