Oral Contraceptive Compliance Research Articles

Magnetic Resonance Imaging (MRI) of hormone-induced breast changes in young premenopausal women

ObjectivesWe conducted a pilot study to identify whether MRI parameters are sensitive to hormone-induced changes in the breast during the natural menstrual cycle and whether changes could also be observed during an oral contraceptive (OC) cycle. Materials and MethodsThe New York University Langone Medical Center Institutional Review Board approved this HIPAA-compliant prospective study. All participants provided written informed consent. Participants were aged 24-31 years.We measured several non-contrast breast MRI parameters during each week of a single menstrual cycle (among 9 women) and OC cycle (among 8 women). Hormones were measured to confirm ovulation and classify menstrual cycle phase among naturally cycling women and to monitor OC compliance among OC users. We investigated how the non-contrast MRI parameters of breast fibroglandular tissue (FGT), apparent diffusion coefficient (ADC), magnetization transfer ratio (MTR), and transverse relaxation time (T2) varied over the natural and the OC cycles. ResultsWe observed significant increases in MRI FGT% and ADC in FGT, and longer T2 in FGT in the luteal vs. follicular phase of the menstrual cycle. We did not observe any consistent pattern of change for any of the MRI parameters among women using OCs. ConclusionsMRI is sensitive to hormone-induced breast tissue changes during the menstrual cycle. Larger studies are needed to assess whether MRI is also sensitive to the effects of exogenous hormones, such as various OC formulations, on the breast tissue of young premenopausal women.

Using changes in binding globulins to assess oral contraceptive compliance

BackgroundValidity of oral contraceptive pill (OCP) clinical trial results depends on participant compliance. Ethinyl estradiol (EE2) induces increases in hepatic binding globulin (BG) levels. Measuring these BG increases may provide an effective and convenient approach to distinguish noncompliant from compliant OCP users in research settings. This analysis evaluated the usefulness of measuring increases in corticosteroid-, sex-hormone- and thyroxine-binding globulins (CBG, SHBG and TBG, respectively) as measures of OCP compliance. MethodsWe used frozen serum from a trial that compared ovarian suppression between normal-weight and obese women randomized to one of two OCPs containing EE2 and levonorgestrel (LNG). Based on serial LNG measurements during the trial, 17% of participants were noncompliant. We matched noncompliant participants with compliant participants by age, body mass index, ethnicity and OCP formulation. We measured CBG, SHBG and TBG levels and compared change from baseline to 3-month follow-up between the noncompliant and compliant participants. Construction of receiver operator characteristic (ROC) curves allowed comparison of various BG measures. ResultsChanges in CBG and TBG distinguished OCP noncompliant users from compliant users [area under the ROC curve (AUROC), 0.86 and 0.89, p<.01]. Changes in SHBG were less discriminating (AUROC 0.69) ConclusionsEE2-induced increases in CBG and TBG provide a sensitive integrated marker of compliance with an LNG-containing OCP.

Predictors of noncompliance in an oral contraceptive clinical trial

BackgroundThis analysis was conducted to identify the participant characteristics associated with noncompliance in an oral contraceptive (OC) clinical trial. Study DesignWe studied ovarian suppression among normal-weight and obese women during the use of levonorgestrel (LNG)-containing combination OCs. Participants underwent twice weekly phlebotomy during the study cycle and received up to $360 for participation. Along with other study assays, we analyzed 903 specimens from 181 women to measure LNG to assess OC compliance. Consistently undetectable LNG levels indicated noncompliance. To evaluate predictors of OC noncompliance during this study, we compared the characteristics of compliant and noncompliant participants using multivariable logistic regression. We assigned each participant to a relative poverty level based on US census data; all other individual characteristics came directly from participant responses during the baseline interview. ResultsOne hundred eighty-one women completed the study; 31 were noncompliant (17%). In multivariable analyses, poverty level was the strongest predictor of noncompliance. Compared with those women in the quartile with the lowest level of residential poverty, other women were far more likely to be noncompliant, especially women in the quartile with the greatest prevalence of poverty (adjusted odds ratio, 8.4; 95% confidence interval, 1.5–46.1). Additional factors associated with noncompliance were education level less than a bachelor's degree and Hispanic ethnicity. Other demographic and psychometric measures were not associated with compliance. ConclusionsWe found that noncompliance was strongly associated with residential poverty level, an indirect measure of individual income. In the United States, poverty is associated with female obesity, Hispanic ethnicity and low education, which were also associated here with noncompliance. Study compensation may motivate poor individuals to participate in clinical trials for income. Noncompliance in clinical trials, particularly differential noncompliance, jeopardizes study validity.

