FIGURE LEGENDS
Figure 1. Cumulative numbers of women
who continued OC (C), discontinued (D), switched (S), became pregnant, and who
had unknown outcome (drop-out or loss to follow-up) over 12 months of study.
A prospective study of
the effects of oral contraceptives on sexuality and well-being
and their relationship to
discontinuation
Stephanie A. Sanders
PhD*†
Cynthia A. Graham PhD‡
Jennifer L. Bass MPH*
John Bancroft MD*
* The Kinsey
Institute for Research in Sex, Gender & Reproduction, Indiana University,
Bloomington, Indiana
† Gender
Studies,
‡Department of
Psychology,
Corresponding author: Stephanie A. Sanders, PhD, Morrison Hall 313, Indiana University, 1165 E. Third Street, Bloomington, Indiana 47405-3700 (email: sanders@indiana.edu; bus. tel. 812-855-7686; fax: 812-855-8277)
Running head: Oral contraceptives, sexuality and
well-being
ABSTRACT
The purpose of the
study was to
explore predictors of discontinuation of oral contraceptives (OC) including
pre-OC characteristics and adverse physical, emotional and sexual effects of
OCs. Women aged 18+ in committed,
sexually active relationships were assessed
before starting OC and reassessed at 3, 6 and 12 months or shortly after
discontinuation. Assessment included: pre-OC attitudes and expectations about
the pill; self-reported side effects; and perimenstrual symptoms including PMS,
physical and emotional well-being, and sexual interest, enjoyment and frequency
of sexual activity. Seventy-nine women
completed the study, 38% continued OCs, 47% discontinued and 14% switched to
another OC. Emotional side effects, worsening of PMS, decreased frequency of
sexual thoughts and decreased psychosexual arousability correctly categorized
87% of cases using logistic regression.
Emotional and sexual side effects were the best predictors of
discontinuation/switching, yet such OC effects have been largely ignored in the
research literature.
Key words: Contraceptives, oral; sex;
sexuality; affect; mood; hormones
1.
INTRODUCTION
The need for
methods of contraception and fertility regulation that are acceptable and
widely used remains a world-wide problem of major proportions. The scope for developing new techniques for
fertility regulation is considerable and much research effort is currently
being expended on this goal. However,
the ultimate value of a method depends on its acceptability and usage. The 2
new hormonal methods introduced in the early 1990’s in the US – hormonal
implants and injectables – have had limited impact. In 1995, fewer than 2% of US women were using
the implant, and under 3% were using the injectable[1]. Although US trends in contraceptive use
suggest that there has been a decline in oral contraceptive (OC) use among
certain subgroups of women (e.g., low income women and those under 25), the
pill remains the most widely used form of reversible contraception, used by 27%
of all contraceptive users[2]. However, in spite of the introduction of
low-dose OCs with assumed reduction in side effects, a substantial proportion
of women who begin taking the pill discontinue the method within the first few
months of use. American surveys report annual discontinuation rates among OC
users of 29%[3] with a much higher percentage among adolescents[4,5]. Comparable evidence from developing countries
is limited, but suggests consistently higher discontinuation rates for
OCs[6,7].
Although
many authors cite the experience of side effects as a major factor involved in
early discontinuation of OCs[8], the available data mainly relates to
adolescent populations, and focuses on problems with ‘cycle control’, with only
superficial attention paid to other behavioral side effects, such as changes in
mood and sexuality. Few studies have attempted any systematic investigation of
the factors related to discontinuation and most of the past research has relied
on retrospective recall for past OC experiences; many studies have, for example,
interviewed ‘past’ OC users about their experiences with OCs[9].
In 1987, the
Human Reproduction Program (HRP) and Division of Mental Health of the World
Health Organization (WHO) commissioned a review of the literature on the
effects of oral contraceptives on the sexuality and well-being of women[10]
which demonstrated the paucity of research in this area, particularly with more
modern low-dose OCs. Two types of study were proposed to address the problem:
(i) assessment of the direct pharmacological or hormonal effect of OCs on
well-being and sexuality in women who have been sterilized, so that placebo
control is possible and there are no complicating psychological implications of
fertility control, and (ii) study of
women about to start on OCs for contraceptive purposes allowing for assessment
of interactions between psychological factors and the direct hormonal effects
of the OC.
