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The side effects of contraceptives

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  • 1. The Side Effects of Contraceptives www.freelivedoctor.com
  • 2. Objectives
    • Learn more about side effects
    • Consider side effects from client’s cultural & personal context
    • Understand side effects’ impact on use & continuation
  • 3. Side effects influence:
    • Initial decision to use FP
    • Continuation with method(s)
    • Satisfaction with method & FP
  • 4. Contraceptive discontinuation due to side effects and health concerns in selected countries www.freelivedoctor.com
  • 5. Negative impacts are reduced by:
    • Discussing side effects before method selection
    • Managing side effects promptly
    • Allowing method switching
  • 6. Side Effects vs. Complications
    • SIDE EFFECTS : symptoms or conditions that pose no significant health risk
    • COMPLICATIONS : serious health problems or conditions
  • 7. Side Effects vs. Complications
    • Headache
    • Increased menstruation
    • Light or no menstruation
    • Menstrual cramping
    • Severe headaches
    • Very heavy bleeding (twice as long or as much )
    • Severe, constant pain in the chest, leg or belly
  • 8. Side Effects vs. Complications
    • Weight gain or loss
    • Nausea
    • Vaginal dryness
    • Local skin irritation
    • Skin or eyes that become unusually yellow (jaundice)
    • Loss of sensation in arms or legs
  • 9. 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
  • 10. 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
  • 11. 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
  • 12. 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
  • 13. Positive or negative consequences: client’s responses
    • Feel “unwell”
    • Feel too weak to work
    • Unable to participate in religious community activities
    • Unable to cook
    • Feel unattractive or more attractive
    • Limit sexual activity or enhance sexual pleasure
    • Discontinue contraceptive method or use it irregularly
  • 14. 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
  • 15. Discontinuation of contraception and women’s perception of counseling in Niger and The Gambia 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). Percent of women who discontinued method after 6-8 months www.freelivedoctor.com
  • 16. 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
  • 17. www.freelivedoctor.com
  • 18.
    • Important to pay attention to concerns of client’s partner
    • E.g. , Counseled husbands of Norplant users reassured re partner’s spotting
    Side effect counseling & method use www.freelivedoctor.com
  • 19. Why providers may not inform clients about side effects
    • Reasons
    • Too Busy
    • Worried that clients may reject method(s)
    • Possible Solutions
    • Reassure that counseling can be brief. Provide literature.
    • Reassure that side effect counseling increases use & continuation.
  • 20. Why providers may not inform clients about side effects
    • Reasons
    • Unaware of frequency of sides effects
    • Lack of support material
    • Possible Solutions
    • Give providers training on common side effects.
    • Provide simple written & AV materials for providers
  • 21. 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
  • 22. If clients want a specific method:
    • Screen for suitability (medical conditions & HIV/STI risks)
    • If suitable, give side effects information on that method ONLY
  • 23. 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
  • 24. 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
  • 25. 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
  • 26. 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
  • 27. Steps to managing side effects
    • Help client weigh contraceptive & non-contraceptive benefits versus side effect
    • If client still wants another method, help explore options
  • 28. 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
  • 29. 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 !