Menstrual Bleeding Changes Are NORMAL: Proposed Counseling Tool to Address Common Reasons for Non-Use and Discontinuation of Contraception

Rademacher, Kate H.; Sergison, Jill E.; Glish, Laura; Maldonado, Lauren Y.; Mackenzie, Amelia C. L.; Nanda, Geeta; Yacobson, Irina

doi:10.9745/ghsp-d-18-00093

Cited by 26 publications

(26 citation statements)

References 27 publications

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“…Health workers, including CHWs, involved in providing family planning education and provision should be equipped to provide reproductive education to help women understand and differentiate between nonharmful and harmful side effects. FHI360 has developed a job aid called "NORMAL" to help health workers counsel clients on expected changes of menstruation on various forms of hormonal contraception [9]. There is evidence that job aids with accurate injectable information have been shown to increase injectable use in low-resource settings and could be adapted to the Ghanaian context [30].…”

Section: Discussionmentioning

confidence: 99%

“…Side effects include menstrual changes (heavier bleeding, amenorrhea or oligomenorrhea), changes in weight, headaches, dizziness, nausea, and cardiovascular impacts. In addition, women may harbor fears of long-term effects of contraceptive use, such as infertility and childbirth complications [8,9]. A 2014 systematic review found a significant proportion of women attributed their unmet need for family planning to a fear of side effects: 28% in Africa, 23% in Asia, and 35% in Latin America and the Caribbean [10].…”

Section: Introductionmentioning

confidence: 99%

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Side effect concerns and their impact on women’s uptake of modern family planning methods in rural Ghana: a mixed methods study

Schrumpf

Stephens

Nsarko³

et al. 2020

BMC Women's Health

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Background: Despite availability of modern contraceptive methods and documented unmet need for family planning in Ghana, many women still report forgoing modern contraceptive use due to anticipated side effects. The goal of this study was to examine the use of modern family planning, in particular hormonal methods, in one district in rural Ghana, and to understand the role that side effects play in women's decisions to start or continue use. Methods: This exploratory mixed-methods study included 281 surveys and 33 in-depth interviews of women 18-49 years old in the Amansie West District of Ghana between May and July 2018. The survey assessed contraceptive use and potential predictors of use. In-depth interviews examined the context around uptake and continuation of contraceptive use, with a particular focus on the role of perceived and experienced side effects. Results: The prevalence of unmet need for modern family planning among sexually active women who wanted to avoid pregnancy (n = 135) was 68.9%. No factors were found to be significantly different in comparing those with a met need and unmet for modern family planning. Qualitative interviews revealed significant concerns about side effects stemming from previous method experiences and/or rumors regarding short-term impacts and perceived long-term consequences of family planning use. Side effects mentioned include menstrual changes (heavier bleeding, amenorrhea or oligomenorrhea), infertility and childbirth complications. Conclusion: As programs have improved women's ability to access modern family planning, it is paramount to address patient-level barriers to uptake, in particular information about side effects and misconceptions about longterm use. Unintended pregnancies can be reduced through comprehensive counseling about contraceptive options including accurate information about side effects, and the development of new contraceptive technologies that meet women's needs in low-income countries.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Side effect concerns and their impact on women’s uptake of modern family planning methods in rural Ghana: a mixed methods study

Schrumpf

Stephens

Nsarko³

et al. 2020

BMC Women's Health

View full text Add to dashboard Cite

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“…Data were then compiled in a single dashboard so results could be compared and discussed. The dashboard will be updated on a regular basis as new data become available; the current version is available online through the Knowledge for Health platform 38 . There were some challenges with implementation of this approach across countries and projects.…”

Section: Implementation Of the Global Lng Ius Learning Agendamentioning

confidence: 99%

“…The dashboard will be updated on an ongoing basis. The current version (as of November 2018) is available online in the IUD Toolkit on the Knowledge for Health platform 38 …”

Section: Implementation Of the Global Lng Ius Learning Agendamentioning

confidence: 99%

A Global Learning Agenda for the Levonorgestrel Intrauterine System (LNG IUS): Addressing Challenges and Opportunities to Increase Access

Rademacher

Sripipatana

Pfitzer³

et al. 2018

Glob Health Sci Pract

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The LNG IUS is one of the most effective forms of reversible contraception and has important noncontraceptive benefits but is currently not used at scale in any Family Planning 2020 focus country. A global working group developed a shared learning agenda to answer critical questions, harmonize approaches, avoid duplication, and facilitate introduction of the method within the context of informed choice.

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“…During clinical consultations, providers should address the benefits of menstrual regulation and suppression, highlighting these as safe options for women, to reduce misinformation and knowledge disparities. Additionally, providers globally should discuss the monthly bleeding patterns associated with different contraceptive options to reduce health concerns and contraceptive discontinuation [23, 47]. This may improve the acceptability of contraceptive options, including LARC, that function to reduce menstrual frequency and may open up further options for women.…”

Section: Discussionmentioning

confidence: 99%

The myth of menstruation: how menstrual regulation and suppression impact contraceptive choice

et al. 2019

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BackgroundWomen in the US have access to various hormonal contraceptive methods that can regulate menstruation. This study examined the attitudes and perceptions of reproductive-aged women toward contraceptive methods, including how menstrual regulation and suppression preferences influenced contraceptive choice.MethodsData collection used a mixed-methods approach, including 6 focus groups (n = 61), individual interviews (n = 18), and a web-based survey (n = 547).ResultsParticipants described contraceptive method preferences that allowed monthly bleeding and daily control, expressing concerns about long-acting reversible contraception (LARC) because of decreased user involvement. Some participants noted LARC improved their menstrual control. Many participants felt menstruation was healthy, whereas suppression was abnormal and resulted in negative health outcomes. Though participants indicated LARC as beneficial (M = 4.99 ± 1.66), convenient (M = 5.43 ± 1.68), and healthy (M = 4.62 ± 1.69), they chose combined oral contraceptives due to convenience.ConclusionsFindings suggest women need more information about menstrual regulation and suppression before selecting a contraceptive method, specifically in relation to LARC versus combined oral contraception. Framing menstrual suppression as healthy and natural may improve perceptions of long-term health consequences related to LARC. Providers should discuss menstrual suppression safety to ensure selection of contraceptive options aligning with women’s preferences and needs.

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Menstrual Bleeding Changes Are NORMAL: Proposed Counseling Tool to Address Common Reasons for Non-Use and Discontinuation of Contraception

Abstract: A new family planning counseling tool uses the simple mnemonic device “NORMAL” to help family planning counselors and providers communicate to their clients key messages about menstrual bleeding changes associated with use of hormonal contraception and the copper IUD.

Cited by 26 publications

References 27 publications

Side effect concerns and their impact on women’s uptake of modern family planning methods in rural Ghana: a mixed methods study

Side effect concerns and their impact on women’s uptake of modern family planning methods in rural Ghana: a mixed methods study

A Global Learning Agenda for the Levonorgestrel Intrauterine System (LNG IUS): Addressing Challenges and Opportunities to Increase Access

The myth of menstruation: how menstrual regulation and suppression impact contraceptive choice

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