The only
example of the first type of study since that time, a placebo-controlled,
double-blind comparison of combined (COC) and progestogen-only (POP) OCs,
carried out in 2 contrasting cultures (Scotland and Philippines) and funded by
the HRP was reported by Graham et al.[11]. This showed negative effects of the
COC on sexual interest in the Scottish women, approximately half of whom
reported loss of sexual interest as a side effect. The lack of this effect in
the Filipino women was probably due to the fact that they reported
significantly lower sexual interest and generally more negative sexual
relationships than the Scottish women before starting on the OC. In both
centers, the COC was associated with more negative mood change than the POP,
which in general was strikingly free of adverse effects apart from the expected
disruption of bleeding patterns.
The study
reported in this paper is one of the few examples of the second type in which
pre-OC characteristics and changes from the pre-OC baseline are assessed to see
if they predict the acceptability and continuation of OC when used specifically
for fertility control. Two earlier studies relating pre-pill characteristics to
patterns of discontinuation focused on expectations of bleeding changes[12],
and social/situational factors associated with switching to another method[13].
In contrast, the present study involved a comprehensive assessment of women
before starting on OCs, providing a baseline of a woman’s mood and sexuality as
well as her attitudes and expectations about the pill, motivation for
parenthood, etc. The present small study was intended as a pilot for a larger
study which will require external funding.
It nevertheless is sufficient to demonstrate the relevance to
discontinuation of adverse effects of OCs on mood and sexuality.
2.1. Participants
Women attending family planning clinics and a university
health center in
2.2 Design
This study
was approved by the Institutional Review Board for the Protection of Human
Subjects. After obtaining informed
consent, women were carefully assessed before starting on OCs. Participants
were randomly assigned to Ortho-Cyclen (monophasic, 0.035mg ethinyl estradiol
and 0.250 mg norgestimate) or Ortho Tri-Cyclen (triphasic, 0.035mg ethinyl
estradiol and 0.180mg, 0.215mg, 0.250mg norgestimate). They were re-assessed at
3, 6, and 12 months or as soon as possible following discontinuation of OC use
or switching to another pill.
2.3 Methods of Assessment
Some assessments were carried out
only at the pre-OC stage. Follow-up assessments included some measures repeated
from baseline and others used only during follow-up evaluations. The initial assessment took approximately 2 hours
and follow-up assessments approximately one.
2.3.1.
Repeated measures
2.3.1.1. Demographic and Relationship
Questionnaire (DRQ)
Completed/updated at all assessments, the DRQ included age, employment status, marital status, education,
racial/ethnic background, income, assessment of relationship status and
commitment (e.g., seriousness of, and commitment to, the relationship; length
of relationship; sexual exclusivity vs. non-exclusivity; number of nights spent
together; any change to a new partner during the study), and the extent to
which the participant was concerned about sexually transmitted disease.
2.3.1.2.
Interviewer Ratings of Sexual Function (IRSF)
The
IRSF[11,14-16] is a semi-structured interview used to obtain frequencies of
intercourse, lovemaking without intercourse, and masturbation during a
specified period of time (in this study the previous 3 months or the time since
last interview). It also obtains information regarding initiation of
lovemaking, orgasm, vaginal lubrication, frequency of sexual desire, enjoyment,
arousal, ‘tense’ feelings, feeling ‘close and comfortable’ with the partner
during lovemaking, and male partners’ experience of sexual problems. For most
items, ratings are made on a 6-point scale corresponding to the percentage of
occasions of sexual activity during the specified time period on which the
behavior/response occurred. The IRSF was administered at each assessment.
2.3.1.3.
Sexual Experience
Scale (SES)
This measure,
developed by Frenken and Vennix[17], has 4 primary scales: the Sexual Morality
Scale (SES1); the Psychosexual Stimulation Scale (SES2); the Sexual Motivation
Scale (SES3); and the Attraction to Marriage Scale (SES4) modified to refer to
non-marital and marital relationships. All 4 scales were completed at the initial
assessment. SES 2 and SES 4 were repeated at each follow-up.
2.3.1.4.
