title: Menstrual irregularity from hormonal contraception: a cause of reproductive health concerns in minority adolescent young women.
abstract: BACKGROUND
  Adolescents are frequent users of hormonal contraception (HC), yet their adherence to these methods is often poor. Concerns about side effects, especially those affecting the menstrual system, are often given as reasons for contraceptive nonadherence or discontinuation. We sought to identify teens' concerns and misperceptions about the menstrual-related side effects of HC.
  
  
  METHODS
  Open focus groups were conducted with both sexually active and virgin adolescent women aged 12-18 years who were recruited from the Philadelphia area. The adolescents did not have to be contraceptive users in order to participate. The question put to each group was, "What are the things you have heard about the birth control pill, Depo-Provera and Norplant?" Groups were audio-recorded, transcribed and analyzed using qualitative software.
  
  
  RESULTS
  We conducted 13 female-only groups. Participants raised frequent concerns about menstrual-related side effects, believing that these side effects were evidence of possible negative effects of HC on their reproductive health. Four themes related to hormonal contraceptive-induced menstrual irregularity emerged from the groups. Theme 1: Menstruation is natural and should not be altered in any way. Theme 2: The menstrual period is necessary for cleansing of the body. Theme 3: "Spotting," intermenstrual bleeding and amenorrhea cause doubts about the method's effectiveness and worries about pregnancy. Theme 4: All menstrual irregularity, from intermenstrual bleeding to amenorrhea, causes worry about the effects on fertility and on physical health.
  
  
  CONCLUSIONS
  Teens have concerns about the menstrual irregularity caused by HC. Providers understand that these side effects are minor and of little medical consequence. Yet, adolescent patients may be ascribing great significance to these effects and may be declining these methods because of fear and misperceptions.
authors.affiliation: Craig-Dalsimer Division of Adolescent Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA. liana_clark@merck.com
authors.forename: Liana R
authors.initials: LR
authors.lastname: Clark
authors.forename: Kenyette T
authors.initials: KT
authors.lastname: Barnes-Harper
authors.forename: Kenneth R
authors.initials: KR
authors.lastname: Ginsburg
authors.forename: William C
authors.initials: WC
authors.lastname: Holmes
authors.forename: Donald F
authors.initials: DF
authors.lastname: Schwarz
mesh_terms: D000293:Adolescent; D001741:Black or African American; D002648:Child; D003278:Contraceptives, Oral, Hormonal / Q000009:adverse effects*; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006630:Hispanic or Latino; D006801:Humans; D008599:Menstruation Disturbances / Q000139:chemically induced*; D008913:Minority Groups; D018456:Reproductive Medicine; D012725:Sexual Behavior
chemical_list: D003278:Contraceptives, Oral, Hormonal