Expectations versus reality: Two cross-sectional studies on expected and experienced discontinuation symptoms in current and former contraceptive pill users
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Sage Publ.
Abstract
Background: Discontinuation of the contraceptive pill is common, but little research has explored women’s personal
experiences with discontinuation symptoms and associated psychological factors.
Objectives: These studies provide initial cross-sectional data on symptoms associated with discontinuation of the
contraceptive pill, focusing on both expected symptoms in current users and experienced symptoms in former users.
We examined how psychological factors (e.g., beliefs about medicine, trait anxiety) relate to these symptoms.
Design: Two parallel online questionnaires were administered: One with current and another with former contraceptive
pill users (n = 642).
Methods: We analyzed expected discontinuation symptoms in current users and experienced symptoms in former
users. Multiple linear regressions assessed the relationships between psychological factors (beliefs about and sensitivity
to medicine, trait anxiety, reason for usage, time since discontinuation) and discontinuation symptoms.
Results: In current users, expected symptoms were associated with concerns about (b = 0.32, p < 0.001, 95% CI [0.35,
0.97], f2 = 0.10) and perceived necessity of (b = 0.24, p < 0.001, 95% CI [0.22, 0.86], f2 = 0.06) the contraceptive pill,
perceived overuse of medication (b = 0.17, p = 0.013, 95% CI [0.13, 1.11], f2 = 0.03), and trait anxiety (b = 0.21, p = 0.003,
95% CI [0.06, 0.29], f2 = 0.05). Former users who indicated non-contraceptive reasons for using the contraceptive pill
experienced more discontinuation symptoms (b = 1.68, p < 0.001, 95% CI [0.78, 2.59], f2 = 0.03).
Conclusions: These studies provide the first data on contraceptive pill discontinuation symptoms, showing that current
users expect them, and former users experienced them. Psychological factors (e.g., trait anxiety) were linked to expected
symptoms, suggesting nocebo-like mechanisms. Future research integrating nocebo theory (e.g., addressing negative
expectations directly) could help empower women to make informed choices when discontinuing the contraceptive pill.
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