Understanding Contraceptive-Induced Menstrual Changes: Insights from contraceptive discontinuation due to side effects in 7 low- and middle-income countries

Abstract Background: Concerns about side effects and perceived adverse health effects have been identified as major drivers of contraceptive nonuse and discontinuation among women, leading to reduced uptake of contraceptive methods. A major side effect is contraceptive-induced menstrual changes, which may manifest as alterations in menstrual frequency, regularity of onset, flow duration, and blood volume compared with the normal menstrual cycle. The rates of contraceptive discontinuation in low and middle-income countries (LMICs) due to menstrual side effects are alarmingly high. Therefore, this study sought to determine the contraceptive discontinuation due to side effects to give insights into contraceptive-induced menstrual changes in 7 LMICs. Methodology: We conducted a secondary analysis using data from 7 Demographic and Health Surveys. The outcome variable, discontinuation due to contraceptive-induced menstrual changes (CIMCD), was constructed using the variable on “reason for discontinuation”. Side-effect-related discontinuation was classified into two mutually exclusive categories:(i) menstrual changes, and (ii) other non-menstrual side effects. Subsequently, the outcome variable was generated, coded as “1” for women who discontinued contraception due to menstrual changes and “0” for women who discontinued due to other side effects. The sample characteristics were summarised using frequencies and percentages, while prevalence was presented using weighted proportions and confidence intervals. Results: In most countries, more than 50% of the interviewed women had ever used contraceptives. Contraceptive discontinuation rate was highest among women from Ghana (50.4%), followed by those from Tanzania (47.5%) and then Nepal (44.9%). The weighted prevalence of CIMCD was highest in the Ivory Coast (42.6%), followed by Tanzania (38.7%), Ghana (38.0%), Burkina Faso (32.9%), Nepal (30.1%), Kenya (29.7%), and the Philippines (13.8%). Adolescents aged 15–19 years and those who had discontinued use of injectable contraceptives consistently experienced the highest prevalence of CIMC-related discontinuation in most countries. Conclusion: This multi-country analysis demonstrates that contraceptive-induced menstrual changes remain a major driver of contraceptive discontinuation across diverse LMICs due to inadequacies of the one-size-fits-all approach prevalent in contraceptive development and family planning services. The study findings highlight the need for targeted interventions, such as personalisation in contraceptive technologies, to address the unique individual-level factors.