managing common side effects in family planning users · side effects in this pocket guide refer to...

Managing Common Side Effects

in Family Planning Users

A Pocket Guide

1

Table of Contents Table of Contents .................................................................................................................................................... 1

Introduction: ........................................................................................................................................................... 2

Common Side Effects addressed in this handbook: ............................................................................................... 4

Management of Common Side Effects ................................................................................................................... 5

DEPO-PROVERA .................................................................................................................................................. 5

COMBINED ORAL PILLS (COCs) ......................................................................................................................... 10

PROGESTIN ONLY PILLS ..................................................................................................................................... 13

IMPLANTS: ........................................................................................................................................................ 16

INTRA UTERINE CONTRACEPTIVE DEVICE (IUCD): ............................................................................................ 19

2

Introduction:

Side effects in this Pocket Guide refer to unwanted reactions

which may occur due to use of a Family Planning method.

Different methods will have different side effects but in most

cases, these normally subside after a few months. It is

important to note that not all users of a particular method

will experience side effects . Furthermore, clients that do not

follow proper instructions for use of modern contraceptives

can make some side effects worse and risk pregnancy .

Concerns about side effects affect women’s satisfaction and

use of modern contraception. If the client reports side effects,

the provider must listen to her concerns, give her advice and

if appropriate, treat. In addition to ensuring that pregnant

clients are not started on Family Planning methods (except

condoms), counseling about side effects is the most

important help clients need to continue using the method..

It is important to rule out pregnancy and abortion in clients

who complain about side effects since none of the Family

Planning methods offers 100 % protection against pregnancy.

In fact therapeutic actions of some hormonal Family Planning

methods mimic pregnancy.

This Pocket Guide addresses some of the common side effects

experienced by Family Planning users.

4

Common Side Effects addressed in this handbook:

DEPO-PROVERA

COMBINED ORAL

CONTRACEPTIVES

PROGESTIN ONLY

PILLS

IMPLANTS

IUD

• Bleeding Problems

• Dry sex

• Loss of Libido

• Weight gain

• Delayed return of fertility

• Headache

• Breast tenderness

• Mild headaches

• Chest pain

• Palpitations

• Bleeding problems

• Weight gain


• Weight gain

• Loss of Libido


5

Management of Common Side Effects

DEPO-PROVERA

6

Managing side effects among Depo-provera users

No Monthly Period:

• Assess for pregnancy:

▪ If pregnant, reassure that Depo-Provera will not affect her

pregnancy and refer to ANC

▪ If not pregnant, reassure

Depo-Provera may stop women having monthly periods

but this is not harmful. She can continue with the method

or choose another one.

Irregular Bleeding:

▪ Assess for pregnancy/abortion

▪ Reassure that many women using Depo-Provera get

irregular bleeding. It is not harmful and should lessen or

stop after few months.

If irregular bleeding continues

▪ Give 400mg – 800mg Ibuprofen 3 times daily OR 500mg

Mefenamic Acid 2 times daily after meals for 5 days,

beginning when irregular bleeding starts.

If irregular bleeding continues or starts after several months of

normal or no monthly bleeding

▪ Investigate other reasons (unrelated to Depo-Provera) and

treat accordingly

▪ Help client choose another method of family planning if

necessary

7

Heavy Bleeding

If between 8-12 weeks of first injection

▪ Assess for pregnancy/ abortion

▪ Reassure

▪ Repeat Injection Depo-Provera and change return date

At 2nd injection:


▪ Reassure

▪ Give one cycle of COC

At 3rd or later injection:


▪ Reassure

▪ Give:

- one cycle of COC 1 pill daily for 21 days, OR

50µ ethinyl estradol daily for 21 days

- Ibuprofen 800mg 3 times daily OR

500mg Mefenamic Acid 2 times daily after meals for 5 days,

beginning when irregular bleeding starts

- Iron tablets to prevent anaemia

If bleeding persists

▪ Investigate other reasons (unrelated to Depo-Provera) and

treat accordingly

8


necessary

Delayed return to fertility:

• A woman should not be worried if she has not become

pregnant even 12 months after stopping use. Reassure her

and counsel about the fertile days (ovulation normally

occurs 14 days before the next menstrual period for a

woman whose cycle is 28 days and is regular).

Weight gain:

• Rule out weight gain due to pregnancy

• Interview client on diet, exercises, eating habits promoting

weight gain and counsel as needed. Explain to client that all

hormonal contraceptive may have a slight effect on weight.

• If weight gain is more than 2kg, instruct her on diet and

exercises.

Loss of libido:

• Take proper history

• Find out if she has stress, fatigue, anxiety, depression and

possibly if she’s on new medication. Explore if this is due to

dry vagina and/or painful intercourse

• Explore lifestyle, and suggest changes where needed.

Advise on foreplay and if possible involve spouse.

• Help client to choose another method of family planning

where necessary

9

Headache:

• Explore possible social, financial, health or physical causes

of headaches. Ask her to keep a record of the timing and

number of headaches for next 2 weeks and ask her to come

for follow up.

• Evaluate cause of headache (Is blood pressure raised? Does

she have Sinus infection? [Purulent nasal discharge and

tenderness in the area of sinuses])

• Give pain relievers such as: Asprin OR Ibuprofen OR

Paracetamol

NB: The monthly injectable (combined injectable

contraceptive [CIC]) can cause migraine:

Regardless of her age, a woman who develops migraine

headaches, with or without aura, or whose migraine

headaches becomes worse while using monthly injections

should stop using injectables

10

COMBINED ORAL PILLS (COCs)

11

Managing side effects among COC users.

Some of the COC brands in Uganda include Lofeminol,

Microgynon, Neogynon, Pillplan, Eugynon.

