Skip to main content

Advertisement

SpringerLink
Log in

The Pill at 56 and Counting: Still Contracepting After All These Years

  • Family Planning (A. Burke, Section Editor)
  • Published:
Current Obstetrics and Gynecology Reports Aims and scope Submit manuscript

Abstract

Oral contraceptives are one of the most popular contraceptive methods worldwide. They offer many benefits other than contraceptive efficacy; women also choose the pill for medical or personal reasons. While the pill is extremely safe, there are still concerns about side effects and complications, difficulties with cycle control and compliance. Several approaches have been developed to improve overall experience with oral contraceptives, including lowering doses of estrogen to diminish side effects, though that can create more bleeding irregularities and possibly reduce efficacy. Modifications of pill scheduling by proposing extended or continuous cycle have shown good results decreasing symptoms related to menses. Contraceptive pills can effectively decrease certain premenstrual and menstrual symptoms. Finally, the use of new technologies to try to increase adherence is being explored, though without convincing results so far.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Burkman R, Bell C, Serfaty D. The evolution of combined oral contraception: improving the risk-to-benefit ratio. Contraception. 2011;84:19–34.

    Article  CAS  PubMed  Google Scholar 

  2. Higgins JA. Celebration meets caution: long acting reversible contraception (LARC)’s boons, potential busts, and the benefits of a reproductive justice approach. Contraception. 2014;89(4):237–41.

    Article  PubMed Central  PubMed  Google Scholar 

  3. ACOG practice bulletin no 110. Noncontraceptive uses of contraceptives. Obstet Gynecol. 2010;115(1):206.

    Article  Google Scholar 

  4. Gallo MF, Nanda K, Grimes DA, Lopez LM, Schulz KF. 20 μg versus >20 μg estrogen combined oral contraceptives for contraception. Cochrane Database Syst Rev. 2013;8:CD003989.

    PubMed  Google Scholar 

  5. Warner Chilcott Canada. Lolo monograph. Toronto: Warner Chilcott Canada; 2013. Website: http://www.actavis.ca/NR/rdonlyres/45C0D770-B17C-42B0-8DF4-729451E56DE6/0/131LoloPMFrDec202013Rev2.pdf (Consultation : september 2015)

  6. FDA PI. Lo Loetrin Fe. 2012. Website : http://www.drugs.com/pro/lo-loestrin-fe.html%23i4i_clinical_studies_id_8a86f5a1-607e-4baa-a6b9-09ded3a75189 (Consultation : septembre 2015)

  7. Archer DF, Nakajima ST, Sawyer AT, et al. Norethindrone acetate 1.0 milligram and ethinyl estradiol 10 micrograms as an ultra-dose oral contraceptive. Obstet Gynecol. 2013;122(3):601–7. This article constitutes the base of the analysis of the efficacy, safety and tolerability of very low-dose estrogen COC. It is, among other things, on the Pearl Index presented in this study that the questioning about the precision and the value of Pearl Index re-emerged, at least in Canada.

    Article  CAS  PubMed  Google Scholar 

  8. Burkman R, Clinical Pearls. Factors affecting reported contraceptive efficacy rates in clinical studies. Int J Fertil. 2002;47(4):153–61. This paper provides multiple explanations of the discrepancy between Pearl Index between different studies and over time.

    Google Scholar 

  9. Gerlinger C et al. Different pearl indices in studies of hormonal contraceptives in the United States: impact of study population. Contraception. 2014;90(2):142–6.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Bachman G, Sulak PJ, Sampson-Landers C, Benda N, Marr J. Efficacy and safety of a low-dose 24-day combined oral contraceptive containing 20 micrograms ethinylestradiol and 3 mg drospirenone. Contraception. 2004;70:191–8.

    Article  Google Scholar 

  11. Nelson A, Parke S, Makalova D, Serrani M, Palacio S, Mellinger U. Efficacy and bleeding profile of a combined oral contraceptive containing oestradiol valerate/dienogest: a pooled analysis of three studies conducted in North America and Europe. Eur J Contracept Reprod Health Care. 2013;18(4):264–73.

    Article  CAS  PubMed  Google Scholar 

  12. Jensen JT, Garie SG, Trummer D, Elliesen J. Bleeding profile of a flexible extended regimen of ethinylestradiol/drospirenone in US women: an open-label, three-arm, active-controlled, multicenter study. Contraception. 2012;86(2):110–8.

