Introduction: Discontinuation of hormonal contraceptives is correlated with the experience of unwanted effects and is an important cause of unwanted pregnancy. Previous studies have not identified the factors that influence whether a woman will switch to another hormonal contraceptive, switch back to condom use or stop contraception altogether when side effects are experienced.
Methods: This qualitative study used in-depth interviews to explore factors influencing young women's decision making regarding highly effective hormonal contraceptives in 51 women aged 16-25 years living in or just outside London, UK.
Results: Young women's decision making regarding hormonal contraceptives is not simply determined by the experience of unwanted effects but reflects the meaning of unwanted effects in relation to underlying beliefs regarding the nature of hormones in contraceptives, 'natural' menses, menstrual control and the importance of avoiding pregnancy. When unwanted effects were experienced, women with no concerns about the nature of hormones tended to switch to other highly effective hormonal contraceptives. Those with underlying concerns regarding the nature of hormones returned to (inconsistent) condom use or stopped using contraception altogether. This was linked to experiencing unwanted pregnancy.
Conclusions: Eliciting attitudes regarding the nature of hormones in contraceptives, menstrual control and natural menses could enable health care practitioners to offer more tailored advice, interventions and contraceptives to women.