Can unintended pregnancies be reduced by dispensing a year’s worth of hormonal contraception?
EVIDENCE-BASED ANSWER:
Probably, although studies that looked directly at this outcome are limited. A systematic review showed that women who received a larger number of pills at one time were more likely to continue using combined hormonal contraception 7 to 15 months later (strength of recommendation [SOR]: A, consistent evidence from 2 cohort studies and 1 randomized, controlled trial), which might be extrapolated to indicate lower unintended pregnancy rates.
One of the large retrospective cohort studies included in the review demonstrated a significantly lower rate of pregnancy among women who received 12 or 13 packs of oral contraceptives at an office visit compared with 1 or 3 packs (SOR: B, large retrospective cohort study).
RECOMMENDATIONS
The Centers for Disease Control and Prevention (CDC)’s Selected Practice Recommendations for Contraceptive Use recommend prescribing or providing as much as a 1-year supply of combined hormonal contraceptives at the initial visit and each return visit.5
The American College of Obstetricians and Gynecologists (ACOG) supports over-the-counter access to oral contraceptives, effectively allowing an unlimited supply.6
EDITOR’S TAKEAWAY
Adequate evidence of benefits and strong support from the CDC and ACOG should encourage us to offer 1-year supplies of combined oral contraceptives. Even though the higher-quality studies reviewed also showed a cost savings, up-front patient expense may remain a challenge.
