Advancing Sexual and Reproductive Health and Rights
 
Perspectives on Sexual and Reproductive Health
Volume 40, Number 3, September 2008

Prior Pill Experiences and Current Continuation Among Pill Restarters

By Debra Kalmuss, Shelly Koenemann, Carolyn Westhoff, Stephen Heartwell, Sharon Edwards, Mimi Zieman, Linda Cushman, Christina Robilotto, Gretchen Stuart

CONTEXT: Discontinuation of oral contraceptives often puts women at risk for unintended pregnancies. Understanding why a woman discontinued pill use can provide insight into her risk of discontinuation if she restarts use.

METHODS: Women younger than 25 obtaining oral contraceptives at three university health centers in 2003–2005 were recruited to participate in a randomized trial; 628 former users were interviewed about their previous experience with the method, and were followed up three months after restarting use. Bivariate and multinomial logistic regression analyses were used to assess the relationship between prior reasons for stopping pill use and method continuation.

RESULTS: Women who had discontinued using oral contraceptives because of side effects were less likely to be very sure about restarting the pill at baseline (73%) than were those who had stopped for logistical or fertility-related reasons (88–94%). They also were less likely to have been satisfied with the pill in the last use interval (49% vs. 95–98%) and less likely to be satisfied with it in the three months after restarting (76% vs. 89–93%). These women were more likely to report a short duration of use than an intermediate duration or continuous use during follow-up (odds ratios, 2.5 and 4.5).

CONCLUSIONS: When counseling women who are restarting pill use, providers should ask about their experiences with the method and reasons for discontinuation; counseling for women who discontinued because of side effects should address their risk factors for early discontinuation and informing them about other contraceptive choices.

Perspectives on Sexual and Reproductive Health, 2008, 40(3):138–143

DOI:10.1363/4013808







 

 
 

AUTHOR AFFILIATIONS

Debra Kalmuss is professor of clinical population and family health, and Linda Cushman is associate professor of clinical population and family health, Mailman School of Public Health, Columbia University, New York. Carolyn Westhoff is professor, and Christina Robilotto is administrative manager, Department of Obstetrics and Gynecology, Columbia University. Shelly Koenemann is senior research associate, Bixby Center for Global Reproductive Health, University of California, San Francisco. Stephen Heartwell and Gretchen Stuart are professors of obstetrics and gynecology, University of Texas–Southwestern, Dallas. Sharon Edwards is a physician, Mount Sinai Adolescent Health Center, New York. Mimi Zieman is clinical associate professor of obstetrics and gynecology, Emory University, Atlanta.