title: Impact of the 2013 French Pill Crisis on Women's Behaviour Regarding Contraception.
abstract: BACKGROUND
  In the last decade, several epidemiological studies have shown the increased risk of venous thromboembolism associated with third- and fourth-generation oral contraceptives (C3Gs and C4Gs) versus older combined first- and second-generation oral contraceptives (C1Gs and C2Gs). In France, in December 2012, a lawsuit filed against the National Agency for the Safety of Medicines and Health Products (ANSM) by a patient who had experienced a stroke, possibly due to the use of a C3G, triggered a national 'pill crisis'. Consequently, a 'crisis cell' was set up and pre-existing health recommendations were reinforced. The main aim of this study was to evaluate, in real time, the impact of the French health authorities' recommendations and communications on French women's behaviour regarding contraception.
  
  
  METHODS
  Real-time monthly sales data reported during 2013 were compared with monthly sales data reported in 2012. Analyses were stratified according to the type of contraceptive and age. An index corresponding to the number of months of contraception sold was developed to facilitate comparison of the different contraceptives despite their distinct features and to assess the overall trend of contraception.
  
  
  RESULTS
  After a 2-year analysis (2013 versus 2012), a significant 45 % decrease (p < 0.0001) in C3G-4G sales was observed, compared with a significant increase of 30 % (p < 0.0001) in C1G-2G sales. The sharp increase in C1G-2G sales focused specifically on C2Gs with an oestrogen concentration below 20 µg. Moreover, a large (47 %) increase was reported in sales of intrauterine devices (p < 0.0001). Finally, taking all types of contraceptive sales into account, a slight decrease (1 %) in overall sales was identified.
  
  
  CONCLUSIONS
  Thanks to an effective national communication plan, real-time monitoring of drug sales and favourable reactions from physicians and patients, French women changed their behaviour regarding contraception. However, this study was conducted over a short period following the crisis. A longitudinal analysis is required in order to assess any real long-term changes.
authors.affiliation: National Agency for the Safety of Medicines and Health Products (ANSM), 143-147 Boulevard Anatole France, 93285, Saint-Denis Cedex, France. magali.lemaitre@ansm.sante.fr.
authors.forename: Magali
authors.initials: M
authors.lastname: Lemaitre
authors.affiliation: National Agency for the Safety of Medicines and Health Products (ANSM), 143-147 Boulevard Anatole France, 93285, Saint-Denis Cedex, France.
authors.forename: Glenn
authors.initials: G
authors.lastname: Lastennet
authors.affiliation: Celtipharm, Vannes, France.
authors.forename: David
authors.initials: D
authors.lastname: Syr
authors.affiliation: National Agency for the Safety of Medicines and Health Products (ANSM), 143-147 Boulevard Anatole France, 93285, Saint-Denis Cedex, France.
authors.forename: Joseph
authors.initials: J
authors.lastname: Emmerich
authors.affiliation: National Agency for the Safety of Medicines and Health Products (ANSM), 143-147 Boulevard Anatole France, 93285, Saint-Denis Cedex, France.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Zureik