Menstrual Health Questionnaire (MHQ)[18-20]
This covers
menstrual history (including cycle length and variability, pain, blood loss,
duration of flow and its variability, and intermenstrual bleeding and/or
spotting), retrospective ratings of perimenstrual symptoms for the last
menstrual cycle, self-assessment of premenstrual syndrome (PMS), previous
contraception and pregnancy history (including births, miscarriages, abortion,
and post-partum depression), and previous psychiatric illness and medications.
Menstrual variables, perimenstrual symptoms, PMS, and the woman’s perceptions
of the effects of the pill on the pain, blood loss, and PMS were assessed at
follow-up.
2.3.1.5. Menstrual Bleeding
Diary (MBD)
This records bleeding (which days it
occurs and its heaviness) and spotting across the cycle, occurrence of
period-type pain and its severity, use of painkillers, and any days of missed
pills. These were collected monthly.
2.3.1.6. Side-Effects Questionnaire (SEQ)
A modified
version of the interviewer-administered questionnaire developed by Graham and
colleagues[11], the first part elicits any spontaneous reports of
changes noticed by the woman while on OC and the second part contains an
18-item checklist covering mood, physical changes and changes in sexuality,
both positive and negative. Ratings of change (none, mild, moderate, or marked)
and directionality (positive or negative) when appropriate, are recorded. Mean
scores (ranging from marked negative to marked positive effects) were
calculated combining items as follows: physical
side effects (headaches, feeling bloated, tender breasts, weight gain,
nausea, aches and pains, skin changes, abdominal cramps, tiredness); emotional side effects (feeling in a
better mood, feeling in a worse mood, less emotional, more emotional); and sexual side effects (loss of sexual
interest, increased sexual interest, loss of sexual enjoyment, increased sexual
enjoyment, lack of vaginal lubrication). The SEQ was administered at all
follow-up interviews.
2.3.2
Measures used only at initial assessment
2.3.2.1.
Contraceptive Methods Questionnaire (CMQ)
Administered
pre-OC, this assessed contraceptive history in detail, any problems with
previously used contraceptive methods, contraceptive risk-taking, and attitudes
about contraceptive characteristics. It incorporates a modified version of the
Contraceptive Attributes Questionnaire[21] assessing the importance of various
contraceptive characteristics in the woman’s choice of a method. Women also
rated the degree to which they believed that OC had each of these
characteristics at baseline and at final follow-up. A subjective expected
utility score for OC was calculated weighting the woman’s perception of the
pill’s attributes by the value she placed on these attributes.
2.3.2.2.
Motivation for Parenthood Questionnaire (MPQ)
This assesses
a woman’s desire to have a child in the future, when she would prefer to have
that child, her perceptions of her partner’s desires, the woman’s determination
not to become pregnant during the upcoming year including an item about whether
she would consider abortion, and whether she has ever worried about her
fertility.
2.3.2.3. Effects on
Menstruation Questionnaire (EMQ)
This assesses
the woman’s attitude about changes in her menstrual bleeding pattern that could
result from OC use.
Analyses were conducted using
SPSS 10.0 for Windows. Women were
classified into 2 groups for analysis: the DS group - those who discontinued OC
use or switched from the originally assigned to another pill at any stage
during the 12 months of the study; and the C group - those who continued the
original OC. In the first stage of
analysis, group comparisons were performed on 2 types of variables a) baseline
measures, and b) measures of change on OC during the first 3 months of use (or
until discontinuation or switching if less than 3 months). For baseline and
non-repeated measures, analysis of variance, t-tests, and multivariate GLM
(General Linear Model) procedures were used. Chi-square analyses
were used to compare groups on
categorical variables. For repeated measures, change scores (follow-up –
baseline) were calculated and examined using multivariate GLM analyses
comparing groups and variables within a measure. Post-hoc analyses were
performed to explore significant main effects and interactions.
In the
second stage of analysis, variables showing significant group differences in
the first stage were used as ‘predictors’ in logistic
regression analyses with discontinuation/continuation as the dependent
variable. Several models were explored using the Forward Stepwise
procedure including all of the significant ‘predictor’ variables in various
combinations until a sound statistical solution was reached. The
combination of significant predictor variables identified through this process
that resulted in the best model was then used to develop a logistic regression
equation using the Enter method.
