(78) Navigating the Trial-and-Error Landscape of Contraceptive Prescribing: A Call for Personalized Contraceptive Care

Background: Globally, 870 million use contraceptives to prevent pregnancy or manage conditions such as endometriosis, premenstrual syndrome, and polycystic ovary syndrome. Despite widespread use, selecting appropriate contraceptives often involves significant trial and error. Up to 40% of women discontinue contraceptives within the 1st year due to side effects. This unpredictability contributes to healthcare burdens, including increased clinic visits and emergency room (ER) evaluations. Furthermore, sociodemographic and genetic factors likely influence individual response to contraception, leading to variability in side effects. Our study aims to 1) quantify the burden of trial-and-error contraceptive prescribing and 2) identify sociodemographic factors that modify the burden experienced during contraceptive trials.

Methods: Retrospective chart review of 99 patients from a pediatric and adolescent gynecology clinic was performed, using 'Contraception' CPT code. Data collected included age, sociodemographics (race, language, insurance), indications for contraception, number and duration of contraceptive trials, and side effects. Descriptive statistics and subgroup analyses based on language, race, and insurance were performed to explore the burden of side effects.

Results: Mean age was 19.7 years. Most (94%) were English-speaking, with 52% having private insurance and 24% with Medicaid or no insurance, respectively. Common indications for contraception included AUB and birth control. AUB patients required the most contraceptive trials (p=0.03). Patients trialed a mean of 2.2 contraceptive methods and required 6.3 clinic visits over 19.3 months to find a suitable method. Race was not associated with number of contraceptive trials (p=0.49). Spanish-speaking patients attended more contraceptive visits and were more likely to require ER care (p=0.03, p=0.02). Four patients had unintended pregnancies, with a mean of 4 contraceptive trials among them.

Conclusions: Trial-and-error approach to contraceptive prescribing poses significant challenges for patients and healthcare providers. The variability in response to hormonal contraception, driven by sociodemographic and potentially genetic factors, delays effective treatment and escalates healthcare costs. Our findings underscore the urgent need for personalized contraception approaches, informed by research into genetic and demographic predictors of side effects. Early research suggests that genetic variants in CYP450 influence individual metabolism of hormonal contraceptives. Addressing these gaps will optimize patient outcomes, decrease system-wide burdens, and reduce healthcare disparities.