Continuation rates of oral hormonal contraceptives in a cohort of first-time users: a population-based registry study, Sweden 2005–2010

Abstract

ObjectiveTo investigate if continuation rates in first-time users of oral hormonal contraceptives differed between different formulations and to measure if the rates were related to the prescribing categories, that is, physicians and midwives.DesignA longitudinal national population-based registry study.SettingThe Swedish prescribed drug register.ParticipantsAll women born between 1977 and 1994 defined as first-time users of hormonal contraceptives from 2007 to 2009 (n=226 211).Main outcome measuresA tendency to switch the type of hormonal contraceptive within 6 months use and repeated dispensation identical to the first were estimated as percentages and relative risks (RRs). Physicians’ and midwives’ prescription patterns concerning the women's continuation rates of oral hormonal contraceptive type.ResultsIn Sweden, there were 782 375 women born between 1977 and 1994 at the time of the study. Of these, 226 211 women were identified as first-time users of hormonal contraceptives. Ethinylestradiol+levonorgestrel, desogestrel-only and ethinylestradiol+drospirenone were the hormonal contraceptives most commonly dispensed to first-time users at rates of 43.3%, 24.4% and 11.1%, respectively. The overall rate of switching contraceptive types in the first 6 months was 11.3%, which was highest for desogestrel-only (14.3%) and lowest for ethinylestradiol+drospirenone (6.6%). The switching rate for all three products was highest in the 16-year to 19-year age group. Having a repeated dispensation identical to the initial dispensation was highest for users of ethinylestradiol either combined with levonorgestrel or drospirenone, 81.4% and 81.2%, respectively, whereas this rate for the initial desogestrel-only users was 71.5%. The RR of switching of contraceptive type within the first 6 months was 1.35 (95% CI 1.32 to 1.39) for desogestrel-only and 0.63 (0.59 to 0.66) for ethinylestradiol+drospirenone compared with ethinylestradiol+levonorgestrel as the reference category. There were no differences in the women's continuation rates depending on the prescriber categories.ConclusionsDesogestrel-only users conferred the highest switcher rate to another hormonal contraceptive within a 6-month period. Users of ethinylestradiol+levonorgestrel were more prone to switch to another product within 6 months than women using ethinylestradiol+drospirenone. These findings may be of clinical importance when tailoring hormonal contraceptives on an individual basis.

Association Between Long-term Oral Contraceptive Use and Risk of Crohn’s Disease Complications in a Nationwide Study

“…25 The apparent lack of a statistically significant association between current use of oral contraceptives and risk of surgery may be explained by prior observation in this registry that a substantial percentage of women (~25%) either completely stop using oral contraceptives or switch to a nonhormonal type, particularly intrauterine devices, within 6 months of first oral contraceptive prescription. 19 In addition, nearly 15% of women switch from one type of oral contraceptive to another within the first 6 months of the first oral contraceptive prescription. 19 Therefore, a large percentage of current users include individuals who only briefly use oral contraceptives.…”

“…These Anatomical Therapeutic Chemical codes have been used previously to describe patterns of OC use in Sweden. 19 Information on OC use was updated monthly and entered in our models as current, past, or nonusers. In addition, we calculated and updated the cumulative duration of OC intake and the cumulative DDD of use for each participant by adding the number of months and DDD use over follow-up time, respectively.…”

Combined hormonal contraceptives: prescribing patterns, compliance, and benefits versus risks

“…Consequently, new progestogens with the potential of a more beneficial profile concerning side effects have been developed. Despite these improvements, the discontinuation rates during the first 6 months of use are still high (20-25%) [Josefsson et al 2013].…”

“…For example, levonorgestrel containing COCs constituted almost 57% of all first-time prescriptions in [2005][2006][2007][2008][2009][2010] in Sweden compared with approximately 5% in Denmark during the same period [Josefsson et al 2013;Wilson et al 2012].…”

“…A Swedish register study found no difference in overall continuation rates between different COCs after first-time prescription but use of all COCs showed higher continuation rates than progestin-only pills [Josefsson et al 2013]. …”