3. RESULTS
3.1. Participants
One-hundred-seven women entered the
study; 26 were lost to follow-up (footnote [1]),
2 became pregnant, leaving 79 participants with a known outcome. Of these, 30
(38%) were still on the same OC at the end of 12 months, 37 (47%) had discontinued
OC, and 12 (14%) had switched to another pill. The cumulative numbers of
participants who discontinued, switched to another OC, continued on the
original OC, or were lost to follow-up over the 12 months of the study are
shown in Figure 1. Of those who discontinued/switched, 3 did so for reasons
unrelated to the effects of the OC. This leaves 76 women for whom we can
evaluate the predictors of continuation or discontinuation. Of these, 46% had
been assigned to Ortho-Cyclen and 54% to Ortho Tri-Cyclen. When asked the reasons for discontinuation or
switching, the
following were cited spontaneously: physical side effects (37%), emotional side
effects (33%), problems with bleeding or spotting (18%), relationship ended
(18%) (footnote [2]),
sexual side effects (8%), forgetting pill (16%), and medical reasons (4%). Selected variables related to demographic and relationship characteristics and
menstrual, contraceptive, and reproductive history of the participants are
shown in Table 1.
Only
one baseline measure was related to discontinuation. The DS group had used a
higher mean number of contraceptive methods in their lifetime (M = 3.20, sd =
1.31) than the C group (M = 2.50, sd = 1.11) (t = -2.402, df = 74, p = 0.012).
In contrast, several variables
measuring change on OC were related to discontinuation.
3.2.1. Interviewer Ratings of Sexual Functioning
As shown in Table
3, more women reported a decline in the frequencies of sexual intercourse and
sexual thoughts at follow-up than reported increases. Significantly more of the
women reporting decreases in frequencies of intercourse and sexual thoughts
discontinued or switched OC. Table 2 shows the means and standard deviations
(sd) of the IRSF change scores that were significantly different between groups
(F(8,58) = 2.931, p = 0.008). Significant reductions in the frequencies of
intercourse (F(1,66) = 7.127, p = 0.016), lovemaking without intercourse
(F(1,66) = 26.869, p = 0.017), and sexual thoughts (F(1,66) = 12.236, p =
0.001) were found for the DS group.
For each of the 3 SEQ scores,
participants were classified as those with minimal side effects (scores -0.5 to
+0.5), those who had predominantly negative side effects (scores < -0.5),
those with predominantly positive side effects (scores > 0.5). As shown in
Table 3, more women reported predominantly negative sexual, emotional, and
physical side effects than reported predominantly positive changes.
Significantly more of the women reporting predominantly negative side effects
discontinued or switched OC.
3.2.3. Sexual Experience Scales
Change scores analyzed by group
revealed a significant decrease in SES2 psychosexual arousability as measured
by SES2 scores for the DS group (F(2, 63) = 4.757, p=0.012). Means (sd) are
reported in Table 2.
3.2.4.
Menstrual Variables
3.2.4.1. PMS
Fifty seven
percent believed that they suffered from PMS prior to starting OC. Fourteen
percent said they did not, and 29% were not sure. Asked about severity of their PMS, 35% rated
it as mild, 35% as moderate, 11% as severe, and 18% as “varying too much to
say” (this group was assigned a ‘moderate’ score for analyses). There were no
group differences found for baseline ratings of PMS severity. As
shown in Table 3, when asked about their perceptions of the pill’s effect on
PMS, more women reported that it helped than reported that OC made PMS
worse. All those that perceived that the
pill made PMS better also indicated that the pill reduced menstrual pain. Significantly more women who reported that
the pill made PMS worse discontinued or switched OC.
3.2.4.2. Blood Loss
Before
starting OCs, 1% reported light, 55% moderate, 40% heavy, and 4% very heavy
blood loss in the last month. No group differences were found in this initial
rating. When asked about their perceptions of the pill’s effect on blood loss,
more women reported that their periods were lighter and/or shorter than
reported that they were heavier and/or longer (Table 3). Significantly more
women who reported that the pill made their periods heavier and/or longer
discontinued or switched OC.
Table 4 presents the result of a logistic
regression analysis showing the statistically most favorable model predicting
discontinuation. This included 4 ‘predictor’
variables: i) Emotional Side Effects Score (SEQ); ii) change score for the
Frequency of Sexual Thoughts (IRSF); iii) the woman’s rating of the Effect of
the Pill on PMS (MHQ); and iv) change score for Psychosexual Stimulation Score
(SES2). The model is based on data from 53 women with complete data on all 4
variables who were not among the 4 cases eliminated based on Studentized
residuals greater than 2. The model successfully categorized 86.8% of the women
into C and DS groups and explained 87% of the variance in outcome.
