Menstrual irregularity from hormonal contraception: a cause of reproductive health concerns in minority adolescent young women

Clark, Liana R.; Barnes-Harper, Kenyette T.; Ginsburg, Kenneth R.; Holmes, William C.; Schwarz, Donald F.

doi:10.1016/j.contraception.2006.03.026

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Volume 74, Issue 3 , Pages 214-219, September 2006

Menstrual irregularity from hormonal contraception: a cause of reproductive health concerns in minority adolescent young women

Liana R. Clark
- Craig-Dalsimer Division of Adolescent Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA
- Corresponding author. Merck Vaccine Division, Merck & Co., Inc., West Point, PA 19486-0004, USA. Tel.: +1 215 652 2640; fax: +1 215 993 4490.
Kenyette T. Barnes-Harper
- Craig-Dalsimer Division of Adolescent Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
Kenneth R. Ginsburg
- Craig-Dalsimer Division of Adolescent Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA
William C. Holmes
- Department of Internal Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA
Donald F. Schwarz
- Craig-Dalsimer Division of Adolescent Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA

Received 20 May 2005; received in revised form 8 February 2006; accepted 17 March 2006. published online 24 May 2006.

Abstract

Context

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.

Keywords: Hormonal contraception, Adolescents, Menstrual irregularity, Depo-Provera®, Oral contraceptive pills, Norplant®