Acceptability, side-effects and discontinuation of second and third-generation oral contraceptive pills in Bangladesh: A quasi-experimental study

Background The third-generation oral contraceptive pill (3G-OCP) has improved side-effect profile compared to the second-generation (2G-OCP). In Bangladesh, comparative data on these two generations of OCPs is nonexistent. This study aimed to compare acceptability, side-effects and discontinuation rates between 3G- and 2G-OCPs. Methods This quasi-experimental study was conducted from October 2017 to June 2018 in two unions of one sub-district in Bangladesh. From each intervention and control unions, 1400 women were enrolled after screening for selection criteria. All the women in the intervention union received 3G-OCP while those in the control union had 2G-OCP. Women from both the groups were provided six cycles of OCPs, two at enrollment, and two each at two subsequent home-visits at 2-months apart by the health workers. Data was collected thrice: immediately after enrolment, and two subsequent follow-up visits at 2-months interval by the study interviewers. Life table analysis was done to compare cumulative discontinuation rates and Hazard Ratio (HR) was estimated for likelihood of discontinuation of 3G-OCP as compared to 2G-OCP due to side-effects. Results After 24-weeks of enrollment, 69.1% (n=967) of the women from the intervention and 58.0% (n=812) from the control group continued with the method. The major reason for discontinuation was pill use-related side-effects (3G-OCP: 20.4% vs. 2G-OCP: 19.5%). Initially, the reported side-effects for 3G-OCP were higher than those for 2G-OCP (47.3% vs. 33.2%). However, after 24-weeks of use, the corresponding figures became similar (9.5% vs. 8.7%). The cumulative discontinuation rate due to side-effects was 22.8% and 25.2% for 3G- and 2G-OCP respectively which was not statistically significant (p=0.14). After adjusting for potential covariates, the likelihood of discontinuation of 3G-OCP was 14% lower (HR=0.86, p=0.075) than 2G-OCP which was statically significant at 10% level. The study observed three deaths (one in intervention and two in control), of which one death in the control group was due to stroke. Conclusion The 3G-OCP was less likely to be discontinued than the 2G-OCP due to side effects. After 24-weeks of use the reported side-effects of the two types of OCPs was similar. However, one stroke-related-mortality due to use of 2G-OCP, demanded further larger studies.