Discontinuation of hormonal contraception in Oman: prevalence and reasons

Abstract

Background: Discontinuation of hormonal contraceptives is an important contributor to unmet need of contraception. Aims: To determine the discontinuation rate and the reasons for discontinuation of hormonal contraception among Omani women. Methods: This was a 2-stage sampling, multicentre, retrospective cohort study conducted in 2018 at primary health care centres in Muscat Region, Oman. It included newly registered users of hormonal contraceptives in birth spacing clinics from January to December 2016 and the course of care over the following 12 months. A telephone interview was conducted to complement some of the missing data. The contraceptive methods available were combined oral contraceptives, progesterone only pills and injectable depot medroxyprogesterone acetate. Results: We included 404 women and 87.8% were breast-feeding. By the end of the first year, (268; 66.3%) women discontinued their contraceptive method. More than half (55.2% 148/268) of the discontinuation was attributed to adverse effects and the most prevalent was menstrual abnormality (102/268; 38.1%). Only 5.6% (15/268) discontinued contraception because they desired pregnancy. Partners and logistics of availability and access played a minimal role in discontinuation. Age and number of children did not influence the discontinuation rate. Conclusion: This study improves our knowledge about the rate of discontinuation of hormonal contraception and its related factors in Oman, which can be used for population-specific counselling. Future research should study the contraception behaviour of breast-feeding women to assess when and why they discontinue their contraceptive methods.

Moving beyond the mean: Promising research pathways to support a precision medicine approach to hormonal contraception

“…Although weight gain falls outside the purview of neuropsychological effects, it is an issue that many women considering using HCs are concerned with. Women routinely report experiencing weight changes in response to HC use, and undesired changes in body weight are one of the top three reasons that women discontinue HC use (see e.g., Al-Ghashri et al, 2021). A review of the extant research literature examining links between HC use and weight gain, however, would lead one to conclude that there is no impact of HC use on weight gain or body weight composition.…”

“…This would be true for them regardless of whether they were the only ones to experience this effect, or if enough other women experienced the effect to cause a shift in the mean. The literature suggests that, for some women, changes in body weight are significant enough to impact their decisions to continue or discontinue their HC regimen (Al-Ghashri et al, 2021), which means that they are important to women and therefore important to public health.…”