WORKSHOP 2 :

Contraceptive Counselling on Side Effect

BY:DR NOR HUDA BT MAT ALI Clinical Specialist Hospital Tengku Ampuan Afzan

Objectives
Importance of Contraceptive counselling Learn more about side effects Consider side effects from clients cultural & personal context Understand side effects impact on use & continuation

Adherence to contraception

pregnancies unintended
(Hatcher,R.A,Contraceptive Technology 19th ed 2009)

Some research suggest that actual method failure may be responsible for <10% unintended pregnancy, remainder associated with poor adherence (Jones et al 2002 Structured repeated instructions and informations on side effects improved adherence (Cocchrane Systemic Review

CONTRACEPTIVE COUNSELLING

No contraceptive agent is PERFECT

Satisfaction is enhanced when appropriate preutilization counseling is offered and when side effects are successfully managed

Informed choices

Identify Medical Eligibility Criteria (MEC) and contraindications Identify Non-contraceptive benefits
Selected Practice Recommendations (SPR)

Reproductive Age

Reproductive Goal

Medical conditions

Lifestyle

Logistic & cost

Effective Contraceptive Counselling The best method of contraception for patients is one that will be in harmony with their wishes, fears, preferences and lifestyle; A method that is more likely to be used correctly
(Hatcher,R.A.,et al, Contraceptive Technology 19th ed 2009, p 41)

REASONS FOR NOT USING/ DISCONTINUATION

Reason To conceive Fear of Side Effects Husband issue Medical factors Others Total 1994 Peninsular M 53 10.3 8 3.4 25.4 100.00 39.3 26.8 12.6 5.4 15.9 100.00 2004 Sabah 52.5 26.4 4.8 4.8 11.6 100.00 Sarawak 44.1 27.5 9.6 4.2 14.6 100.00

Source: NPFDB, MPFS 1994 & 2004

Fear of Side Effects

Age Group (years old) Total (%)

25-29 30-34 35-39 40-44 45-49

Source: NPFDB, MPFS 2004

22.7 24.4 33.2 28.3 34.4

Side effects influence:

Initial decision to use FP Continuation with method(s)

Satisfaction with method & FP

Negative impacts are reduced by:

Discussing side effects before method selection Managing side effects promptly Allowing method switching

Side Effects vs. Complications

SIDE EFFECTS: symptoms or conditions that pose no significant health risk COMPLICATIONS: serious health problems or conditions

Side Effects vs. Complications

Headache Increased menstruation Light or no menstruation Menstrual cramping

Severe headaches Very heavy bleeding (twice as long or as much ) Severe, constant pain in the chest, leg or belly

Side Effects vs. Complications

Weight gain or loss Nausea Vaginal dryness Local skin irritation

Skin or eyes that become unusually yellow (jaundice) Loss of sensation in arms or legs

Clinic Follow up: Observation of Side Effects

Most contraceptives have some side effects Some side effects are common and mild; others are rare Some improved over time Some are easily treated

Clinic Follow up: Observation of Side Effects

Clients may experience one or several Side effects can vary by brand
Type & severity vary by method & user

The truth about side effects

Important to distinguish side effects from rumors or misinformation
Challenge: Exp: Clients believe that certain methods will render a woman sterile Solution: Exp: Always discuss returning to fertility as a significant issue

Positive or negative consequences of side effects: clients responses

Feel unwell Feel too weak to work Unable to participate in religious community activities Unable to cook Feel unattractive or more attractive

Limit sexual activity or enhance sexual pleasure Discontinue contraceptive method or use it irregularly

Side effect counseling & method use

Important to pay attention to concerns of clients partner E.g. , Counseled husbands of Implant users reassured regarding partners spotting

Why providers may not inform clients

about side effects?

Too Busy
Reassure that counseling can be brief. Provide Pamphletes.

Worried that Reassure that side effect counseling increases use & continuation. clients may reject method(s) Provide literature.
Unaware of frequency of sides effects Lack of support material

Give providers training on common side effects

Provide simple written & AV materials for providers

Helping clients know what to expect

Say that many clients experience no side effects

Give information regarding how to manage side effects Make clients feel comfortable returning for assistance, if needed

Helping clients choose a method

Describe side effects of various methods, their frequency & duration Reassure regarding safety of methods Emphasize client satisfaction with methods in general Elicit & answer questions; correct misinformation courteously

Helping clients know what to expect: reminders

Elicit and respond to client concerns Be concise & clear Be honest regarding frequency or severity of side effects Provide support material

Why help clients manage side effects?

Increase clients comfort, satisfaction with & continuation with the method Discover if side effect is due to incorrect method use
Discover if side effect signals a more serious condition

Steps to managing side effects

Ask how/why the side effect concerns client Respond in clear language Explain usual duration of side effect Explore with client what to do if it persists

Steps to managing side effects

Help client weigh contraceptive & non-contraceptive benefits versus side effect If client still wants another method, help explore options

Case Study

29 years old woman with 2 kids complain of prolonged bleeding for 2 months since implanon was inserted and her husband requested her to have the implanon removed.

Case Study

35 years old woman with 5 kids and poor spacing was referred to you for FP. Shes not keen for implanon as she hear rumors related to weight gain when using the method.

Case study

29 years old, Para 3 with history of 1 previous scar in 2007. Mirena inserted 2 month post partum. 1 year after that no IUD string felt. Had regular self check up for IUD string before that. Whats the next step

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