[3rd and 4th generation estroprogestatives French controversy: What effect on women's behavior?].

Objective: The primary objective of this study was to determine the reasons given by women who have changed or suspended their contraceptive method in 2013. What influence had the 3rd and 4th generation estroprogestatives (EP) French controversy and advices from doctors? Did they notice any consequences of the controversy on their lifestyle? Did they feel an impact on their behavior to health professionals?

Methods: A study was conducted on women of childbearing age. Data collection took place between November 4 and December 16, 2013. The included subjects were between 18 and 55 years old females. Subjects were surveyed through an anonymous self-administered questionnaire distributed through pharmacies. The protocol called for the construction of clusters of subjects by having heard about, or not, of the controversy. Patients reporting having heard about the controversy have formed the "exposed" group while the others have formed the "unexposed" group. We compared two parameters between these two groups: the rate of subjects who reported having modified or suspended their contraceptive method in 2013 on one hand, and the rate of subjects who reported having made a change in their contraceptive method without or against advices from a doctor on the other hand.

Results: The sample included 988 subjects. The average age was 34 years. The level of exposure to media debates was 86.5%. Of the respondents, 19.8% were under 3rd or 4th generation EP in 2012, thus directly involved in the discussions and affected by health recommendations. Of the patients, 38.5% reported having changed their contraception in 2013. In these women, when they confirmed having heard about the controversy, 40.1% of them claimed to have conducted this process without or against advices from a doctor. This number dropped to 18.2% for those who had not heard of it. Media coverage of the 3rd and 4th generation EP vascular risk was not mentioned more by patients who suspended all medical contraceptive method than it was by patients who simply changed their method. In all, 52.1% of women who completely stopped their contraception indicated that this choice was at least partly due to a change in their sexuality or reproductive life. This reason was evoked only in 19.0% of women who have simply made a change of contraceptive method. Among the views of women, the EP controversy was one of the reasons for a change of contraception method in 41.8% of cases, while advices from a doctor did play a role in 19.9% of cases. One has seen a decline of 11.0% of oral contraception between 2012 and 2013, almost superimposed on that of oral 3rd and 4th generation EP (10.6%). However, the use of 1st and 2nd generation EP stagnated: their increase was 0.4%. Beyond any change of contraceptive method, 66.9% of women expressed the absence of any impact of the controversy on their behavior. Of the women, 6.1% showed a loss of confidence in health professionals.

Conclusion: We have shown how patients who stopped or modified their contraception method during 2013 placed the controversy influence in the forefront of the reasons for their decision. Although a medical reason has been widely quoted, only one in five felt that the advice of her doctor had clearly contributed to her choice. The influence of the media seemed to encroach on the doctor-patient relationship, which is fundamental to the quality of healthcare in the long term.