Accuracy of Self-Screening for Contraindications to Combined Oral Contraceptive Use

Abstract

Objective To estimate how well a convenience sample of women from the general population could self-screen for contraindications to combined oral contraceptives using a medical checklist. Methods Women 18-49 years old (N=1,271) were recruited at two shopping malls and a flea market in El Paso, Texas, and asked first whether they thought pills were medically safe for them. They then used a checklist to determine the presence of level 3 or 4 contraindications to combined oral contraceptives according to the World Health Organization Medical Eligibility Criteria. Women were then interviewed by a blinded nurse practitioner who also measured blood pressure. Results The sensitivity of the unaided self-screen to detect true contraindications was 56.2% (95% CI: 51.7%-60.6%) and specificity 57.6% (54.0%-61.1%). The sensitivity of the checklist to detect true contraindications was 83.2% (79.5%-86.3%) and specificity 88.8% (86.3%- 90.9%). Using the checklist, 6.6% (5.2%-8.0%) of women incorrectly thought they were eligible for use when, in fact, they were contraindicated, largely due to unrecognized hypertension. Seven percent (5.4%-8.2%) of women incorrectly thought they were contraindicated when they truly were not, primarily due to misclassification of migraine headaches. In regression analysis, younger women, more educated women and Spanish-speakers were significantly more likely to correctly self-screen (p<0.05). Conclusion Self-screening for contraindications to oral contraceptives using a medical checklist is relatively accurate. Unaided screening is inaccurate and reflects common misperceptions about the safety of oral contraceptives. Over-the-counter provision of this method would likely be safe, especially for younger women and if independent blood pressure screening were encouraged.

Knowledge of pharmacists on proper use of oral contraceptive pills and missed dose instructions in United Arab Emirates

“…Grossman et al, had found that approximately 39 % of women in United States had at least one contraindication for oral contraceptives [13]. In this study, pharmacists were able to recognize more contraindications compared to students, such as: liver tumor and migraine.…”

Over-the-counter access to oral contraceptives as a reproductive healthcare strategy

“…One analysis found that 39% of women in a convenience sample in El Paso, Texas, had at least one relative contraindication to COCs [10]. The most common contraindications in this sample were hypertension, smoking while aged 35 years or older, and migraine with aura.…”

“…In the other US study, a convenience sample of reproductive age women in El Paso, Texas (N ¼ 1271) was given a checklist to identify relative and absolute COC contraindications, and then they underwent screening by a nurse practitioner [10]. The accuracy of the self-screening tool was as follows: sensitivity 83.2% [95% confidence interval (CI) 79.5-86.3%], specificity 88.8% (95% CI 86.3-90.9%), positive predictive value 82.8% (95% CI 79.2-86.0%), and negative predictive value 89.0% (95% CI 86.6-91.1%).…”

Should women have over-the-counter access to oral contraceptive pills?

“…The main safety question is whether women can accurately identify contraindications to use without the assistance of a clinician. In two studies in the USA, women were able to accurately identify contraindications to combined OCPs using a simple checklist, although in one study, 7% of women had unrecognized hypertension that was not identified until they saw a clinician [2,3]. Women were much more accurate at identifying contraindications to progestinonly OCPs, a formulation that has fewer and rarer contraindications compared to combined OCPs [4].…”