Searchable abstracts of presentations at key conferences in endocrinology
Endocrine Abstracts (2011) 26 S14.1

ECE2011 Symposia Female contraception update (3 abstracts)

Compliance and the risk of pregnancy

Anna Glasier


University of Edinburgh, Edinbrugh, UK.


Unintended pregnancy is common. Most European governments are concerned by abortion rates which, if not rising, seem stubbornly difficult to reduce. Moreover by no means all unintended pregnancies are aborted: in the UK, almost one third of pregnancies which end in childbirth are unplanned or mistimed. While no method of contraception is 100% effective, few induced abortions are the result of true method failures; most are due to unprotected sex or incorrect/ inconsistent use of contraception.

Most currently available methods of contraception rely on correct and consistent use for their effectiveness. The oral contraceptive pill has a theoretical failure rate during perfect use of only 1 in 1000 but in reality and during typical use the failure rate is actually 8 in 100 So-called ‘pill failures’ account for a substantial percentage of abortions in countries where oral contraceptives are widely used. Forgetting to take a pill (or pills) is extremely common and continuation rates are usually <50% at the end of 1 year of use.

The so-called long acting reversible contraceptives (intrauterine, implantable and injectable methods) are much less (or not at all) dependent on compliance for their effectiveness and typical use failure rates are not different from those estimated for perfect use. Moreover for contraceptive implants and intrauterine methods discontinuation rates are much lower because the method cannot simply be stopped but has to be removed by a health provider.

Interventions to assist women with compliance with contraception have proved disappointing. Reminding women to return to the clinic for their next injection of Depo Provera made no difference to compliance or to continuation rates at the end of a year of use. A randomised trial of daily telephone text messages reminding women to take their pill was similarly ineffective.

Since compliance with regular medication is often poor, even when the result of non-adherence is death; since most European women have to use contraception for more then 30 years of their lives; and since each act of sexual intercourse carries with it a risk of pregnancy of only 30% it is important that new contraceptive methods take into particular account the ease or difficulty of compliance.

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