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Der Anteil der Frauen die eine Antibabypille der sog. 3. Generation einnehmen ist in den vergangenen Jahren bis 2001 weiter zurückgegangen. PapersInfluence of the third generation pill controversy on prescriptions for oral contraceptives among first time users: population based studyLolkje
de Jong-van den Berg Department of Social Pharmacy, Pharmacoepidemiology and Pharmacotherapy, Groningen University Institute for Drug Exploration, Antonius Deusinglaan 2, 9713 AV Groningen, Netherlands Correspondence to: L de Jong-van den Berg jongltw@farm.rug.nl Women taking
oral contraceptives containing gestodene or desogestrel (the so
called third generation oral contraceptives) have a higher
risk of venous thrombosis than women taking a second generation
pill.1
After the first publication on the subject, in 1995,2
the discussion in Dutch medical journals was conservative;
prescribing physicians were advised to not alarm women who
did not have a risk of deep vein thrombosis, be cautious
in the prescribing of third generation oral contraceptives
to young women who start taking the oral contraceptive
pill, and encourage women at risk of deep vein thrombosis
to change from taking a third generation pill to taking
a second generation pill.
3
4 Many experts, mainly epidemiologists and
clinical pharmacologists, have participated in the debate
about the safety of third generation pills.5
But what do prescribing physicians think and do? Our aim was
to determine whether this controversy has resulted in
a change in the proportion of women prescribed a third
generation oral contraceptive among first time users
of any oral contraceptive since 1995.
We used pharmacy
dispensing data from the InterAction database (a general prescription
drugs database) in the northern Netherlands. In 2000, the
database contained prescriptions from a population of
approximately 37 000 women aged 15-44, and 224 prescribers
(general practitioners and outpatient specialists). We selected
all prescriptions for oral contraceptives from 1 January
1994 to 31 December 2000. First time users
of oral contraceptives were defined as women who, according
to the database, either were prescribed any oral contraceptive
for the first time or who had not been prescribed an
oral contraceptive for at least one year. Hence, 1994 was
used as a washout period. We calculated for first time users
of oral contraceptives the proportion of women per year receiving
a third generation oral contraceptive (1995 to 2000).
To study a change in the proportion, we used SPSS version
10 to calculate The prevalence of women aged 15-44 taking the pill was stable from 1995 to 2000 (around 54%) (table). In 1995, the proportion of first time oral contraceptive users taking a third generation pill was 73% for the youngest age group (15-20 years) and 65% for the women aged 20-24. For all other age groups, except for 30-34, the proportions were also above 50%, indicating that more than half of the first time users received a third generation oral contraceptive. In 1996, the first year after the pill scare, the proportions decreased to below 50% for all age groups. The change was most evident in women younger than 20; for these users the percentage of all first time users prescribed a third generation oral contraceptive decreased from 73% in 1995 to 11% in 2000.
The number of
women prescribed the third generation pill decreased dramatically
after the pill scare in 1995; the decrease was most notable
for women under 25. The percentage of women prescribed
a third generation oral contraceptive continued to decline
over the following six years.
Contributors: LdJvdB and HT designed the study, analysed and interpreted the data, and wrote the manuscript. PvdB and BB managed the data and analysed the pharmacy data. LdJvdB is the guarantor.
Funding: None.
Competing interests: None declared.
(Accepted
15 May 2002) ©
2003 BMJ Publishing Group Ltd
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Participants,
methods, and... 
Comment
2
tests for linear trend after stratification by age (<20, 20-24, 25-29, 30-34, 35-39, and
40
years).
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