Continuation rates for oral contraceptives and hormone replacement therapy

Despite the safety and effectiveness of low oestrogen-dose oral contracepti ves (OC) and postmenopausal hormone replacement there is poor continuity of use of these agents by women. Patterns of use and the reasons affecting di fferent frequencies of use in different countries are presented. Continuity and discontinuation rates are difficult to assess accurately but it is bel ieved that the main reasons why women discontinue use of these agents are c oncerns about their perceived health risks and the presence of, or fear of, adverse clinical effects, particularly unscheduled uterine bleeding and we ight gain, More information is needed about OC continuation rates in order to improve the acceptability of these safe, effective agents. Most women di scontinue use of postmenopausal hormonal replacement within 2 years of init iating the therapy. Reasons include disappearance of symptoms of oestrogen deficiency, lack of awareness of health benefits of oestrogen, presence of side-effects (such as breast tenderness and weight gain), presence of uteri ne bleeding and increasing age. Suggestions to increase continuation of OC include extensive individual pretreatment counselling with a different emph asis in different age groups, education at the time of follow-up visits and telephone calls, and extensive use of educational aids such as brochures, pamphlets and audio tapes, and improvement of pharmaceutical packaging info rmation. In conclusion there is an urgent need to assess the value of these strategies by long-term large controlled studies.