Berenson AB, Odom SD, Breitkopf CR, Rahman M. Physiologic and psychologic symptoms associated with use of injectable contraception and 20 microg oral contraceptive pills. Am J Obstet Gynecol. 2008; 199:(4)351.e1-351.e12

Darney P, Patel A, Rosen K Safety and efficacy of a single-rod etonogestrel implant (Implanon): results from 11 international clinical trials. Fertil Steril. 2009; 91:1646-53

Edelman AB, Koontz SL, Nichols MD, Jensen JT. Continuous oral contraceptives: are bleeding patterns dependent on the hormones given?. Obstet Gynecol. 2006; 107:(3)657-665

Faculty of Sexual and Reproductive Healthcare. Progestogen Only Injectable. 2014. (accessed 13 April 2021)

Faculty of Sexual and Reproductive Healthcare. Problematic Bleeding With Hormonal Contraception. 2015a.

Faculty of Sexual and Reproductive Healthcare Progestogen Only Pills. 2015b.

Faculty of Sexual and Reproductive Healthcare Intrauterine Contraception. 2015c. (accessed 13 April 2021)

Faculty of Sexual and Reproductive Healthcare. Combined Hormonal Contraception. 2019. (accessed 13 April 2021)

Faculty of Sexual and Reproductive Healthcare Progestogen Only Implant. 2021. (accessed 13 April 2021)

Gemzell-Danielsson K, Schellschmidt I, Apter D. A randomized, phase II study describing the efficacy, bleeding profile, and safety of two low-dose levonorgestrel-releasing intrauterine contraceptive systems and Mirena. Fertil Steril. 2012; 97:616-622

Grimes D, Hubacher D, Lopez LM Non-steroidal anti-inflammatory drugs for heavy bleeding or pain associated with intrauterine-device use. Cochrane Database Syst Rev. 2006; 4

Grossman Barr N. Managing adverse effects of hormonal contraceptives. Am Fam Physician. 2010; 82:(12)1499-506

Loder EW, Buse DC, Golub JR. Headache as a side effect of combination estrogen-progestin oral contraceptives: a systematic review. Am J Obstet Gynecol. 2005; 193:(3 pt 1)636-649

MacGregor EA. Contraception and headache. Headache. 2013; 53:247-276

Modesto W, Bahamondes MV, Bahamondes L. A randomized clinical trial of the effect of intensive versus non-intensive counselling on discontinuation rates due to bleeding disturbances of three long-acting reversible contraceptives. Hum Reprod. 2014; 29:(7)1393-1399

National Institute for Health and Care Excellence. Management of acne vulgaris in Primary Care. 2020. (accessed 13 April 2021)

Royal College Obstetricians and Gynaecologists. Green Top Guideline no 48: Premesntrual Syndrome, Diagnosis and Management. 2016. (accessed 13 April 2021)

Worly BL The relationship between progestin hormonal contraception and depression: a systematic review. Contraception. 2018;

Managing the side effects of contraception

02 June 2021
Volume 32 · Issue 6


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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