If you don't remember your password, you can reset it by entering your email address and clicking the Reset Password button. You will then receive an email that contains a secure link for resetting your password
If the address matches a valid account an email will be sent to __email__ with instructions for resetting your password
The aim of this survey was to understand US women's contraception journey from her first prescribed method to her current one including reasons for choosing and stopping/switching methods, healthcare provider relationships, and bleeding preferences.
Study design
We administered a nationally-representative, web-based survey of US women aged 16 to 50 years currently using (N=1656) or had previously used (N=1448) prescription contraception, or who had never used it but would consider using it in the future (N=103). Statistical analyses were based on overlap formulae with sample weights adjusted to 2010 US census demographic benchmarks.
Results
The survey was sent to 11,906 women, and 5957 responded (50% response rate). Among qualified respondents, 3104 had experience with prescription contraception. Oral contraceptives (OC) remain the most frequently prescribed method as first or subsequent contraception. However, as women switch to their current prescription method, more chose IUD contraception. As reported by respondents, only 48% of current users received counseling on how to use specific methods, and 58% were counseled on bleeding patterns to expect, while 67% were offered counseling on potential side effects. Many of the side effects reported in this study for first and current prescription contraception were nonspecific and may be related to a nocebo effect, lack of understanding about normal bodily fluctuations, or poor compliance. Many women (34%) reported ‘making their periods lighter’ as a reason for using their current prescription method, and 53% would prefer to skip their monthly period altogether.
Conclusions
Misperceptions about contraception are common, and prescription contraception choice can be quite complex. Clinicians can enhance patient satisfaction by providing adequate information and matching methods to women's lifestyles, reproductive choices, and pregnancy risk.
Implications
This study provides insight into modern women's attitudes and views toward prescription contraception that may be important to clinicians and women themselves.
Oral contraception (OC) remains the most widely used form of prescription contraception in the US. OC, however, is plagued by high discontinuation rates due to factors such as the inconvenience/difficulty taking them daily and safety concerns with hormone use [
] and, along with implants, represent important contraceptive options for most women. IUDs provide reversible, long-term, uninterrupted and consistent contraception, with a failure rate comparable to that of male or female permanent contraception [
Although much is known about contraceptive use from the perspective of healthcare providers (HCP), little is known about perceptions regarding use of these methods from the patient perspective, as well as how the patient-HCP interaction affects women's attitudes and ultimate choices of contraception. The objective of this population-based survey of US women was to better understand prescription contraception utilization and current attitudes toward prescription methods available in the US.
2. Materials and methods
2.1 Survey population
We recruited survey participants from members of the GfK KnowledgePanel®, a nationally representative and random panel of US households recruited via address-based sampling methodology. KnowledgePanel® includes households that are cell-phone only (eg, no landlines) and provides services and equipment to capture the 25% of US families without internet access. Female KnowledgePanel® members aged 16 to 50 were notified of the survey via e-mail. We screened respondents for prior and current use of prescription contraception and, for prescription contraception-naïve respondents, their interest in using it in the future.
2.2 Survey questionnaire
Between July 17 and August 10, 2015, qualified women completed the self-administered 45-min online survey addressing general understanding of various prescription contraception methods, first and current prescription contraception use, HCP relationship, information-seeking behavior, and demographic information (see Table A.1 for survey questions). For many questions, the order of choices was randomized; however, hormonal and nonhormonal IUD were always listed together. KnowledgePanel® members received points, redeemable for prizes, for their participation. Western IRB (Puyallup, WA, USA) reviewed the questionnaire and research design and approved this research.
2.3 Statistical analysis
Analyses concerning first prescription contraception were limited to women starting first prescription contraception after the year 2000. Panel sample weights were adjusted to 2010 US census demographic benchmarks to more accurately reflect the composition of US adult women [
], and sample weights were calculated based on specific design parameters: age group, race/ethnicity, education, income, internet at home, region, and residence. Unless otherwise noted, all results are reported as adjusted values. All statistical analyses were carried out at the .05 significance level using overlap formulae. All reported comparisons are significant at the .05 level except for those where statistical analyses were not performed. Statistical analyses were not performed for questions with very small base populations (<30 respondents), or between those starting first prescription contraception after year 2000 and ever users, never users, or current users.
3. Results
3.1 Survey population
Of the 11,906 women contacted, 5957 responded (ie, opened the survey, providing a 50% response rate) and 5209 were screened. Among qualified respondents (ie, those who completed the survey and were ultimately included in the analyses), 3104 had experience with prescription contraception (ever users): 1656 current users (excluding emergency contraception) and 1448 prior users (Fig. 1). An additional 103 contraception-naïve women who were interested in using it in the future were included as never users.
Fig. 1Survey Population. aBased on survey questions S1 and/or S7 (see Table A.1). bOther reasons included declined to participate, incomplete surveys, unconfirmed age. BC indicates birth control; IUD, intrauterine device; OC, oral contraception.
Prior users were older, more likely to be or to have been pregnant, and more likely to have undergone a permanent contraception procedure than current or never users (Table 1 and Table A.2). Current users were more likely to have attended or graduated from college than prior or never users. Non-Hispanic whites were less likely to be never users, and African Americans were less likely to be current users. The majority of respondents (68%) had experience with OC, while fewer had experience with other forms: 15% injection, 4% implant, 7% patch, 7% vaginal ring, and/or 13% IUD.
Table 1Survey respondent demographics and clinical characteristics.
Ever Users
%, Unless otherwise noted
Current Users N=1656
p-Value: Current vs. Prior Users
p-Value: Current vs. Never Users
Prior Users N=1448
p-Value: Prior vs. Never Users
Never Users N=103
Ever Users Starting First Prescription Contraception After Year 2000
Only 17% of respondents had undergone a permanent contraception procedure or had been told they were unable to conceive. Among respondents not currently using prescription contraception who were able to conceive, 60% were either ‘not planning to use’/’not sure about using’ prescription contraception in the future, with the most frequent reasons (>5% of respondents) being: side effects (12%/29%), not currently sexually active (12%/1%), concern about amount of hormones (11%/17%), partner had vasectomy (10%/19%), preferred nonprescription contraception (8%/14%), actively trying to get pregnant (8%/2%), preference for male condoms (7%/18%), heard ‘negative things' (4%/7%), and cost concerns (4%/6%; Table A.1).
