Exploring the relationship between medicine related beliefs and side-effect experience among White oral contraceptive users in the UK

Objectives Side-effects are often central to the decision to discontinue oral contraceptives. However, many oral contraceptive side-effects may be the result of a psychological nocebo effect. In this preliminary study, we investigate whether correlates of nocebo effects are associated with oral contraceptive side-effect experience. Design An exploratory online cross-sectional survey of 275 female, predominantly young, White respondents was conducted. Associations between psychological factors previously implicated in nocebo responses (beliefs about medicines, perceived sensitivity to medicines, side-effect expectations, medicine information seeking, anxiety and trust in medicines), and oral contraceptive side-effect experience were assessed using regression analyses. Results Increased side-effect expectations, stronger beliefs that medicines cause harm and are overused, increased perceived sensitivity to medicines, and decreased trust in medicine development were associated with increased attribution of symptoms to the oral contraceptive. Higher side-effect attribution scores were also associated with discontinued oral contraceptive use. Conclusion These preliminary findings demonstrate a potential role that nocebo-related factors may have in impacting oral contraceptive side-effect experience. Importantly, these factors are amenable to psychological interventions which could be employed to reduce oral contraceptive side-effect experience and, as a result, unnecessary discontinuation. Future research must first assess such relationships using a prospective design to confirm the direction of the associations identified using more diverse samples of oral contraceptive users to increase the generalisability of findings.