Technical Consultation on Contraceptive-Induced Menstrual Changes

The family planning (FP) and menstrual health (MH) fields often fail to incorporate these considerations into research, programs, policies, and product development. FHI 360 is leading the way in understanding the impacts of CIMCs on users' lives and exploring approaches to address these. The CIMCs meeting, held in November 2020, convened experts in the fields of FP and MH to discuss the topic. Presentations covered topics related to CIMCs and contraceptive research and development, biomedical research, social-behavioral research, implementation science, policy, and programs. The meeting reflected four crosscutting themes: expanding choice, gender, self-care, and changing needs throughout the life course. Expanding choice is essential for both FP and MH, and the idea of providing choice for menstrual products and facilities is crucial to address the unique needs of every menstruator. In FP, providing full contraceptive method choice and the option to voluntarily choose among a variety of methods with multiple product attributes is essential to meeting users' needs and preferences. A new concept called "menstrual choice" was introduced, which refers to people who menstruate having the menstrual cycle experience they want or need. Improving gender equity is important to advance both MH and FP outcomes, but it is often overlooked or taken for granted in both fields. The sociocultural context and impact of gender norms on attitudes and perceptions related to CIMCs require more research. The World Health Organization defines self-care as the ability of individuals, families, and communities to promote health, with or without the support of a health care provider, which is central to both FP and MH. Self-care can help promote effective FP-MH integration, and several presenters gave examples of how self-care can improve users' ability to communicate about reproductive health and access services. A life course approach is essential to the conversation about CIMCs, as individuals' needs and preferences regarding FP use often change throughout their lifetime. Menstruators have different experiences during their lives, and the MH sector often focuses narrowly on youth, which may exclude a large population of menstruators and FP users from programmatic interventions and cause missed opportunities for integration. Presenters and panelists explained that to integrate MH and FP and address CIMCs, researchers, clinicians, and policymakers will need to consider the changing experiences and preferences of users in many stages of life, from menarche to menopause. The CIMCs meeting provided an opportunity to facilitate new and increased connections between the FP and MH fields and spark a conversation on this multifaceted topic. The overall goal was to contribute to the development of a research agenda and a wider "call to action" for CIMCs, which began during the consultation and is continuing collaboratively now. The eventual call to action will be based on the presentations and discussions from the Virtual Technical Consultation on Contraceptive-Induced Menstrual Changes. CIMCs have consequences, including nonuse, dissatisfaction with methods, and discontinuation of contraceptives. Studies have found that 20-33% of unmarried women with unmet need report not using contraception because they are concerned about side effects, including menstrual and bleeding changes. However, CIMCs may also impact users' lives in positive ways, resulting in opportunities. For example, contraceptives can be used to treat menstrual disorders such as heavy bleeding and to prevent or improve health conditions such as anemia. They can also provide lifestyle benefits, offering users more freedom to participate in daily activities and reducing the burden of purchasing menstrual products each month. The MH and FP sectors overlap in many ways, which can provide opportunities for linking and integrating beyond addressing CIMCs. MH can be an important and early entry point for RH information and services, including FP. Early access to information about menstruation and RH can decrease stigma and improve self-efficacy, which can remove barriers to education and improve RH overall, including access to FP. The two sectors should begin to work together now to collect more MH data and evaluate integrated programs, strengthen implementation of comprehensive sexuality education, and support health care providers to discuss menstruation, menstrual disorders, CIMCs, and management options. The experiences and preferences of contraceptive users span a wide range globally and, at times, represent unexpected views and attitudes. A recent scoping review found that preferences related to nonstandard bleeding frequencies like amenorrhea range widely across countries and are viewed negatively in some studies and positively in others. CIMCs are a major reason for contraceptive nonuse, dissatisfaction, or discontinuation, and users often link CIMCs with health risks and consequences.