Figures & Tables
Tables
- TABLE 1.
Programmatic Guidance for Family Planning and Menstrual Health Integration on Education and Awarenessa
Preadolescence and Adolescence Mid-Life and Reproductive Years Perimenopause and Menopause Include evidence-based puberty and comprehensive sexuality education for youth/adolescents that includes age-appropriate information on menstruation and fertility, managing menstrual bleeding and MH, and FP, including CIMCs, across settings, including for both in- and out-of-school youth of all genders.
Follow evidence-informed guidance on comprehensive sexuality education.9
Continue to provide evidence-based sexuality education and information about menstruation and fertility, managing menstrual bleeding and pain, MH, and FP.
For mid-life and reproductive years: Counseling and education should include information about postpartum return to fertility.
For perimenopause and menopause: Counseling and education should include information about perimenopause and menopause.
Expand access to evidence-based tools that provide access to FP and MH education, products, and services to people of all ages and genders, including tools that can be accessed directly by individuals through digital channels. Examples of existing tools that provide integrated information include AskNivi,10 Managing Menstruation: Know Your Options,11 Natural Cycles,12 and Love Matters.13
Train and strengthen the capacity of CHWs and hold them accountable in providing sensitive, evidence-based counseling and education about menstruation and fertility, managing menstrual bleeding, pain and disorders, MH, and FP, including CIMCs.
For preadolescence and adolescence: Counseling and education should be age-appropriate and youth-responsive.
For mid-life and reproductive years: Counseling and education should include information about postpartum return to fertility.
For perimenopause and menopause: Counseling and education should include information about perimenopause and menopause.
Provide support information and education to stakeholders, such as educators and school staff, parents/guardians, community-based workers (across sectors), peer educators, and community and faith leaders, that align with and support the education provided by schools, CHWs, and other channels.
Train and strengthen the capacity of stakeholders such as community-based workers (across sectors) and community and faith leaders to provide sensitive, evidence-based education about FP, MH, and CIMCs.
For perimenopause and menopause: Education should continue throughout perimenopause and until menopause is confirmed.
Abbreviations: CHW, community health worker; CIMC, contraceptive-induced menstrual change; FP, family planning; MH, menstrual health.
↵a In all areas of integration, conduct programmatic research, implementation science, and routine or enhanced monitoring and evaluation that can be used to inform and improve future programs.
- TABLE 2.
Programmatic Guidance for Family Planning and Menstrual Health Integration by Improving Systems-Level Interactionsa
Preadolescence Adolescence Mid-Life and Reproductive Years Perimenopause and Menopause Intesgrate delivery of MH commodities and services into FP within health systems.
Provide affordable, high-quality MH products and facilities, including clean, private toilets with space for washing and disposal, and other resources to FP clients during counseling and/or service provision and/or referrals for products and services.
Recognize that FP users may need more, less, or different MH products when they are using contraception and that this can change over time.
Integrate the delivery of FP commodities and services into MH programs.
Provide affordable, high-quality FP services, including counseling and method provision and/or referrals for FP services as part of both school and community-based MH programs.
Train and strengthen the capacity of providers and hold them accountable to delivering integrated care.
Ensure that those providing sexual and reproductive health services are trained in both comprehensive FP and MH counseling as described in the section above, including training on contraceptive-induced menstrual changes and management of menstrual disorders, as well as youth-responsive services.
Promote self-care,29 including self-reassurance about contraceptive-induced menstrual changes.
Ensure people have the information they need and reliable access to MH products, facilities, and other resources including self-care options for menstrual pain.
Support individuals to gain the self-efficacy and bodily autonomy they need to use resources with confidence.
Ensure FP users are included in MH research and programs, including research involving menstrual products and development of MH standards.
Consider the needs and preferences of end users in a holistic way that explicitly includes both FP and MH when designing and implementing MH or FP research, programs, products, systems, and standards.
Revise health management information systems and reporting tools to support and report on integrated care, including adding information about MH to existing FP registers.
Abbreviations: FP, family planning; MH, menstrual health.
↵a In all areas of integration, conduct programmatic research, implementation science, and routine or enhanced monitoring and evaluation that can be used to inform and improve future programs.
- TABLE 3.
Programmatic Guidance for Family Planning and Menstrual Health Integration by Improving Client-Level Interactions Within Health Systemsa
Preadolescence Adolescence Mid-Life and Reproductive Years Perimenopause and Menopause Provide information and counseling on MH, including information about the full range of available options for managing menstrual (and contraceptive-induced) bleeding and pain, including information on self-care options and if feasible, access to, or at least information on where to access, commercial menstrual products locally, using tools such as Managing Menstruation: Know Your Options.11
Recognize that FP users may need more, less, or different MH products when they are using contraception and that this can change over time.
