Global research and learning agenda for building evidence on contraceptive-induced menstrual changes for research, product development, policies, and programs

Abstract

Background: Contraceptive-induced menstrual changes (CIMCs) can affect family planning (FP) users’ lives in both positive and negative ways, resulting in both opportunities and consequences. Despite this, and despite the important links between FP and menstrual health (MH), neither field adequately addresses CIMCs, including in research, product development, policies, and programs globally. Methods: In November 2020, a convening of both MH and FP experts reviewed the existing evidence on CIMCs and identified significant gaps in key areas. Results: These gaps led to the establishment of a CIMC Task Force in April 2021 and the development of the Global Research and Learning Agenda: Building Evidence on Contraceptive-Induced Menstrual Changes in Research, Product Development, Policies, and Programs Globally (the CIMC RLA), which includes four research agendas for (1) measurement, (2) contraceptive research and development (R&D) and biomedical research, (3) social-behavioral and user preferences research, and (4) programmatic research. Conclusions: Guided by the CIMC RLA, researchers, product developers, health care providers, program implementers, advocates, policymakers, and funders are urged to conduct research and implement strategies to address the beneficial and negative effects of CIMCs and support the integration of FP and MH. CIMCs need to be addressed to improve the health and well-being of women, girls, and other people who menstruate and use contraceptives globally. Disclaimer: The views expressed in this article are those of the authors. Publication in Gates Open Research does not imply endorsement by the Gates Foundation.

A Field Test of the NORMAL Job Aid With Community Health Workers in Kenya to Address Contraceptive-Induced Menstrual Changes

“… 16 , 17 , 18 The job aid appeared to increase the effectiveness of their counseling primarily by reducing clients’ concerns about CIMCs and helping clients select or switch FP methods. This is a significant finding because, while the current literature identifies a need for more and better counseling tools that address CIMCs, 2 , 3 there is little research that has been conducted on the content needs, importance, and effectiveness of CIMC job aids and counseling. The original facility-based version of the NORMAL tool was informed by feedback and experience from private- and public-sector health care providers in Haiti and Zambia but was not formally tested for effectiveness.…”

“…In addition, CIMCs often change over time with continued contraceptive method use; for example, a user might experience heavier bleeding when they begin using a method but then later become amenorrheic. 1 , 2 Evidence indicates fears, misconceptions, or negative experiences related to CIMCs among users often contribute to discontinuation and nonuse of family planning (FP) methods. Common fears include that CIMCs can lead to negative health consequences, including infertility.…”

What Have We Learned? Implementation of a Shared Learning Agenda and Access Strategy for the Hormonal Intrauterine Device

“…8 There are also opportunities to support integrated service delivery and increase connections with other health areas including maternal health, nutrition, and menstrual health. 67 Research is ongoing to further evaluate the potential of the hormonal IUD to help alleviate anemia. 68 Continued coordination to address these priorities will help maximize impact as the hormonal IUD is introduced at a wider scale.…”

Consensus recommendations for measuring the impact of contraception on the menstrual cycle in contraceptive clinical trials

“…Experiencing CIMCs can both negatively and positively impact use dynamics, health, and wellbeing for contraceptive users, as well as the individual and sociocultural acceptability of contraception [1]. When users find CIMCs undesirable, negative consequences can include contraceptive dissatisfaction, reduced quality of life, increased burden around managing menstrual health, reduced sexual wellness, and potential unintended pregnancy if users discontinue contraception while still wanting to prevent pregnancy [1][2][3][4]. On the other hand, experiences of CIMCs users consider desirable can result in benefits, such as management of for menstrual and gynecologic disorders and symptoms, method satisfaction, improved sexual wellness, and reduced burden or costs of menstrual materials [1][2][3][4][5][6].…”

“…When users find CIMCs undesirable, negative consequences can include contraceptive dissatisfaction, reduced quality of life, increased burden around managing menstrual health, reduced sexual wellness, and potential unintended pregnancy if users discontinue contraception while still wanting to prevent pregnancy [1][2][3][4]. On the other hand, experiences of CIMCs users consider desirable can result in benefits, such as management of for menstrual and gynecologic disorders and symptoms, method satisfaction, improved sexual wellness, and reduced burden or costs of menstrual materials [1][2][3][4][5][6]. Which CIMCs users determine to be desirable or undesirable for them can vary widely and is influenced by individual preferences and norms and community-level norms-especially around menstruation, menstrual health, and sexual and reproductive health-as well as perspectives of partners and wider social and contextual factors [1][2][3]7,8].…”