COVID hastens demise of combined contraceptive pills in UK

General practitioners in England dramatically decreased their prescriptions of the combined contraceptive pill during the first COVID-19 lockdown, and these rates have not recovered since, according to new research published in The European Journal of Contraception & Reproductive Health Care.

The study, carried out by Anglia Ruskin University (ARU), analyzed NHS prescribing data from general practices, because around 80% of women in the UK access the contraceptive pill through their GP.

The research found that contraception provided by combined pill prescription was down by 22% during April-June 2020 when compared with the same dates the previous year.

Combined estrogen-containing oral contraceptive pills (commonly known as the combined pill) require the patient to have their blood pressure and weight monitored annually, and the researchers believe the drop was largely down to patients not attending face-to-face GP appointments.

This monitoring is not required for prescription of the progestogen-only pill, which carries fewer risks for cardiovascular health, and numbers of prescriptions of this type of pill remained steady during the April-June 2020 lockdown.

Data from April-June 2021, after lockdown restrictions had ended, shows prescriptions of the combined pill had not recovered to previous levels.

These changes in prescribing contraception continued a trend seen since 2014, with the combined pill being prescribed less each year. In 2014 estrogen-containing oral contraceptive pills provided twice as many months of contraception as progestogen-only pills (POPs), but in 2021, the months of contraception provided by each type of pill were equivalent. The POP has recently become available over the counter from pharmacists, which may increase its use further.

Prescription of other forms of contraception, such as implants and intrauterine contraceptive devices, or coils, reduced by three-quarters over the first three months of lockdown, but rebounded over the following year.

Author of the paper Dr. Susan Walker, Associate Professor at Anglia Ruskin University (ARU), said, "The restriction of access to face-to-face contraceptive consultation in general practice during the first COVID-19 lockdown had a significant effect on contraceptive prescribing and provision during that time.

"Prescription and provision of the combined pill reduced and provision of the POP remained stable, which is likely to be an effect of the need to monitor blood pressure and BMI for women on the combined pill. This demonstrates that remote prescription of the POP is possible, and this enforced change in prescribing habits may inform future guidelines for easing access to the POP without face-to-face consultation.

"The reduction in prescription of the combined pill has persisted into 2021 and this continues the steady trend in the decrease in the proportion of contraceptive pills containing estrogen, in comparison to progestogen-only pills, seen over the previous seven years."