Rationale, aims and objectives Many women are prescribed oestrogen-containing contraceptives for whom oestrogen-containing methods may be less suitable.
Methods Two surveys examining contraceptive prescription practices among doctors (n = 419) and attitudes towards contraception among women (n = 1623) in France, Germany, Spain, Italy and Russia were evaluated.
Results Progestin-only pills and hormone-free intrauterine devices were the most commonly prescribed contraceptives for women with medical conditions for which oestrogen-containing methods are not preferred (40% and 20%, respectively), those suffering from oestrogen-related side effects (32% and 21%) and those with concerns about the safety of oestrogen-containing methods (28% and 24%). Combined oral contraceptives (COC) were prescribed to ≥10% in these two groups. One-quarter of contraceptive users had asked to be switched from one COC to another because of oestrogen-related side effects; a similar proportion had been switched by their doctor for this reason. Half of the women surveyed did not want or had concerns about foreign/additional oestrogen, and about 80% said that they would consider switching to a different hormonal contraceptive to minimize oestrogen exposure. Although most doctors were aware of the World Health Organization medical eligibility criteria for contraceptive use, they still prescribed COCs or other oestrogen-containing contraceptives to women with medical conditions for which oestrogen-containing options are not favoured, suggesting a need for additional education.
Conclusion By complying with guidelines and heeding women's concerns, doctors can individualize their contraceptive recommendation to improve safety, acceptance and compliance and, ultimately, reduce the risk of an unintended pregnancy.