Prescribed Short-Acting Hormonal Contraceptive Use Among Premenopausal Females

Importance: Hormonal contraceptive use has important implications for both reproductive and general health. However, the patterns and trends of short-acting hormonal contraceptive use among US premenopausal females remain insufficiently characterized. Objective: To evaluate trends in and factors associated with prescribed short-acting hormonal contraceptive use among US premenopausal females. Design, Setting, and Participants: Serial, cross-sectional analyses were conducted using US nationally representative data from the National Health and Nutrition Examination Survey (NHANES), including 10 survey cycles between 1999 to 2000 and 2017 to 2020 (before the COVID-19 pandemic). Participants included noninstitutionalized premenopausal females aged 15 years to younger than 60 years without a history of breast cancer. Data were analyzed from January to November 2025. Exposures: NHANES cycle. Main Outcomes and Measures: The prevalence of prescribed short-acting hormonal contraceptive use was extracted from the prescription medication data collected during household interviews. Data primarily reflect oral contraceptives and were categorized as combined estrogen and progestin or progestin-only formulations. Results: Data on 15 531 premenopausal females (14.7% aged 15 to <20 years, 59.3% aged 20 to <40 years, 26.1% aged 40 to <60 years) were analyzed. Participants predominantly had an educational level higher than high school (59.8%), were privately insured (59.3%), and never smoked (58.7%). From 1999 to 2020, the prevalence of prescribed short-acting hormonal contraceptive use significantly increased from 5.2% (95% CI, 2.2%-11.5%) to 15.1% (95% CI, 10.7%-20.7%) for females aged 15 to younger than 20 years, was stable for females aged 20 to younger than 40 years (16.7% [95% CI, 13.2%-21.0%] to 13.3% [95% CI, 10.7%-16.4%]), and remained low among those aged 40 to younger than 60 years (3.8% [95% CI, 1.5%-9.3%] to 7.0% [95% CI, 4.0%-12.1%]). Compared with non-Hispanic White females, non-Hispanic Black and Hispanic females had lower prevalence of use and exhibited the greatest relative increases (prevalence ratio, 3.7 [95% CI, 1.0-13.7] among non-Hispanic Black females and 1.8 [95% CI, 0.9-3.7] among Hispanic females) from 1999 to 2020. Progestin-only formulations accounted for 0.4% (95% CI, 0.1%-2.5%) of the prescribed short-acting hormonal contraceptive prescriptions in 1999 to 2000 and remained low (5.2% [95% CI, 3.0%-8.9%)] in 2017-2020. The prevalence of short-acting hormonal contraceptive use varied by race and ethnicity in all age groups, by family income to poverty ratio, educational attainment, health insurance coverage, marital status, and weight status among females aged 20 to younger than 40 years and by family income to poverty ratio and smoking status among females aged 40 to younger than 60 years. Conclusions and Relevance: In this serial cross-sectional study of US premenopausal females, prescribed short-acting hormonal contraceptive use increased among females aged 15 to younger than 20 years and among non-Hispanic Black and Hispanic females. Across all groups, the use of progestin-only formulations remained low over time.