The Side Effects of Contraceptives

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Objectives

Learn more about side effects Consider side effects from client’s

cultural & personal context Understand side effects’ impact on use

& continuation

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Side effects influence:

Initial decision to use FP Continuation with method(s)

Satisfaction with method & FP

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Contraceptive discontinuation due to side effects and health concerns in selected countries

Country Year Side Effects(%)*

HealthConcerns (%)

Morocco 1992 16.8 6.7

Egypt 1992 30.4 10.2

DominicanRepublic

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 fordiscontinuation include desired pregnancy and method failure.

Source: Outlook 12(3) October 1994

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Negative impacts are reduced by:

Discussing side effects before method selection

Managing side effects promptly Allowing method switching

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Side Effects vs. Complications

SIDE EFFECTSSIDE EFFECTS: symptoms or conditions that pose no significant health risk

COMPLICATIONSCOMPLICATIONS: serious health problems or conditions

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Side Effects vs. Complications 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

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Side Effects vs. Complications

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

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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

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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 & userwww.freelivedoctor.com

The truth about side effectsImportant 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

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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

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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

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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

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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).

Per

cen

t of

wom

en w

ho

dis

con

tin

ued

met

hod

aft

er 6

-8 m

onth

s

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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

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Effect of pretreatment counseling on discontinuationrates 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 counselingReceived routine counseling only

Source: Zhen-Wu, L. et al. Effect of Pretreatment Counseling on Discontinuation rates in ChineseWomen Given Depomedroxy Progesterone Acetate for Contraception. Contraception 53(6):357-361 (June 1996).

Per

cent

of w

omen

who

disc

onti

nued

met

hod

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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

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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.

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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

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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 neededwww.freelivedoctor.com

If clients want a specific method:

Screen for suitability (medical conditions & HIV/STI risks)

If suitable, give side effects information on that method ONLY

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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

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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

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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

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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

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Steps to managing side effects

Help client weigh contraceptive & non-contraceptive benefits versus side effect

If client still wants another method, help explore options

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Steps to managing side effects

For some side effects, advising a treatment may be appropriate

Some effects may be relieved by switching formulations or brand

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Steps to managing side effects reminders

Different clients have different levels of tolerance for side effects.

Respect these differences.

Always permit client to discontinue or

switch to another method!www.freelivedoctor.com