# Contraceptive-induced menstrual changes in low- and middle-income countries: a systematic scoping review

## TL;DR

This study reviews how contraceptives affect menstrual cycles in low- and middle-income countries, showing that these changes often lead to contraceptive discontinuation and unplanned pregnancies.

## Contribution

The study provides a comprehensive overview of contraceptive-induced menstrual changes, emphasizing the need for better counseling and new contraceptive methods.

## Key findings

- The prevalence of contraceptive-induced menstrual changes varies widely by contraceptive type.
- Contraceptive discontinuation due to these changes increases the risk of unplanned pregnancies.
- Non-steroidal anti-inflammatory drugs are the most studied treatment for these changes.

## Abstract

Contraceptive-induced menstrual changes (CIMCs) contribute substantially to women’s dissatisfaction with and discontinuation of contraceptives. We summarised evidence on the prevalence, health impact, treatment, and barriers to accessing treatment for CIMC in low- and middle-income countries (LMICs).

Nine databases (MEDLINE, Embase, Emcare, PsycINFO, Global Health, Global Index Medicus, CINAHL, Web of Science, and Scopus) were systematically searched for studies published from January 1, 2000, to December 16, 2024. Eligible studies included reproductive-age women (15–49 years) using any modern contraceptive (excluding barrier and permanent methods) in LMICs. Findings were categorised according to the World Health Organization’s Belsey definitions of frequency and severity of CIMC-related bleeding. Quantitative data were summarised using descriptive statistics and qualitative data using thematic synthesis.

Here we include 321 studies conducted in 44 countries. The prevalence of CIMCs range from 0–94% and vary by contraceptive type. Two-fifths (40.2%) of the prevalence reports did not define the type of CIMC experienced by participants. The most frequently reported health impact of CIMCs is contraceptive discontinuation leading to an unmet need for contraception. Non-steroidal anti-inflammatory drugs are the most frequently investigated treatment. No studies report on the barriers to accessing treatment for CIMCs in LMICs.

CIMC impacts contraceptive users in various ways depending on the contraceptive type and user’s perception of it, highlighting the importance of counselling. Primary research must use standardised definitions of CIMC to improve data quality. Investment in research and development of innovative therapeutics and novel approaches to reducing CIMC is needed to mitigate the unmet need for contraception in LMICs.

Contraceptives are essential for preventing unplanned pregnancies. However, users may experience changes in their menstrual cycle which may cause dissatisfaction. This study mapped out the most recent research on menstrual changes caused by contraceptives–including how often it occurs, how it impacts users, how it is treated and what hinders treatment–in low and middle-income countries. Our results show that the frequency of menstrual changes caused by contraceptives differed by contraceptive type. These changes cause many women to stop contraceptives making them more likely to have unplanned pregnancies. This highlights the importance of counselling contraceptive users and the need to develop new contraceptive methods that have less influence on the menstrual cycle.

Makama et al. comprehensively review the prevalence, health impact, treatment, and barriers to accessing treatment for contraceptive-induced menstrual changes in low- and middle-income countries. They highlight the importance of contraceptive counselling and need for investment in innovative therapeutics and novel approaches to contraception.