Reported side effects from hormonal contraceptives among those seeking abortion care versus contraceptive services.

Introduction: We aim to describe and compare the prevalence of subjective side effects associated with hormonal contraceptive use among reproductive healthcare users seeking either abortion care or contraceptive services.

Methods: This substudy derives from a previously reported cross-sectional survey involving 1006 users of public reproductive healthcare services in the Helsinki metropolitan area in Finland. We included all 813 respondents with a history of hormonal contraceptive use (mean age 27 years, IQR 24-33 for abortion care; 24 years, IQR 19-30 for contraceptive services). The study followed STROBE guidelines.

Results: Altogether 400 respondents sought abortion care, while 413 sought contraceptive services (counselling, prescription renewal, symptoms and/or dissatisfaction with their contraceptive method). Combined oral contraceptives and progestin-only pills were the most used methods in both groups. Respondents seeking abortion care reported contraception-associated weight changes, sex-related problems, mood changes, and acne more frequently than those seeking contraceptive services (p-value<0.05 for all). Some 52% of respondents seeking abortion care reported mood changes compared with 29% of those seeking contraceptive services, with a crude OR of 2.7 (95% CI 2.00 to 3.57). After adjustment, the OR for reporting mood changes among respondents seeking abortion care was 1.5 (95% CI 1.05 to 2.23).

Conclusions: Mood changes associated with hormonal contraceptive use were the most frequently reported side effect among all respondents. These findings suggest a need for individualised counselling on mood-related side effects as mood changes may contribute to higher discontinuation rates.