3.2 First prescription contraception ever used
Among ever users, the average age at first prescription contraception use was 19.5 years. The most frequently prescribed method remains OC (Fig. 2). The majority were prescribed OC by their obstetrician/gynecologist (OB/GYN; 49%) or family/general/internal medicine doctor (25%); 3% were prescribed their first contraception by a pediatrician. The conversation about starting prescription contraception was initiated by the clinician for 27% of respondents, by a family member for 11%, and 7% by other/do not remember, while 55% started the conversation themselves. Respondents remembered discussing the following methods with their clinician: OC (93%), implant (7%), patch (15%), vaginal ring (16%), injection (26%), and IUD (20%).
Fig. 2First and current prescription contraception. Based on survey questions B18 and S1 (see Table A.1). Statistical comparisons for those starting first prescription contraception after year 2000 not performed. aFor ever users starting first prescription contraception after year 2000. bFor current users. IUD indicates intrauterine device; OC, oral contraception.
Over two-fifths (45%) of respondents said they sought out prescription contraception for primary reasons other than birth control (eg, to regulate menstruation). A larger proportion of women prescribed injection (70%) were primarily seeking birth control compared with OC (50%) or other methods (63% to 84%). Women who sought prescription contraception to improve acne/regulate periods were nearly as likely to be prescribed OC (5%/20%) or other methods (0% to 2%/4% to 17%), but not injection (0%/7%). Compared with the overall survey population, women choosing IUD were significantly more likely to be seeking birth control (78% vs. 55%) and less likely to be seeking regulation of periods (4% vs. 17%).
Nearly half of respondents (49%) reported being concerned about side effects before starting their first prescription. The most frequent (>5% of respondents) concerns were weight gain (57%), mood swings (18%), blood clots (9%), infertility (9%), nausea/vomiting (7%), irregular/missed periods (6%), and other (15%). Of all side effects, only mood swings differed significantly between younger (20% in 16−34 year olds) and older (7% in 35−50 year olds) women. Compared with injection, respondents using OC were more likely to switch methods due to forgetting to take/missed doses (36% vs. 0%), but less likely because of wanting more regular periods (4% vs. 12%) and/or other reasons (10% vs. 32%). There were no other differences between OC and other prescription methods in reasons for switching or stopping first prescription contraception. Reported side effects (selected from a list of common side effects; see question A5 in Table A.1) for first prescription contraception were similar, regardless of method (Table 2).
Compared with first prescription contraception, the pattern of current prescription contraception (including those still on their first method) was similar, although fewer respondents were currently using OC and more were using IUD (Fig. 2). Nulliparous women were more likely than parous women to be currently using OC (26% vs. 12%) and less likely to be using IUD (3% vs. 8%); there were no other differences in current use based on parity. Current OC/implant users were more likely to want children in the future (35%/2%) than not (15%/1%); there were no other differences in desire to have children by contraceptive method.
Over half (56%) of current users had continuously used their first prescription method. An additional 11% had taken some time off, but restarted the same method. Of the remaining 33%, 52% switched from OC (as first or subsequent method) to their current method, 2% from implant, 7% from patch, 10% from vaginal ring, 17% from injection, 9% from IUD, and 3% from other. The majority of current users who had a prescription method in mind prior to visiting their clinician were prescribed that method (Fig. 3).
Fig. 3Prescription contraceptive method in mind prior to HCP visit versus method prescribed for current prescription users.a Based on survey question D8 (see Table A.1). Methods in the top row indicate method respondents had in mind prior to HCP visit, while methods in the left-most column indicate method prescribed. aNot still using first prescription contraception. HCP indicates health care provider; IUD, intrauterine device.
Compared with their younger counterparts, older women were just as likely to be using their current prescription method for birth control (71% vs. 75%), to make periods lighter (32% vs. 35%), and/or to help control mood swings (5% vs. 7%), but significantly less likely to improve acne (3% vs. 13%), regulate periods (35% vs. 44%), and/or reduce menstrual cramps (20% vs. 30%).
The proportions of women reporting side effects (as selected from a list of common side effects; see question A5 in Table A.1) with their current method was markedly lower than reported for the first (Table 2). Among those reporting side effects with their current method, younger women were more likely than older women to report breast tenderness/enlargement (13% vs. 8%), fatigue (12% vs. 8%), mood changes (18% vs. 9%), increased vaginal discharge (10% vs. 5%), and/or concern about not being able to get pregnant after stopping (9% vs. 1%), but less likely to report increased blood pressure (2% vs. 5%).
Compared with current OC users, current IUD users were equally satisfied (77% vs. 75%), but significantly more IUD users believed their method was effective (92% vs. 87%) and fit their lifestyle (86% vs. 71%). There were several significant differences in side effects perceived to be related to hormonal IUD/nonhormonal IUD, or OC, particularly proportions of women reporting monthly periods, irregular menstrual bleeding, and cramps as side effects (Table 2).
3.4 Bleeding preferences
Over half of qualified respondents (53%) would prefer to skip their monthly period. Respondents felt that the ideal number of bleeding days per month was 2.5, with 0 (19%) and 3 (29%) days being most frequently reported. There were no significant differences in bleeding preference by parity or race/ethnicity. Not having a monthly period was reported as a side effect by 26% of current users (Table 2), while 34% of current users reported making their period lighter as a reason for using prescription contraception. Compared to women who preferred to get periods, women who preferred to skip periods were more likely to use IUDs (10% vs. 5%).
3.5 HCP relationship
The majority of respondents (90%) reported having a primary clinician for their women's health needs: 54% OB/GYN, 24% family/general/internal medicine, 5% nurse practitioner, 3% physician assistant, 2% pediatrician/adolescent doctor, 1% midwife, and 1% other. Of these, 44% received counseling about types of prescription methods. Only 28% felt that the role of hormones in general and reproductive health was well explained, while 42% felt that it had been explained somewhat.
