Oral contraceptives and compliance: reaction to cardiovascular alarm among users

The effectiveness of oral contraceptives (OC) is dependent on correct daily intake as well as continuous use. The latest cardiovascular alarm in 1995 led to discontinuations, presumably due to concerns about the long-term safety of OCs. The aim of this study was to investigate women's experiences and concerns about OCs in general as well as after the latest cardiovascular alarm. In 1993 and 1996, questionnaires were offered to 645 and 644 consecutive women visiting a midwife or a gynecologist at eleven family planning clinics in order to get their first prescription of oral contraceptives or to renew their prescription. The study was carried out in Uppsala, a city in Sweden with 180000 inhabitants. In 1993, 95%, answered the questionnaire and in 1996 the corresponding figure was 92%. Change of brand was common and increased from 38% in 1993 to 44% in 1996. Mild side-effects were reported by about 25%. Concerns about oral contraceptives increased from 36% to 41% (p < 0.01), particularly regarding the risk for thrombosis. Fewer than 1% expressed this concern in 1993 but 29% did so in 1996. Negative media coverage leads to increased concerns and declining confidence among users of oral contraceptives and has to be met by adequate oral and written information by the counsellor.