To test, to
some extent, the predictive value of the model, the logistic regression
equation was then used to predict the group membership for 15 women with
missing data (and therefore not used in the first logistic regression
analysis), but who had at least 2 of the 4
variables. Mean values were substituted for missing data. Eighty percent
were classified correctly, suggesting some generalizability of the model to
women similar to those in our sample.
4. DISCUSSION
The discontinuation rate found in this study falls within the range
reported by others using different samples and methodologies [3,4,5,6,7]. It is
difficult to ascertain whether the methodology used in this study might have
influenced discontinuation. It is possible that participation in a prospective
study with payment for reassessments for as long as OC use continued during the
first year may have influenced more women to continue than would have otherwise
been the case. On the other hand, it is possible focusing on the effects of OC use may have
increased discontinuation. However, it should be noted that our findings
compare quite well with that of Rosenberg and Waugh[8] who reported a 32%
discontinuation rate among new pill starters by the end of the sixth month in
their prospective study. In our study 33% discontinued by the end of the sixth
month.
This study demonstrates, in spite of
a small sample size, that adverse effects on mood and sexuality are important
factors in discontinuation of OCs. Although physical side effects were more
marked in the women who discontinued, they did not enter into the best
predictive model. Consistent with previous studies, most women who discontinued
or switched OCs in this study did so within the first 3 months of use[8]. Furthermore,
even those who discontinued after the first 3 months of use, often reported
negative side effects related to mood and/or sexuality at the first (3-month)
follow-up visit.
There is a substantial gap in the literature explaining the
reasons for OC discontinuation[9,10], and yet these 2 potentially important
factors – emotional and sexual well-being – have been virtually ignored.
Although this study included careful assessment of pre-pill characteristics of
women (social/situational and psychological) which might be associated with
discontinuation, we found only one baseline measure associated with
discontinuation (number of previous contraceptive methods used). In contrast,
several variables which assessed change
in sexual or emotional well-being after starting the pill were strongly related
to discontinuation. The literature dating back to 1960 has acknowledged that
negative mood changes are reported by women taking the pill, and may be a
reason for discontinuation, and, today, the information provided to physicians
on OCs includes “mental depression” in the category of adverse reactions which
are “believed to be drug-related”[22]. Yet, systematic investigation of their
occurrence and of pre-pill characteristics that might relate to such effects, and
the possible mechanism underlying such effects, is strikingly absent. A
noteworthy early exception was interest in the possibility that OCs altered
tryptophan metabolism[23,24].
There has been even less attention paid to sexual side
effects. Most studies on discontinuation, even those which elicit detailed
information about reasons for discontinuation or provide a list of possible
side effects to participants, do not include sexual variables[9,25]. Our
results are consistent with those of Graham et al.[11] in suggesting direct
adverse hormonal effects of OCs on sexuality in a proportion of women. While
this may not apply to all formulations of oral contraceptives, it is worth
noting that the combined OCs used in these 2 studies contained different progestagens
(norgestimate in this study, levonorgestrel in Graham et al.[11]). We remain
ignorant of the mechanisms underlying adverse effect on sexuality. OC-induced
reduction of free testosterone (T) or direct effects of the progestagen remain
2 possibilities; there may be others. We had hoped to measure the change in
free T from baseline to 3 months of OC use and relate this to changes in sexual
interest, but this was one of the casualties of our lack of funding. It is also
distinctly possible that women vary in the behavioral impact of this reduction
in free T, which would account for this effect being restricted to a sub-group.
Currently, despite 40 years of use, we have no way of
predicting which women are likely to experience adverse effects of OCs on mood
or sexuality, nor which OC formulations are more likely to be responsible. It
has been suggested that, at least without the use of placebo control, the
evaluation of such subjective changes, which can be influenced by a variety of
factors in women’s lives, is too difficult[26]. We believe that this study,
plus our earlier placebo-controlled study[11] show that it can be done and that
the dearth of such research can no longer be justified. It is worth noting that
studies on the male contraceptive pill, although still in the developmental
phase, have already included evaluation of possible effects on
sexuality[27]. Similar evaluations are
also needed on other hormonal methods such as the injectables and implants.
