There might be blood: a scoping review on women’s responses to contraceptive-induced menstrual bleeding changes

Abstract

Introduction: Concern about side effects and health issues are common reasons for contraceptive non-use or discontinuation. Contraceptive-induced menstrual bleeding changes (CIMBCs) are linked to these concerns. Research on women's responses to CIMBCs has not been mapped or summarized in a systematic scoping review. Methods: We conducted a systematic scoping review of data on women's responses to CIMBCs in peer-reviewed, English-language publications in the last 15 years. Investigator dyads abstracted information from relevant studies on pre-specified and emergent themes using a standardized form. We held an expert consultation to obtain critical input. We provide recommendations for researchers, contraceptive counselors, and product developers. Results: We identified 100 relevant studies. All world regions were represented (except Antarctica), including Africa (11%), the Americas (32%), Asia (7%), Europe (20%), and Oceania (6%). We summarize findings pertinent to five thematic areas: women's responses to contraceptive-induced non-standard bleeding patterns; CIMBCs influence on non-use, dissatisfaction or discontinuation; conceptual linkages between CIMBCs and health; women's responses to menstrual suppression; and other emergent themes. Women's preferences for non-monthly bleeding patterns ranged widely, though amenorrhea appears most acceptable in the Americas and Europe. Multiple studies reported CIMBCs as top reasons for contraceptive dissatisfaction and discontinuation; others suggested disruption of regular bleeding patterns was associated with non-use. CIMBCs in some contexts were perceived as linked with a wide range of health concerns; e.g., some women perceived amenorrhea to cause a buildup of "dirty" or "blocked" blood, in turn perceived as causing blood clots, fibroids, emotional disturbances, weight gain, infertility, or death. Multiple studies addressed how CIMBCs (or menstruation) impacted daily activities, including participation in domestic, work, school, sports, or religious life; sexual or emotional relationships; and other domains. Conclusions: Substantial variability exists around how women respond to CIMBCs; these responses are shaped by individual and social influences. Despite variation in responses across contexts and sub-populations, CIMBCs can impact multiple aspects of women's lives. Women's responses to CIMBCs should be recognized as a key issue in contraceptive research, counseling, and product development, but may be underappreciated, despite likelyand potentially substantialimpacts on contraceptive discontinuation and unmet need for modern contraception.

Impact of Experiencing Specific Side-Effects on Contraceptive Switching and Discontinuation in Uganda: Results from a Longitudinal PMA Survey

“…Our nding that increased menstrual bleeding was associated with discontinuation aligns with a growing body of literature, highlighting the importance of contraceptive-induced bleeding changes (1,11).…”

“…This belief carries profound social consequences and, therefore, may greatly reduce motivation to use contraception (17,39) We did not nd signi cant effects with discontinuation or switching among women who reported less bleeding, although irregular bleeding was shown to reduce the risk of switching. Evidence from qualitative studies in Africa suggests that amenorrhea and irregular bleeding are often viewed negatively and associated with concerns about future fertility, particularly among nulliparous women (11), however recent qualitative evidence in Uganda found that the potential for lighter periods as a side effect of contraception was viewed favorably by women (36). Zimmerman and colleagues found that two-thirds of sexually active women in Uganda strongly agreed that not having a menstrual period as a result of contraceptive use was unhealthy, but agreement was not strongly associated with either discontinuation or switching (Under Review).…”

“…Changes to menstrual bleeding, including increased bleeding, amenorrhea, and irregular bleeding and spotting, have been shown to be particularly in uential on contraceptive use (1,8,11). A recent review conducted by Wood and colleagues highlighted the critical dearth of population-based estimates regarding the extent that women experience contraceptive-induced changes in sexual experience in LMICs (12).…”

Prevalence and Correlates of Perceived Infertility in Ghana

“…In Ghana, fear of health concerns and side effects are top reasons for nonuse of modern contraception among women with unmet need (Staveteig 2016), with particular concern around irregular menstrual cycles (Hindin, McGough, and Adanu 2014; Staveteig 2017). These fears may in turn be linked with perceptions that menstrual changes lead to infertility (Atijosan, Adeyeye, and Ogungbayi 2019; Polis, Hussain, and Berry 2018).…”

Optimizing the Design of a Contraceptive Microarray Patch: A Discrete Choice Experiment on Women’s Preferences in India and Nigeria

“…A recent scoping review comprising 100 studies with data on women's responses to contraceptive-induced menstrual bleeding changes concluded that menstrual changes are top reasons for method dissatisfaction, discontinuation, and non-use (25). While the authors point out that substantial variability exists around responses to bleeding changes based on individual experience and social in uence, the importance of contraceptive-induced bleeding changes for women's daily lives and contraceptive satisfaction have been underappreciated by family planning programs and contraceptive product developers.…”