The side effects of contraceptives

The Side Effects of
Contraceptives
www.freelivedoctor.com

Objectives
Learn more about side effects
Consider side effects from client’s
cultural & personal context
Understand side effects’ impact on use
& continuation

Side effects influence:
Initial decision to use FP
Continuation with method(s)
Satisfaction with method & FP

Contraceptive discontinuation due to side effects and health concerns
in selected countries
Country Year Side Effects
(%)*
Health
Concerns (%)
Morocco 1992 16.8 6.7
Egypt 1992 30.4 10.2
Dominican
Republic
1991 16.8 8.7
Jordan 1991 17.2 4.6
Indonesia 1991 11.4 15.5
Paraguay 1990 19.7 9.3
*Percent of total discontinuation for all methods combined. Other reasons for
discontinuation include desired pregnancy and method failure.
Source: Outlook 12(3) October 1994

Negative impacts are reduced by:
Discussing side effects before method
selection
Managing side effects promptly
Allowing method switching

Side Effects vs. Complications
SIDE EFFECTSSIDE EFFECTS: symptoms or
conditions that pose no significant
health risk
COMPLICATIONSCOMPLICATIONS: serious health
problems or conditions

Headache
Increased
menstruation
Light or no
menstruation
Menstrual cramping
Severe headaches
Very heavy bleeding
(twice as long or as
much )
Severe, constant
pain in the chest, leg
or belly

Weight gain or loss
Nausea
Vaginal dryness
Local skin irritation
Skin or eyes that
become unusually
yellow (jaundice)
Loss of sensation in
arms or legs

Side Effects: Some Observations
Most contraceptives have some side
effects
Some side effects are common; others
are rare
Some go away over time
Some are easily treated

Side Effects: Some Observations
It can be unclear if side effects are
caused by method
Clients may experience one or several
Side effects can vary by brand
Type & severity vary by method & user

The truth about side effects
Important to distinguish side effects from
rumors or misinformation
– ChallengeChallenge:: Clients believe that certain
methods will render a woman sterile
– SolutionSolution:: Always discuss returning to fertility
as a significant issue

Consequences of Side Effects
Elicit concerns re possible impact on
clients’ lives
Pay particular attention to cultural
beliefs or taboos
Include both positive & negative
consequences

Positive or negative consequences:
client’s responses
Feel “unwell”
Feel too weak to
work
Unable to participate
in religious
community activities
Unable to cook
Feel unattractive or
more attractive
Limit sexual activity
or enhance sexual
pleasure
Discontinue
contraceptive
method or use it
irregularly

Side effect counseling & method use:
Niger & Gambia
Women not counseled far more likely to
drop out
Women fully counseled far more likely
to continue with the same or different
method

Discontinuation of contraception and women’s perception of
counseling in Niger and The Gambia
51%
19%
14%
37%
0%
10%
20%
30%
40%
50%
60%
Niger (n=178) Gambia (n=139)
Felt counseling was inadequate Felt counseling was adequate
Source: Cotton N. et al. Early Discontinuation of Contraceptive Use in Niger and The Gambia. International Family Planning
Perspectives 18(4):145-149 (December 1992).
Percentofwomenwhodiscontinued
methodafter6-8months

Side effect counseling & method use:
China
Women counseled before taking DMPA
4 times more likely to continue 12
months later
This research led to new policy to
counsel on side effects

Effect of pretreatment counseling on discontinuation
rates in Chinese women given DMPA for contraception.
11%
25%
42%
3%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
At 3 months at 12 months
Received detailed structured pretreatment and ongoing counseling
Received routine counseling only
Source: Zhen-Wu, L. et al. Effect of Pretreatment Counseling on Discontinuation rates in Chinese
Women Given Depomedroxy ProgesteroneAcetate for Contraception. Contraception 53(6):357-
361 (June 1996).
Percentofwomenwho
discontinuedmethod

Important to pay attention to concerns
of client’s partner
E.g. , Counseled husbands of Norplant
users reassured re partner’s spotting
Side effect counseling & method use

Why providers may not inform
clients about side effects
Reasons
Too Busy
Worried that clients
may reject method(s)
Possible Solutions
Reassure that
counseling can be
brief. Provide
literature.
Reassure that side
effect counseling
increases use &
continuation.

Why providers may not inform
clients about side effects
Reasons
Unaware of frequency
of sides effects
Lack of support
material
Possible Solutions
Give providers
training on common
side effects.
Provide simple written
& AV materials for
providers

Helping clients know
what to expect
Say that many clients experience no
side effects
Give information re how to manage or
outlast side effects
Make clients feel comfortable returning
for assistance, if needed

If clients want a specific method:
Screen for suitability (medical
conditions & HIV/STI risks)
If suitable, give side effects information
on that method ONLY

Helping clients choose a method
Describe side effects of various
methods, their frequency & duration
Reassure re safety of methods
Emphasize client satisfaction with
methods in general
Elicit & answer questions; correct
misinformation courteously

Helping clients know what to expect:
reminders
Elicit and respond to client concerns
Be concise & clear
Be honest re frequency or severity of
side effects
Provide support material

Why help clients
manage side effects?
Increase client’s comfort, satisfaction
with & continuation with the method
Discover if side effect is due to incorrect
method use
Discover if side effect signals a more
serious condition

Steps to managing side effects
Ask how/why the side effect concerns
client
Respond in clear language
Explain usual duration of side effect
Explore with client what to do if it
persists

Help client weigh contraceptive & non-
contraceptive benefits versus side effect
If client still wants another method, help
explore options

For some side effects, advising a
treatment may be appropriate
Some effects may be relieved by
switching formulations or brand

reminders
Different clients have different levels of
tolerance for side effects.
Respect these differences.
Always permit client to discontinue or
switch to another method!

The side effects of contraceptives

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