Among current users, 48% remembered being offered counseling on a variety of methods, 48% on how to use specific methods, 58% on what to expect from periods, and 67% on potential side effects. Women who reported receiving counseling about contraceptive methods and/or the role of hormones were significantly more likely to be satisfied with how their clinician managed their prescription contraception compared with the overall survey population (88% vs. 80%).
Compared with first prescription contraception, more current users reported choosing their current prescription contraception based on their own research (62% vs. 38%) and clinician recommendations (25% vs. 13%); 9% and 8% relied on advertising, 12% and 15% on cost effectiveness, and/or 24% and 58% on family/friend recommendation. The most frequently consulted sources of information on contraception were the internet (40%) and family/friends (22%); 6% reported talking with a pharmacist and 2% reported consulting a doctor.
Current IUD (66%) and OC (57%) users were more likely to see an OB/GYN for their women's health needs than a family/general/internal medicine provider (16% and 23%, respectively). Women who received counseling about contraceptive methods and/or the role of hormones were more likely to be current IUD users (67%) than current OC users (47%).
4. Discussion
Demographic patterns in prescription contraception use observed in this study were consistent with national trends [
]. It is notable that we administered this survey and collected the data after implementation of the Affordable Care Act, so a trend in the opposite direction (expanded use) might have been expected.
In this study, the type of clinician and whether patients received counseling from their clinician influenced choice of prescription method, highlighting the importance of the patient-HCP relationship. In previous studies, <20% of primary care providers offered IUDs [
Observational, prospective, multicentre study to evaluate the effects of counselling on the choice of combined hormonal contraceptives in Italy--the ECOS (Educational COunselling effectS) study.
]. Interestingly, there were no statistical differences in the proportions of women dissuaded from using particular prescription methods based on age, race/ethnicity, or parity. Given that a previous study demonstrated that racial/ethnic disparities in clinician recommendations for IUD were only apparent among women of lower socioeconomic status [
], this lack of difference may be because the current analysis did not consider socioeconomic status.
The results from this survey also confirm that control of menstrual bleeding is among the reasons women seek prescription contraceptives. While the majority of women preferred to skip or shorten periods, only 34% reported desiring lighter periods as a reason for using their current method. This suggests that patients' desire for bleeding control is quite varied, and recommendations should be carefully matched to each patient's preferences. Younger women were more likely to prefer having scheduled bleeding, similar to results previously published [
Preferred frequency and characteristics of menstrual bleeding in relation to reproductive status, oral contraceptive use, and hormone replacement therapy use.
Many of the side effects reported in this study (as selected from a list of common side effects; see question A5 in Table A.2) are nonspecific and likely unrelated to prescription contraception and perhaps related to a nocebo effect (ie, negative placebo effect) [
] urges HCPs to implement optimistic counseling that emphasizes that patients will most likely feel well with their prescription contraceptive and only discuss side effects that are evidence based. In this study, more women reported being offered counseling on potential side effects (67%) than on correct and consistent use (48%) or what to expect from periods (58%). Additionally, some of the reported side effects may be related to incorrect use of their prescription (ie, menstrual bleeding irregularities) or a lack of understanding about normal monthly bodily changes (ie, water retention, breast tenderness).
The response rate observed in this study is within the range observed for other studies of this type [
]. Potential nonresponse/nonsampling bias was mitigated by adjusting panel sample weights based on US census data. However, there is still the possibility that the women participating in this study had different attitudes than those who decided not to participate.
As with any survey, recall and selection bias may limit the conclusions that can be drawn. In order to minimize the impact of recall bias, analyses of first prescription contraception were limited to those who had started after the year 2000. To reduce the potential for selection bias, we recruited participants from among a US population-based panel. The survey format and question wording may have also influenced the results, especially related to perceived side effects as respondents were asked to choose side effects from a list, potentially skewing or inflating responses.
In this nationally representative survey, OC remains the most popular first prescription contraception choice with many women never switching from OC to a subsequent method. For those who did switch, over half switched from OC to their current method. As women switched to their current prescription method, the proportion choosing IUD rose. These survey results highlight women's feelings of lack of counseling and discussion on side effects with HCPs and further underscores that, whether choosing a first or subsequent method, HCPs play an important role in recommending methods that must be carefully matched to individual patient preferences and counseling patients about prescription contraception options, usage, risks, and benefits. The survey demonstrates the need for improved counseling to dispel myths and improve understanding of side effects in both older and younger cohorts.
Funding
This study was supported by Allergan plc.
Declaration of interest
Anita Nelson has received grants from Agile, Bayer, ContraMed, and Merck. Dr. Nelson has received honoraria and is a member of the Speakers Bureau for Allergan plc, Aspen, Bayer, Merck, and Teva. Dr. Nelson is a consultant and on the Advisory Board for Allergan plc, Agile, Bayer, ContraMed, Female Health Co., Merck, MicroCHIPS Biotech, and Pharmanest.
Stephen Cohen has nothing to disclose relative to this project.
Alex Galitsky and Dale Kappus are employees of GfK, which conducted the survey with financial support from Allergan plc.
Mark Hathaway is a Trainer for Merck (Nexplanon) and is an Advisory Board Member for Afaxys, Allergan, Contramed, and Medicines360.
Majid Kerolous and Kiren Patel are employees of Allergan plc.
Linda Dominguez has received financial compensation for her work as a speaker for Merck & Co. and as a speaker and consultant for Allergan plc.
Acknowledgements
Medical writing and editorial assistance for this manuscript was provided by Jennifer Jaworski, MS, of Prescott Medical Communications Group (Chicago, IL) and was funded by Allergan plc.
Appendix A. Appendices
Table A.1Selected Survey Questions Administered to Women Regarding Contraception Methods and Use.
Question number
Base
Question
S0.
All
Please enter your date of birth.
S0_1.
All
What is your gender?
S1.
