title: The impact of menstrual side effects on contraceptive discontinuation: findings from a longitudinal study in Cairo, Egypt.
abstract: BACKGROUND
  Although many research studies have documented the relationship between menstrual side effects of contraceptives and discontinuation of use, few have sought to identify factors that predispose women to discontinue because of changes in bleeding patterns. Such information is important to enable family planning providers to better help women and couples choose appropriate methods and use them successfully.
  
  
  METHODS
  Forty-eight women participating in six focus group discussions described their experiences using the IUD, the hormonal implant or the three-month injectable. Subsequently, 259 women using one of these methods for the first time were followed for up to 18 months to determine patterns of menstrual bleeding and perceptions of menstrual cycle change over time. Multivariable analytical methods were used to examine the associations between selected measures and method discontinuation.
  
  
  RESULTS
  Contraceptive discontinuation differed by method: Nearly 70% of injectable users had stopped using their chosen method after one year, compared with 34% of IUD users and 10% of implant users. Before initiating a method, women reported an average of five bleeding days per cycle. During the first six months of use, IUD users reported an average of six days of bleeding per cycle; injectable and implant users reported 11-12. In multivariable models, each additional day of bleeding was significantly associated with a 2-4% increase in discontinuation, depending on method type. Among IUD users, women whose husbands knew that they had visited a clinic to initiate a method were less likely than others to discontinue method use (hazard ratio, -1.9). Age was significantly associated with decreased discontinuation among implant users.
  
  
  CONCLUSIONS
  Counseling about bleeding and other side effects should be tailored to women's personal contexts and contraceptive experiences.
authors.affiliation: Behavioral and Social Science Research Unit, Family Health International, Durham, NC, USA. btolley@fhi.org
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Tolley
authors.forename: Sarah
authors.initials: S
authors.lastname: Loza
authors.forename: Laila
authors.initials: L
authors.lastname: Kafafi
authors.forename: Stirling
authors.initials: S
authors.lastname: Cummings
mesh_terms: D000328:Adult; D003268:Contraception Behavior; D003271:Contraceptive Agents, Female / Q000009:adverse effects*; D004534:Egypt; D005260:Female; D017144:Focus Groups; D006801:Humans; D007434:Intrauterine Devices / Q000009:adverse effects*; D008137:Longitudinal Studies; D008599:Menstruation Disturbances / Q000209:etiology*; D015233:Models, Statistical; D011795:Surveys and Questionnaires
chemical_list: D003271:Contraceptive Agents, Female