the side effects of contraceptives
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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