Choice and Factors Associated With Contraceptive Use Among Perimenopausal Women Attending a Tertiary Hospital in Western Kenya.

Abstract

Background Women aged ≥ 40 years old are perimenopausal as they are in a transition phase marked with hormonal fluctuations that signal the end of fertility. Although their fertility is reduced, they are still at risk of pregnancy that is associated with adverse maternal-fetal compared to their younger counterparts. Pregnancies among women older than forty years are often complicated by comorbidities such as cardiovascular disease and malignancies; a situation that necessitates contraceptive use until menopause. Objective To determine the proportion of contraception use, choice, as well as factors influencing contraception utilization among women aged forty years or more at Moi Teaching and Referral Hospital (MTRH). Materials and methods A cross-sectional study among women aged 40–55 years attending specialist outpatient clinics at MTRH between January to December 2020. The clinics were stratified into 5 major clinical departments (Internal Medicine, Surgery, Obstetrics and Gynecology, General Oncology and Psychiatry) and proportionately sampled systematic (k = 10). Their sociodemographic and clinical characteristics as well as reproductive history, contraception use, or choice were collected using an interviewer-administered questionnaire. Descriptive statistical techniques were used to describe the study participants, while Pearson Chi Square and Fisher’s exact tests were used to test the association between predictor variables and contraceptive use. Logistic regression was used to control for confounders and adjusted odds ratios computed at 95% confidence interval. Results We enrolled 359 women with a mean age of 44.8 (± 3.7) years, majority (94.4%) of whom attained at least a primary level of education and 352 (98.1%) had previously given birth. The overall proportion of contraception use was 44.6% (n = 160), with nearly equal proportions using modern hormonal (45.6%) and non-hormonal (46.9%) contraception methods. The leading contraceptives used were Depot Medroxy Progesterone Acetate (DMPA) at 23.1% and bilateral tubal ligation (22.5%). There was a significant increased likelihood between being aged 40–44 years (p = 0.003), multiparous (p = 0.003) and married (p = 0.005) and contraception use. Women who professed the catholic faith (p = 0.013), desired to conceive (p = 0.003) and experienced premenopausal symptoms (p < 0.001) had a significantly reduced likelihood of using any form of contraception. Those diagnosed with hypertension (p = 0.013) and cardiac disease (p = 0.008) were significantly more likely to use non-hormonal contraceptives. Conclusion Less than half of the perimenopausal women enrolled used contraceptives. Majority of them opted for DMPA and bilateral tubal ligation. Being 40–44 years, married and multiparous were significantly associated with contraceptive use. Significant barriers to contraception were being catholic, desiring to conceive and having premenopausal symptoms. Women with heart disease and hypertension significantly used modern non-hormonal contraceptives.