Regional and Individual Variation in Bleeding Patterns Associated with Steroid Contraception

Abstract

The disturbance in menstrual bleeding induced by many methods of contraception is an important side-effect because of its potential impact on acceptability. Amenorrhea tends to be rejected because most women value menstruation as an assurance that they are not pregnant; it is also indicative of femininity, fertility and continuing youth, and widely viewed as important to general well-being¹. Prolonged or unpredictable bleeding may, at best, be merely inconvenient or embarrassing, but in some cultures the taboos associated with menstruation can make any disruption to the normal pattern almost intolerable. As many as 25% of women recruited to trials of the long-acting injectable, depot medroxypro-gesterone acetate (DMPA), discontinue method use within a year because of bleeding problems.^2,3 In recent studies of newer methods, the one-year cumulative discontinuation rates for bleeding irregularities have ranged from 9% among women using monthly injectables to 17% in a group using a vaginal ring.^4,5