Contraindications to Combined Oral Contraceptives Among Over-the-Counter Compared With Prescription Users

Abstract

Objective To compare the estimated proportion of contraindications to combined oral contraceptives between women who obtained combined oral contraceptives in U.S. public clinics, compared with women who obtained combined oral contraceptives over the counter (OTC) in Mexican pharmacies. Methods We recruited a cohort of 501 women who were residents of El Paso, Texas who obtained combined oral contraceptives over the counter (OTC) in Mexico and 514 women who obtained combined oral contraceptives from family planning clinics in El Paso. Based on self-report of WHO category 3 and 4 contraindications and interviewer-measured blood pressure, we estimated the proportion of contraindications and, using multivariable-adjusted logistic regression, identified possible predictors of contraindications. Results The estimated proportion of any category 3 or 4 contraindication was 18%. Relative contraindications (category 3) were more common among OTC users (13% vs 9% among clinic users, p=0.006). Absolute contraindications (category 4) were not different between the groups (5% for clinic users vs 7% for OTC users, p=0.162). Hypertension was the most prevalent contraindication (5.6% of clinic users and 9.8% of OTC users). After multivariable adjustment, OTC users had higher odds of being contraindicated compared to clinic users (OR 1.59, 95% CI: 1.11–2.29). Women aged 35 years or older (OR 5.30, 95% CI: 3.59–7.81) and those with body mass index 30.0 kg/m2 or greater (OR 2.24, 95% CI: 1.40–3.56) also had higher odds of being contraindicated. Conclusions Relative combined oral contraceptive contraindications are more common among OTC users in this setting. Progestin-only pills might be a better candidate for the first OTC product given their fewer contraindications.

Necessity of Education for Oral Contraceptive Use in Korea: Results from the Fourth Korean National Health and Nutrition Examination Survey 2007-2009

“…Studies of Mexican women reported no significant differences in contraindications between users of OTC and prescription drugs [9]. Grossman et al [10] have shown that the prevalence of contraindications is higher in OTC users than in prescription users in the same region. They stated that this could happen because some women who were refused prescriptions by physicians could obtain OCs from a pharmacy.…”

“…The proportion of women who are found to have contraindications to OC use has been different in various studies, depending on the guidelines used in each study. Grossman et al [10] reported that 18% of OC users had at least one contraindication to OC use according to WHO medical eligibility criteria. They included more conditions, such as migraine and thrombotic conditions in the contraindications.…”

“…Although abnormal BMI is not a contraindication to OC use, obesity is frequently related to chronic conditions, such as hypertension and diabetes. Grossman et al [10] have suggested that BMI can be used as a screening tool for contraindication statuses.…”

“…Another study from the USA has indicated that OTC users have higher odds of relative OC contraindications to OC use than prescription users. Recruiting a cohort from the same region in Texas, they compared the prevalence of contraindications between women who obtained OCs from the clinic in the USA and those who obtained from pharmacies in Mexico [10]. …”

Conhecimentos dos Médicos Residentes de Ginecologia e Obstetrícia sobre Contracepção Hormonal em Situações Especiais

“…Por causa do componente estrogênico, o uso de contraceptivos hormonais combinados está proscrito nas seguintes situações especiais: mulheres com HAS leve a grave, antecedentes pessoais de tromboembolismo arterial, cefaleia com sinais de focalização e tabagistas de mais de 15 cigarros/dia 42,43 . No entanto, nestes casos, não há contraindicações para o uso dos contraceptivos progestínicos isolados, uma vez que seus benefícios melhoram a qualidade de vida das mulheres e reduzem os danos associados a morbidade e mortalidade neonatais e as consequências negativas relacionadas às gestações indesejadas 33 .…”