Understanding contraceptive-induced menstrual changes: insights from contraceptive discontinuation due to side effects in 7 low- and middle-income countries

Background

Concerns about side effects and perceived adverse health effects have been identified as major drivers of contraceptive non-use and discontinuation among women, leading to reduced uptake of contraceptive methods. A major side effect is contraceptive-induced menstrual changes (CIMC), which may manifest as alterations in menstrual frequency, regularity of onset, flow duration, and blood volume compared with the normal menstrual cycle. The rates of contraceptive discontinuation in low and middle-income countries (LMICs) due to side effects are alarmingly high. Therefore, this study sought to determine contraceptive discontinuation due to side effects to give insights into contraceptive-induced menstrual changes in 7 LMICs.

Methodology

We conducted a secondary analysis of data from 7 Demographic and Health Surveys. The outcome variable, contraceptive-induced menstrual changes discontinuation (CIMCD), was constructed using the variable on “reason for discontinuation”. Side-effect-related discontinuation was classified into two mutually exclusive categories: (i) menstrual changes, and (ii) other non-menstrual side effects. Subsequently, the outcome variable was generated, coded as “1” for women who discontinued contraception due to menstrual changes and “0” for women who discontinued due to other side effects. The sample characteristics were summarised using frequencies and percentages, while the proportion of CIMCD among women with side effect-related discontinuation was presented using weighted proportions and confidence intervals.

Results

In most countries, more than 50% of the interviewed women had ever used contraceptives. Contraceptive discontinuation rate was highest among women from Ghana (50.4%), followed by those from Tanzania (47.5%) and then Nepal (44.9%). The weighted proportion of CIMCD was highest in the Ivory Coast (42.6%), followed by Tanzania (38.7%), Ghana (38.0%), Burkina Faso (32.9%), Nepal (30.1%), Kenya (29.7%), and the Philippines (13.8%). Adolescents aged 15–19 years and those who had discontinued use of injectable contraceptives consistently experienced the highest prevalence of CIMC-related discontinuation in most countries.

Conclusion

This multi-country analysis demonstrates that CIMC remains a major reason for contraceptive discontinuation across diverse LMICs. The study findings highlight the need for targeted interventions, such as a more user-centered approach in contraceptive technologies, to address the unique individual-level factors and inadequacies of the one-size-fits-all approach prevalent in contraceptive development and family planning services.