The Side Effects of Contraceptive by liaoxiuli


									     The Side Effects of

     Elisa Wells, M.P.H.
Kristina Gryboski, Ph.D. and
    Elaine Murphy,Ph.D.

   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                 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
   Managing side effects promptly
   Allowing method switching
Side Effects vs. Complications
   SIDE EFFECTS: symptoms or
    conditions that pose no significant
    health risk
   COMPLICATIONS: serious health
    problems or conditions
Side Effects vs. Complications
   Headache                Severe headaches
   Increased               Very heavy bleeding
    menstruation             (twice as long or as
   Light or no              much )
    menstruation            Severe, constant
   Menstrual cramping       pain in the chest, leg
                             or belly
Side Effects vs. Complications

   Weight gain or loss        Skin or eyes that
   Nausea                      become unusually
   Vaginal dryness             yellow (jaundice)
   Local skin irritation      Loss of sensation in
                                arms or legs
Side Effects: Some Observations
   Most contraceptives have some side
   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

  – Challenge: Clients believe that certain
    methods will render a woman sterile
  – Solution: 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
Positive or negative consequences:
         client’s responses
   Feel “unwell”              Limit sexual activity
   Feel too weak to            or enhance sexual
    work                        pleasure
   Unable to participate      Discontinue
    in religious                contraceptive
    community activities        method or use it
   Unable to cook              irregularly
   Feel unattractive or
    more attractive
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
                                    Discontinuation of contraception and women’s perception of
                                    counseling in Niger and The Gambia

Percent of women who discontinued

     method after 6-8 months





                                                                    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).
Side effect counseling & method use:
    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.

                         45%                                                                 42%


 Percent of women who
  discontinued method



                           5%              3%
                                         At 3 months                            at 12 months
                        Rec eived detailed structured pretreatment and ongoing counseling
                        R eceived routine c ounseling only

             Source: Zhen-Wu, L. et al. Effect of Pretreatment Counseling on Discontinuation rates in Chinese
             Women Given Depomedroxy Progesterone Acetate for Contraception. Contraception 53(6):357-
             361 (June 1996).
Side effect counseling & method use

   Important to pay attention to concerns
    of client’s partner
   E.g. , Counseled husbands of Norplant
    users reassured re partner’s spotting
    Why providers may not inform
      clients about side effects
Reasons                    Possible Solutions
 Too Busy                  Reassure that
                             counseling can be
                             brief. Provide
   Worried that clients
    may reject method(s)
                              Reassure that side
                               effect counseling
                               increases use &
    Why providers may not inform
      clients about side effects
Reasons                  Possible Solutions
 Unaware of frequency    Give providers
  of sides effects         training on common
                           side effects.
   Lack of support
    material                Provide simple written
                               & AV materials for
         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:
    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
   Respond in clear language
   Explain usual duration of side effect
   Explore with client what to do if it
    Steps to managing side effects

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

   If client still wants another method, help
    explore options
    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
    Steps to managing side effects
   Different clients have different levels of
    tolerance for side effects.

   Respect these differences.

   Always permit client to discontinue or
    switch to another method!

To top