7/27/2019 WORKSHOP 2- Contraception Counselling
1/30
WORKSHOP 2 : ContraceptiveCounselling on Side Effect
BY:-DR NOR HUDA BT MAT ALIClinical SpecialistHospital Tengku Ampuan Afzan
7/27/2019 WORKSHOP 2- Contraception Counselling
2/30
Objectives
Importance of ContraceptivecounsellingLearn more about side effectsConsider side effects from clientscultural & personal contextUnderstand side effects impact onuse & continuation
7/27/2019 WORKSHOP 2- Contraception Counselling
3/30
Adherence to contraception
pregnancies unintended(Hatcher,R.A,Contraceptive Technology 19 th ed 2009)
Some research suggest that actual
method failure may be responsible for
7/27/2019 WORKSHOP 2- Contraception Counselling
4/30
CONTRACEPTIVECOUNSELLING
No contraceptive agent is PERFECT
Satisfaction is enhanced when appropriatepreutilization counseling is offered and whenside effects are successfully managed
7/27/2019 WORKSHOP 2- Contraception Counselling
5/30
Informed choices
Identify Medical EligibilityCriteria (MEC) andcontraindications
Identify Non-contraceptivebenefits
Selected Practice Recommendations
(SPR)
7/27/2019 WORKSHOP 2- Contraception Counselling
6/30
ReproductiveAge
ReproductiveGoal
Medicalconditions Lifestyle
Logistic &
cost
7/27/2019 WORKSHOP 2- Contraception Counselling
7/30
Effective Contraceptive Counselling
The best method of contraception forpatients is one that will be in harmonywith their wishes, fears, preferences
and lifestyle; A method that is morelikely to be used correctly
(Hatcher,R.A.,et al, Contraceptive Technology 19 th ed 2009, p 41)
7/27/2019 WORKSHOP 2- Contraception Counselling
8/30
REASONS FOR NOT USING/DISCONTINUATION
Reason 1994 2004
Peninsular M Sabah Sarawak
To conceive 53 39.3 52.5 44.1
Fear of SideEffects
10.3 26.8 26.4 27.5
Husband issue 8 12.6 4.8 9.6
Medical factors 3.4 5.4 4.8 4.2Others 25.4 15.9 11.6 14.6
Total 100.00 100.00 100.00 100.00
Source: NPFDB, MPFS 1994 & 2004
7/27/2019 WORKSHOP 2- Contraception Counselling
9/30
Fear of Side Effects
Age Group (years old) Total (%)
25-29 22.730-34 24.435-39 33.240-44 28.345-49 34.4
Source: NPFDB, MPFS 2004
7/27/2019 WORKSHOP 2- Contraception Counselling
10/30
7/27/2019 WORKSHOP 2- Contraception Counselling
11/30
Negative impacts are reducedby:
Discussing side effects before methodselectionManaging side effects promptlyAllowing method switching
7/27/2019 WORKSHOP 2- Contraception Counselling
12/30
Side Effects vs.Complications
SIDE EFFECTS : symptoms orconditions that pose no significant
health risk
COMPLICATIONS : serious health problems or conditions
7/27/2019 WORKSHOP 2- Contraception Counselling
13/30
Side Effects vs.Complications
HeadacheIncreasedmenstruationLight or nomenstruationMenstrual cramping
Severe headachesVery heavybleeding (twice as
long or as much )Severe, constantpain in the chest, legor belly
7/27/2019 WORKSHOP 2- Contraception Counselling
14/30
Side Effects vs.Complications
Weight gain or lossNausea
Vaginal drynessLocal skin irritation
Skin or eyes thatbecome unusuallyyellow (jaundice)Loss of sensation inarms or legs
7/27/2019 WORKSHOP 2- Contraception Counselling
15/30
Clinic Follow up:Observation of Side Effects
Most contraceptives have some sideeffectsSome side effects are common andmild; others are rareSome improved over timeSome are easily treated
7/27/2019 WORKSHOP 2- Contraception Counselling
16/30
Clients may experience one or several
Side effects can vary by brand
Type & severity vary by method & user
Clinic Follow up:Observation of Side Effects
7/27/2019 WORKSHOP 2- Contraception Counselling
17/30
The truth about side effects
Important to distinguish side effects fromrumors 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
7/27/2019 WORKSHOP 2- Contraception Counselling
18/30
Positive or negativeconsequences of side effects:
clients responses Feel unwell Feel too weak toworkUnable toparticipate inreligiouscommunityactivitiesUnable to cookFeel unattractive ormore attractive
Limit sexualactivity or enhancesexual pleasureDiscontinuecontraceptive
method or use itirregularly
7/27/2019 WORKSHOP 2- Contraception Counselling
19/30
Important to pay attention to concernsof clients partner
E.g. , Counseled husbands of Implantusers reassured regarding partnersspotting
Side effect counseling & methoduse
7/27/2019 WORKSHOP 2- Contraception Counselling
20/30
Reassure that counseling can be brief. Provide Pamphletes.Too Busy
Reassure that side effect counseling increases use & continuation.
Provide literature.
Worried thatclients may
reject method(s)
Give providers training on
common side effects
Unaware offrequency of
sides effects
Provide simple written &AV materials for providers
Lack of supportmaterial
Why providers may not inform clients
about side effects ?
7/27/2019 WORKSHOP 2- Contraception Counselling
21/30
Helping clients knowwhat to expect
Say that many clients experience noside effects
Give information regarding how tomanage side effects
Make clients feel comfortablereturning for assistance, if needed
7/27/2019 WORKSHOP 2- Contraception Counselling
22/30
Helping clients choose amethod
Describe side effects of variousmethods, their frequency & durationReassure regarding safety of methodsEmphasize client satisfaction withmethods in generalElicit & answer questions; correctmisinformation courteously
7/27/2019 WORKSHOP 2- Contraception Counselling
23/30
Helping clients know what toexpect: reminders
Elicit and respond to client concerns
Be concise & clear
Be honest regarding frequency orseverity of side effects
Provide support material
7/27/2019 WORKSHOP 2- Contraception Counselling
24/30
Why help clientsmanage side effects?
Increase clients comfort, satisfactionwith & continuation with the method
Discover if side effect is due to incorrectmethod use
Discover if side effect signals a moreserious condition
7/27/2019 WORKSHOP 2- Contraception Counselling
25/30
Steps to managing sideeffects
Ask how/why the side effect concernsclientRespond in clear languageExplain usual duration of side effectExplore with client what to do if itpersists
7/27/2019 WORKSHOP 2- Contraception Counselling
26/30
Steps to managing sideeffects
Help client weigh contraceptive &non-contraceptive benefits versus sideeffect
If client still wants another method,help explore options
7/27/2019 WORKSHOP 2- Contraception Counselling
27/30
Case Study
29 years old woman with 2 kidscomplain of prolonged bleeding for 2months since implanon was inserted
and her husband requested her tohave the implanon removed.
7/27/2019 WORKSHOP 2- Contraception Counselling
28/30
Case Study
35 years old woman with 5 kids andpoor spacing was referred to you forFP. Shes not keen for implanon as she
hear rumors related to weight gainwhen using the method.
7/27/2019 WORKSHOP 2- Contraception Counselling
29/30
Case study
29 years old, Para 3 with history of 1previous scar in 2007. Mirena inserted2 month post partum. 1 year after that
no IUD string felt. Had regular selfcheck up for IUD string before that.Whats the next step
7/27/2019 WORKSHOP 2- Contraception Counselling
30/30