    Article  CAS  PubMed  Google Scholar 

  13. Trussell J, Portman D. The creeping pearl: why has the rate of contraceptive failure increased in clinical trials of combined hormonal contraceptive pills? Contraception. 2013;88:604–10. This article suggests two factors that contribute mainly to the increase of Pearl Index over time : pregnancy tests that are used more often and that are more sensitive and a decrease in adherence of participants due to changes in demographics.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Lobo Abascal P, Luzar-Stiffler V, Giljanovic S, Howard B, Weiss H, Trussell J. Differences in reporting pearl Indices in the United States and Europe: focus on a 91-day extended-regimen combined oral contraceptive with low-dose ethinyl estradiol supplementation. Europe J Contraception Reprod Health Care. 2015;2:1–4.

    Google Scholar 

  15. Edelman A, Micks E, Gallo MF, Jensen JT, Grimes DA. Continuous or extended cycle vs. cyclic use of combined hormonal contraceptives for contraception. Cochrane Database Syst Rev. 2014;7:CD004695.

    PubMed  Google Scholar 

  16. Klipping C, Duijkers I, Fortier MP, et al. Contraceptive efficacy and tolerability of ethinylestradiol 20 μg/drospirenone 3 mg in a flexible extended regimen: an open-label, multicentre, randomized, controlled study. J Family Planning Reprod Health Care. 2012;38:73–83.

    Article  Google Scholar 

  17. Strowitzki T, Kirsch B, Elliesen J. Efficacy of ethinylestradiol 20 μg/drospirenone 3 mg in a flexible extended regimen in women with moderate-to-severe primary dysmenorrhoea: an open-label, multicentre, randomised, controlled study. J Family Planning Reprod Health Care. 2012;38:94–101.

    Article  Google Scholar 

  18. Portman D, Kaunitz A, Howard B, Weiss H, Hsieh J, Ricciotti N. Efficacy and safety of an ascending-dose, extended-regimen levonorgestrel/ethinyl estradiol combined oral contraceptive. Contraception. 2014;89:299–306.

    Article  CAS  PubMed  Google Scholar 

  19. Darwish M, Bond M, Ricciotti N, Hsieh J, Fiedler-Kelly J, Grasela T. A comparison of the pharmacokinetic profile of an ascending-dose, extended-regimen combined oral contraceptive to those of other extended regimens. Reprod Sci. 2014;21(11):1401–10.

    Article  PubMed  Google Scholar 

  20. Mendoza N, Lobo P, Lertxundi R, Correa M, Gonzalez E, Salamanca A, et al. Extended regimens of combined hormonal contraception to reduce symptoms related to withdrawal bleeding and the hormone-free interval: a systematic review of randomised and observational studies. European J Contraception Reprod Health Care. 2014;9(5):321–39.

    Article  Google Scholar 

  21. Neville R, Greene A, Mcleod J, Tracy A, Surie J. Mobile phone text messaging can help young people manage asthma [published erratum appears in BMJ 2008;336 (7649)]. BMJ. 2002;325:600.

    Article  PubMed Central  PubMed  Google Scholar 

  22. FranklinVL WA, Pagliari C, Greene SA. A randomized controlled trial of sweet talk, a text-messaging system to support young people with diabetes. Diabet Med. 2006;23:1332–8.

    Article  Google Scholar 

  23. Whittaker R, Borland R, Bullen C, Lin RB, McRobbie H, Rodgers A. Mobile phone-based interventions for smoking cessation. Cochrane Database of Systematic Reviews 2009, Issue 4. [DOI: 10.1002/14651858.CD006611.pub2]

  24. Bastawrous A, Cheeseman R, Kumar A. iPhones for eye surgeons. Eye. 2012;26(3):343–54.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  25. Free C, Phillips G, Watson L, Galli L, Felix L, et al. The effectiveness of mobile-health technologies to improve health care service delivery processes: a systematic review and meta-analysis. PLoS Med. 2013;10(1):e1001363. doi:10.1371/journal.pmed.1001363.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Free C, Phillips G, Galli L, Watson L, Felix L, et al. The effectiveness of mobile-health technology-based health behaviour change or disease management interventions for health care consumers: a systematic review. PLoS Med. 2013;10(1):e1001362. doi:10.1371/journal.pmed.1001362.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Free C, Phillips G, Felix L, Galli L, Patel V, Edwards P. The effectiveness of M-health technologies for improving health and health services: a systematic review protocol. BMC Research Notes 2010;3(1):250. [: http://biomedcentral.com/ 1756–0500/3/250]

  28. Kallander K, Tibenderana J, Akpogheneta O, Strachan D, Hill Z, Asbroek A, et al. Mobile health (mHealth) approaches and lessons for increased performance and retention of community health workers in low- and middleincome countries: a review. J Med Internet Res. 2013;15(1):e17.

