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

BACKGROUND

In 2017, an estimated 214 million women of reproductive age living in low-resource settings wanted to avoid pregnancy but were not using a modern method of contraception.¹ Data from Demographic and Health Surveys conducted between 2005 and 2014 reveal that almost one-third of women cite concerns about side effects or fear of health risks as a reason for non-use of modern contraception.² In addition, nearly 40% of women who want to avoid pregnancy report they used a contraceptive in the past but discontinued use because of method-related issues.³ Evidence shows that menstrual bleeding changes associated with contraceptive use contribute to both discontinuation rates and non-use of contraception.^4–10 Many women fear that menstrual changes—such as heavier bleeding, prolonged bleeding, irregular bleeding, spotting, and absence of bleeding (amenorrhea)—can lead to negative health consequences, including infertility. In addition, women often perceive that menstruation is a natural sign of femininity; they worry absence of bleeding is a sign of pregnancy; and they fear a build-up of “dirty” or “bad” blood in their bodies. Unsurprisingly, changes in menstrual bleeding are known to impact women's daily lives and relationships with their partners.^10–18

Helping women understand the typical bleeding changes associated with the use of modern contraceptive methods could lead to greater acceptance of these changes, increased method uptake, improved satisfaction, and higher continuation rates.^10,19 In particular, both health care providers and contraceptive users should understand that changes to menstrual bleeding—including absence of bleeding—due to the use of contraceptive methods will not negatively impact women's health. …