Reasons for hormonal contraceptive use in a cohort of African-American women living in the Detroit area.

This analysis utilized data from the Study of Environment, Lifestyle & Fibroids (SELF), a prospective cohort study of 1,693 young (23–35 years), African-American women living in the Detroit, Michigan area. SELF was designed to investigate risk factors for uterine fibroid incidence and growth [ 9 ]. Recruitment and baseline data collection were completed in 2010–2013 [ 10 ]. Participants were recruited from the Detroit area via advertisements in local print, radio, and television media, brochures at clinics and community events, and via the Henry Ford Health System (HFHS) [ 9 ]. The primary eligibility requirements were age, self-identified African-American/Black, and having no prior clinical diagnosis of uterine fibroids. SELF was approved by the institutional review boards of the National Institute of Environmental Health Sciences and HFHS. Information on each participant’s history of HC use was collected via telephone interview as part of an enrollment questionnaire. Women were asked if they had ever used each of the following types of HC: “birth control pills” (oral contraceptives; OCs), “mini-pill” (progestin-only OCs), hormonal implant, hormonal patch, vaginal ring, “hormone shots like Depo-Provera,” and hormonal intrauterine devices (H-IUD). Brief descriptions and examples of common brand names were provided for hormonal implants and shots. For each HC type (and separately for each H-IUD), women were asked about their reason(s) for use. Women responded to separate “yes/no” questions regarding the following reasons for use: “to prevent pregnancy?” “for irregular menstrual cycles, or to regulate how often you had periods?;” “for heavy bleeding?” “for menstrual pain?” or “for any other reason?”. Women who reported “any other reason” were asked to report the specific other reason(s). All data management and analyses were performed in SAS 9.4 (SAS Institute, Cary, NC, USA).

Ever use of HCs was common in this cohort (n=1,455, 86%). Average age of HC initiation was 18. Ever use of estrogen-containing HCs was reported by 87% of ever-HC users ( Table 1 ). COCs were the most frequently reported HC type ever used (81%). Ever use of progestin-only HCs was reported by 59%, and the Depo-Provera shot was the most commonly reported progestin-only type (49%). More than half of ever-HC users (58%) had used both estrogen-containing and progestin-only HCs. Among women who ever used HCs, most (57%) reported using two or more HC types ( Table 1 ). Nearly half of ever HC users reported using HCs for non-contraceptive purposes (49%), including irregular menstrual cycles (40%) and heavy menstrual bleeding (22%; Table 2 ). About half (48%) of COC users reported non-contraceptive reasons for use, along with ~25% of patch, ring, shot, and H-IUD users, and 10% of implant users. Menstrual problems were reported as a reason for use by 45% of COC users, ~25% of ring, shot, and H-IUD users, 21% of patch users, and 7% of implant users. Seven percent of all HC users used HCs exclusively for non-contraceptive purposes: 11% of COC users, and 4–5% of users for each of the other HC types.

We described reasons for hormonal contraceptive use among African-American women. In this large cohort of young, Black women, COCs were the most commonly used HC. Non-contraceptive reasons for HC use were common, and reasons for use varied by HC type. Menstrual problems were the most frequently cited non-contraceptive reason for HC use. Eleven percent of COC users used COCs exclusively for relief from menstrual problems, rather than for birth control. As these data are approximately 10 years old, and limited to Detroit, we must acknowledge the potential for limited generalizability. That stated, we arrived at similar estimates (where comparable) as other researchers. For example, our findings that COCs were the most common HC type used among African-American women are consistent with earlier, nationally representative findings [ 2 , 3 ]. Moreover, our findings that HCs were frequently used for non-contraceptive purposes are consistent with earlier, nationally representative findings regarding oral contraceptives [ 8 ]. Using data from the 2006–2008 National Survey of Family Growth (NSFG), the Guttmacher Institute estimated that 14% of OC users (more than 1.5 million U.S. women) used OCs for non-contraceptive purposes alone, most commonly to relieve menstrual pain and irregularity [ 8 ]. Similarly, our study found that 11% of COC users used COCs exclusively for non-contraceptive reasons, mostly for relief from menstrual problems ( Table 2 ). Published data on reasons for use for other types of HCs within the NSFG are lacking. The 2015–2017 NSFG (the most recently published NSFG data) collected information on reasons for IUD or pill use for use occurring in the current or prior month (relative to interview date). Prior NSFG data asked about reasons for pill use only [ 11 ]. Formal analyses of these data stratified by race have yet to be published. We examined clinical reasons for use of hormonal contraceptives across all HC types and in African-American women specifically. While the NSFG collected reasons for use for recently used oral or intrauterine HCs, SELF collected all reasons women ever used each type of HC – including the patch, the shot, and the ring. A formal analysis of the NSFG data would provide context for our findings and allow for examination of nationally representative trends in reasons for pill use stratified by race over time. The emphasis of most public health research and interventions regarding HCs to date has been on pregnancy prevention. Our finding that a sizeable proportion of women used HCs for non-contraceptive purposes are reinforced by prior, nationally representative findings [ 8 ] and point to HCs as important for management of conditions that affect quality of life.

The use of hormonal contraceptives (HCs) in the U.S. has increased since the 1990s and continues to rise [ 1 , 2 ]. At least 80% of African-American women are ever users of HCs [ 3 ], and approximately 20% were currently using HCs in 2006–2013 [ 1 , 4 ]. In the 1990s and early 2000s, the U.S. saw a dramatic increase in the number of available HCs, from the initial approvals of implantable and injectable contraceptives (referred to as long-acting reversible contraceptives, or LARC) to the introduction of the patch and the ring [ 3 , 5 ]. In this new context, contraceptive selection is related to convenience, cost, side effects, peer utilization, and awareness of method [ 6 , 7 ], and many women try more than one HC route in their lifetime [ 3 ]. Yet, studies of reasons for HC use are relatively limited, and mainly concern reasons for choosing one HC type over another in the context of family planning [ 6 , 7 ], as opposed to clinical indication(s) for use, and most focus on oral contraceptive use. Such data are especially limited for African Americans because even if included, findings are not reported stratified by race [ 8 ]. We collected HC history in a cohort of African-American women who came of age during the 20-year period in which the variety of available HCs increased dramatically in the U.S. [ 3 , 5 ]. Our objective was to describe characteristics of HC users and reasons for HC use by HC type.