The impact of this state of affairs
on clinical practice is clear. Reviewing
recent publications which focused on improving clinician-patient communication
about the benefits and risks of OCs[28], we found none recommending
that clinicians raise the possibility that sexual and/or emotional side effects
may occur. Indeed, we find the implication that drawing attention to such
effects increases their likelihood and hence should be avoided[26]. Thus, the
likelihood is that clinicians rarely inquire about possible sexual and
emotional side-effects and may not take women’s reports about any such changes
seriously. In our view, women should be encouraged to discuss sexual and
emotional effects of OCs with their health care provider in much the same way
as they are encouraged to report physical effects such as bleeding, headaches,
or breast tenderness.
Our interests are not in
discrediting OCs. We see them as a profoundly important contraceptive method.
We recognize that for the majority of women they do not produce such effects
and have a variety of health benefits beyond effective contraception. But we
are concerned about their apparently low acceptability and by the apparent
gender bias in concern about contraceptive effects on sexuality and mood that
might relate to acceptability. Only by identifying the mechanisms underlying
adverse effects associated with discontinuation can we expect to develop OCs
which are free of such effects. In the meantime, we believe that women should
be fully informed and that clinicians need to discuss potential effects of OCs on
sexuality and mood with their patients.
ACKNOWLEDGEMENTS
We thank
Stephanie Hinton for assistance with interviewing and data collection; Dr. Judy
Klein, Planned Parenthood of Central and Southern Indiana, and the
Requests for reprints should be addresses to: Stephanie A.
Sanders, Ph.D.; Associate Director; The Kinsey Institute for Research in Sex,
Gender, and Reproduction;
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[28]
Table 1. Comparison of the overall sample of women recruited
to the study and the sample used for analyses of predictors of discontinuation
|
Background variable |
Sample mean (sd) or percentage of sample |
|
|
|
Recruited sample n= 107 |
Analysis sample n= 76 |
|
General Demographics |
|
|
|
mean (sd) age in years |
22.5 (3.3) |
22.5 (4.42) |
|
% attended college/university or
technical school |
85.8 |
86.8 |
|
mean (sd) years of education |
14.07 (2.18) |
14.27 (2.36) |
|
race,
% White |
81.3 |
89.5 |
|
% African-American |
9.3 |
5.3 |
|
% other minorities |
9.3 |
5.3 |
|
mean personal income |
“lower middle
income” |
“lower middle
income” |
|
|
|
|
Menstrual &
Reproductive History
|
|
|
|
mean age at first menstruation (years) |
12.6 (1.5) |
12.7 (sd = 1.5) |
|
% 1st time OC user |
43.9 |
44.7 |
|
% reporting previous pregnancies |
31.8 |
31.6 |
|
% reporting live births |
16.8 |
15.8 |
(continued)
Table 1 (continued).
|
|
|
|
|
Relationship
History |
|
|
|
marital status % single |
67.0 |
65.3 |
|
% separated,
divorced |
5.7 |
5.3 |
|
% living with
partner |
23.6 |
22.7 |
|
% married |
3.8 |
6.7 |
|
current relationship % serious/married |
90.6 |
89.3 |
|
%
dating |
9.4 |
10.7 |
|
% sexually exclusive relationship |
97.2 |
96.0 |
|
mean nights/week spent with partner |
3.9 (2.5) |
4.1 (2.4) |
|
median (min-max) length of relationship (months) |
12 (2 - 88) |
11 (2 - 88) |
|
|
|
|
|
Concern
about STI |
|
|
|
% not at all concerned |
43.5 |
41.3 |
Table 2. Comparison of continuation (C) and discontinuation/switch (D/S)
