Abstract PS3-03-20: Trends in Hormonal Contraceptive Use Among Premenopausal Women in the United States, 1999-2020

Abstract Background: Hormonal contraceptive use in premenopausal women has been associated with a small but meaningfully higher risk of breast cancer. However, contemporary patterns of hormonal contraceptive use among premenopausal women in the United States (US) are unclear. Objective: To evaluate trends in and correlates of hormonal contraceptive use among premenopausal women in the US. Methods: Serial, cross-sectional analyses of hormonal contraceptive use using US nationally representative data from the National Health and Nutrition Examination Survey (NHANES) were conducted. Participants included noninstitutionalized premenopausal women from ten NHANES study cycles (1999-2000 to 2017-March 2020 pre-pandemic). The prevalence of hormonal contraceptive use was extracted from prescription medication data collected during household interviews. Hormonal contraceptive formulations were determined by hormone type. Trends in the prevalence of hormonal contraceptive use across study cycles were examined using multivariable logistic regressions, adjusting for sociodemographic factors. Results: Data on 15531 premenopausal women from ten NHANES cycles were analysed. From 1999 to 2020, the prevalence (95% CI) of hormonal contraceptive use significant increased from 5.2% (2.2 to 11.5%) to 15.5% (11.2 to 21.1%) for young women aged 15-20 years, was stable among women aged 20-40 years (from 16.9% 13.3 to 21.3% to 15.8% 13.0 to 19.0%), and remained stably low among those aged 40-60 years (from 3.8% 1.5 to 9.3% to 7.0% 4.0 to 12.1%). Compared to non-Hispanic White women, non-Hispanic Black and Hispanic women consistently had lower prevalence of use but exhibited greater relative increases (prevalence ratio PR=3, 95% CI: 1.0 to 8.5, PR=2, 95% CI: 0.9 to 4.1, respectively) from 1999 to 2020. Combined estrogen and progestin formulation accounted for over 95% of the hormonal contraceptive prescriptions in 1999-2020, yet progestin formulation increased approximately five-fold, accounting for 16.3% (10.8 to 2.8%) of all prescriptions in 2017-2020. The prevalence of contraceptive use varied by race/ethnicity and family income to poverty ratio in all age groups, as well as by educational attainment, health insurance coverage, marital status, and weight status among women 20-40 years. Conclusions and Relevance: In the past two decades, hormonal contraceptive use in the US significantly increased among young women aged 15-20 years and among non-Hispanic Black premenopausal women of all age groups. Combined estrogen and progestin formulations account for the majority of hormonal contraceptive use; however, prescriptions for progestin formulations are increasing. Future investigations are needed to elucidate the implications of these changes in hormonal contraceptive use on the incidence of breast cancer. Citation Format: L. Yang, H. Harsanyi, I. Bacha, S. Uttamapinan, A. Toriola. Trends in Hormonal Contraceptive Use Among Premenopausal Women in the United States, 1999-2020 abstract. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS3-03-20.