Takaisin Tulosta

Strategies to improve adherence and acceptability of hormonal contraception

Evidence summaries
Editors
Last reviewed as up-to-date 24.5.2019Latest change 24.5.2019

Level of evidence: D

Intensified counselling might possibly improve adherence and continuation of hormonal contraception.

A Cochrane review «»1 «Halpern V, Grimes DA, Lopez L, Gallo MF. Strategie...»1 included 10 studies with a total of 6 242 subjects. The included trials investigated interventions in women using a variety of different shorter-term hormonal contraceptive methods. Intensified counselling improved continuation of hormonal contraceptive methods compared with usual care (table «Intensive counseling compared to usual care ...»1). There were no difference in discontinuation in 12 months. Women in the daily text-message group were more likely than the standard-care group to continue use (OR 1.33, 95% CI 1.03 to 1.73; 2 trials, n=933, I²=69%).

Table 1. Intensive counseling compared to usual care
Outcome Relative effect (95% CI) Risk with usual care Risk with intensive counseling (95% CI) № of participants (studies)
Continuation of hormonal contraceptive method OR 1.28 (1.07 to 1.54) 392 per 1 000 452 per 1 000 (408 to 498) 2624 (6)
Rate of discontinuation due to menstrual disturbances OR 0.20 (0.11 to 0.37) 320 per 1 000 86 per 1 000 (49 to 148) 350 (1)
Rate of discontinuation due to all other adverse events OR 0.73 (0.36 to 1.47) 549 per 1 000 470 per 1 000 (304 to 641) 350 (1)
Pregnancy OR 1.24 (0.98 to 1.57) 18 per 100 21 per 100 (18 to 25) 1985 (3)

Comment: The quality of evidence is downgraded by limitations in study quality (e.g., no blinding, more than 20% loss to follow up), indirectness, and by inconsistency (heterogeneity, I² = 79%).

References

  1. Halpern V, Grimes DA, Lopez L, Gallo MF. Strategies to improve adherence and acceptability of hormonal methods for contraception. Cochrane Database Syst Rev 2006 Jan 25;(1):CD004317 [Review content assessed as up-to-date: 4 September 2013]. «PMID: 16437483»PubMed