Nausea in COC users:

• Assess for pregnancy and malaria

• Suggest taking COCs at bedtime or with food.

If symptoms continue:

• Consider locally available remedies (e.g. eating roasted

grains, roasted cassava, boiled greens)

Breast tenderness:

• Assess for pregnancy

• Recommend that she wears a supportive bra

• Examine for breast infection, lumps, or nipple discharge

suspicious for cancer. If breastfeeding, examine for breast

infection.

- If there is infection, use warm compresses. Refer for

appropriate evaluation.

- If the examination shows a suspicious lump or

discharge refer for appropriate evaluation.

• Counsel her on non-hormonal FP methods.

• Try hot or cold compresses

• Suggest Asprin, Ibuprofen, Paracetamol or other pain

relievers.

12

Mild headaches:

• Take proper history (explore when headaches occur,

whether she can continue with her daily tasks, what

medicines relieves her headaches)

• Take her blood pressure

If blood pressure is normal:

• Give pain relievers such as: Asprin OR Ibuprofen OR

Paracetamol

• If headaches get worse or occur more often, refer for

appropriate evaluation.

Palpitations:

• Rule out anemia and check blood pressure and weight

• Reassure that this is common in COCs users and usually

disappears in a few months

• Evaluate for other causes unrelated to the method and

refer appropriately.

Chest pain:

Evaluate for the cause and refer appropriately

13

PROGESTIN ONLY PILLS

14

Common brands of POPs in Uganda include Ovrrete, Microlut

and Microval

Bleeding problems among POP users:

No monthly periods


▪ If pregnant, reassure that the Pills will not affect her

pregnancy and refer to ANC refer to ANC

▪ If not pregnant and/or breast-feeding, reassure that it is

normal. Some women using POPs stop having monthly

periods but this is not harmful.

Irregular bleeding:


▪ Reassure that many women using POPs get irregular

bleeding whether breast-feeding or not. It is not harmful

and should lessen or stop after several months of use.

▪ Counsel on how to reduce irregular bleeding e.g. making

up for missed pills including after vomiting or diarrhoea.

If bleeding continues:

▪ Give 400mg – 800mg Ibuprofen 3 times daily after meals

for 5 days, beginning when irregular bleeding starts.

▪ Check for anaemia and treat accordingly

15

If irregular bleeding persists or starts after several months of

normal or no monthly bleeding

▪ Investigate other reasons (unrelated to POPs) and treat

accordingly

▪ Change to another Pill formulation for at least 3 months,

OR

▪ Help client choose another method of family planning

Heavy or Prolonged Bleeding (twice as much as usual or

longer than 8 days):


▪ Reassure

▪ Give:

- Ibuprofen 800mg 3 times daily after meals for 5 days, OR

other non steroidal anti-inflammatory drugs (NSAID)

beginning when irregular bleeding starts


• Educate on nutrition

If heavy bleeding persists:

▪ Investigate other reasons (unrelated to POPs) and treat

accordingly

▪ Change to another Pill formulation for at least 3 months,

OR


16

IMPLANTS:

17

Bleeding problems among Implant users:

No bleeding:


▪ If pregnant, reassure that the Implant will not affect her

pregnancy and refer to ANC refer to ANC

▪ If not pregnant, reassure, Implants may stop women

having monthly periods but this is not harmful. She can

continue with the method.

Irregular bleeding:


▪ Reassure that many women using Implants get irregular

bleeding. It is not harmful and should lessen or stop within

1 year.

If irregular bleeding continues

▪ Give 400mg – 800mg Ibuprofen 3 times daily OR 500mg

Mefenamic Acid 2 times daily after meals for 5 days,

beginning when irregular bleeding starts.


If bleeding persists:

▪ Give one cycle of COC 1 pill daily for 21 days, OR

▪ 50µ ethinyl estradol daily for 21 days

▪ Investigate other reasons (unrelated to Implants) and treat

accordingly


18

Heavy or Prolonged Bleeding (twice as much as usual or

longer than 8 days):


▪ Reassure

▪ Give:

- Ibuprofen 800mg 3 times daily OR

- 500mg Mefenamic Acid 2 times daily after meals for 5

days, beginning when irregular bleeding starts

- one cycle of COC 1 pill daily for 21 days


- Educate on nutrition


▪ Investigate other reasons (unrelated to Implants) and treat

accordingly


Weight gain:

• Manage as for Depo-Provera

Loss of Libido:

• Manage as for Depo-Provera

19

INTRA UTERINE CONTRACEPTIVE DEVICE (IUCD):

20

Bleeding Problems among IUCD users

No monthly period:


▪ If pregnant, reassure that IUD will not affect her

pregnancy and refer to ANC.

If not pregnant investigate other reasons for amenorrhea

Irregular bleeding:


▪ Reassure that many women using IUD get irregular

bleeding. It is not harmful and should lessen or stop after

several months of use.

If bleeding continues:

▪ Give 400mg Ibuprofen 2 times daily OR Indomethazine

25mg 2 times daily after meals for 5 days, beginning when

irregular bleeding starts.


If irregular bleeding persists:

▪ Investigate other reasons (unrelated to IUD) and treat

accordingly


necessary

Heavy bleeding:


21

▪ Reassure

▪ Give:

- Ibuprofen 400mg 2 times daily after meals for 5 days, OR

Indomethazine 25mg 2 times daily after meals for 5 days,

OR

Tranexamic acid 1500mg 3 times daily for 3 days, then

1000mg once daily for 2 days


- Educate on nutrition


▪ Investigate other reasons (unrelated to IUD) and treat

accordingly


necessary

managing common side effects in family planning users · side effects in this pocket guide refer to...

Documents