All
Which of the following best describes your experience with each of the following contraceptives? [currently using (a); used in the past (b); familiar with method, but never used (c); aware of method but don't know anything about it (d); never heard of (e)] 1. Birth control pills 2. A hormonal intrauterine device (IUD) – Mirena, Skyla, Liletta – placed by a healthcare professional into the uterus 3. Contraceptive implant – Implanon or Nexplanon – administered by a healthcare professional by inserting beneath the skin on the underside of the arm 4. Contraceptive patch – Ortho Evra 5. Contraceptive ring – NuvaRing 6. Contraceptive shot (under the skin) or injection – Depo-Provera or Depo subQ 7. A cervical cap (FemCap) 8. A non-hormonal intrauterine device (IUD) – ParaGard – placed by a healthcare professional into the uterus 9. Contraceptive diaphragm 10. Contraceptive sponge – available without healthcare professional's prescription 11. (Male use of) condoms for having sex 12. Fertility Awareness: calendar rhythm, natural family planning 13. Withdraw or Outercourse 14. Other
S1a.
All with ≥1 S1 items 1–10 = a
For each of the following forms of contraception listed below, please indicate your experience. [currently using, used in the past, never used] Show if S1 item 1 = a a. SPRINTEC 28 b. TRI-SPRINTEC-28 c. LO LOESTRIN FE d. TRINESSA-28 e. ORTHO-TRI-CY LO 28 f. MICROGESTIN FE 1/20 28 g. MINASTRIN 24 FE h. TRI-PREVIFEM 28 i. JUNEL FE 1/20–28 j. GILDESS FE k. SEASONALE l. SEASONIQUE m. Yasmin n. Other brand / Unknown brand generic contraceptive pills o. (Derived from S1) Depo-Provera / Depo subQ p. (Derived from S1) FemCap q. (Show if S1 item 3 = a or b) Implanon r. (Show if S1 item 2 = a or b) Liletta s. (Show if S1 item 2 = a or b) Mirena t. (Show if S1 item 3 = a or b) Nexplanon u. (Derived from S1) NuvaRing v. (Show if S1 item 2 = a or b) Skyla w. (Derived from S1) Ortho Evra x. Other hormonal method y. (Derived from S1) Contraceptive diaphragm z. (Derived from S1) Contraceptive sponge aa. ParaGard
S1c.
Current users
How long have you been using your current contraceptive method? Your best estimate is fine.
S2a.
All
Are you currently pregnant?
S1d.
All
Have you ever been pregnant?
S4.
All
Have you had any procedures that have made you unable to get pregnant? a. Yes, hysterectomy b. Yes, Essure procedure c. Yes, tubal sterilization (tubes tied or removed) d. Yes, some other procedure e. No, never. However, I′ve been told by a healthcare provider that I will not be able to have children f. No, I never had any procedures
S6.
Prior users AND never users
What are the main reasons why you are currently not using prescription
Prescription contraceptives include pills, vaginal ring, implant, injections, or IUDs that must be prescribed, administered, or inserted by a healthcare professional. IUD indicates, intrauterine device.
contraceptives? a. (Show if S2a = Yes) I′m currently pregnant b. I′m actively trying to get pregnant c. (Show if S4 = a-d) I had a procedure that makes me unable to get pregnant d. I prefer male condoms e. (Show if prior user) My previous prescription contraception method did not control my cycle well (I was bleeding and/or spotting) f. (Show if never user) I am worried that prescription contraception would change my cycle (I would bleed and/or spot throughout the month) g. (Show if prior user) I experienced side effects while on a prescription contraceptive h. It is inconvenient i. It's expensive/ I can't afford it; it's not covered by my health insurance j. It's expensive/ I can't afford it; I don't currently have health insurance k. I heard negative things (via friends/family/media) about it l. Religious beliefs/religious upbringing m. I′m not interested in having sexual relations with men n. I′m concerned about the amount of hormones I′d be exposed to o. My partner had a vasectomy p. I am not currently sexually active q. I don't currently see a healthcare professional r. I simply prefer non-prescription contraceptives s. My partner is not fertile t. I don't believe in contraception u. (Show if S4 = e) I′ve been told by a healthcare provider that I am unable to have children v. Other
S7.
Prior users AND never users
Which of the following contraceptive methods, if any, do you plan to use at any time in the future? Please select all that apply. a. Prescription contraceptives – such as pills, vaginal ring, implant, injections, diaphragm, or IUD – prescribed, administered or inserted by a healthcare professional b. Non-prescription (over-the-counter) contraceptives, such as sponge, condoms, etc. c. Sterilization (having tubes tied) d. None of the above e. Not sure
S7b.
Prior users AND All with all S1 items 1–9 = b/c and S7 ≠ a
What are the main reasons why you are not planning to use prescription
Prescription contraceptives include pills, vaginal ring, implant, injections, or IUDs that must be prescribed, administered, or inserted by a healthcare professional. IUD indicates, intrauterine device.
contraceptives at any time in the future? a. (Show if S4 = a-d) I had a procedure that makes me unable to get pregnant b. I prefer male condoms c. (Show if prior user) My previous prescription contraception method did not control my cycle well (I was bleeding and/or spotting) d. (Show if all S1 items 1–9 = b/c and S7 ≠ a) I am worried that prescription contraceptives would change my cycle (I would bleed and/or spot throughout the month) e. I am concerned about side effects f. It is inconvenient g. It's expensive/ I can't afford it; it's not covered by my health insurance h. It's expensive/ I can't afford it; I don't currently have health insurance i. I heard negative things (via friends/family/media) about it j. Religious beliefs/religious upbringing k. I′m not interested in having sexual relations with men l. I′m concerned about the amount of hormones I′d be exposed to m. My partner had a vasectomy n. I simply prefer non-prescription contraceptives o. My partner is not fertile p. I don't believe in contraception q. Other
S8.
All with S4 = f and S6 ≠ c
Do you plan to have biological children in the future?
A2.
All
Some hormonal prescription contraceptives reduce the number of menstrual periods. How do you feel about that? a. I strongly prefer to skip my period as much as possible b. I moderately prefer to skip my period as much as possible c. I somewhat prefer to skip my period as much as possible d. Neutral e. I somewhat prefer to get my period each month f. I moderately prefer to get my period each month g. I strongly prefer to get my period each month
A3.
All
If you could choose the number of menstrual bleeding days each month, what would it be?
