The Side Effects of Contraceptive

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The Side Effects of Contraceptive Powered By Docstoc
					     The Side Effects of
      Contraceptives


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

   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
Republic
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
    selection
   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
    effects
   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
    consequences
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
     method
                                    Discontinuation of contraception and women’s perception of
                                    counseling in Niger and The Gambia

                                           60%
Percent of women who discontinued



                                                                                                                            51%
                                           50%
     method after 6-8 months




                                           40%
                                                                         37%


                                           30%

                                                                                       19%
                                           20%
                                                                                                                                           14%

                                           10%


                                              0%
                                                                    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:
                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
Effect of pretreatment counseling on discontinuation
rates in Chinese women given DMPA for contraception.

                         45%                                                                 42%
                         40%

                         35%

 Percent of women who
  discontinued method
                         30%
                                                     25%
                         25%

                         20%

                         15%
                                                                                 11%
                         10%

                           5%              3%
                           0%
                                         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
                             literature.
   Worried that clients
    may reject method(s)
                              Reassure that side
                               effect counseling
                               increases use &
                               continuation.
    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
                                   providers
         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:
             reminders
    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
    client
   Respond in clear language
   Explain usual duration of side effect
   Explore with client what to do if it
    persists
    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
              reminders
   Different clients have different levels of
    tolerance for side effects.

   Respect these differences.

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

				
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