Human Reproduction, Vol. 15, No. 8, 1865-1871,
August 2000
© 2000 European Society of Human Reproduction and Embryology
Continuation rates for oral contraceptives and hormone replacement therapy
Correspondence: Correspondence should be addressed to Professor P.G. Crosignani, Clinica Ostetrica e Ginecologica I, Facolta de Medicina e Chirurgia, Universita Degli Studi di Milano, Via Commenda, 12-20122 Milano, Italy. E-mail: piergiorgio.crosignani{at}unimi.it
Despite the safety and effectiveness of low oestrogen-dose oral contraceptives (OC) and postmenopausal hormone replacement there is poor continuity of use of these agents by women. Patterns of use and the reasons affecting different frequencies of use in different countries are presented. Continuity and discontinuation rates are difficult to assess accurately but it is believed that the main reasons why women discontinue use of these agents are concerns about their perceived health risks and the presence of, or fear of, adverse clinical effects, particularly unscheduled uterine bleeding and weight gain. More information is needed about OC continuation rates in order to improve the acceptability of these safe, effective agents. Most women discontinue use of postmenopausal hormonal replacement within 2 years of initiating the therapy. Reasons include disappearance of symptoms of oestrogen deficiency, lack of awareness of health benefits of oestrogen, presence of side-effects (such as breast tenderness and weight gain), presence of uterine bleeding and increasing age. Suggestions to increase continuation of OC include extensive individual pretreatment counselling with a different emphasis in different age groups, education at the time of follow-up visits and telephone calls, and extensive use of educational aids such as brochures, pamphlets and audio tapes, and improvement of pharmaceutical packaging information. In conclusion there is an urgent need to assess the value of these strategies by long-term large controlled studies.
Key words: counselling/discontinuation rates/hormone replacement therapy/oral contraception
1 A meeting was organized by ESHRE (Anacapri, August 28–30, 1999) with financial support from Schering S.p.A. to discuss the above subjects. The speakers included M.H.Birkhauser (Bern), J.Collins (Hamilton), A.Glasier (Edinburgh), U.Habenicht (Berlin), P.Kenemans (Amsterdam), C.La Vecchia (Milano), D.R.Mishell (Los Angeles), J.C.Stevenson (London) and B.Tarlatzis (Thessaloniki). The discussants included D.T.Baird (Edinburgh), P.G.Crosignani (Milano), E.Diczfalusy (Rönninge), M.Meschia (Milano), L.Puglisi (Milano) and S.O.Skouby (Copenhagen). This report was prepared by P.G.Crosignani and B.L.Rubin.
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