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ics Gynecology & Obstetrics Bagnan et al., Gynecol Obstet 2017, 7:9
DOI: 10.4172/2161-0932.1000452
ISSN: 2161-0932

Research Article OMICS International

Side Effects of Hormonal Contraception of Patients in the Family Planning

of Centre University Hospital of Mother and Child Lagoon, Cotonou
(Benin)
Tonato Bagnan JA1, Aboubakar M1, Tognifode V1, Lokossou M.S.H.S1, Obossou AAA2*, Salifou K2, Assogba E1 and Perrin RX1
1Department of Mother and Child, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
2University of Parakou, Cotonou, Benin
*Corresponding author: Obossou Awadé Afoukou Achille, Department of Mother and Child, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin,
Tel: 00229 95 85 32 79; E-mail: [email protected]
Received date: August 31, 2017; Accepted date: September 19, 2017; Published date: September 26, 2017
Copyright: © 2017 Bagnan TJA, et al. This is an open-access article distributed under the terms of the creative commons attribution license, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Objective: To take a census of side effects related to the use of hormonal contraception reported by the women
received in the Family Planning (FP) Service of CHU-MEL.

Patients and methods: It was a cross-sectional prospective study which was carried out in the family planning
service ofCHU-MEL in Cotonouover a three-month period from June 1st to August 31st, 2016.

Results: 303 women were involved in this survey. The average age was 33 years (extremes of 15 and 49
years).Side effects were vaginal bleeding apart from the menses (37.2%) amenorrhea (32%) and weight increase
(27.3%). The reasons for abandonment of hormonal contraceptionwere amenorrhea (13%), weight gain (11%),
pelvic pain (0.07), nausea (0.05%) and bleeding (0.04).

Conclusion: Hormonal contraception has many side effects. Some of them are well known by patients. They
influence compliance with treatment. Their management is not always optimal and leads to abandonment.

Keywords: Hormonal contraception; Side effects; Cotonou Centre University Hospital of Mother and Child Lagoon, Cotonou
(Benin) (CHU-MEL).
Introduction
Materials and Methods
Hormonal contraception is considered as one of the greatest socio-
medical achievements in terms of individual freedom. It was a cross-sectional prospective study which was conducted in
Pharmacologically, it has always been improved since the introduction the family planning service of the Centre HospitalierUniversitaire de la
of the pill in the 1960s because the biological effects of the sexual Mère et de l’EnfantLagune (CHU-MEL) in Cotonouover a three-
steroids used are better known. These effects result from the month period from June 1st to August 31st, 2016. The population for
interaction of the steroids with their receptors found on the genital this study consisted of women who made visits for medical
organs but also on the extra-genitalones, which on the one hand, examination in the family planning service of CHU-MEL during the
accounts for the effects expected on genital organs when contraception study period. It was a non-probability exhaustive sampling method.
is used, but also the extra-genital effects observed. Side effects can be We included in this study women aged 15 to 49 years using hormonal
major (venous or arterial thromboembolic accidents, metabolic contraception regardless of the duration of use and they gave their
disorders, hormone dependent cancer) or minor (amenorrhea, consent. In the context of this study we adopted hormonal methods
spotting, weight increase). offered at CHU-MEL: pills, injectable contraceptives, implants. The
variables studied were related to socio demographic data, obstetrics
They vary from a user to another for the same contraceptive or for
and gynecology history as well as medical and surgical history and side
different contraceptives. Some effects are independent of the route of
effects reported by users. The contraceptive methods adopted were
administration (oral, vaginal or transdermal) and are linked to the
those which were available in the service at the time of this study
molecule.
namely Jadelle implant, combined oral contraceptives (COC), the
But the range of side effects is wide. A good knowledge by care emergency contraceptive pill and injectable contraceptives. Data were
providers of the majority of the side effects reported by the users collected by means of a questionnaire administered during a
themselves could help to improve counseling and thus the observance confidential interview. C S PRO version (6.2), Excel (2010 and 2016)
of hormonal contraception by the clients. and SPSS 23 software was used to process and analyze data. Fisher chi
square test was used to study the association of 2 variables with 5% as a
That’s the justification for our study whose objective was to take a
significance threshold.
census of the side effects related to the use of hormonal contraception
reported by the patients received in the family planning service of the