    Article  PubMed Central  PubMed  Google Scholar 

  29. Smith C, Gold J, Ngo TD, Sumpter C, Free C. Mobile phone-based interventions for improving contraception use. Cochrane Database Syst Rev. 2015;6:CD011159. doi:10.1002/14651858.CD011159.pub2. This recent systematic review provided a large overview on the question of new technologies used in contraceptive adherence.

    PubMed  Google Scholar 

  30. Castano P, Bynum J, Andres R, Lara M, Westhoff C. Effect of daily text messages on oral contraceptive continuation: a randomised controlled trial. Obstet Gynecol. 2012;119(1):14–20. doi:10.1097/AOG.0b013e31823d4167.

    Article  PubMed  Google Scholar 

  31. Hou M, Hurwitz S, Kavanagh E, Fortin J, Goldberg A. Using daily text-message reminders to improve adherence with oral contraceptives: a randomized controlled trial. Obstet Gynecol. 2010;116(3):633–40. doi:10.1097/AOG.0b013e3181eb6b0f.

    Article  PubMed  Google Scholar 

  32. Trent M, Tomaszewski K. Family planning appointment attendance among urban youth: results from the depotext trial. J Adolesc Health. 2013;52(2):S88. doi:10.1016/j.jadohealth.2012.10.207.

    Article  Google Scholar 

  33. Smith C, Ngo T, Gold J, Vannak U, Ly S, Free C. Mobile Technology for Improved Family Planning (MOTIF): a single blind randomised trial of a mobile phone-based intervention to support post-abortion family planning.

  34. Tsur L, Kozer E, Berkovitch M. The effect of drug consultation center guidance on contraceptive use among women using isotretinoin: a randomized, controlled study. J Women's Health. 2008;17(4):579–84. doi:10.1089/jwh.2007.0623.

    Article  Google Scholar 

  35. Over-the-counter access to oral contraceptives. Committee Opinion No. 544. American college of obstetricians and gynecologists. Obstet Gynecol. 2012;120:1527–31.

    Article  Google Scholar 

  36. Grossman D, Grindlay K, Li R, Potter JE, Trussell J, Blanchard K. Interest in over-the-counter access to oral contraceptives among women in the United States. Contraception. 2013;88(4):544–52.

    Article  PubMed Central  PubMed  Google Scholar 

  37. Grossman D. Should the contraceptive pill be available without prescription? Yes. BMJ. 2008;337:a3044.

    Article  PubMed  Google Scholar 

  38. Baum S, Burns B and all. Perspectives among a diverse sample of women on the possibility of obtaining oral contraceptives over the counter: a qualitative study. Women’s health issues. 2015 :1–6

  39. Jarvis S. Should the contraceptive pill be available without prescription? No. BM. 2008;337:a3056.

    Article  Google Scholar 

  40. Norman WV, Soon JA, Panagiotoglou D, Albert A, Zed PJ. The acceptability of contraception task-sharing among pharmacists in Canada—the ACT-Pharm study. Contraception. 2015;92:55–61.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Family Medicine, University of Montreal, Montreal, QC, Canada

    Maude Côté-Leduc

  2. Department of Obstetrics and Gynecology, University of Montreal, Montreal, QC, Canada

    Geneviève Roy

Authors
  1. Maude Côté-Leduc
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Geneviève Roy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Geneviève Roy.

Ethics declarations

Conflict of Interest

Maude Côté-Leduc declares no conflict of interest.

Geneviève Roy declares personal fees and non-financial support from Bayer for work as a speaker, on advisory boards, and for conference travel expenses; she declares non-financial support from Actavis for conference travel and writing assistance; and personal fees from Merck for advisory board work. Dr. Roy is also a member of a family planning expert committee at the Quebec National Institute of Public Health.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Family Planning

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Côté-Leduc, M., Roy, G. The Pill at 56 and Counting: Still Contracepting After All These Years. Curr Obstet Gynecol Rep 5, 13–19 (2016). https://doi.org/10.1007/s13669-016-0143-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13669-016-0143-5

Keywords

Search

Navigation