Oral contraceptive user compliance

In North America, an estimated 15 million women use the oral contraceptive pill. This represents about 30% of women at risk for pregnancy and demonstrates a 4–5% increase over the past decade.When used correctly, the new low-dose pill has an estimated annual failure rate of 3% in married and 6% in single women.Of all women taking the pill, 50–60% discontinue in their first year. Amenorrhea, breakthrough bleeding, weight gain and mood changes account for 75% of reasons given for pill discontinuation. Concerns about breast cancer, stroke and ‘blood clots' are persistent causes of discontinuation in women today.Negative media coverage of the pill leads to declining confidence, increased concern over risks and eventually poor compliance and discontinuation. A 1985 Gallup Poll showed that 76% of North American respondents believe that the pill carries serious side-effects. Similar studies show that 90% of young women base their decisions regarding the pill on advice from lay publications and their peers.In tackling this problem, we must first consider avoiding the word ‘compliance’. Compliance is perceived by many in the women's movement to imply a powerful relationship of authority that precludes informed choice. Physicians must learn to target specific populations of women and address specific concerns related to age, life experiences and attitudes toward self and society. Women at higher risk – diabetes, hypertension and a family history of breast cancer – require individualized counseling on the specific advantages and disadvantages of the pill. Women in transition (35–50 years of age) should be kept abreast of new and emerging data on the safety of the pill for non-smokers and its benefits in the prevention of ovarian and endometrial cancer and osteoporosis. Emerging data, from animal and human studies on the safety of the pill regarding cardiovascular disease, should be shared with the older patient.The physician must be able to communicate effectively, either directly with patients or indirectly via the media, to empower women to make truly informed choices and become comfortable and confident in dealing with the ramifications of their decisions.