Understanding contraceptive and hormonal medication decision-making for pregnancy prevention and management of gynaecological symptoms: A systematic review of UK evidence

Background There has been a decline in the number of contraceptive appointments and prescriptions in the UK. Existing evidence explores the impact of access, barriers and awareness on contraception use. However, less is known about the nuance of how individuals make these decisions. This review aimed to synthesise recent UK evidence on those assigned female at birth’s attitudes, experiences and decision-making around contraception and hormonal medication for pregnancy prevention and/or gynaecological reasons. Methods Five academic databases and six online sources were systematically searched. Included studies were published in English from 2015 onwards and contained primary data on contraceptive decision-making for pregnancy prevention and/or gynaecological treatment in the UK. Studies were critically appraised for methodological reliability and usefulness. Data were coded deductively, inductively grouped conceptually, and mapped onto a conceptual framework. Results 21 studies met the inclusion criteria. The majority were qualitative and focused on pregnancy prevention. The synthesis demonstrates that decision-making is shaped by how methods felt in relation to the body; trading off positive and adverse effects; experiences navigating different information sources; balancing clinical and cultural pressures against bodily autonomy; and personal perceptions of risk and fulfilling intimate desires. Conclusion Contraceptive and hormonal medication decision-making is a dynamic process shaped by complex trade-off balances, trial-and-error processes, evolving needs, and individual contexts. Individuals often want to involve and trust others by sharing the decision-making process. Person-centred healthcare consultations must recognise the complexity of choice, use, and to support contraceptive and hormonal medication decision-making across the life course.