Gynecol Obstet, an open access journal Volume 7 • Issue 9 • 1000452

ISSN:2161-0932
Citation: Bagnan TJA, Aboubakar M, Tognifode V, Lokossou MSHS, Obossou AAA, et al. (2017) Side Effects of Hormonal Contraception of
Patients in the Family Planning of Centre University Hospital of Mother and Child Lagoon, Cotonou (Benin). Gynecol Obstet 7: 452. doi:
10.4172/2161-0932.1000452

Page 2 of 5

Administrative authorizations at various levels as well as the Side effects of contraceptive methods
informed consent of the respondents were obtained before the
interview. The anonymity of the respondents and the confidentiality of Weight increase is the side effect mostly reported by the respondents
the information collected were ensured. using the pill with respective proportions of 22.3% and 56.6% (Table
1).
Results Percentage injectable Emergency
pill implant contraceptives contraception pill

Socio demographic data Weight

increase 22.3 48.1 56.6 14.8
In total 303 women were chosen within the framework of this
survey. Genital
bleeding 12.9 34.1 48.9
The average age was 33 years with extremes of 15 and 49 years.
Those whose age is between 25 and 34 years represented 42.6%. Amenorrhea 12.9 60.3 54.4

Moreover, 104 women that is to say 34.3% had a secondary school

level. Table 1: Distribution of side effects according to the contraceptive
method.
Married women were the most represented in our sample with a
proportion of 83.2%. Single women represented 9.9%, divorced women Amenorrhea is the side effect mostly reported by implant users with
(5.3%) and widows (1.7%). a proportion of 60.3%
Reasons for abandonment of hormonal contraception methods
Gravidity, parity (Table 2).
Multigravidas represented 53.1% of our population and 42.2% of
women were pauciparous. Hormonal contraceptivemethods

Hormonal contraception used Injectable Implan Tota

Reasons for abandonment Pill ECP t l %
contraceptiv
The implant was the hormonal contraception the respondents es
mostly used (47.85%) followed by injectable contraceptives (35.31%)
(Figure 1). Genital bleeding apart from 0.0
the menses 1 0 1 7 9 4

0.0
Hypermenorrhea 1 0 1 7 9 4

Amenorrhea 0 0 15 13 28 13

0.0
Nausea 4 0 1 6 11 5

Weight gain 4 0 6 14 24 11

0.0
Weight loss 0 0 1 7 8 3

0.0
Vertigo 2 0 0 9 11 5

0.0
Headaches 2 0 3 8 13 6

Figure 1: Distribution of the respondents according to the hormonal 0.0

contraception used. HBP/Palpitations 0 0 3 9 12 5

0.0
Chest pain 3 0 0 7 10 4
[The pill (7.26), morning-after pill (0.33%), injectable contraceptives
(35.31%), the implant (47.85%)] 0.0
Pelvic pain 1 0 0 14 15 7

Reasons for use

Table 2: Distribution of reasons for abandonment according to the
The majority of our sample used hormonal contraception in order hormonal contraceptive method.
to space births.
If we consider all the side effects, amenorrhea and weight gain are
the main reasons for abandonment respectively in13% and 11% of
cases.

Gynecol Obstet, an open access journal Volume 7 • Issue 9 • 1000452

ISSN:2161-0932
Citation: Bagnan TJA, Aboubakar M, Tognifode V, Lokossou MSHS, Obossou AAA, et al. (2017) Side Effects of Hormonal Contraception of
Patients in the Family Planning of Centre University Hospital of Mother and Child Lagoon, Cotonou (Benin). Gynecol Obstet 7: 452. doi:
10.4172/2161-0932.1000452

