Contraceptive practices during monitoring for molar pregnancy: A mixed methods analysis

To describe patterns in contraceptive use and factors influencing contraceptive decision-making during the post-molar beta-hCG monitoring period.

This was a mixed methods analysis of patients who received care for molar pregnancy at a regional gestational trophoblastic disease center in the South between March 1996 and February 2025. Associations between demographic factors and contraception use during monitoring were assessed using chi-square and Kruskal-Wallis tests. Semi-structured interviews were conducted from December 2024 to April 2025 until thematic saturation was reached with patients diagnosed since August 2022, to minimize recall bias. Interviews were recorded, transcribed, and analyzed for patterns using NVivo 14.

A total of 264 patients were identified for the database. Ten completed a qualitative interview, of whom four did not use contraception during monitoring. Most identified as white (56.4% in database, 70% among those interviewed) and non-Hispanic (85.7%, 70%, respectively). Within the database, 21.6% reported no contraception use during monitoring. The most utilized methods were combined hormonal contraceptives (37.5%), barrier methods (21.6%), and medroxyprogesterone acetate injection (14.8%). Significant differences in method were identified based on age, race, county, and number of live births at molar pregnancy diagnosis. In interviews, participants discussed several key findings related to contraceptive decision-making: (1) familiarity, (2) temporary use, (3) importance of monitoring, (4) side effects, and (5) trying new things.

Despite guideline-based recommendations, more than one-fifth of patients did not use contraception during monitoring for molar pregnancy. Qualitative data demonstrate that method selection is uniquely shaped by the importance of beta-hCG monitoring and desire for expeditious return to fertility.

One-fifth of patients did not use contraception during molar pregnancy monitoring, highlighting an opportunity for improved contraceptive counseling and alignment with guidelines to reduce the risk of unintended pregnancy and avoid potential confounding of malignant transformation.