Acceptability and women’s perceptions on progesterone only contraception: a comprehensive review
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20263079Keywords:
Progesterone-only contraceptives, Patient acceptability and satisfaction, Long-acting reversible contraception, Contraceptive counselling, Bleeding irregularitiesAbstract
Progesterone-only contraceptives (POCs) represent a crucial pillar of modern family planning, offering highly effective options free from oestrogen-related cardiovascular risks. This review systematically examines patient preferences, satisfaction rates, and acceptability profiles across the primary POC modalities: progesterone-only pills (POPs), subdermal implants, long-acting injectables, and levonorgestrel-releasing intrauterine systems (LNG-IUS). Based on multi-country trial networks, health technology assessments, and real-world database registry cohorts, this paper details how bleeding abnormalities, return-to-fertility expectations, and metabolic profiles drive patient adherence or premature discontinuation. While long-acting reversible contraceptives (LARCs) exhibit the highest objective continuation rates, individual consumer choices are profoundly shaped by non-contraceptive benefits, user autonomy, and cultural perspectives. Strategic, structured patient counselling that balances expected bleeding disruptions against highly effective, discrete therapeutic benefits remains the definitive clinical intervention to improve long-term user satisfaction and minimize unmet contraceptive needs.
References
Gavin LE, Moskosky SB, Carter MW, Curtis KM, Glass EE, Godfrey EM, et al. Providing quality family planning services: recommendations of CDC and the U.S. Office of Population Affairs. MMWR Recomm Rep. 2014;63(RR-04):1-54.
Holt K, Reed R, Crear-Perry J, Scott C, Wulf S, Dehlendorf C. Centering reproductive justice and patient-centeredness in contraceptive counseling and care: historical framework, contemporary examples, and future directions. Am J Obstet Gynecol. 2020;222(4S):S882-91.
Moreau C, Cleland K, Trussell J. Contraceptive acceptability: a conceptual review and research agenda. Contraception. 2007;76(2):87-93.
Dehlendorf C, Krajewski C, Borrero S. Contraceptive counseling: Best practices to ensure quality communication and advance reproductive health equity. Am J Obstet Gynecol. 2014;211(4):315-21.
Kantorová V, Wheldon MC, Ueffing P, Dasgupta ANZ. Estimating progress towards meeting women's contraceptive needs in the Sustainable Development Goals era. PLoS One. 2020;15(2):e0228741.
Curtis KM, Tepper NK, Jatlaoui TC, Berry-Bibee E, Fowler BL, Gautier RJ, et al. U.S. Medical Eligibility Criteria for Contraceptive Use, 2016. MMWR Recomm Rep. 2016;65(3):1-104.
Glisic M, Shahzad S, Tsoli S, Asllanaj E, Bano A, Rojas LZ, et al. Association between progestin-only contraceptive use and cardiometabolic outcomes: A systematic review and meta-analysis. Eur J Prev Cardiol. 2018;25(10):1042-52.
Abdel-Aal NM, Soliman AT, Elawdy MM. Depot medroxyprogesterone acetate (DMPA) and its metabolic, bone, and menstrual effects: A comprehensive overview. J Endocrinol Invest. 2021;44(9):1821-35.
Winner B, Peipert JF, Zhao Q, Buckel C, Madden T, Allsworth JE, et al. Effectiveness of long-acting reversible contraception. N Engl J Med. 2012;366(21):1998-2007.
Mansour D, Bahamondes L, Critchley H, Darney P, Fraser IS. The management of unacceptable bleeding patterns associated with progesterone-only contraceptives. Hum Reprod Update. 2011;17(4):441-55.
Bitzer J, Simon JA, Beerthuizen R, Drnovsek L, Fait T, Franke-Antolin M, et al. Women's preferences, perceptions, and satisfaction with progesterone-only contraceptives: A multi-country survey. Eur J Contracept Reprod Health Care. 2022;27(3):201-9.
Trussell J. Contraceptive failure in the United States. Contraception. 2011;83(5):397-404.
Rivera R, Yacobson I, Grimes D. The mechanism of action of hormonal contraceptives and intrauterine devices. Am J Obstet Gynecol. 1999;181(5 Pt 1):1263-9.
Critchley HO, Brenner RM, Henderson TA, Williams AR, Nayak NR, Slayden OD, et al. Endometrial effects of progesterones and progesterone receptor modulators. Hum Reprod Update. 2020;26(4):512-35.
Palomba S, Falbo A, Di Cello A, Materazzo C, Zullo F. Etonogestrel subdermal implant: a review of clinical efficacy, safety, and patient acceptability. Patient Prefer Adherence. 2012;6:415-23.
Bahamondes L, Valeria Bahamondes M, Shulman LP. Levonorgestrel-releasing intrauterine system: uses and non-contraceptive benefits. Expert Rev Med Devices. 2018;15(4):257-66.
Palacios S, Regidor PA, Colli E, Skouby SO, Apter D, Roemer T, et al. A multicenter, randomized, open-label study to evaluate the efficacy, safety, and tolerability of a drospirenone-only pill (4 mg) in a 24/4 regimen. Acta Obstet Gynecol Scand. 2019;98(12):1549-57.
Modesto W, Bahamondes MV, Bahamondes L. Prevalence of low continuation rates of the etonogestrel-releasing contraceptive implant due to bleeding disturbances. Open Access J Contracept. 2014;5:73-8.
Gemzell-Danielsson K, Mansour D, Fiala C, Kaunitz AM, Nappi RE. Management of pain associated with the insertion of intrauterine contraceptives. Hum Reprod Update. 2013;19(4):410-9.
Madden T, Sekar R, Schrag S, Allsworth JE, Secura GM, Peipert JF. Risk factors for intrauterine device expulsion or removal for pain or bleeding inside a large cohort tracking initiative. Am J Obstet Gynecol. 2014;210(6):531.e1-e7.