Contraindications to progestin-only oral contraceptive pills among reproductive-aged women

Abstract

Background Progestin-only oral contraceptive pills (POPs) have fewer contraindications to use compared to combined pills. However, the overall prevalence of contraindications to POPs among reproductive aged women has not been assessed. Study Design We collected information on contraindications to POPs in two studies: 1) the Self-Screening Study, a sample of 1,267 reproductive aged women in the general population in El Paso, Texas, and 2) the Prospective Study of Oral Contraceptive (OC) Users, a sample of current OC users who obtained their pills in El Paso clinics (n=532) or over the counter (OTC) in Mexican pharmacies (n=514). In the Self-Screening Study, we also compared women’s self-assessment of contraindications using a checklist to a clinician’s evaluation. Results Only 1.6% of women in the Self-Screening Study were identified as having at least one contraindication to POPs. The sensitivity of the checklist for identifying women with at least one contraindication was 75.0% (95% CI: 50.6–90.4%), and the specificity was 99.4% (95% CI: 98.8–99.7%). In total, 0.6% of women in the Prospective Study of OC Users reported having any contraindication to POPs. There were no significant differences between clinic and OTC users. Conclusion The prevalence of contraindications to POPs was very low in these samples. POPs may be the best choice for the first OTC oral contraceptive in the US.

Computer-assisted provision of hormonal contraception in acute care settings

“…Clinician counseling is known to affect women’s contraceptive choices [16–18] and contraceptive use [19]; however, there has been little attention to potential clinician bias against the use of progestin-only pills. In contrast to estrogen-containing contraceptives, the prevalence of contraindications to progestin-only pills, which pose less risk of thromboembolic disease [20], is very low [21]. …”

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 .…”

Contracepção em mulheres com condições clínicas especiais. Critérios médicos e elegibilidade

“…13 Existem poucas contraindicaç ões consideradas como categorias 3 e 4 e se aplicam aos progestágenos isolados independentemente da via de administraç ão: são o câncer de mama, as doenças hepáticas, como cirrose e tumores hepáticos, e as usuárias de anticonvulsivantes e tuberculostáticos. 5,14 A publicação da Organização Mundial da Saúde (OMS) Medical eligibility criteria for contraceptive use, de 2010, acrescentou como contraindicação ao uso de progestágenos (categoria 3) o histórico de cirurgia bariátrica disabsortiva, as pacientes com lúpus eritematoso sistêmico e anticorpo antifosfolípide positivo ou desconhecido e o uso de terapia antirretroviral com ritonavir. 5…”