Feasibility study of the use of a daily electronic mail reminder to improve oral contraceptive compliance

Women who ingest their oral contraceptive pill (OCP) as part of a daily routine are more likely use their OCPs correctly. This trial examines the feasibility of an electronic-mail (e-mail) reminder system to improve OCP compliance. An e-mail reminder was sent to 50 new OCP users daily for 3 months. Subjects sent an e-mail reply to confirm receipt. OCP compliance was recorded on diaries. Four subjects were discontinued for not checking their e-mail. Active participants missed a median of 18% of the e-mail reminders (range: 0–65%). A follow-up visit was scheduled after completion of three OCP cycles. Of the 40 subjects returning completed diaries, 50% missed no active pills at all and 20% missed at least one in each cycle. Most found the daily e-mail somewhat (65%) or very helpful (19%) for OCP compliance. Of those continuing OCPs, 64% wanted to continue receiving e-mail reminders at the completion of the study. Because inconsistent OCP use is a significant cause of unplanned conception, the use of e-mail to improve OCP compliance has the potential to decrease unintended pregnancies.

Improving compliance in oral contraception: 'the reminder card'

Objectives: To assess oral contraceptive compliance and to evaluate the reminder card device as a means of improving compliance. The study also aimed to evaluate ease of use of the card and women'sattitudes to it after several months of use.Methods: In France, 975 women requesting oral contraception (whether repeat prescription or first-time use) were asked retrospectively about missedpills during the previous 3 or 6 months. The decision of whether or not to provide a patient with a reminder card at inclusion was left to the gynecologist. Usefulness of and satisfaction with the remindercard were also assessed.Results: Of all study participants, 60% acknowledged missing at least one pill since starting oral contraception. Compliance appeared to be significantly better in cardusers than non-users (p < 0.001). More than 80% of card users stated that the device had prevented them from forgetting to take the pill on at least one occasion. Forty-six per cent of preventedmissed pills occurred during the first week of the cycle. No pregnancies were recorded. Among the card users, 98% found the card easy to use and 97% were satisfied with the card.Conclusions:Use of the reminder card significantly improved compliance. Users found the reminder card acceptable and easy to use. This type of reminder device could potentially reduce the number of unwanted pregnanciesand hence the number of requests for pregnancy termination.

Side effects and oral contraceptive discontinuation in rural Bangladesh

Using data from a survey on oral contraceptive (OC) compliance in rural Bangladesh, this study examines the role of side effects on OC discontinuation along with other potential predictors. A total of 1403 currently married women aged 15–49 years were interviewed; of these 43% discontinued OCs. Of the women who discontinued, 53% did so because of side effects, which was the main self-reported reason for OC discontinuation. Multivariate analysis revealed that after adjusting for duration of OC use, women who experienced side effects were 1.4 times more likely to discontinue OC use than their counterparts without such experience. Discontinued OC use was also associated with being Muslim, not being visited by field-workers, OC use as first method of contraception, lack of husband’s support, and was inversely associated with duration of OC use. Adequate counseling about OC use, emphasizing the possibility of side effects, and better management of them, coupled with improved client-provider interaction and husband’s supportive role could help in reducing OC discontinuation in rural Bangladesh.

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.

Yasmin — a New Oral Contraceptive, a New Progestogen: The Reasons Why

There are over 60 million women using oral contraceptives worldwide, yet there are wide differences between different countries in the use of oral contraceptives and, in particular, in discontinuation rates. Large differences in rates of sterilization and of teenage pregnancy also highlight the fact that there are considerable geographical differences in oral contraceptive use. There are probably many reasons for these differences, including lack of information about the non-contraceptive benefits of oral contraceptives, differences in national health-care policies and systems, women’s fears about side-effects and possible side-effects, and social, cultural and religious differences. In order to provide better choices of oral contraceptives, there is a need to consider new oral contraceptives, such as Yasmin® (Schering AG, Berlin, Germany), which is formulated with ethinylestradiol and drospirenone, a progestogen which is pharmacologically very similar to progesterone. Unlike other progestogens, drospirenone is associated with weight stability or slight weight loss due to less water retention, one of the factors which is known to be of great importance in supporting compliance with oral contraceptives. Drospirenone also shares with some other progestogens the capacity to improve acne and seborrhea in hyperandrogenic women. Taken together, these properties make it likely that the combination of ethinylestradiol with drospirenone will contribute to improving oral contraceptive compliance, thereby maximizing the overall benefits of oral contraception.