A5.
All with S1 item 2, 3, or 6 = c
Below are the prescription contraceptive methods that you said you are familiar with, but have never used. Which of the following side effects, if any, do you associate with each method? Please select any that you believe apply. For anything you don't know or unsure about, please leave it blank. [An intrauterine device (IUD) – Mirena, Skyla, Liletta, or ParaGard; Implant: Implanon or Nexplanon; Injection: Depo-Provera or Depo subQ] a. Blood clots / risk of stroke b. Breast tenderness/enlargement c. Cramps d. Fatigue e. Dizziness f. Hair loss g. Headaches/migraines h. Increased blood pressure i. Increased risk of cancer j. Loss of sexual desire/changes in libido k. Menstrual bleeding irregularities l. Mood changes m. Nausea/vomiting n. Vaginal dryness o. Weight gain p. Water retention / bloating q. Yeast infection/vaginal infection r. Not having monthly period s. Concern about not being able to get pregnant after stopping this method t. Increase in vaginal discharge
B18.
Ever users starting first prescription BC after year 2000
Thinking back to when you started prescription contraceptive for the first time, what was the first method your doctor prescribed? a. Birth control pills b. A hormonal intrauterine device (IUD) – Mirena, Skyla, Liletta c. Contraceptive implant – Implanon or Nexplanon d. Contraceptive patch – Ortho Evra e. Contraceptive ring – NuvaRing f. Contraceptive shot (under the skin) or injection – Depo-Provera or Depo subQ g. A cervical cap – FemCap h. A non-hormonal intrauterine device (IUD) – ParaGard i. Contraceptive diaphragm j. Other
B1.
Ever users starting first prescription BC after year 2000
(If S1 = a or b for only 1 product, skip B1 and derive age from S1c) How old were you when you first started using [insert from B18]? Your best estimate is fine.
B2a.
Ever users starting first prescription BC after year 2000
Thinking back to when you first started using [insert: from B18], what were the reasons? Select all that apply. a. (Show if S4 = f) Birth control b. Improve my acne c. Regulate my period d. Reduce menstrual cramps e. Make periods lighter f. Help control mood swings g. Other
B2b.
Ever users starting first prescription BC after year 2000
Now, please select the primary reason why you first started using [insert from B18). a. (Show if S4 = f) Birth control b. Improve my acne c. Regulate my period d. Reduce menstrual cramps e. Make periods lighter f. Help control mood swings g. Other from B2a
B6.
Ever users starting first prescription BC after year 2000
Who initiated the first discussion you had with your healthcare provider about prescription contraceptives? a. Doctor or other healthcare provider b. I did c. Family member d. Other e. Don't remember
B7.
Ever users starting first prescription BC after year 2000
Which type of healthcare provider first prescribed your [insert from B18]? a. Obstetrician / Gynecologist (OB / GYN) b. Family Doctor, General Doctor, or Internal Medicine Physician c. Pediatrician or Adolescent Doctor d. Nurse Practitioner (NP) e. Physician's Assistant (PA) f. Midwife g. Other h. I do not remember / Not sure
B11.
Ever users
Is the healthcare provider who first prescribed your [insert from B18] the same person you currently see for your women's health needs?
B12.
Ever users starting first prescription BC after year 2000
Thinking back to when you first started using [insert from B18], did you have any concerns about using prescription contraceptives? Select all that apply. a. I was concerned about side effects b. I was concerned about effectiveness c. I was concerned about affordability/costs d. I had other concerns (please specify) e. No, I didn't have any particular concerns f. Don't remember
B13.
Ever users with B12 = a and starting first prescription BC after year 2000
In your own words, please indicate which side effects you were concerned about before first starting [insert from B18].
B14.
Ever users starting first prescription BC after year 2000
Thinking back to when you first started using [insert from B18], did you have a specific prescription contraceptive method in mind that you wanted to use?
B15.
Ever users with B14 = Yes and starting first prescription BC after year 2000
Which prescription contraceptive did you have in mind? a. Birth control pills b. A hormonal intrauterine device (IUD) – Mirena, Skyla, Liletta c. Contraceptive implant – Implanon or Nexplanon d. Contraceptive patch – Ortho Evra e. Contraceptive ring – NuvaRing f. Contraceptive shot (under the skin) or injection – Depo-Provera or Depo subQ g. A cervical cap – FemCap h. A non-hormonal intrauterine device (IUD) – ParaGard i. Contraceptive diaphragm j. Other
B16.
Ever users with B14 = Yes and starting first prescription BC after year 2000
Before you saw your healthcare provider, why did you think that [insert from B15] was right for you? a. I researched the method and thought it was right for me b. The method I thought was the most cost effective for me c. My healthcare provider had previously recommended this method d. My mom / parental figure has had experience / recommended the method e. My sister has had experience / recommended the method f. My significant other / partner / husband recommended the method g. Another family member has had experience / recommended the method h. Friend(s) have had experience / recommended the method i. I saw an advertisement for the method j. Other
B19.
Ever users starting first prescription BC after year 2000
Which other prescription contraceptive methods, if any, did your healthcare provider discuss with you at that time s/he first prescribed [insert from B18]? (Omit item selected in B18) a. Birth control pills b. A hormonal intrauterine device (IUD) – Mirena, Skyla, Liletta c. Contraceptive implant – Implanon or Nexplanon d. Contraceptive patch – Ortho Evra e. Contraceptive ring – NuvaRing f. Contraceptive shot (under the skin) or injection – Depo-Provera or Depo subQ g. A cervical cap – FemCap h. A non-hormonal intrauterine device (IUD) – ParaGard i. Contraceptive diaphragm j. Other k. None
B21.
Ever users starting first prescription BC after year 2000
Again, thinking back to when you started using prescription contraceptives for the first time, did your healthcare provider talk you out of choosing any specific prescription contraceptive methods?
B22.
