Pathophysiological Consequences Associated with Hormonal Contraceptives Use in Sub-Saharan Africa: A Scoping Review

Although the safety profile of hormonal contraceptives (HCs) in African populations is still unclear, their use is growing in Sub-Saharan Africa (SSA) to lower unwanted pregnancies. Hematological, cardiometabolic, endocrine, immunological, and psychological consequences are among the reported negative outcomes. This scoping review summarizes the most recent data on the pathophysiological consequences associated with the use of HCs in SSA.

A comprehensive search via PubMed, African Journal Online, Wiley Online Library, and Google Scholar, following PRISMA-ScR guidelines, identified studies published between 2000 and 2025 on adverse outcomes of HCs in SSA. Eligible studies involved laboratory analysis, cross-sectional surveys, cohort studies, and randomized controlled trials and were conducted in English. Data were charted by country, design, contraceptive type, and adverse outcomes.

Fifty-one eligible studies from SSA were analyzed, revealing diverse pathophysiological consequences. Hematological effects were reported in 7 studies, showing a higher hematological profile and reduced anemia risk among users of HCs. Cardiometabolic impacts were noted in 17 studies, with dyslipidemia (40-60% prevalence), hypertension, and weight gain (1-3 kg/m² BMI increase) linked to depot medroxyprogesterone acetate (DMPA) and combined oral contraceptives (COCs). Endocrine effects were observed in 3 studies, while 12 studies showed vulnerability of HCs users to sexually transmitted and other forms of infections. Immune dysregulation and microbiota changes were reported in 5 studies. A study each reported varying consequences, including anthropometry, bone density, sexual dysfunction and depression, bleeding irregularities, electrocardiogram, spermatotoxicity, and biochemical changes.

Use of HCs in SSA is linked to a variety of diseases in the immunological, metabolic, endocrine, hematologic, and psychological domains. To inform safe contraceptive usage and reproductive health policy in SSA, these findings highlight the necessity of integrated contraceptive counseling, clinical monitoring for comorbidities, and additional region-specific research.