Pill reluctance? Facts and consequences

Abstract

Background: In recent years there seems to have been a trend towards alternatives to the “pill”. Objective: The question arises as to what the postulated “pill reluctance” is all about, whether a move away from hormonal contraception is actually taking place, what the possible reasons for this could be and whether any effects of it can be determined. Material and methods: A literature search was carried out concerning (1) evidence for changes in contraceptive behavior in Germany, Austria and Switzerland, (2) evidence relating to the currently much-discussed effects of hormonal contraceptives on psyche and sexuality and (3) evidence for an increase in abortions. Results: The use of the pill shows a downward trend. At present it is not possible to say whether there has been a significantly more frequent use of copper intrauterine devices (IUD). Concern about side effects is a major reason for a considerable percentage of women surveyed to avoid hormonal contraceptives. According to recent review articles, most women using combined oral contraceptives experience no or a positive effect on mood, the incidence of depressive symptoms is low and only relevant in subgroups. The effects of hormonal contraceptives on women’s sexuality have not been sufficiently studied and the available data suggest that only a minority perceive a positive or negative change in their sexuality. There is no evidence for an increase in abortions. Conclusion: Considering the importance of side effects in terms of satisfaction with and adherence to contraceptive methods, an individually tailored contraceptive counselling is essential.