~ Written by Rebecca Callahan, Scientist, Kate Rademacher, Technical Advisor, & Lucy Wilson, Monitoring and Evaluation Advisor, FHI 360
What do family planning and menstrual hygiene management (MHM) have in common? Beyond a shared purpose to improve the health and well-being of women and girls, some family planning methods can actually improve menstrual hygiene. Menstrual Hygiene Day on May 28 offers an opportunity to explore synergies between the two fields.
In recent years, the MHM movement has focused on the critical role that good menstrual hygiene management plays in enabling women and girls to achieve their full potential. Reducing the stigma associated with menstruation and ensuring that adolescent girls and women are able to safely manage their menses can eliminate some of the barriers that prevent girls and women in many countries from participating in day-to-day activities, such as attending school.
At the same time, the effort to increase access to long-acting reversible contraceptives (LARCs) for adolescents and young women has gained momentum. The LARCs for youth movement aims to expand reproductive choice and reduce unintended pregnancy. Around the world, the use of LARC methods, including intrauterine devices (IUDs) and contraceptive implants, has increased in recent years. The American College of Obstetrics and Gynecology and the American Academy of Pediatrics now recommend their use among teens.
Thus far, the complementarity of the MHM and LARCs for youth campaigns has gone unexplored.
Some LARC methods, such as the levonorgestrel-releasing intrauterine system (LNG-IUS), which is effective for up to five years, as well as shorter-acting methods, such as the three-month injectable depot-medroxyprogesterone acetate (DMPA), substantially reduce menstrual bleeding and often lead to complete cessation of menstruation, a condition known as amenorrhea.
Some women have viewed the menstrual changes associated with contraceptive use, especially increased or irregular bleeding, as a negative or undesirable side effect. However, recent evidence suggests that decreased bleeding, and amenorrhea in particular, is acceptable to women and is even considered an important side benefit.1,2 Surveys have shown that teens and young women are especially interested in limiting or controlling the timing of menstruation through the use of hormonal contraceptives.3,4
For young women in developing countries, where access to menstrual hygiene supplies and safe places to manage their menses are sometimes limited, the advantage of contraceptive-induced menstrual control could be especially important.
Youth-focused family planning initiatives are critical and could create a bridge between the MHM and family planning fields. Such linkages could focus on helping young women who are ready to use contraception learn how different family planning methods may affect their menstruation. In particular, the increasing popularity and availability of the LNG-IUS presents an opportunity both to promote highly effective, long-acting contraception and to reduce the burden of menstruation among youth.
An example of the acceptability of the LNG-IUS among teens in the United States comes from the ongoing Contraceptive CHOICE project, in which nearly one-third of women ages 15–19 enrolled in the study chose the device when offered free access to seven different long- and short-acting methods.5 After one year of use, more than 80 percent were still using this method.6
Although data from developing countries are limited, evidence from Kenya suggests a latent demand for LNG-IUS in low-resource settings when it is made available.7,8
The recent addition of LNG-IUS to the World Health Organization’s Essential Medicines List and the approval of Medicines360’s new, more affordable LNG-IUS, LILETTA™, by the U.S. Food and Drug Administration, are good signs that this method will soon be more accessible to young girls and women in low- and middle-income countries. An ongoing collaboration between FHI 360, Marie Stopes International and Medicines360 to support introduction of Medicines360’s LNG-IUS in Kenya is an important first step in this effort.
Menstrual Hygiene Day calls attention to the importance of equipping girls and young women with the tools and knowledge they need to safely manage their menses. Expanding access to LARC methods for youth offers both the potential to improve reproductive health by reducing unintended pregnancy and an innovative strategy for addressing menstrual hygiene needs. We are optimistic that forging connections between the MHM and family planning fields will lead to improved outcomes for women and girls around the world.
References:
1. Baldaszti E, Wimmer-Puchinger B, Löschke K. Acceptability of the long-term contraceptive levonorgestrel-releasing intrauterine system (Mirena): a 3-year follow-up study. Contraception. 2003;67(2):87-91.
2. Backman T, Huhtala S, Blom T, Luoto R, Rauramo I, Koskenvuo M. Length of use and symptoms associated with premature removal of the levonorgestrel intrauterine system: a nation-wide study of 17,360 users. Br J Obstet Gynaecol. 2000;107(3):335-9.
3. Szarweski A, von Stenglin A, Rybowski S. Women’s attitudes towards monthly bleeding: results of a global population-based survey. Eur J Contracept Reprod Health Care. 2012;17:270-83.
4. Association of Reproductive Health Professionals (ARHP). Menstruation and menstrual suppression survey, 2005. Available from: http://www.arhp.org/Publications-and-Resources/Studies-and-Surveys/Menstruation-and-Menstrual-Suppression-Survey/Full-Report. Accessed 11 May 2015.
5. Secura GM, Madden T, McNicholas C, Mullersman J, Bucket CM, Zhao Q, Peipert JF. Provision of no-cost, long-acting contraception and teenage pregnancy. N Engl J Med. 2014;371(14):1316-23.
6. Rosenstock JR, Peipert JF, Madden T, Zhao Q, Secura GM. Continuation of reversible contraception in teenagers and young women. Obstet Gynecol. 2012;120(6):1298-305.
7. Hubacher D, Masaba R, Manduku CK, Chen M, Veena V. The levonorgestrel intrauterine system: cohort study to assess satisfaction in a postpartum population in Kenya. Contraception. 2015;91(4):295-300.
8. Hubacher D, Masaba R, Manduku CK, Veena V. Uptake of the levonorgestrel intrauterine system among recent postpartum women in Kenya: factors associated with decision-making. Contraception. 2013;88(1):97-102.