Contraceptive-induced menstrual changes (CIMCs) affect contraceptive users’ lives in both positive and negative ways. These include consequences such as dissatisfaction with and discontinuation of contraceptives, as well as opportunities ¹ , such as improved quality of life and potential treatment of menstrual disorders ² . Despite the important links between family planning (FP) and menstrual health (MH), ^a neither field adequately addresses CIMCs, including in research, product development, policies, and programs globally.

CIMCs encompass all changes to a users’ menstrual cycle caused by using contraception, including:

Some individuals dislike CIMCs, which can contribute to dissatisfaction or discontinuation or non-use of contraception ^{1, 3– 5} . These negative reactions are the result of the varied and real impacts of CIMCs on users’ lives and their beliefs surrounding menstruation. CIMCs, particularly heavier, longer, irregular, or painful bleeding, may exacerbate difficulties in managing menstruation, including changes in the quantity or type of menstrual materials needed, increased need for analgesics, and an increase in the need for safe, private, accessible water, sanitation, and hygiene (WASH) facilities ^{6, 7} . In addition, CIMCs can have significant effects on users’ abilities to participate in regular activities like school, work, sex, and social and religious activities ^{4, 8} . For example, in some contexts, social norms inhibit users from participating in religious practices or household work like cooking when they are menstruating ¹⁰ . CIMCs can also be associated with psychosocial impacts caused by the stress of managing these changes and worry related to hiding CIMCs among those trying to use their contraceptive method discreetly ¹¹ . CIMCs can also negatively affect sexual satisfaction and well-being ¹² . In addition, beliefs about CIMCs can reduce individuals’ motivation to begin or continue using contraception, and can influence the attitudes and behaviors of providers ¹³ . Some contraceptive users fear that CIMCs indicate, or can lead to, negative health consequences, especially bleeding that is heavier in volume or longer in duration. On the other hand, some users may fear that contraceptive-induced amenorrhea—or paused bleeding—means there is a buildup of “dirty” or “bad” blood in their bodies that might indicate or lead to major health issues including infertility, although these are not clinically documented health effects of contraceptive-induced amenorrhea ^{4, 14– 16} .

CIMCs can also have advantages that motivate individuals to begin and/or continue contraceptive use. Reduced menstrual bleeding, pain, or cramping, as well as paused bleeding can offer increased freedom to engage in regular activities, improved convenience, improved sexual satisfaction, decreased stress and worry, and reduced spending if fewer menstrual materials are needed ^{2, 17} . Some individuals choose to use contraception primarily, or at least in part, for the resulting beneficial menstrual changes, including the management of menstrual and gynecologic disorders and symptoms, such as heavy menstrual bleeding, which affects approximately 30 percent of those who menstruate ¹⁸ , and endometriosis, which affects an estimated 10% of menstruators worldwide ¹⁹ . Contraceptives that reduce bleeding may also prevent or improve other health conditions, including iron deficiency and iron deficiency anemia, which can be caused by heavy menstrual bleeding and affects about a third of women of reproductive age globally ²⁰ . Finally, CIMCs can be beneficial for transgender and gender expansive persons who may use contraceptives to induce amenorrhea and reduce the effects menstruation may have on gender dysphoria ²¹ .

The CIMC RLA includes four research agendas focused on: (1) measurement, (2) contraceptive research and development (R&D) and biomedical research, (3) social-behavioral and user preferences research, and (4) programmatic research. It was developed to provide guidance to researchers, product developers, health care providers, program implementers, advocates, policymakers, and funders interested in expanding understanding of CIMCs. For all four agendas, it is essential that research is conducted with diverse populations across different locations, races and ethnicities, socio-economic status, ages, abilities/disabilities, sexual orientations, and gender identities, and that researchers recognize the complexity and intersection of identities that play a role in people’s perceptions, experiences, and behavior. In addition, groups who have been historically systematically marginalized or underserved should be involved to the extent possible in this research, including youth, perimenopausal people, people with disabilities, people living with HIV, postpartum people, refugees, migrants or other mobile populations, sex workers, people in the LGBTQ (lesbian, gay, bisexual, transgender, queer) community, survivors of abuse and violence, and those who are incarcerated.

Guided by the CIMC RLA, researchers, product developers, health care providers, program implementers, advocates, policymakers, and funders are urged to conduct research and implement strategies to address the beneficial and negative effects of CIMCs and support the integration of FP and MH. Due consideration of CIMCs will help to avoid missed opportunities to integrate MH into sexual and reproductive health and vice versa. Moving forward, CIMCs need to be addressed to improve the health and well-being of women, girls, and other people who menstruate and use contraceptives globally.

No data are associated with this article.