Title : Benign gynecological conditions and lifetime contraceptive patterns: a population-based analysis of the 2022–2023 national survey of family growth
Abstract:
Background
Selecting an appropriate contraceptive method is often a dynamic, trial-and-error process shaped by medical, behavioral, and contextual factors. Although side effects and early discontinuation are common among healthy women, those living with benign gynecological disorders - such as uterine fibroids, polycystic ovary syndrome (PCOS), and endometriosis - face additional clinical challenges, as contraceptive methods are frequently used, not only for pregnancy prevention, but also as treatment options for symptom management. Yet, how these conditions influence women’s lifetime patterns of contraceptive use has not been explored.
Objective
To examine whether benign gynecological conditions are associated with greater inconsistency in contraceptive use, measured by the number of hormonal or intrauterine methods used over a lifetime.
Methods
We conducted a retrospective observational analysis using the female respondent sample of the 2022–2023 National Survey of Family Growth (NSFG). Women between 15 and 49 years old who provided complete data on contraceptive history and gynecologic diagnoses were included in the analysis. The primary outcome was the number of different contraceptive methods ever used. The primary independent variable was self-reported diagnosis of any gynecological condition (including uterine fibroids, PCOS, and/or endometriosis). Sociodemographic and clinical covariates comprised: age, race/ethnicity, poverty level, English proficiency, insurance coverage, gravidity, parity, and infertility status. Bivariate analyses compared socio-demographic, clinical characteristics and contraceptive patterns between groups. Multivariable negative binomial regressions, with robust standard errors, estimated adjusted associations, controlling for relevant demographic and clinical variables. Additional models were performed for each diagnosis individually to assess condition-specific differences in contraceptive patterns.
Results
Among 4469 participants, 18.7% (n=837) reported at least one benign gynecological condition. Prevalence estimates were 8.8% for PCOS (n=394), 8.2% for uterine fibroids (n=368), and 6.0% for endometriosis (n=267). Women with any gynecological condition had a significantly greater number of contraceptive methods over their lifetime in bivariate analysis (mean=1.9, SD=1.3 VS mean=1.8, SD =1.2, p=0.001) but the association was no longer significant after adjusting for age, gravidity, race, infertility, insurance coverage, English proficiency and poverty level (p=0.07). Similarly, women with PCOS reported significantly higher numbers of contraceptives methods used (mean=1.9, SD=1.2 VS mean=1.8, SD=1.2, p=0.02) but the association did not persist in adjusted analyses (p=0.39). Women with endometriosis had a significantly greater number of contraceptive methods over their lifetime in bivariate analysis (mean=2.1, SD=1.3 VS mean=1.8, SD=1.2, p<0.0001). This association remained significant in the adjusted model, where they had approximately 18% more contraceptive methods across their reproductive history compared with women without endometriosis (RR=1.18; 95% CI 1.05 - 1.31; p=0.004). No significant association with number of methods used was observed for diagnosis of uterine fibroids.
Conclusion
Endometriosis was associated with a significantly greater number of methods used across the women’s reproductive lifespan. This suggests that women with endometriosis may experience more prolonged or complex journeys in identifying the best contraceptive option and highlights the need for better contraceptive options and adequate family planning counseling.