The importance of field-workers in Bangladesh’s family planning programme

This study explored the importance of field-workers in Bangladesh's Family Planning Programme. Three separate sources of data were used to develop the analysis. The first data set provides information that was collected as part of a study to calculate the costs of both clinic and home service delivery program of the government. The second data set provided information on the perspective of the field-workers' clients to determine the level of knowledge, attitudes and practices concerning specific issues of oral contraceptive compliance. The third source of data provided information on the willingness and ability to pay for doorstep delivery of contraceptives in two rural areas. Using the three independent studies, it was shown that the length of client-provider interactions was short, and that the percentage of visits in which various family planning, and maternal and child health topic discussion was low. Furthermore, clients lack important information on contraceptives and do not put a high value on interactions with field-workers. The vast majority of clients view the field-worker program as a convenience and not as an important source of information. Furthermore, the studies show even poorer quality of care services, and the reported visits of the field-workers often do not involve discussions on family planning methods. The results indicated that field-workers are not doing a good job in motivating women to adopt contraceptive use. In addition, the high cost and low quality of services indicate that other models of service delivery need to be considered.

Causes and consequences of oral contraceptive noncompliance

Compliance difficulties are more common among oral contraceptive users than is generally appreciated. Inconsistent use and method discontinuation are estimated to account for approximately 20% of the annual 3.5 million annual unintended pregnancies in the United States. In the past research focused on adolescents, for whom predictors of poor oral contraceptive compliance include multiple sex partners, low evaluation of personal health, low degree of concern about pregnancy, and previous abortion. More recent research confirms that compliance problems are common among all age groups, with 47% of women missing ≥1 pill per cycle and almost a quarter (22%) missing ≥2 pills per cycle. Good compliance has been linked to patient satisfaction with the clinician, the absence of certain side effects, establishing a regular daily routine to take oral contraceptives, and reading information distributed with oral contraceptive packaging. Clinicians are the focal point for improving oral contraceptive compliance. They should focus counseling on the transience of most side effects, instructions on dealing with a missed pill, provision of a backup method, and establishment of a daily pill-taking routine. Easy-to-understand literature should be given to patients to take home. (Am J Obstet Gynecol 1999;180:S276-9.)

Adolescent contraception.

Adolescent pregnancy rates have declined modestly, most likely because of the increased use of condoms, especially at first intercourse. Condom distribution in schools appears to be effective in promoting condom use without increasing sexual activity. Although, to date, no contraceptive has been as effective as Norplant in reducing teen pregnancy, use of the method has declined dramatically. Depo-Provera use is increasing, but continuation rates are disappointing and the impact on teen pregnancy rates is as yet unknown. Emergency contraception remains underutilized, and interventions to improve oral contraceptive compliance are beginning to be explored. School-based programs that provide contraception without adding a strong educational component fail to improve contraceptive use or reduce pregnancy rates. Use of any contraceptive by teens is cost effective.

Oral Contraceptive Compliance during Adolescence

Annals of the New York Academy of SciencesVolume 816, Issue 1 p. 422-431 Oral Contraceptive Compliance during Adolescence D. SERFATY, D. SERFATY Saint-Louis Hospital 9 rue de Villersexel 75007 Paris, FranceSearch for more papers by this author D. SERFATY, D. SERFATY Saint-Louis Hospital 9 rue de Villersexel 75007 Paris, FranceSearch for more papers by this author First published: 17 December 2006 https://doi.org/10.1111/j.1749-6632.1997.tb52172.xCitations: 10Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume816, Issue1Adolescent Gynecology and Endocrinology: Basic and Clinical AspectsJune 1997Pages 422-431 RelatedInformation

Compliance with contraceptives and other treatments

To define some of the issues unique to compliance with oral contraceptives, and some comparisons with other preventive and therapeutic treatments. Reports of compliance with medical treatment were used, with a focus on studies using microelectronic monitoring to assess compliance. Studies included the general population and a variety of demographically different groups. Twenty-nine studies of medication compliance (including surveys and clinical trials with specific interventions), across a broad range of medical disorders, were selected for comparison with reports of oral contraceptive compliance. Rates of compliance with contraceptive methods are low, but differ little from rates of compliance with other medical treatments. Several questions might be used to ascertain the likelihood that an individual is willing to use an oral contraceptive as prescribed (eg, willingness to take a daily pill, to return for follow-up, and to report adverse effects). Studies of a variety of medical disorders have shown that no consequence is so severe that all patients can be assumed to comply with the prescribed treatment plan. Inadequate compliance often diminishes treatment efficacy, which suggests the need for alternative methods that do not require daily compliance.

