Table 2 Thematic analysis of the health impact of contraceptive-induced menstrual changes

Increased economic burden

Bleeding impeded their ability to work and earn a living; CIMC resulted in extra healthcare costs due to unanticipated visits to the hospital; increased need for sanitary pads

‘I haven’t been able to work for the past three weeks as the bleeding is heavy and moving about is difficult.’

^{34,35,37,68,69}

Interferes with regular activities

Excessive bleeding interfered with daily life activities by causing fatigue and an inability to complete household tasks; women experienced discomfort due to bleeding; women had to wash always to feel clean; missed school because of heavy periods

‘Because of physical weakness and dizziness, I could not manage all the domestic work properly.’

^{35,36,37,38,39,40,42,68,70}

Experiences of social stigma, shame and exclusion

Prolonged and/or irregular bleeding interrupted religious practices; religious and cultural beliefs prevented prayers, sexual intercourse and attending gatherings during bleeding

‘… but when I started using it, I didn’t know how to pray anymore. Because I don’t know when I’m going to finish my period and I can resume my prayers.’

^{35,37,38,39,42}

Unmet need for contraception

Menstrual irregularities were a major cause of contraceptive discontinuation

‘I stopped using it because I was menstruating every two weeks.’

^{5,34,35,36,42,44,45,48,51,54,59,61,71,72,73,74,75}

Psychological impact

Concern about the possibility of infertility; fear of side effects; worry about pregnancy when amenorrhoea was experienced; fear of expulsion of IUD due to excessive bleeding; self-consciousness and feelings of shame due to the possibility of staining clothes;

‘I was mentally upset I could not go to any gathering because I always had to be conscious of my clothes because they might be soaked with blood.’

^{33,42,48,51,75,76}

Contributes to marital problems

Cohabitation problems including verbal and physical abuse from partners; sexual abstinence because of bleeding

‘It’s the heavy menstruation that makes a man leave his wife’

‘…am removing the implant because my partner and I are no longer having sex like before because of the bleeding, which is not stopping.’

^{38,50,57,69,73,77}

Health concerns

Possibility of anaemia due to excessive bleeding

‘I had to remove the implant because my periods became very heavy and I was losing a lot of blood.

^{35,39,40,49,50,51}