Months dispensed and oral contraceptive discontinuation
=======================================================

* Rudiger Pittrof

*   hormonal contraception
*   family planning service provision

“I just ran out” appears to be a common explanation for discontinuation of oral contraception in clinical experience but surprisingly this was not mentioned in the excellent article by Inoue *et al*.1

There is a simple option for reducing the risk of “just running out”: supply more months of contraception per prescription. A recent systematic review2 found two randomised controlled trials and two cohort studies (168 075 women) of good quality that compared continuation rates if three versus more months of oral contraception were supplied. Three of the four studies reported increased continuation of pill use in women who received a greater number of oral contraceptive pill packs.

A record linkage study of 84 401 women in California showed that controlling for age, race or ethnicity, and previous pill use, women who received a 1-year supply of oral contraception were 30% less likely to have a pregnancy than women who received shorter supplies.3 

Faculty guidance on combined hormonal contraception (CHC)4 does not specifically recommend the number of months to be supplied at initial prescribing but states: “A follow-up visit 3 months after the first prescription of a combined hormonal method is advised to allow BP [blood pressure] to be rechecked, and assessment of any problems. Women may be offered up to a 12 months’ supply of COC [combined oral contraceptives] or CTP [combined transdermal patch] at the follow-up appointment. A yearly routine follow-up visit, plus advice to return at any time if there are problems, is recommended. Follow-ups should involve checking BP, BMI [body mass index] and enquiring about any health changes”.

WHOMEC 20155 has removed all family history, BMI and dyslipidaemia restrictions for CHC. While it is clear that CHC can increase BP, the effect is not strong and is unlikely to lift women who start with a low BP above a clinically significant threshold (>140/ or >/90).

If we can increase continuation rates and prevent unplanned pregnancies by reducing the opportunities to run out by simply supplying more packs of oral contraceptives then we need to review our reasons for not providing 1 year of oral contraceptive at initial prescribing and ask women to check their BP themselves at their local pharmacy after 3 months. At follow-up visits, 12-month prescriptions should be the norm.

## Footnotes

*   Competing interests None declared.

## References

1.   Inoue K , Barratt A , Richters J . Does research into contraceptive method discontinuation address women's own reasons? A critical review. J Fam Plann Reprod Health Care 2015;41:292–299. [doi:10.1136/jfprhc-2014-100976](http://dx.doi.org/10.1136/jfprhc-2014-100976) 
    
    [Abstract/FREE Full Text](http://jfprhc.bmj.com/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6MTQ6ImZhbWlseXBsYW5uaW5nIjtzOjU6InJlc2lkIjtzOjg6IjQxLzQvMjkyIjtzOjQ6ImF0b20iO3M6Mjk6Ii9mYW1pbHlwbGFubmluZy80Mi8yLzE2MS5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

2.   Steenland MW , Rodriguez MI , Marchbanks PA , et al . How does the number of oral contraceptive pill packs dispensed or prescribed affect continuation and other measures of consistent and correct use? A systematic review. Contraception 2013;87:605–610. [doi:10.1016/j.contraception.2012.08.004](http://dx.doi.org/10.1016/j.contraception.2012.08.004) 
    
    [PubMed](http://jfprhc.bmj.com/lookup/external-ref?access_num=23040121&link_type=MED&atom=%2Ffamilyplanning%2F42%2F2%2F161.atom) 

3.   Foster DG , Hulett D , Bradsberry M , et al . Number of oral contraceptive pill packages dispensed and subsequent unintended pregnancies. Obstet Gynecol 2011;117:566–572. [doi:10.1097/AOG.0b013e3182056309](http://dx.doi.org/10.1097/AOG.0b013e3182056309) 
    
    [CrossRef](http://jfprhc.bmj.com/lookup/external-ref?access_num=10.1097/AOG.0b013e3182056309&link_type=DOI) 
    
    [PubMed](http://jfprhc.bmj.com/lookup/external-ref?access_num=21343759&link_type=MED&atom=%2Ffamilyplanning%2F42%2F2%2F161.atom) 
    
    [Web of Science](http://jfprhc.bmj.com/lookup/external-ref?access_num=000287649400008&link_type=ISI) 

4.  Faculty of Sexual and Reproductive Healthcare.  *Combined Hormonal Contraception* . 2012. [http://www.fsrh.org/pdfs/CEUGuidance CombinedHormonalContraception.pdf](http://www.fsrh.org/pdfs/CEUGuidanceCombinedHormonalContraception.pdf) [accessed 14 November 2015].
    
    

5.  World Health Organization. Medical Eligibility Criteria for Contraceptive Use (5th edn). 2015. [http://apps.who.int/iris/bitstream/10665/181468/1/9789241549158_eng.pdf?ua=1](http://apps.who.int/iris/bitstream/10665/181468/1/9789241549158_eng.pdf?ua=1) [accessed 14 November 2015].