Ever users with B21 = Yes and starting first prescription BC after year 2000
Which prescription contraceptive method(s) did your healthcare provider talk you out of choosing at that time? (Omit item selected in B18) a. Birth control pills b. A hormonal intrauterine device (IUD) – Mirena, Skyla, Liletta c. Contraceptive implant – Implanon or Nexplanon d. Contraceptive patch – Ortho Evra e. Contraceptive ring – NuvaRing f. Contraceptive shot (under the skin) or injection – Depo-Provera or Depo subQ g. A cervical cap – FemCap h. A non-hormonal intrauterine device (IUD) – ParaGard i. Contraceptive diaphragm j. Other
B23_1.
Ever users with B22 = b and starting first prescription BC after year 2000
In your own words, please describe the reasons why your healthcare provider talked you out of choosing a hormonal intrauterine device (IUD) – Mirena, Skyla, Liletta.
B23_2.
Ever users with B22 = h and starting first prescription BC after year 2000
In your own words, please describe the reasons why your healthcare provider talked you out of choosing a non-hormonal intrauterine device (IUD) – ParaGard.
B25.
Ever users starting first prescription BC after year 2000
Which of the following best describes your experience with your first contraception method – [insert from B18]? Please think back to when you started using prescription contraceptives for the first time. a. I have continuously used (without ever switching or stopping for more than a month) my first and only prescription contraceptive method, and I′m still using it now b. I stopped using this prescription contraceptive method after a period of time, and then restarted, and still using it now c. I stopped using this prescription contraceptive method after a period of time, because I switched to another prescription contraceptive method d. I stopped using this prescription contraceptive method after a period of time (eg, I tried to conceive, didn't see the need, etc.); I have not used any prescription contraceptives since then
B27a.
Ever users with B25 = d and starting first prescription BC after year 2000
To the best of your recollection, what are the main reasons why you eventually stopped using this prescription contraceptive method? a. (If S1d = Yes) I experienced an unplanned pregnancy b. I experienced side effects/it caused discomfort/pain c. It was inconvenient/ didn't fit with my lifestyle d. (Show if B18 = a) I kept forgetting to take it / missed doses e. It was too expensive/ I couldn't afford it f. I heard negative things (via friends/family/media) about it g. (Show if B2a = b-g) It didn't improve my non-birth control symptoms (eg, to regulate a menstrual cycle, to treat acne, etc.). h. My partner had a vasectomy i. I was no longer sexually active j. I wanted a product that would give me fewer periods in a year k. I wanted a product that would give me more regular periods (ie, approximately once a month) l. My mother, family member, my partner or friend recommended a new method m. I was trying to get pregnant/ I wanted something that would allow a quicker return to fertility n. I was concerned about the amount of hormones I was being exposed to o. Other
B27b.
Ever users with B25 = c and starting first prescription BC after year 2000
To the best of your recollection, what are the main reasons why you eventually stopped using this prescription contraceptive method and switched to a different prescription contraceptive method? a. (Show if S1d = Yes) I experienced an unplanned pregnancy b. I experienced side effects/it caused discomfort/pain c. It was inconvenient/ didn't fit with my lifestyle d. (Show if B18 = a) I kept forgetting to take it / missed doses e. It was too expensive/ I couldn't afford it f. I heard negative things (via friends/family/media) about it g. (Show if B2a = b-g) It didn't improve my non-birth control symptoms (eg, to regulate a menstrual cycle, to treat acne, etc.). h. I wanted a product that would give me fewer periods in a year i. I wanted a product that would give me more regular periods (ie, approximately once a month) j. My mother, family member, my partner or friend recommended a new method k. I was trying to get pregnant/ I wanted something that would allow a quicker return to fertility l. I was concerned about the amount of hormones I was being exposed to m. Other
B28.
Ever users with B27a/B27b = b and starting first prescription BC after year 2000
Please indicate which side effects you experienced while using your first prescription contraceptive method – [insert from B18] -- that you believe are directly associated with it. a. Blood clots / risk of stroke b. Breast tenderness/enlargement c. Cramps d. Fatigue e. Dizziness f. Hair loss g. Headaches/migraines h. Increased blood pressure i. Increased risk of cancer j. Loss of sexual desire/changes in libido k. Menstrual bleeding irregularities l. Mood changes m. Nausea/vomiting n. Vaginal dryness o. Weight gain p. Water retention / bloating q. Yeast infection/vaginal infection r. Not having monthly period s. Concern about not being able to get pregnant after stopping this method t. Increase in vaginal discharge u. Other v. None
C1.
All
(If B11 = Yes, skip C1 and use answer to B7) Who is your current primary healthcare provider for your women's health needs? a. Obstetrician / Gynecologist (OB / GYN) b. Family Doctor, or General Doctor, or Internal Medicine Physician c. Pediatrician or Adolescent Doctor d. Nurse Practitioner (NP) e. Physician's Assistant (PA) f. Midwife g. Other h. I do not have a healthcare provider for my women's health needs
C4.
All with C1 ≠ h
What is the gender of your current healthcare provider for your women's health needs?
C10.
Current users with C1 ≠ h
How satisfied or dissatisfied are you with how your healthcare provider helps you with your birth control? [extremely dissatisfied, moderately dissatisfied, somewhat dissatisfied, neither satisfied nor dissatisfied, somewhat satisfied, moderately satisfied, extremely satisfied]
C12.
All with C1 ≠ h
Has your healthcare provider offered you counseling about types of contraceptive methods available?
C13.
All with C1 ≠ h
To what extent has your healthcare provider counseled you on the hormones' (estrogen and progestin) role in your general and reproductive health? [didn't explain at all (1), (2), (3), explained somewhat (4), (5), (6), completely explained, and I left with no questions (7)]
C15.
Current users with C1 ≠ h C4 = Female
You mentioned that your healthcare provider is a female. Did she share with you her personal experience of using prescription contraceptives?
D1a.
Current users
Earlier in the survey you mentioned that you're currently using [insert S1 item = a]. What are the reasons for using it? Select all that apply. a. (Show if S4 = f) Birth control b. Improve my acne c. Regulate my period d. Reduce menstrual cramps e. Make periods lighter f. Help control mood swings g. Other
D2.
Current users
How satisfied or dissatisfied are you with [insert S1 item = a]? [extremely dissatisfied, moderately dissatisfied, somewhat dissatisfied, neither satisfied nor dissatisfied, somewhat satisfied, moderately satisfied, extremely satisfied]
D3.
