EXECUTIVE SUMMARY
In national statistics, the pill continues to lead the pack, with 25.9% of contracepting women (9.7 million women) reporting its use. Female sterilization was listed by 25.1% (9.4 million women), followed by the male condom (15.3%, 5.8 million women) and long-acting reversible contraception (LARC) (11.6%, 4.4 million women).
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About 14% of Contraceptive Technology Update Contraception Survey participants said more than half of their patients using pills choose extended or continuous regimens, with 25% saying 11-25% of patients use such regimens.
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When it comes to use of pills in older women who smoke, 75% of survey participants say they would not prescribe pills to healthy women ages 35-39 who smoke 10 cigarettes a day, with 93% reluctant to write prescriptions for women older than 40 with similar smoking habits.
How are oral contraceptives (OCs) being used in today’s family practice picture? Results of the Contraceptive Technology Update Contraception Survey give insight on how providers are using this form of birth control in their daily practice.
There has been a “slight decrease” in the use of OCs as more women are wanting a longer-term method, along with the availability of coverage of such methods from the Affordable Care Act, says Corinne Rovetti, APRN-BC, nurse practitioner at the Knoxville Center for Reproductive Health in Knoxville, TN.
According to national statistics, among women using contraception, the pill continues to lead the pack, with 25.9% of contracepting women (9.7 million women) reporting its use.1 Female sterilization was listed by 25.1% (9.4 million women), followed by the male condom (15.3%, 5.8 million women), and long-acting reversible contraception (LARC) (11.6%, 4.4 million women).1 (Contraceptive Technology Update reported on the trends. See “More women reported to be moving to long-acting reversible contraceptives,” January 2016.)
OTHER BENEFITS SEEN
Most women who use OCs do so to prevent pregnancy; however, more than half also identify noncontraceptive health benefits, such as treatment for excessive menstrual bleeding, menstrual pain, and acne, as reasons for use.2
Oral contraceptives help relieve or reduce dysmenorrhea, which is experienced by up to 40% of all adult women and can lead to absences from work and school.3 Use of OCs also can aid in treating menorrhagia, which can lead to anemia; pills also can reduce acne and excess hair growth.4 Other noncontraceptive uses include prevention of menstrual-related migraines and treatment of pelvic pain that accompanies endometriosis and of bleeding due to uterine fibroids.
Menstrual regulation is cited by many women who choose to use oral contraceptives. In a national analysis of pill users, 28% said they used the method for this purpose.2 About 14% of CTU survey participants said more than half of their patients using pills choose extended or continuous regimens, with 25% saying 11-25% of patients use such regimens.
WHEN TO OFFER OPTIONS
When it comes to use of pills in older women who smoke, most CTU survey respondents vote thumbs down.
Three-quarters of participants say they would not prescribe pills to healthy women ages 35-39 who smoke 10 cigarettes a day, with 93% reluctant to write prescriptions for women older than 40 with similar smoking habits.
What does the U.S. Medical Eligibility Criteria for Contraceptive Use (US MEC) say about use of combined pills and smoking?5 For women age 35 or above who smoke 15 cigarettes or fewer per day, combined pills are classed as Category 3 (theoretical or proven risks usually outweigh the advantages of using the method). For women ages 35 and older who smoke more than 15 cigarettes a day, the MEC classes pill use as Category 4 (unacceptable risk).
PICKING QUICK START
Same-day initiation of contraception, known as Quick Start, is an accepted practice among family planners.
Almost 90% of CTU survey respondents say their facilities do Quick Start for combined hormonal methods. That statistic compares favorably with the 45% of adolescent health providers who reported Quick Start use in 51 health centers throughout the United States with high rates of teen pregnancy.6
About three-quarter of CTU survey respondents say they will prescribe combined OCs to nonbreastfeeding mothers 4-6 weeks postpartum.
According to the US MEC, in women who are less than 21 days postpartum, use of combined hormonal contraceptives represents an unacceptable health risk (Category 4). In women who are 21-42 days
postpartum and have other risk factors for venous thromboembolism (VTE) in addition to being postpartum, the risks for combined hormonal contraceptives usually outweigh the advantages and therefore, generally, should not be used (Category 3). In the absence of other risk factors for VTE, the advantages of combined hormonal contraceptives generally outweigh the risks, and they usually can be used (Category 2).7
REFERENCES
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Daniels K, Daugherty J, Jones J, et al. Current contraceptive use and variation by selected characteristics among women aged 15-44: United States, 2011-2013. Natl Health Stat Report 2015; 86:1-15.
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Jones RK. Beyond Birth Control: The Overlooked Benefits of Oral Contraceptive Pills. New York: Guttmacher Institute, 2011.
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Dawood MY, Primary dysmenorrhea: Advances in pathogenesis and management. Obstet Gynecol 2006; 108(2):428-441.
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Nelson AL, Cwiak C. Combined oral contraceptives (COCs). In: Hatcher RA, Trussell J, Nelson AL, et al. Contraceptive Technology: 20th revised edition. New York: Ardent Media; 2011.
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Centers for Disease Control and Prevention. U.S. medical eligibility criteria for contraceptive use. Morb Mortal Wkly Rep 2010; 59(RR04):1-6.
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Romero LM, Middleton D, Mueller T, et al. Improving the implementation of evidence-based clinical practices in adolescent reproductive health care services. J Adolesc Health 2015; 57(5):488-495.
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Centers for Disease Control and Prevention. Update to CDC’s U.S. Medical Eligibility Criteria for Contraceptive Use, 2010: Revised recommendations for the use of contraceptive methods during the postpartum period. Morb Mortal Wkly Rep 2011; 60(26):878-883.