Page 3 of 5

The most important reason for abandonment of the pill is nausea to pregnancy prevention has other indications such as the regulation of
and weight gain: 4 women out of the 85 users stopped taking the pill menstrual cycles, dysmenorrhea etc. Since our study was conducted in
for each of these reasons that is to say 4.71%. the family planning service, these indications cannot be found here. In
fact, for these reasons patients are received for a gynecological
Amenorrhea and weight gain are the main reasons for
examination.
abandonment of injectable contraceptives respectively in the following
proportions: 9.15% and 6.66%.
Side effects related to hormonal contraceptive methods
Weight gain, pelvic pain and amenorrhea are the most frequent
reasons for implant removal respectively in the following proportions: As any medicine, contraceptives can cause alternately minor and
7.69%; 7.69% and7.14%. major side effects. Since the introduction of the pill in the 1960s,
pharmaceutical industries have been continuously innovating.
Biological effects of sexual steroids used are better known, their doses
Discussion lowered and the risks better apprehended leading to an improvement
The limits of our study relate to: of their tolerance [5].
• The difficulties to have all the information because the files are Most side effects occur in the first three cycles. They can result in an
badly filled by the medical staff. abandonment of contraception hence the need for giving appropriate
advice to the client by counseling. Nevertheless, this information is not
• The refusal of some patients to take part in the study. always given by health workers.
• Patients don’t have enough time to properly answer questions. According to the DHS IV, 37.6% of the pill users, 52.6% injectable
• Difficulties in contacting clients to add the missing information methods and 60.8% of IUD declared that they had been informed of
in the files. the side effects of their method.

Socio demographic characters Weight increase

In Benin, the contraceptive prevalence by modern methods are slow. It is one of the most frequently experienced side effects among the
According to the 2011-2012 Demographic and Health Survey (DHS) respondents who used the implant (56.6%), injectable methods
IV [1] among the women aged 14to 15 years, the contraceptive (48.78%), the pill (22.35%), the morning after pill (11.1%). In 2001, a
prevalence was 14% with 9% for modern methods and 5% for study carried out in France about the frequency of use of the pill
traditional ones. According to the same survey, there is no significant showed that the most experienced side effects among all the age groups
gap as for women between age groups in terms of knowledge of were weight increase (31%), accounting for the low proportion of
contraceptive methods. On the other hand, the level of knowledge women very satisfied with their pill [2].
increases with the educational level. The average age of the respond However, in our study, a quantification of weight increase was not
entsin our set was 33 years. This result is much higher than the 27.9 possible on account of the type of study. In case of weight increase,
years found by Matungulu in the Democratic Republic of Congo [2]. whether it is rapid or gradual, it is due to estrogen which causes
The age group varying from 24 and 34 years is the most represented in sodium and water retention and it is also due to progestogen which has
our study. However in Martin and all set in France, the most an anabolic effect. It seems less frequent with low-dose pills and
represented age group is 20 to 25 years [3]. apparently, with those containing the new progestogens with low
androgenic activity. Nevertheless, comparative placebo-controlled
Gynecology and obstetrics history trials failed to establish a link between weight increase and the use of
In our study, 53.1% of the respondents were multigravidas and combined oral contraceptives at low dose [6]. The GP also found a
42.2% pauciparous. Moreover 24.09% of the respondents had at least large proportion of weight increase of 30% among pill users [7].
one history of voluntary termination of pregnancy (TOP). Prejudices As for progestational contraception, it is one of the limiting factors
related to hormonal contraception expose lots of women to unwanted with certain products. medroxyprogesteroneacetate (MPA) is the most
pregnancies which often result in voluntary TOPs. However, in their incriminated in weight increase with 50% of the users who report a
study carried out in Cameroon Diallo A and all observed that weight gain in Polaneczky’s study (average weight gain of 4.1 kg) [5].
multiparous were the largest number of users of hormonal This weight gain seems to be due to an appetite stimulation and to a
contraceptive methods with a proportion of41.91% [4]. possible anabolic effect.
The other progestogens used as oral contraceptives, Pregnanes and
Use of hormonal contraceptive methods
Nor pregnanes, have no anabolic effect and are not in theory
In our study, a clear preference for long term methods is noticed. responsible for weight increase, and yet sometimes observed. The
This preference of users can be accounted for by their less binding implant is responsible for more than 10% of weight increase, and more
character for women. However, women were only offered frequently if there is an overweight at the outset [8].
contraceptive methods available in the FP service of CHU-MEL during
Reservations should be expressed about weight increase reported by
the survey. Patients were not offered the full range of methods.
the users of emergency contraception (morning-after pill). Emergency
contraception is defined as all the means of contraception used after
Reasons for recourse sexual intercourse and before implantation. The most commonly used
The only reason for having recourse to contraception in this study is means can cause a reduction of the risk of pregnancy in the range of
related to pregnancy prevention. Hormonal contraception in addition 75% to 89%. The method of emergency contraception is meant for an