Current users
How effective or ineffective do you believe [insert S1 item = a] is at preventing pregnancy? [extremely not effective, moderately not effective, somewhat not effective, neither effective not ineffective, somewhat effective, moderately effective, extremely effective]
D7.
Current users
How well does [insert S1 item = a] fit with your lifestyle? [doesn't fit with my lifestyle at all, fits barely, fits a little, fits somewhat, fits moderately well, fits very well, fits extremely well with my lifestyle]
D5.
Current users
Please indicate which side effects you have experienced while using [insert S1 item = a] that you believe are directly associated with this prescription contraceptive method. a. Blood clots / risk of stroke b. Breast tenderness/enlargement c. Cramps d. Fatigue e. Dizziness f. Hair loss g. Headaches/migraines h. Increased blood pressure i. Increased risk of cancer j. Loss of sexual desire/changes in libido k. Menstrual bleeding irregularities l. Mood changes m. Nausea/vomiting n. Vaginal dryness o. Weight gain p. Water retention / bloating q. Yeast infection/vaginal infection r. Not having monthly period s. Concern about not being able to get pregnant after stopping this method t. Increase in vaginal discharge u. Other v. None
D6.
Current users
Which of the following do you believe is the active ingredient/hormone in [insert S1 item = a]. a. Estrogen and Progestin together b. Progestin alone c. (Show if S1 item 2 = a or S1 item 8 = a) Copper d. Not sure / don't know
D7.
Current users with>1 S1 item 1–9 = b
Now, think back to the time when your healthcare provider prescribed your current contraceptive. Before seeing your healthcare provider, did you have a specific prescription contraceptive method in mind that you wanted to use?
D8.
Current users with D7 = Yes
(If S1 items 1–9 ≠ b, skip and derive answer from B15) Which prescription contraceptive did you have in mind? a. Birth control pills b. A hormonal intrauterine device (IUD) – Mirena, Skyla, Liletta c. Contraceptive implant – Implanon or Nexplanon d. Contraceptive patch – Ortho Evra e. Contraceptive ring – NuvaRing f. Contraceptive shot (under the skin) or injection – Depo-Provera or Depo subQ g. A cervical cap – FemCap h. A non-hormonal intrauterine device (IUD) – ParaGard i. Contraceptive diaphragm j. Other
D9.
Current users with D7 = Yes
Why did you think that the prescription contraceptive method you had in mind before seeing your health care provider was right for you? a. I researched the method and thought it was right for me b. The method I thought was the most cost effective for me c. My healthcare provider had previously recommended this method d. My mom / parental figure has had experience / recommended the method e. My sister has had experience / recommended the method f. My significant other / partner / husband recommended the method g. Another family member has had experience / recommended the method h. Friend(s) have had experience / recommended the method i. I saw an advertisement for the method j. This method seemed easy to use for me k. Other
D10.
Current users
At the time your healthcare provider prescribed your current prescription contraceptive, did s/he offer you any of the following…? a. Counseling about a variety of different types of contraceptive methods available b. Education on how to use specific contraceptive method devices (eg, ring, IUD, patch) c. Setting expectations about what a period would be like (eg, experience, frequency, etc.) d. Information about potential side effects
D14.
Current users
At the time your healthcare provider prescribed your current contraception method, did s/he talk you out of choosing any specific prescription contraceptive methods?
D15.
Current users with D14 = Yes
(If S1 items 1–9 ≠ b, skip and derive answer from B22) Which prescription contraceptive method(s) did your healthcare provider talk you out of choosing at that time? a. Birth control pills b. A hormonal intrauterine device (IUD) – Mirena, Skyla, Liletta c. Contraceptive implant – Implanon or Nexplanon d. Contraceptive patch – Ortho Evra e. Contraceptive ring – NuvaRing f. Contraceptive shot (under the skin) or injection – Depo-Provera or Depo subQ g. A cervical cap – FemCap h. A non-hormonal intrauterine device (IUD) – ParaGard i. Contraceptive diaphragm j. Other
D20.
All with S1 item 1 = a
In the past 30 days, how many times did you forget to take your birth control active pill as indicated (including forgetting to start a new pack on time)? If never, please insert 0 (zero). Your best estimate is fine.
D25.
Current users with>1 S1 items 1–9 = b
Which of the following best describes how you started currently using [insert S1 item = a]? Please note: When using pills, changing pill brands and/or doses is not considered a switch in methods. a. I had used this method, and after taking time off (eg, pregnancy, lack of need), I re-started using it b. I had used another method, and after taking time off (eg, pregnancy, lack of need), I switched to this method c. I switched from another prescription contraceptive method, which I used immediately prior to starting my current method
D26.
Current users with>1 S1 items 1–9 = b and D25 ≠ a
Which of the following best describes the contraception method you switched from? Please note: When using pills, changing pill brands and/or doses is not considered a switch in methods. a. I switched from the original (first) prescription contraceptive method I ever used b. The prescription contraception method I switched from was not the original (first) prescription contraceptive method I ever used
D27.
Current users with>1 S1 items 1–9 = b and D25 ≠ a
(If D26 = a, skip D27 and derive answer from B18) Which prescription contraceptive method did you switch from? a. Birth control pills b. A hormonal intrauterine device (IUD) – Mirena, Skyla, Liletta c. Contraceptive implant – Implanon or Nexplanon d. Contraceptive patch – Ortho Evra e. Contraceptive ring – NuvaRing f. Contraceptive shot (under the skin) or injection – Depo-Provera or Depo subQ g. A cervical cap – FemCap h. A non-hormonal intrauterine device (IUD) – ParaGard i. Contraceptive diaphragm j. Other
E5.
All with S1 item 1 = a-c
Please indicate the degree to which you agree or disagree with the following statement: I am concerned about the amount of estrogen [“I am” for S1 item 1 = a, “Women are” for S1 item 1 = b or c] exposed to when using birth control pills. [strongly disagree, disagree, somewhat disagree, neither agree or disagree, somewhat agree, agree, strongly agree]
Z00a.