group means (sd) for outcome variables showing significant differences
|
|
Mean (sd) |
|
|
Variables |
C Group |
DS Group |
|
|
|
|
|
Number of contraceptives used previously (CMQ) * |
2.50 (1.11) |
3.20 (1.31) |
|
Change in frequency
of intercourse (IRSF) * |
0.12 (1.08) |
-0.57 (1.16) |
|
Change in frequency
of lovemaking without intercourse (IRSF) * |
-0.10 (1.99) |
-1.38 (2.19) |
|
Change in frequency
of thinking about sex (IRSF) **** |
0.09 (0.66) |
-0.78 (1.19) |
|
Change
in psychosexual arousability score (SES2) * |
0.47 (4.48) |
-2.78 (4.77) |
|
Sexual side effects
score (SEQ) * |
-0.04 (0.26) |
-0.25 (0.51) |
|
Emotional side
effects score (SEQ) **** |
-0.02 (0.43) |
-0.35 (0.69) |
|
Physical side
effects score (SEQ) *** |
-0.04 (0.42) |
-0.27 (0.58) |
* p </= 0.05
** p </= 0.01
*** p </= 0.005
**** p </= 0.001
Table 3. Comparison of continuation and discontinuation/switching
OC for those who experienced negative vs positive changes in sexuality, mood,
and menstrual-related variables
|
Change from
pre-OC baseline |
% of overall sample |
% Continued |
% Discontinued or switched |
Chi-sq df = 2 |
p |
|
Frequency of intercourse
|
|
|
|
8.61 |
0.014 |
|
lower |
36 |
20 |
80 |
|
|
|
higher |
23 |
50 |
50 |
|
|
|
Frequency of sexual
thoughts |
|
|
|
19.15 |
<0.001 |
|
lower |
39 |
11 |
89 |
|
|
|
higher |
17 |
58 |
42 |
|
|
|
Sexual side effects |
|
|
|
6.30 |
0.043 |
|
predominantly negative |
19 |
14 |
86 |
|
|
|
predominantly positive |
1 person |
1 person |
|
|
|
|
Emotional side
effects |
|
|
|
14.82 |
0.001 |
|
predominantly negative |
40 |
14 |
86 |
|
|
|
predominantly positive |
7 |
60 |
40 |
|
|
|
Physical side
effects |
|
|
|
5.93 |
0.052 |
|
predominantly negative |
27 |
20 |
80 |
|
|
|
predominantly positive |
8 |
67 |
33 |
|
|
|
Perceptions of OC
effect on PMS |
|
|
|
14.44 |
0.001 |
|
pill made PMS worse |
21 |
14 |
86 |
|
|
|
pill made PMS better |
35 |
74 |
26 |
|
|
(continued)
Table 3 continued.
|
Change from
pre-OC baseline |
% of overall sample |
% Continued |
% Discontinued or switched |
Chi-sq df = 2 |
p |
|
perceptions
of OC effect on blood loss |
|
|
|
9.54 |
0.008 |
|
pill made period heavier and/ or longer |
16 |
22 |
78 |
|
|
|
pill made period and/or shorter |
59 |
38 |
62 |
|
|
Table 4.
Summary of logistic regression model predicting discontinuation
|
|
|
|
|
|
|
|
95% CI Exp
(B) |
|
|
|
B |
S.E. |
Wald |
df |
Sig. |
Exp (B) |
Lower |
Upper |
|
|
|
|
|
|
|
|
|
|
|
Difference
frequency of sexual thoughts |
-4.866 |
2.227 |
4.774 |
1 |
0.029 |
0.008 |
0.0001 |
0.606 |
|
Difference
psychosexual stimulation score |
-0.978 |
0.456 |
4.594 |
1 |
0.032 |
0.376 |
0.154 |
0.920 |
|
Emotional side
effects score |
-10.891 |
5.060 |
4.634 |
1 |
0.031 |
0.000 |
0.000 |
0.377 |
|
Rating of pill’s
effect on PMS x pre-OC PMS severity
rating |
-0.981 |
0.621 |
2.496 |
1 |
0.114 |
0.375 |
0.030 |
1.266 |
|
Constant |
-4.575 |
2.144 |
4.555 |
1 |
0.033 |
0.010 |
|
|
FIGURE LEGENDS
Figure 1. Cumulative numbers of women
who continued OC (C), discontinued (D), switched (S), became pregnant, and who
had unknown outcome (drop-out or loss to follow-up) over 12 months of study.
1. Comparison on a number of background variables of those lost to follow-up and those who remained in the study revealed no significant differences.
2. Results of analyses conducted omitting participants who cited their relationship ended as a reason for discontinuation were substantially the same as those reported herein. Termination of a relationship may or may not be related to the effects of OC; therefore, we included these participants in the analyses reported herein.