The patient's reaction to side effects of oral contraceptives

Approximately 14 million American women currently use oral contraceptives. This represents only 32% of those at risk for pregnancy. Many studies suggest that bleeding irregularities are a primary reason for discontinuation of oral contraceptives, especially among adolescents. The Triphasic Randomized Clinical Trial study and several others suggest that intermenstrual bleeding may be experienced by at least one third of women taking oral contraceptives at one time or another. The socioeconomic costs of these episodes, realized in calls and visits to physicians, as well as pill discontinuation, pregnancy, and perhaps abortion, carry their own unique set of risks. Absence of withdrawal bleeding, or amenorrhea, is another concern because, to the woman, it signals pregnancy. Roughly two thirds of patients who have amenorrhea while taking oral contraceptives will consult a physician. Physicians should select oral contraceptives with the lowest doses of hormones and fewest side effects such as breakthrough bleeding or amenorrhea, which are major obstacles to compliance.