Hormonal Birth Control Dropout in Oman Tied to Side Effects, Not Partner Influence

A study in Oman found that 66% of women discontinued hormonal contraception within a year, mainly due to side effects like menstrual irregularities and mood changes. Education level influenced discontinuation, while partner involvement and access issues had minimal impact.

A comprehensive study conducted by the Ministry of Health in Oman, Sultan Qaboos University Hospital, and the College of Medicine and Health Sciences has revealed a high rate of hormonal contraceptive discontinuation among Omani women. Published in the Eastern Mediterranean Health Journal, the study followed 404 women registered at birth spacing clinics across the Muscat Governorate. These women, aged 15 to 49, were tracked for one year to understand which hormonal contraceptive methods they used and why many of them eventually stopped. The methods studied included combined oral contraceptives (COCs), progestogen-only pills (POPs), and depot medroxyprogesterone acetate (DMPA) injections. Notably, nearly 88% of participants were breastfeeding at the time they began contraception, which shaped their preference for progestogen-only methods.

High Discontinuation Rates Signal Deeper Issues

The study found that 66.3% of the women discontinued their chosen hormonal contraceptive within the first year—a rate higher than that reported in countries like Germany, Italy, and the United States, though slightly lower than in Brazil and Turkmenistan. POPs had the highest drop-out rate at an alarming 94.3%, with most users stopping within the first six months. DMPA and COCs followed with 54% and 45.5% discontinuation rates, respectively. The primary driver of this trend was adverse effects, which accounted for over half of the discontinuations. Menstrual irregularities were the most frequently cited complaint, alongside mood changes, weight gain, headaches, gastrointestinal discomfort, and, in rare instances, venous thromboembolism.

Interestingly, only 5.6% of women discontinued contraception because they wished to conceive. This suggests that health concerns rather than fertility desires are at the heart of the issue. The data also showed that many women followed the advice of their healthcare providers to stop or switch methods, which contributed to nearly one-third of the discontinuations.

Side Effects: The Leading Cause of Dropout

Menstrual disturbances were by far the most disruptive side effect reported, including irregular, heavy, or prolonged bleeding. POP users experienced this the most, with many reporting changes severe enough to prompt discontinuation. Mood-related side effects were also widely reported, particularly among COC users. About a quarter of women across all contraceptive types noted emotional disturbances such as irritability and depression. Weight gain, although a concern for some, was mostly moderate, less than five kilograms for most women, and was not the leading cause of discontinuation. Sexual dissatisfaction and gastrointestinal complaints were rare and did not appear to significantly influence discontinuation rates.

While 82% of women felt they had received adequate counselling about potential side effects, the high discontinuation rate raises concerns about the depth and effectiveness of that counselling. It is possible that women either forgot the information provided or found it unhelpful once side effects actually began. This highlights the need for better, more responsive follow-up care once women start using contraception.

Surprising Influence of Education and Minimal Partner Involvement

One of the most unexpected findings was the link between education and contraceptive discontinuation. Women with secondary school or higher education were nearly three times more likely to stop using their contraceptive method compared to women with limited or no formal education. This contradicts widely held assumptions that more educated women are better equipped to manage side effects or make long-term health decisions. The study suggests that other factors, perhaps including access to more information, higher expectations for comfort, or greater assertiveness in healthcare interactions, may influence the decision to discontinue.

In contrast to trends seen in many parts of the world, especially in some African nations, male partners had little influence on discontinuation in this Omani sample. Only one woman reported stopping contraception due to her husband’s objection. This indicates a relatively high level of autonomy among Omani women once the initial decision to use contraception has been made, and suggests that the role of male partners, while significant in approving, does not heavily affect continuation.

Implications for Policy, Practice, and Future Research

The study is a landmark effort in the Gulf region and the first of its kind in Oman to examine why women stop using hormonal contraception. Its findings carry critical implications for health policy, particularly in tailoring contraception counselling and support to breastfeeding women, who form the bulk of users. Given that the study was conducted in an urban region with well-structured, free contraceptive services, the low influence of logistical barriers is reassuring. Unlike in other countries, access and affordability do not appear to be barriers in Oman.

However, the findings do point to a clear need for improved counselling, particularly in managing expectations around side effects and offering alternative solutions when problems arise. Healthcare providers play a pivotal role, and their advice significantly influences women’s choices. Better training and updated guidelines for providers could help reduce unnecessary discontinuations and improve overall satisfaction.

The authors recommend that future research focus more closely on breastfeeding women and adopt a prospective approach to better capture real-time experiences and reasons for discontinuation. This could help build a more nuanced understanding of women’s needs and preferences, ultimately leading to more effective, sustainable contraceptive use in Oman and beyond.