Observational, prospective, multicentre study to evaluate the effects of counselling on the choice of combined hormonal contraceptives in Italy--the ECOS (Educational COunselling effectS) study.

Background: Adequate counselling on contraceptive methods can help users choose the most appropriate
method. The aim of this study was to assess the effects of structured counselling provided by gynaecologists
on selection of a combined hormonal contraception method.
Methods: Women aged 18–40 years (n = 1871) who were considering the use of a combined hormonal
contraception method (pill, transdermal patch or vaginal ring) underwent a structured counselling session in which
gynaecologists provided comprehensive information. Pre- and post-counselling questionnaires on combined hormonal
contraception choice were completed by participants.
Results: After counselling, many women (38 %) selected a combined hormonal contraception method that was
different from the originally intended one. Preferences for the transdermal patch approximately doubled (from 3.2 %
pre-counselling to 7 %; p < 0.0001) and those for the vaginal ring increased four-fold (from 5.2 to 21.2 %; p < 0.0001),
while preference for the pill remained unchanged (from 64.5 % [pre-] to 64.1 % [post-counselling]). The proportion of
undecided women decreased from 18 to 2.1 % (p < 0.0001). The main reasons for choosing a method were related to
ease of use (all methods), and preferences for administration frequency (daily, weekly or monthly). The number of
patients requiring post-counselling contact with the physician’s office was low (5.1–6.9 %), as was the incidence
of adverse events (1.8–3.1 %).
Conclusions: Counselling has a significant impact on women’s choice of combined hormonal contraception and
encourages them to consider alternative methods to combined oral contraceptives. Moreover, it also enables
women to use their chosen method with confidence.