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Impact of Dispensing Multiple Oral Contraceptive Pill Packs on Continuation and Compliance
Introduction to Oral Contraceptive Pill Dispensing
The method of dispensing oral contraceptive pills (OCPs) can significantly influence their continued use and overall effectiveness. Research has explored whether providing multiple packs of pills at once, as opposed to a single pack, affects user compliance and continuation rates.
Comparison of Single vs. Multiple Pack Distribution
Study Design and Findings
A study conducted in Jamaica compared the effects of providing one pack of pills initially, followed by three packs, versus providing four packs at the start. The primary outcome measured was the proportion of women continuing pill use beyond four months. The results indicated no significant difference in continuation rates between the two groups (odds ratio=1.33; 95% confidence interval=0.88-2.0)1. However, women who received only one pack initially were more likely to return late for resupply, suggesting that providing multiple packs at initiation could reduce clinic visits and associated costs1.
Systematic Review Insights
A systematic review of studies examining the number of pill packs dispensed found that providing a greater number of packs generally increased method continuation. Studies comparing 1 vs. 12, 1 vs. 12-13, or 3 vs. 7 packs showed improved continuation rates. Additionally, more packs were associated with fewer pregnancy tests, fewer pregnancies, and lower costs per client, although there was an increase in pill wastage4. This supports the notion that dispensing more packs at once can enhance consistent and correct use of OCPs.
Effects of Missed Pills on Contraceptive Effectiveness
Study on Missed Pills
Research investigating the impact of missing pills within an OCP cycle found that missing up to four consecutive pills did not result in ovulation. Serum hormone levels and ultrasound assessments indicated suppressed folliculogenesis, and no functional ovarian cysts were detected. This suggests that the anovulatory effect of OCPs persists even after short intervals of noncompliance2.
New Progestogen-Only Pill and Compliance Flexibility
Study on Drospirenone-Only Pill
A new-generation progestogen-only pill containing drospirenone was tested for its ability to maintain ovulation inhibition despite scheduled 24-hour delays in pill intake. The study found that ovulation inhibition was maintained, with only one subject meeting the ovulation criteria after delayed intake. This new pill offers a similar "safety window" as combined oral contraceptives, providing greater flexibility without compromising contraceptive reliability3.
Conclusion
The evidence suggests that dispensing multiple packs of oral contraceptive pills at once can improve continuation rates and reduce the likelihood of gaps in use. Additionally, the new drospirenone-only pill offers enhanced flexibility in intake, maintaining contraceptive effectiveness even with occasional delays. These findings support the recommendation to provide more than one cycle of pills at initiation to enhance compliance and reduce clinic visits.
Sources and full results
Most relevant research papers on this topic
One versus multiple packs for women starting oral contraceptive pills: a comparison of two distribution regimens.
More than one cycle of oral contraceptive pills at initiation is recommended, as it reduces the likelihood of gaps in pill use and reduces clinic and provider costs.
Non-RCT
Large Human TrialEffect of “Missed” Pills on Oral Contraceptive Effectiveness
Missing four pills in an oral contraceptive cycle does not result in ovulation, and the anovulatory effect persists when the pills are reinstituted and taken reliably after noncompliance.
RCTMaintenance of ovulation inhibition with a new progestogen-only pill containing drospirenone after scheduled 24-h delays in pill intake.
The new-generation drospirenone-only pill effectively inhibits ovulation even after four 24-hour delays in tablet intake, allowing for greater flexibility in intake without compromising contraceptive reliability.
RCT
Rigorous JournalHow does the number of oral contraceptive pill packs dispensed or prescribed affect continuation and other measures of consistent and correct use? A systematic review.
A greater number of oral contraceptive pill packs may increase method continuation, but may also lead to increased pill wastage and higher costs per client.
Systematic ReviewOestrogen-free oral contraception with a 4 mg drospirenone-only pill: new data and a review of the literature
The 4 mg drospirenone-only contraceptive pill has good efficacy, low cardiovascular side effects, and a favourable bleeding pattern, maintaining ovulation inhibition even after 24 hours of delayed intake.
Literature ReviewEffect of four combined oral contraceptives on blood pressure in the pill-free interval.
Four oral contraceptives can slightly increase blood pressure, with some of these effects persisting for 7 days without treatment.
RCTEffectiveness of Pediatric Pill Swallowing Interventions: A Systematic Review
Pediatric pill swallowing interventions, such as behavioral therapies, flavored throat spray, verbal instructions, specialized pill cups, and head posture training, can effectively improve medication administration and compliance.
Systematic ReviewThe elvitegravir Quad pill: the first once-daily dual-target anti-HIV tablet
The elvitegravir Quad pill, when approved by the FDA, will become the first once-daily dual-target anti-HIV tablet, improving treatment adherence and offering new perspectives for patients failing existing antiviral regimens.
Characterization of a Pseudomonas aeruginosa gene cluster involved in pilus biosynthesis and twitching motility: sequence similarity to the chemotaxis proteins of enterics and the gliding bacterium Myxococcus xanthus
The new Pseudomonas aeruginosa gene cluster, pilH, pill, and pilJ, are likely part of a signal-transduction network that controls pilus biosynthesis and twitching motility.
Highly CitedDrospirenone 4 mg-only pill (DOP) in 24+4 regimen: a new option for oral contraception
The new drospirenone-only pill offers a better bleeding profile and is more acceptable than traditional progestin-only pills, potentially increasing its acceptability and user base.
Literature Review