Women's views and experiences of their vaginal bleeding patterns: an international perspective from Norplant users.
OBJECTIVE
Contraceptive-induced vaginal bleeding changes may be an undesired side effect, or a welcome opportunity to alter menstrual patterns. In Europe and the US, such changes are increasingly accepted; this study explores the perceptions of women around the globe.


METHODS
Norplant users from five countries (Chile, China, the Dominican Republic, Indonesia and Tunisia; N = 486) were surveyed at entry into a contraceptive clinical trial regarding preferred frequency of menstruation, menses-associated symptoms, and activities during menses.


RESULTS
Most women preferred once-monthly menstruation (81%); women in Chile, younger women, women neither married nor cohabitating, Christian women, and women experienced with hormonal contraception were more likely to accept alternative bleeding patterns. Women in Tunisia and Chile reported more symptoms associated with menses, while women in Beijing reported very few; decreased energy (32%), headaches (26%), abdominal pain (23%) and depression (22%) were most common. Avoidance of activities during menses such as physical work, sports, praying and entering religious sites, was closely tied to study centre. Across all sites, women (90%) avoided sexual intercourse during menses.


CONCLUSIONS
Despite growing acceptance of altering bleeding patterns, women in this study preferred monthly vaginal bleeding. Understanding sociocultural contexts and individual preferences is important when addressing this issue with women from diverse backgrounds.
Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
Catherine
C
d'Arcangues
Emily
E
Jackson
Vivian
V
Brache
Gilda
G
Piaggio
D000328:Adult; D003271:Contraceptive Agents, Female / Q000009:adverse effects; D005194:Family Practice; D005260:Female; D006801:Humans; D016912:Levonorgestrel / Q000009:adverse effects; D008597:Menstrual Cycle / Q000187:drug effects / Q000523:psychology; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014930:Women / Q000523:psychology*
D003271:Contraceptive Agents, Female; D016912:Levonorgestrel