Oral contraceptive pill compliance in adolescent/young adult women

Oral contraceptive pill compliance in adolescent/young adult women

Safety implications of transferring the oral contraceptive from prescription-only to over-the-counter status.

The idea of making oral contraceptives available without prescription has a long history, and has been recently revived in the US and the UK. High dose oral contraceptives have generally been replaced by low dose formulations and, subsequently, most cardiovascular risks have been reduced and a protection against ovarian and uterine cancers has been consistently demonstrated. Oral contraceptive compliance, however, continues to be a problem, but there is no reason to assume that wise practice would be any more or less if oral contraceptives were available over-the-counter (OTC). Some countries have introduced alternatives to prescription-only oral contraceptives, whereby nurses, midwives, social workers and/or pharmacists are incorporated into the distribution process. This article concludes that the balance of risks and benefits is in favour of OTC access for oral contraceptives.

Oral contraceptive user compliance

In North America, an estimated 15 million women use the oral contraceptive pill. This represents about 30% of women at risk for pregnancy and demonstrates a 4–5% increase over the past decade.When used correctly, the new low-dose pill has an estimated annual failure rate of 3% in married and 6% in single women.Of all women taking the pill, 50–60% discontinue in their first year. Amenorrhea, breakthrough bleeding, weight gain and mood changes account for 75% of reasons given for pill discontinuation. Concerns about breast cancer, stroke and ‘blood clots' are persistent causes of discontinuation in women today.Negative media coverage of the pill leads to declining confidence, increased concern over risks and eventually poor compliance and discontinuation. A 1985 Gallup Poll showed that 76% of North American respondents believe that the pill carries serious side-effects. Similar studies show that 90% of young women base their decisions regarding the pill on advice from lay publications and their peers.In tac...

User Characteristics and Oral Contraceptive Compliance in Egypt

Results from the 1988 Egypt Demographic and Health Survey show that many women are not taking oral contraceptives in a manner that ensures full protection by the method. Reports from 1,258 current pill users show a range of incorrect use; 63 percent of women surveyed reported an interruption in their use of the pill in the past month, and of those women, only 40 percent took the correct action when they missed a pill. The majority (89 percent) did not wait the correct number of days between packs. Multivariate analysis revealed that rural women were more likely to take pills out of sequence, compared with their urban counterparts. Failure to take a pill within the previous month was strongly associated with the experience of side effects. The younger women surveyed were more likely to know the correct interval between pill packs than were older women; and women who wanted more children were more likely to know the correct interval than those who did not. The use patterns exhibited by the pill users may be the result of their receiving confusing, incorrect, or incomplete information, and highlight the need to provide women with accurate, updated, and comprehensible information about oral contraceptives.

Cultural factors in oral contraceptive compliance

Cultural factors in oral contraceptive compliance

Contraceptive discontinuation among white, black, and hispanic adolescents

Study Objective: To compare profiles of risk for contraceptive discontinuation among groups of family planning white, black, and Hispanic teenagers.Design: Retrospective chart review comparing groups of patients who returned or failed to return for the 3- to 4-month follow-up appointment after initiating oral contraceptives. For purposes of analysis, patients were divided into three distinct ethnic groups: white, black and Hispanic.Setting: Family Planning Clinic at the University of Texas Medical Branch, Galveston.Participants: 183 indigent adolescents aged ≤17 who initiated oral contraceptives between January 1, 1988 and December 31, 1988.Outcome Measure: Contraceptive continuation defined as return to clinic for 3- to 4-month follow-up appointment.Results and Conclusions: Bivariate and multivariate analyses conducted to identify risk factors for discontinuation within each ethnic group produced unique profiles of risk. Prior pregnancy and age <15 were significantly associated with discontinuation among whites, with heavy menstrual flow serving as a protective factor. For blacks, prior abortion and history of vaginitis were significant risk factors for discontinuation. Among Hispan-ics, the risk factors age and prior pregnancy and the protective factor previous medical problems were identified. To maximize oral contraceptive compliance, researchers and clinicians working with multi-ethnic adolescent populations should be sensitive to cultural differences that may influence treatment compliance.

Cultural factors in oral contraceptive compliance

Cultural factors in oral contraceptive compliance