Women's experiences of amenorrhea following Depo-Provera use at a district hospital in Malawi
Depo-Provera, an injectable contraceptive, is utilized by about 30% of married women in Malawi. Most women have reported their preference to use Depo-Provera due to its effectiveness in preventing pregnancy, reversibility and easy to use since it is given once at 12-weeks intervals. Despite the method having such advantages, it has menstrual effects, and one of the major concerns for women, particularly in Africa, is amenorrhea. In Malawi, 40% of Depo-Provera users report experiencing amenorrhea after one year of use. Despite the concern for amenorrhea, some women have continued using the method. Literature shows that there is limited information on women's experiences of amenorrhea following use of Depo-Provera. A descriptive phenomenological research design was used to explore and describe women’s experiences of amenorrhea following use of Depo-Provera in order to understand how women experience amenorrhea and give meaning to the experience. Data were collected through in-depth unstructured interviews with six women, who were selected using purposive sampling. The interviews were conducted in Tumbuka language. Data analysis was done using Colaizzi’s method of analyzing descriptive phenomenological data. Five themes and some sub-themes emerged from data analysis. The themes were: "Lack of knowledge on cause of amenorrhea", "Fear of pregnancy", "Misconceptions associated with Depo-Provera Induced Amenorrhea", "Lack of proper counseling on amenorrhea resulting from Depo-Provera use" and "Amenorrhea not perceived as a problem when midwives provide adequate information". The themes showed that women accessing family planning services from Chitipa district hospital were not provided with information on amenorrhea resulting from using Depo- Provera. Hence, they expressed fear when they experienced the side effect. Participants stated that they were afraid of becoming infertile after using the family planning method, getting pregnant as well as amenorrhea itself. Their intention to discontinue using the method was largely associated with negative rumors, beliefs and misconceptions. The conclusion of the study is that there is need for midwives to provide information on amenorrhea resulting from Depo-Provera use. This will assist clients to understand that amenorrhea could occur as a side effect, and hence improve continued utilization of the method.