The Contraindications to Combined Oral Contraceptives among Reproductive-Aged Women in an Obstetrics and Gynaecology Clinic: A Single-Centre Cross-Sectional Study

Abstract

This study aimed to determine the estimated proportion of contraindications among women taking combined oral contraceptives (COCs) and to assess the risk factors associated with their contraindications. This study was cross-sectional. Reproductive-aged women (18–49 years) on any COCs between 2018 and 2020 were recruited from one obstetrics–gynaecology clinic in a university-affiliated hospital and were included. Contraindications were defined using the World Health Organization (WHO) Medical Eligibility Criteria (MEC) for Contraceptive Use. Data were collected from electronic medical records for all included women, as well as a standardised, pretested, structured survey for one-third of the women. In this cross-sectional study, 380 women using COCs were included. Their mean age was 31.645 ± 7.366 years. Among them, 131 (34.5%) participated via a survey and electronic records, while the other 249 (65.5%) participated via electronic records only. The majority of the participants had a Bachelor’s degree (59.0%) and were married (62.1%). The overall estimated proportion of patients with at least one contraindication to COCs according to category 3 (relative contraindications) or 4 (absolute contraindications) was 31.3% (95% CI 26.63–35.99). The most common contraindications observed were controlled hypertension, category 3 (12.1%); major surgery with prolonged immobilisation, category 4 (4.7%); migraine with aura at any age, category 4 (4.2%); breastfeeding from six weeks to less than six months postpartum, category 3 (4.0%); and diabetes mellitus with complications, category 4 (3.2%). Significant factors associated with contraindications to COCs were married women (OR 2.19, 95% CI 1.38–3.46), those aged 35 years or more (OR 2.33, 95% CI 1.49–3.66), and those with one or more live births (OR 2.19, 95% CI 1.38–3.46). Ensuring roper assessment prior to prescribing and considering alternatives suitable for long-term use among women taking an oral contraceptive regularly is recommended.

Therapeutic Choices for Ovulatory Dysfunctional Abnormal Uterine Bleeding: A Cross-sectional Study in Chinese Women

“…32,33 Although COC treatment has additional benefits in menorrhagia, irregular menstruation and dysmenorrhea, doctors should fully consider the contraindications in elderly patients to ensure their safety when prescribing COCs. The contraindications include cardiovascular disease, thrombogenic conditions, hyperkalaemia, hormonally sensitive malignancies, hepatic disease, diabetes and migraines [34][35][36][37][38] . According to the results of this study, there was still a high proportion of COC treatment in the senior groups.…”

A Multi-Institutional Informed Consent Proposal as a Prevention Tool for Combined Oral Contraceptive Intake and Thrombotic Risk

“…When prescribing contraceptives to women, physicians have a central role in screening COC for contraindications, explaining the risks and potential side effects, weighing the risks versus benefits, as well as providing advice on the appropriate use of contraceptives [31]. The physician who prescribes the COC or the pharmacist who dispenses them could provide all women with a formal written risk assessment for contraindications [31]. In addition, we should not ignore the role of self-care; women can self-screen using a checklist of contraindications [32].…”

Pharmacotherapy during Pregnancy, Childbirth, and Lactation

“… Overview on the different themes and specific papers discussed in this Special Issue [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ]. …”

“…The two other papers related to the prescription theme have a specific focus on young women with specific medical conditions. In a cross-sectional study of 380 women using combined oral contraceptives, category 3–4 contraindications were present in 31.3% and included—among others—controlled hypertension, major surgery with immobilization, migraine with aura, breastfeeding, or diabetes mellitus with complications [ 16 ]. The use of prescribed medicines to treat chronic diseases during pregnancy has been assessed, using the Swiss Health Care claims data for reimbursement [ 17 ].…”