Additionally, changes in menstrual bleeding – and the meanings girls and women attach to them – can influence decision-making about contraception, like a recent systematic scoping review showed. The study revealed that views of contraceptive-induced menstrual bleeding changes (CIMBCs) vary widely, and that such changes can be influential in contraceptive decision-making processes, including contraceptive continuation. When a woman’s menstruation changes and becomes heavier, prolonged, less predictable or disappears altogether, it can impact multiple aspects of her daily life. It may make her fear infertility or illness, or hinder her participation in social, religious, domestic, and other activities. In the study, some women identified disruptions in menstruation as a disadvantage of hormonal contraception, because they considered menstruation to be a natural part of womanhood, a marker of health and fertility, as well as a reassurance of not being pregnant. Other women viewed amenorrhea (absence of menstruation) or less frequent or lighter menstruation as convenient and a liberation from menstruation-associated problems such as painful periods.
These insights align with what Population Services International (PSI)’s European network member, PSI-Europe, has uncovered in the last months. PSI-Europe partnered with the funding collaborative The Case for Her, to understand the role menstrual health plays across PSI’s network members and its potential to strengthen SRHR interventions. It became clear that, when given the chance to share their reproductive health concerns in clinics, on social media and during in-person conversations, girls and women often bring up menstruation, ask questions and share their worries – and misconceptions – about irregularity and pain. This shows that if we want to serve girls and women, and their SRHR needs, we cannot ignore the important role menstruation plays in how they think of their bodies, fertility and sex lives.
Women’s experiences and perceptions of menstruation and bleeding changes vary widely. Considering this, providers and health workers should ask women about their preferences regarding bleeding changes when selecting a contraceptive method. Only by doing so can they counsel and inform users appropriately about contraceptive options that align with their desires for bleeding patterns as well as return to fertility.
To design and deliver programs that truly put clients at the center, professionals in the public health space, policy-makers and funders, need to recognize women’s lived experience of menstruation and bleeding changes, as key issues in contraceptive research, counseling, and product development, and more generally across SRHR interventions.
Menstrual health is as a topic of vital importance for the SRHR field, and when significantly integrated in programs, it can support girls and women in taking greater control of their health and bodies in every phase of their lives. It is time to call for more research on the linkages between menstrual health and SRHR; better access to counselling on additional contraceptive choices that take into account women’s preferences; and improved integration of menstrual health in SRHR interventions.