Discontinuation of Hormonal Contraception: A Systematic Review and Metanalysis

Women opted to discontinue hormonal contraception for a variety of reasons, the most common of which were abnormal bleeding, weight gain, abdominal pain and cramping, headache, mood changes, and sexual and genitourinary side effects. Table 2 indicates which studies discussed each of these side effect categories.

Abnormal Bleeding

Women reporting abnormal bleeding discontinued their hormonal contraceptive method more often than women experiencing any other type of side effect. Eighty-nine percent of the included studies cited abnormal bleeding as the primary for discontinuation. For instance, studies reported that between 9.6% and 81.9% of women who discontinued injectable contraceptives did so due to abnormal bleeding.^11,12 Several studies found that increased bleeding or irregular bleeding was the most frequent reason for contraceptive method discontinuation among LARC users (from 14.1% to 65.40%).^13-15 Other studies found that abnormal bleeding caused by other forms of hormonal contraception led to discontinuation rates of between 5.3% and 15.0%.^16,17

The qualitative studies corroborated the quantitative data, offering firsthand accounts of how abnormal bleeding could lead to hormonal contraceptive discontinuation.^18-24 A typical account came from a 28-year-old user of a hormonal contraceptive implant: “There wasn’t really any gap where I didn’t have the spotting and that’s the main reason I did get it taken out.^“20

Weight Gain

The second most commonly reported reason for hormonal contraceptive method discontinuation was weight gain, mentioned in 55.6% of the included studies. Quantitative studies indicated that between 1.4% and 40.9% of women who discontinued hormonal contraceptives did so due to weight gain.^11,13,14

In qualitative studies, women frequently reported fear of weight gain as a barrier to initiating hormonal contraceptive methods. One woman using injectable contraceptives stated, “The shot made me gain a lot of weight. I gained 30 pounds 3 weeks after I had it”. ²³

Abdominal Pain, Nausea, Vomiting, and Cramping

Abdominal pain, nausea, vomiting, and cramping were indicated as reasons for discontinuing hormonal contraceptive methods in 33% of the included studies. Several studies found that between 2% and 40.47% of women who used LARCs stopped due to these negative side effects.^13,25-28

Participants in qualitative studies reflected on their experiences with vomiting and cramping.^{21,23,24,29,30} A participant in her forties disclosed, “I haven’t regretted using family planning, but I was constantly getting sick after doing the 3-month injectable method. So, I stopped and got pregnant with my last born because I knew it was the 3-month injectable that was making me sick.”³¹

Headaches

Headaches were cited as a significant factor for discontinuing hormonal contraceptive methods in 26% of the included studies. For example, in the study by Jaisamrarn et al., ²⁶ 33% of women discontinued oral hormonal contraceptives due to headaches. Headaches were a frequently experienced side effect in the qualitative literature as well.^21,22,29 They were generally reported with complaints of fatigue and/or mood changes and emotional liability, but also remained a compelling single cause of dissatisfaction. One 19-year-old implant user who discontinued contraceptives explained, “I had migraines; I’d be sleeping all the time. The headaches were crazy. I could wake up in the night and my head would be banging”.²¹

Mood Changes

Several studies identified mood changes as one of the reasons for discontinuing hormonal contraception methods. Thirty-three percent of the studies in this review cited mood alterations as a reason for cessation, with rates of discontinuation varying between 1.7 and 50%.^17,25 One 31-year-old participant described having a “short fuse at my husband and kids all the time, which isn’t healthy,” which led her to discontinue using hormonal contraception. ²⁰ A 17-year-old implant user noted feelings of depression she experienced while using an implant: “That’s never happened before. I was actually quite frightened”.²¹

Sexual & Genitourinary Side Effects

Changes in sex drive and sexual pleasure were also recognized as contributing factors to hormonal contraceptive discontinuation. Studies reported that between 5.5% and 46.4% of women discontinuing LARCs did so at least in part due to reduced libido.^25,28,32 Studies looking at hormonal contraceptives more broadly found that a change in sexual pleasure or painful intercourse contributed to the discontinuation of contraception in 2.7% to 7% of women, and that a change in sex drive played an even larger role, with 6.3 to 9.9% of women attributing their decision to forgo hormonal contraception methods to reduced libido.^14,33

Sexually transmitted infections and genitourinary-specific side effects were considered in four studies. A small number of participants in these studies did experience GU symptoms, including vaginitis, pelvic pain, abnormal discharge, swelling of the labia minora, and pelvic inflammatory disease, which contributed to both IUD and implant discontinuation, as well as dissatisfaction with progestogen-only injectables.^11,28,34-36

The effect of hormonal birth control on sexuality and sexual satisfaction repeatedly appeared in the qualitative literature.^18,20,21,37  Women reported decreases in sex drive and the impact of abnormal and breakthrough bleeding on their sex lives.^20,21,37 As one woman explained, “[I] didn’t have regular sex, normal sex because of periods, and I wouldn’t like to have sex with someone on their period, it’s just not nice, so that was pretty much problems, everyday problems.”²²