Discontinuation rates among women using either the combined oral contraceptive pills or an intrauterine contraceptive device for contraception: a comparative study

ABSTRACT

To study the contraceptive practice of women using combined oral contraceptive pills and intrauterine contraceptive devices in 4 Jordanian military hospitals; [Prince Hashem Bin Al Hussein, Prince Ali Bin Al Hussein, Princess Haya Bent Al Hussein, and Queen Alia Hospitals] and to study the reasons for discontinuation of these methods among women less than 44 years of age. A retrospective analysis of the family planning medical files of 5800 clients who were current or past user of the contraceptive pills or intrauterine devices for contraception during the period between January 2007 and December 2009 was done. Fifty-eight percent [33671 5800] were current or past contraceptive pills users and 41% [2433/5800] were current or past intrauterine device users. Women included in the study were those who had discontinued using the pills or the devices for more than 6 months [n = 3200], which in turn were divided into two groups Group A, oral contraceptive pills users [n=2050] and Group B, intrauterine devices users [n = 1.150]. We then analyzed according to age, parity, obstetric history, medical history, duration of contraception and reasons for discontinuation of these methods; the data were compared between the two groups.The use of contraceptive methods varies across age, but combined oral contraceptive pills was found to be the most commonly used method among the study population. Only 29% of group A discontinued the pills because of their desire to conceive compared to 23.6% of group B. Fifty-two percent of group A stopped the pills because of undesired side effects, compared to 65% among group B. Four-point-four percent of group A stopped the method due to medical indication compared to 3.2% in group B. Fourteen-point-six percent of group A stopped the pills for personal reasons or lack of availability of the drugs and 8.2% of group B had the device removed because it reached the expired date [being in uterus for 10 years]. However, this is not considered a reason for discontinuation. The main side effects of combined oral contraceptives were breast discomfort, mood changes, weight gain, headache, nausea and vomiting, whereas the commonest side effects related to intrauterine contraceptive device were menstrual bleeding disorders, recurrent vaginal infection, and pelvic pain. In spite of the safety and high efficacy of combined oral contraceptive pills and intrauterine devices as contraceptive methods more than half discontinued their use because of undesired side effects. This may be improved by careful patient selection and appropriate counseling