A survey study on obstetricians and gynecologists'awareness of estrogen dosage and medication regimen in combined short-acting oral contraceptives
Objective To understand the current awareness and application of different types of combined short-acting oral contraceptive(COC)regimens and their estrogen dosages among obstetricians and gynecologists in China,and to provide a reference for clinical individualized medication decisions.Methods From August to December 2022,obstetricians and gynecologists from 155 hospitals in 20 provinces,autonomous regions,and municipalities were invited to participate in a questionnaire survey.The survey aimed to assess their understanding of the estrogen dosages,medication regimens,and indications of the five most commonly used COC in China.Statistical analysis and summarization were conducted using methods including chi-square test,the Bonferroni method,Cramer's Ⅴ coefficient,radar chart,etc.Results Survey questionnaires were distributed to 653 obstetricians and gynecologists,and 650 valid responses were collected,resulting in a recovery rate of 99.54％.There was significant variation in awareness among obstetricians and gynecologists regarding the five most commonly used COC in China.Drospirenone and ethinyl estradiol tablets(Ⅱ)(20 μg/tablet,87.69％;24/4 regimen,84.77％)had the highest awareness,while desogestrel and ethinyl estradiol tablets(20 μg/tablet,45.69％;21/7 regimen,83.54％)had the lowest awareness.For the treatment of acne,premenstrual dysphoric disorder,irritability,depression,premenstrual syndromes,hirsutism and polycystic ovary syndrome,28.77％to 31.69％of obstetricians and gynecologists preferred the 24/4 regimen,while 37.54％to 47.85％selected COC with an estrogen dose of 20 μg/tablet.Notably,for improving irritability symptoms(x2=9.403,P=0.009),the proportion of obstetricians and gynecologists with a master's degree or higher who selected the 24/4 regimen was significantly higher than those with a bachelor's degree or lower,showing a statistically significant difference.Regarding the improvement of menstrual cycle regularity,treatment of menorrhagia and the effectiveness of cycle control,49.38％to 50.00％of obstetricians and gynecologists considered the effectiveness of the two regimens to be similar,and 44.46％to 56.31％considered the effectiveness of the two dosages to be similar.Notably,for improving menstrual cycle regularity(x2=8.402,P=0.015)and treating menorrhagia(x2=6.451,P=0.040),the proportion of associate chief physicians and above who selected the two doses as similar was significantly higher than that of attending physicians and below,with statistically significant differences.There was a weak correlation between obstetricians and gynecologists'choices of different estrogen doses and medication regimens(0.2＜Cramer's V＜0.3,P＜0.05).Conclusion The awareness of different COC among obstetricians and gynecologists in China is uneven,with a generally insufficient understanding of the mechanisms of action of COC.Given the widespread use of COC,it is recommended to enhance training for obstetricians and gynecologists on the mechanisms of action of COC drugs.This includes understanding the relationship between estrogen-progestin dosages,types,and medication regimens,and accurately mastering the indications.This will better enable them to provide individualized medication recommendations.
combined short-acting oral contraceptiveestrogenprogestinregimenobstetrician and gynecologist
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