Contraceptive-induced menstrual changes in low- and middle-income countries: a systematic scoping review

Contraceptive-induced menstrual changes (CIMCs) contribute substantially to women's dissatisfaction with and discontinuation of contraceptives. We summarised evidence on the prevalence, health impact, treatment, and barriers to accessing treatment for CIMC in low- and middle-income countries (LMICs).

Nine databases (MEDLINE, Embase, Emcare, PsycINFO, Global Health, Global Index Medicus, CINAHL, Web of Science, and Scopus) were systematically searched for studies published from January 1, 2000, to December 16, 2024. Eligible studies included reproductive-age women (15-49 years) using any modern contraceptive (excluding barrier and permanent methods) in LMICs. Findings were categorised according to the World Health Organization's Belsey definitions of frequency and severity of CIMC-related bleeding. Quantitative data were summarised using descriptive statistics and qualitative data using thematic synthesis.

Here we include 321 studies conducted in 44 countries. The prevalence of CIMCs range from 0-94% and vary by contraceptive type. Two-fifths (40.2%) of the prevalence reports did not define the type of CIMC experienced by participants. The most frequently reported health impact of CIMCs is contraceptive discontinuation leading to an unmet need for contraception. Non-steroidal anti-inflammatory drugs are the most frequently investigated treatment. No studies report on the barriers to accessing treatment for CIMCs in LMICs.

CIMC impacts contraceptive users in various ways depending on the contraceptive type and user's perception of it, highlighting the importance of counselling. Primary research must use standardised definitions of CIMC to improve data quality. Investment in research and development of innovative therapeutics and novel approaches to reducing CIMC is needed to mitigate the unmet need for contraception in LMICs.