All with S1a item 18, 19, 22, or 27 = a/b
You mentioned you were previously on [insert S1a item = a/b]. Approximately, how much time passed between the first time your healthcare provider counseled you on an IUD option and the time the IUD was inserted? Your best estimate is fine.
Z00b
All with S1a item 18, 19, 22, or 27 = a/b and Z00a>0
You mentioned that your healthcare provider did not insert the IUD the same day when s/he counseled you on an IUD option. What were the main reasons for that? (Select all that apply) a. My healthcare provider was too busy to insert the IUD the same day b. Additional time was need to check my insurance c. I needed more time to think about my out of pocket cost d. I had to wait due to my menstrual cycle e. I needed more time to consider whether the IUD was right for me f. The decision to use the IUD took place when I was pregnant or was trying to get pregnant g. Other h. Don't remember
Z00c.
All with S1a item 18, 19, 22, or 27 = a/b, Z00a>0, and Z00b = a-c/e
If the “same-day” option for IUD insertion was available, would you have preferred it? (definitely not preferred it, probably not preferred it, not sure, probably preferred it, definitely preferred it)
Z1b.
All with S1a item 22, 18, or 27 = a
Out of all available IUD options, why have you been using [insert S1a item 22, 18, or 27] as your current method of birth control?
Z2.
All with S1 item 2/8 = a-c
How effective do you believe intrauterine devices (IUDs) are as a method of birth control? [not at all effective (1), (2), (3), somewhat effective (4), (5), (6), extremely effective (7)
Z3.
All with S1 item 2/8 = a-c
How safe to use do you believe is an intrauterine device (IUD)? [not at all safe (1), (2), (3), somewhat safe (4), (5), (6), extremely safe (7)]
Z4.
All with S1 item 2/8 = a-c
How painful was it to have an intrauterine device (IUD) inserted? [not at all painful (1), (2), (3), somewhat painful (4), (5), (6), extremely painful (7)]
Z5.
All with S1 item 2/8 = a-c
(If S1 item 2 or 8=1 or b) How much of a hassle was it for you to have an intrauterine device (IUD) inserted? (If S1 item 2 or 8 = c) How much of a hassle do you believe it is for you to have an intrauterine device (IUD) inserted? [completely hassle-free (1), (2), (3), neither a hassle or hassle-free (4), (5), (6), a lot of hassle (7)]
Z6.
All with S1 item 2/8 = a-c
(If S1 item 2 or 8=1 or b) How expensive was your intrauterine device (IUD) inserted? (If S1 item 2 or 8 = c) How expensive do you believe it is to have an intrauterine device (IUD) inserted? [not at all expensive (1), (2), (3), somewhat expensive (4), (5), (6), extremely expensive (7)]
Z7.
All with S1 item 2/8 = a-c
(If S1 item 2 or 8=1 or b) How well does an intrauterine device (IUD)fit with your lifestyle? (If S1 item 2 or 8 = c) How well would an intrauterine device (IUD)fit with your lifestyle? [doesn't fit at all with my lifestyle (1), (2), (3), somewhat fits with my lifestyle (4), (5), (6), fits extremely well with my lifestyle (7)]
Z9.
All with S1 items 2 & 8 ≠ a-c
Have you ever considered using an intrauterine device (IUD)?
Z10.
All with S1 items 2 & 8 ≠ a-c
How interested are you in trying an intrauterine device (IUD)? [not at all interested (a), (b), (c), neutral (d), (e), (f), extremely interested (g)]
Z10a.
All with S1 items 2 & 8 ≠ a-b and Z10 = a-c
In your own words, please tell us the reason(s) why you are not interested in trying an intrauterine device (IUD)?
Order of choices listed in this table does not reflect the order they were presented to respondents. For many questions, the order of choices was randomized; however, hormonal IUD and nonhormonal IUD were always listed together.
a Prescription contraceptives include pills, vaginal ring, implant, injections, or IUDs that must be prescribed, administered, or inserted by a healthcare professional.IUD indicates, intrauterine device.
Statistical comparisons for ever users starting first prescription contraception after year 2000 and year started prescription contraception not performed.
Statistical comparisons for ever users starting first prescription contraception after year 2000 and year started prescription contraception not performed.
Before 1980
0
-
-
3
-
N/A
N/A
1980–1989
9
-
-
28
-
N/A
N/A
1990–1999
29
-
-
33
-
N/A
N/A
2000–2009
40
-
-
28
-
N/A
76
2010–2015
22
-
-
6
-
N/A
25
Education level
Less than high school
8
-
<0.05
11
<0.05
29
9
High school
16
<0.05
-
27
-
22
19
Some college
37
<0.05
<0.05
32
-
22
36
Bachelor's degree or higher
39
<0.05
<0.05
31
-
27
36
Yearly household income
<$35,000
23
-
-
26
-
23
28
$35,000–$74,999
31
-
-
30
-
30
32
≥$75,000
46
-
-
44
-
46
41
Marital status
Married
40
<0.05
<0.05
62
<0.05
17
45
Living with partner
14
<0.05
<0.05
10
-
3
13
Widowed
0
<0.05
-
1
-
0
1
Divorced/separated
5
<0.05
-
9
-
3
4
Never married
41
<0.05
<0.05
18
<0.05
77
37
Region
Northeast
19
-
-
17
-
14
17
Midwest
22
-
-
21
-
25
21
South
37
-
-
38
-
30
36
West
23
-
-
24
-
31
26
Metropolitan residence
85
-
-
84
-
92
86
- indicates not significant at the .05 level; N/A, applicable.
a Statistical comparisons for ever users starting first prescription contraception after year 2000 and year started prescription contraception not performed.
Observational, prospective, multicentre study to evaluate the effects of counselling on the choice of combined hormonal contraceptives in Italy--the ECOS (Educational COunselling effectS) study.
Preferred frequency and characteristics of menstrual bleeding in relation to reproductive status, oral contraceptive use, and hormone replacement therapy use.
30447-X&id=gr1.jpg){kind=link}
30447-X&id=gr2.jpg){kind=link}
30447-X&id=gr3.jpg){kind=link}