Laura Gerhardy, Natasha Nassar, Melisa Litchfield, Debra Kennedy, Annika Smith, Malcolm Gillies, Sallie Pearson, Helga Zoega, Antonia Shand
Aims: Oral retinoids are teratogenic in pregnancy, and contraception is recommended to prevent pregnancy. This study assessed the demographic characteristics and trends in use of prescription retinoids and contraception among reproductive-aged women (15–44 years) in Australia.
Methods: Pharmaceutical Benefits Scheme (PBS) dispensing claims were used from a 10% random sample of Australian reproductive-aged women between 2013 and 2021. Annual numbers and trends in dispensing claims were described. Each retinoid dispensing was analysed for whether there was a concomitant contraceptive dispensing within an appropriate time frame to reasonably assume contraception co-use. We have multiplied results by 10 to extrapolate to population numbers.
Results: During the study period there were over 1.5 million PBS retinoid dispensings and over 20 million PBS contraceptive dispensings. Retinoid dispensing increased annually, from 61,080 women in 2013 to 92,590 women in 2021 (an increase from 1.3% of the age-sex specific population to 1.8%). The rate of oral retinoid users doubled over the study period, while topical retinoid use remained static. Oral retinoid use was highest among younger women, and decreased with increasing age. Contraceptive methods changed across the study period, with a decrease in combined oral contraceptive dispensings, and an increase in levonorgestrel intrauterine device dispensings. When adjusted for the contraceptive time supplied with a dispensing, the contraceptive coverage did not change over time. Among women receiving an oral retinoid dispensing, only 25% had a contraception concomitant dispensing in 2021, rising slightly from 19% in 2013.
Conclusions: Oral retinoid use in Australian reproductive aged women has increased over time, while PBS contraception coverage has remained static. Most women dispensed oral retinoids were not concomitantly dispensed PBS contraception, posing a risk of unplanned pregnancy and congenital anomaly. Initiatives are required to improve contraception use in women dispensed oral retinoids.