Gynecol Obstet, an open access journal Volume 7 • Issue 9 • 1000452

ISSN:2161-0932
Citation: Bagnan TJA, Aboubakar M, Tognifode V, Lokossou MSHS, Obossou AAA, et al. (2017) Side Effects of Hormonal Contraception of
Patients in the Family Planning of Centre University Hospital of Mother and Child Lagoon, Cotonou (Benin). Gynecol Obstet 7: 452. doi:
10.4172/2161-0932.1000452

Page 4 of 5

occasional use, mainly as an adjunct to the regular method of and their physical appearance make them hold contrasting views. So,
contraception. The side effects related to emergency contraception and while appreciating the possibility of a non-reproductive sexuality and
reported in a study were nausea (23.1 %) vomiting (5.6 %), dizziness therefore their fertility control, they fear the reported, alleged or
(11.2 %) and fatigue (16.9 %) [9]. experienced adverse effects. One of the main factors which help
women to give support to hormonal contraception or to abandon
Metrorrhagia and amenorrhea hormonal contraceptive methods remains the way they really
experience the side effects [11].
Light-bleeding metrorrhagia (spotting) is common during the first
cycles, especially with very low dose pills. It occurs in 10 to 30% of The most frequent reason for stopping a contraceptive method is the
women during the first months of the use of the combined pill and desire to have children (25%) followed by health problems and side
represents a frequent reason for abandonment. As for amenorrheait effects (13%). However, as for the pilland injectable contraceptives
happens in about 2 to 3% of cases of use. In the other cases, genital specifically the reason put forward by the users is related to health
infection and organic lesion must previously be looked for before problems (28%) and side effects (30%) [1].
thinking of the atrophy of the endometrium, and possibly the These side effects are therefore an important reason for
temporary prescription of a pill with more dose of estrogen, or even a abandonment of hormonal contraception. In our study, 4 women out
light dose of estrogen during a short period [3]. of 85 users that is to say 4.71% stopped using the pill for reasons
Amenorrheais unusual with normodoseoestro-progestogens. First, related to nausea and weight gain. According to the GP, 8% of the pill
an unplanned pregnancy must be eliminated before thinking of a users abandoned this method because of weight increase. FRUZZETI
significant atrophy of the endometrium. They were reported by 60.3% Fin a study conducted in Italy reported similar results. As for the pill,
of the women using the implants and 12.3% of those using injectable the main reasons for abandonment are genital bleeding apart from the
contraception in our study. menses, weight increase and headaches. 20.5% of patients abandoned
the pill because of minor side effects; 4.4% because of major side effects
Grasselin O reported 60.98% of amenorrhea in women using and 3.8% because of compliance [12,13].
injectable contraception and 12.94% of those using the pill. It is the
main side effect of progestogen contraception. Only 40% of long term
users of progestogens-only have regular menstrual cycles.
Conclusions
Injectable progestogensrepresent the main causes of irregular Our study focused on hormonal contraceptive methods prescribed
bleeding and amenorrhea, a significant source of abandonment. in the family planning service of CHU-MEL namely pills, the
morning-after pill, injectable methods and the implant.
With the implant, metrorrhagia is frequent (7%), and willingly
extended over a long period (15%). Amenorrhea occurs among about The main side effects reported by the users are weight increase,
20% of patients. Irregular bleeding remains the most frequent and abnormal genital bleeding and amenorrhea.
annoying problem of this contraceptive method. It is frequent at the As for the main reasons for the abandonment of contraceptive
beginning of the treatment and represents the main cause of a request methods due to side effects nausea and vomiting can be added. Good
for the removal of such a type of contraception. As a matter of fact, it is counseling is indispensable for a successful adherence.
an inconvenience some patients find unacceptable. Providing
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Gynecol Obstet, an open access journal Volume 7 • Issue 9 • 1000452

ISSN:2161-0932
Citation: Bagnan TJA, Aboubakar M, Tognifode V, Lokossou MSHS, Obossou AAA, et al. (2017) Side Effects of Hormonal Contraception of
Patients in the Family Planning of Centre University Hospital of Mother and Child Lagoon, Cotonou (Benin). Gynecol Obstet 7: 452. doi:
10.4172/2161-0932.1000452

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Gynecol Obstet, an open access journal Volume 7 • Issue 9 • 1000452

ISSN:2161-0932