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

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

doi:10.9745/GHSP-D-18-00093

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FIGURE
NORMAL Counseling Tool
Abbreviations: COCs, combined oral contraceptives; DMPA, depot medroxyprogesterone acetate; IUD, intrauterine device; NSAID, nonsteroidal anti-inflammatory drug.

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TABLE.

Content Related to Menstrual Bleeding Changes in Key International Family Planning Counseling and Training Resources

Resource/Lead Organization(s)	Contraceptive Method	Messages/Content Evaluated
Resource/Lead Organization(s)	Contraceptive Method	Type of Expected Bleeding Changes	Comparison of Bleeding Changes Among Different Methods	When to Address Bleeding Changes	Type of Reassurance Provided^a	Strategies to Manage Bleeding Changes and Associated Symptoms	Overview of Function and Biological Process of Menstruation	Potential Benefits of Oligomenorrhea or Amenorrhea	Expected Bleeding Changes for Special Populations^b
The Balanced Counseling Strategy Plus: A Toolkit for Family Planning Service Providers Working in High HIV/STI Prevalence Settings²⁴/Population Council	Implants	Y	Y	After method initiation	2	N	N	Y	N
	DMPA injectable	Y	N	After method initiation	1	N	N	Y	N
	Copper IUD	Y	N	After method initiation	2	N	N	N/A	N
	LNG IUS	Y	N	After method initiation	2	N	N	Y	N
Training Resource Package for Family Planning²⁵^c/ USAID, WHO, and UNFPA	Implants	Y	N	Before method initiation	2	N	N	Y	N
	DMPA injectable	Y	N	Before method initiation	3	Y	N	Y	N
	Copper IUD	Y	N	Before method initiation	2	Y	N	N/A	Y
Providing Long-Acting Reversible Contraception (LARC) Learning Resource Package (Modular/Facility-Based)²⁶^d/MCSP, Jhpiego	Implants	Y	N	Before method initiation	2	Y	N	Y	Y
	Copper IUD	Y	N	Before method initiation	2	Y	N	N/A	N
	LNG IUS	Y	N	Before method initiation	2	Y	N	Y	Y
Pathfinder Family Planning Resources²⁷^–³²^c/Pathfinder	Implants	Y	N	Before method initiation	3	Y	N	Y	N
	DMPA injectable	Y	N	Before method initiation	2	Y	N	Y	Y
	Copper IUD	Y	N	Before method initiation	2	Y	N	N/A	Y
Family Planning: A Global Handbook for Providers, 3rd ed.³³/WHO and K4Health Project, Johns Hopkins CCP	Implants	Y	N	Before and after method initiation	3	Y	N	Y	N
	DMPA injectable	Y	N	Before and after method initiation	3	Y	N	Y	N
	Copper IUD	Y	N	Before and after method initiation	2	Y	N	N/A	N
	LNG IUS	Y	N	Before and after method initiation	2	N	N	Y	N
LNG IUS Training Manual for Family Planning³⁴^e/ICA Foundation	LNG IUS	Y	Y	Before method initiation	2	Y	N	Y	N

↵Abbreviations: CCP, Center for Communication Programs; DMPA, depot medroxyprogesterone acetate; ICA, International Contraceptive Access; IUD, intrauterine device; LNG IUS, levonorgestrel intrauterine system; K4Health, Knowledge for Health; MCSP, Maternal and Child Survival Program; UNFPA, United Nations Population Fund; USAID, United States Agency for International Development; WHO, World Health Organization.
↵a 1=none; 2=general "no harm" message; 3=detailed "no harm" message.
↵b Special populations include youth and postpartum women.
↵c Method-specific information on the LNG IUS is not included in this resource.
↵d Method-specific information on DMPA is not included in this resource.
e Information about the LNG IUS is not included in all resources because it is not widely available in developing countries. The ICA Foundation donates free LNG IUS units and has LNG IUS training resources for providers on their website. The ICA Foundation materials were reviewed for information on the LNG IUS specifically and did not include information on implants, DMPA, or the copper IUD.