Provide access to comprehensive youth-responsive services30 that include MH education and information about the full range of MH and FP, including self-care options, to ensure smooth transition into puberty and to ensure that future MH and FP needs are met as soon as they arise.
Ensure that services are age-appropriate and welcome all genders.
Provide information on FP, including on the full contraceptive method mix including complete and correct information about fertility-based awareness methods and lactation amenorrhea method options.b
If the client chooses to use FP, provide effective, evidence-based counseling during and after method selection about potential contraceptive-induced menstrual changes, using provider job aids such as the NORMAL tool.34
Provide adequate support and clinical treatment for undesirable contraceptive-induced menstrual changes.
Ensure adequate follow-up services and counsel FP users that they can return at any time if they have questions or concerns.
Provide effective, evidence-based postpartum counseling including products for the management of postpartum bleeding, information about the return of menstruation and fertility after pregnancy and after FP use, as well as support on tapering off FP when trying to conceive.
Promote use of the pregnancy checklist41 and/or provide access to low-cost pregnancy tests to ensure same-day provision of contraceptive methods among women seeking services when they are not menstruating (i.e., to ensure providers do not rely on the presence of menses as an indicator that a client is not pregnant before providing contraceptive methods.)
Provide information and services related to perimenopause and menopause, including how to manage symptoms and counsel on contraceptive use during this life stage.
Also, ensure perimenopausal people have access to low-dose contraceptives as an option to relieve menopause symptoms.
Ask about and address concerns about menstruation and menstrual discomfort, including diagnosis and treatment of disorders.
Even in the absence of a diagnosis, provide information on management of symptoms, which should include education on self-care (light exercise, stretching and/or yoga, applying heat such as a hot water bottle, taking ibuprofen or naproxen, and other evidence-based self-care options), contraception, and other available options.
Abbreviations: FP, family planning; MH, menstrual health.
↵a In all areas of integration, conduct programmatic research, implementation science, and routine or enhanced monitoring and evaluation that can be used to inform and improve future programs.
↵b Fertility-based awareness methods are not recommended for early adolescents and during perimenopause because menstrual cycles are unpredictable during these times.
- TABLE 4.
Programmatic Guidance for Family Planning and Menstrual Health Integration by Reaching Populations with Special Needsa,b
Adolescence Mid-Life and Reproductive Years Perimenopause and Menopause When providing services to populations with special or unique needs,b ensure that both their MH and FP needs are adequately addressed and counsel on contraceptive-induced menstrual changes accordingly.
Ensure that individuals are not denied their rights to information about sexual and reproductive health, including MH and FP, and consent to FP method use/provision.
Ensure populations with special or unique needs are included in FP and MH research and product introduction programs and that these research studies and programs are informed by the populations they are serving and designed to be as accessible as possible.
Ensure all individuals with menstrual discomfort and/or disorders have adequate counseling and access to contraception as a management or prevention option.
Ensure people with menstrual disorders are included in FP and MH research and product introduction programs when possible.
Abbreviations: FP, family planning; MH, menstrual health.
↵a In all areas of integration, conduct programmatic research, implementation science, and routine or enhanced monitoring and evaluation that can be used to inform and improve future programs.
↵b Including youth, perimenopausal people, people with disabilities, people living with HIV, postpartum people, refugees, migrants or other mobile populations, sex workers, people in the lesbian, gay, bisexual, transgender, queer community, survivors of abuse and violence, and those who are incarcerated, among others.
- TABLE 5.
Programmatic Guidance for Family Planning and Menstrual Health Integration by Engaging Stakeholders and Strengthening National Policiesa
Preadolescence Adolescence Mid-Life and Reproductive Years Perimenopause and Menopause Implement SBCC and Advocacy Programs Include messaging about FP, MH, and contraceptive-induced menstrual changes in SBCC campaigns and interventions, including interventions that destigmatize and make these topics more understandable to relevant audiences.
Advocate at the policy level to ensure decision-makers are educated on the issues of FP, MH, and contraceptive-induced menstrual changes and aware of the best ways to include these issues in policy-level decisions.
Strengthen National Policies and Guidelines Review and update FP, MH, and SRHR policies to ensure that adequate, evidence-based information about FP-MH integration and contraceptive-induced menstrual changes is included and promoted.
Review and update FP, MH, and SRHR guidelines to ensure that adequate, evidence-based information about FP-MH integration and contraceptive-induced menstrual changes is included. Update clinical guidance and training for health care providers as needed.
Abbreviations: FP, family planning; MH, menstrual health; SBCC, social and behavior change communication; SRHR, sexual and reproductive health and rights.
↵a In all areas of integration, conduct programmatic research, implementation science, and routine or enhanced monitoring and evaluation that can be used to inform and improve future programs.
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