ArticleInternational journal of women's health2026
Beyond Early Attrition: Access Barriers as the Leading Documented Reason for Stopping Monthly Norethisterone Enanthate/Estradiol Valerate Among Established Users in China: A Retrospective Cohort Study.
Article in International journal of women's health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Purpose: Most women who begin monthly norethisterone enanthate 50 mg/estradiol valerate 5 mg (NET-EN/E2V) after an abortion stop within a year; less is known about those who continue. We describe use status, duration, menstrual change and documented reasons for stopping among established users in China. Patients and Methods: We reviewed routine records of 134 women who had received at least six NET-EN/E2V injections at a tertiary maternal and child health hospital in Wuxi, Jiangsu Province, China. Women started between May 2023 and November 2025, with abstraction through May 2026. Duration analyses covered the 98 women no longer receiving injections at data cut-off; reason analyses covered the 61 with a documented reason. We compared post-abortion with other initiation contexts and fitted an exploratory logistic regression for use of at least 12 months. Results: At data cut-off, 36 of 134 women (26.9%) were still receiving injections. Among the 98 no longer active, mean completed-use duration was 11.7±5.8 months and 40 (40.8%; 95% CI 31.6-50.7) reached at least 12 months. Initiation context predicted neither active status (P=0.418) nor duration (P=0.713). Among the 61 women with a documented reason, practical access barriers accounted for 30 (49.2%; 95% CI 37.1-61.4), menstrual change for 18 (29.5%), other side effects for 10 (16.4%) and contraceptive failure for three (4.9%). Practical barriers accounted for 43.5% at 6-11 months and 66.7% at ≥12 months. Conclusion: Among established users with a documented reason for stopping, practical access barriers were recorded more often than pharmacological intolerance, and their share was larger after longer use. Because a reason was documented for only 61 of 98 women who stopped, and earlier discontinuers were excluded by design, these proportions describe documented reasons and do not estimate continuation from initiation. Easing the scheduling burden of monthly clinic visits is an actionable service target.
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