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Sexual health

Managing the side effects of contraception

02 June 2021
Clinical
02 June 2021
Volume 32 · Issue 6

Abstract

Side effects are the most common reason for the discontinuation of contraceptive methods. Dr Katie Boog summarises the available evidence on how to manage them

Although often transient, side effects are the most common reason for individuals to discontinue contraception. The evidence to prove causality is limited, as is evidence-based guidance on how to manage these side effects. This article summarises the available evidence. For individuals who have new or worsening acne on progestogen-only contraception (POC), switching to combined hormonal contraception (CHC) is likely to improve their skin. Continuous or extended CHC use may be beneficial for individuals with premenstrual mood change, and for those who experience headaches in the hormone-free interval. Unpredictable bleeding patterns on POC are common. Injectable users can try reducing the interval between injections to 10 weeks. Implant, injectable or intrauterine system users can be offered a 3-month trial of a combined oral contraceptive pill (COC). CHC and POP users with unpredictable bleeding may benefit from switching to an alternative preparation.

Side effects of contraception are usually transient, resolving within 3–5 months of use (Grossman Barr, 2010). However, while most individuals will find that any adverse effects resolve or lessen to the point of acceptability, side effects are the most common reason for individuals to discontinue a method of contraception (Grossman Barr, 2010).

Side effects can range in severity between individuals and can have different impacts on quality of life, depending on that individual's own circumstances. While one individual may find unpredictable bleeding entirely unacceptable because of their job or lifestyle, another may be happy with this bleeding pattern as it is preferable to their natural, heavy periods. Therefore, it is important to discuss the expected contraceptive side effects, so that users have realistic expectations and can make an informed decision about the most appropriate method of contraception for them. Patient education should be informative but concise, as intensive prolonged counselling has not been shown to improve rates of continuation (Modesto et al, 2014).

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Contraception
Side effects
Adverse events