June 2007

Document Type


Degree Name



Dept. of Public Health and Preventive Medicine


Oregon Health & Science University


Objective The public health impact of unintended pregnancy is significant. An important strategy to help decrease the rate of unintended pregnancy is to implement measures that increase utilization and compliance with effective contraceptive methods. Combined hormonal contraception, in the form of the pill, ring or patch, is currently the most widely used form of reversible contraception for women in the U.S. However, these methods have side effects and complexities of use that frequently result in their misuse or discontinuation. One approach to increase successful use of combined hormonal contraception is to encourage initiation of the method as soon as possible. Women who have recently undergone termination of an undesired pregnancy are in special need of effective contraception. We investigated the concept of early initiation of hormonal contraception in women who have just undergone a medical abortion. The objective of this study was to determine whether early initiation of combined hormonal contraception under direct clinical observation during the follow-up appointment following medical abortion ("Observed Start") increases continuation rates with the method compared to traditional "Sunday Start." Methods Women enrolled in a multicenter medical abortion trial who requested a combined hormonal contraceptive method (pill, ring, or patch) as contraception following medical abortion at up to 63 days gestational age were eligible for this planned sub-study. Women were randomized to either initiate the method under supervision of a clinician at the one-week post-medical abortion follow-up ("Observed Start") or at the first Sunday following this visit ("Sunday Start"). All women received a sample of their chosen contraceptive method, and a prescription for 3 more cycles. Primary outcome was continuation of chosen method at 6 weeks. Secondary outcomes were effect of partner knowledge of contraceptive plan on continuation, and duration of bleeding with each initiation method. Results Of the 1,128 women in the primary trial, 261 subjects enrolled in this sub-study and 36/261 (13.8%) were lost to follow-up. There was no significant difference in method continuation at 6 weeks [Observed Start 108/114 (94.7%), Sunday Start 101/111 (91.0%, p=0.27]. There was no significant difference between groups in duration of bleeding or spotting, or in continuation based on partner knowledge. Conclusion Short-term continuation rates with hormonal contraception following medical abortion are high, and are not significantly improved by initiating the method at the time of the first follow-up visit under observation. The rates of partner knowledge of contraceptive method are also very high, and are highly correlated with being married. Bleeding and spotting duration following medical abortion is not affected by when hormonal contraception is initiated.




School of Medicine



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