Academic journal article International Family Planning Perspectives

The Impact of Menstrual Side Effects on Contraceptive Discontinuation: Findings from a Longitudinal Study in Cairo, Egypt

Academic journal article International Family Planning Perspectives

The Impact of Menstrual Side Effects on Contraceptive Discontinuation: Findings from a Longitudinal Study in Cairo, Egypt

Article excerpt

CONTEXT: Although many research studies have documented the relationship between menstrual side effects of contraceptives and discontinuation of use, few have sought to identify factors that predispose women to discontinue because of changes in bleeding patterns. Such information is important to enable family planning providers to better help women and couples choose appropriate methods and use them successfully.

METHODS: Forty-eight women participating in six focus group discussions described their experiences using the IUD, the hormonal implant or the three-month injectable. Subsequently, 259 women using one of these methods for the first time were followed for up to 18 months to determine patterns of menstrual bleeding and perceptions of menstrual cycle change over time. Multivariable analytical methods were used to examine the associations between selected measures and method discontinuation.

RESULTS: Contraceptive discontinuation differed by method: Nearly 70% of injectable users had stopped using their chosen method after one year, compared with 34% of IUD users and 10% of implant users. Before initiating a method, women reported an average of five bleeding days per cycle. During the first six months of use, IUD users reported an average of six days of bleeding per cycle; injectable and implant users reported 11-12. In multivariable models, each additional day of bleeding was significantly associated with a 2-4% increase in discontinuation, depending on method type. Among IUD users, women whose husbands knew that they had visited a clinic to initiate a method were less likely than others to discontinue method use (hazard ratio, -1.9). Age was significantly associated with decreased discontinuation among implant users.

CONCLUSION: Counseling about bleeding and other side effects should be tailored to women's personal contexts and contraceptive experiences.

International Family Planning Perspectives, 2005, 31(1):15-23

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Many research studies have documented the relationship between menstrual side effects of certain contraceptives and women's discontinuation of use. (1) A few studies have sought to identify user characteristics or aspects of the service delivery environment that predispose some women to discontinue because of changes in bleeding patterns. (2) Yet by focusing on clinical measures of bleeding or by limiting research to a single contraceptive method or class of methods, these studies do little to explain the context in which menstrual side effects lead to discontinuation. Family planning programs need to better understand women's experiences of menstrual-related side effects and how personal and service delivery factors may influence these experiences if they are going to help women and couples choose appropriate methods, use them successfully and meet their reproductive goals.

This study, which was conducted in Cairo, Egypt, with first-time users of the IUD, the hormonal implant and the depot medroxyprogesterone acetate (DMPA) three-month injectable, was designed to improve understanding of the role that the menstrual side effects of contraceptive methods play in women's decisions to discontinue use of those methods.

MENSTRUAL SIDE EFFECTS AND DISCONTINUATION

Contraceptive Methods

Many contraceptive methods produce changes in the menstrual cycle. However, such menstrual changes may vary across individuals, methods and duration of use, complicating providers' task of adequately counseling contraceptive clients. For example, IUDs have been associated with increased menstrual bleeding and cramping. (3) In contrast, the implant and the injectable can cause irregularity in the menstrual cycle, including extended periods of light bleeding or temporary amenorrhea; they may also increase bleeding. And whereas users of the injectable become more likely to miss periods over time, implant users become less likely to do so. …

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