How does the knowledge and the opinions about menstruation
relate with the use of progestin-only injectable contraceptives? A qualitative
study in Istanbul
P. Ay, S. Hidiroglu, M. Solakoglu Ucar, O. O. Kose, A.
Topuzoglu, and D. Save
Marmara University Medical Faculty Department of Public
Health, Istanbul, Turkey
Objective The objective of this qualitative study was
to assess the knowledge and the opinions concerning menstruation as well as
their influence on contraceptive acceptance and practices.
Design and methods
Six focus group discussions were carried out among women residing in a
socioeconomically deprived area in Istanbul. The study group was composed of
married women with a low educational background who had migrated to Istanbul
from the rural parts of the country. The knowledge and beliefs about
menstruation and a woman’s cycle was explored trough an interview guide. Key
themes were identified and a coding frame was developed. Word processing program
was used in the data analysis.
Results Women were not able to explain the
mechanism of menstruation. Concerning the question why women menstruate, the
participants stated fatalistic views as ‘God wanted so’. Menstruation was
believed to be the difference of women from the men and it was directly linked
with fecundity. Menstruation had importance since it was seen as an important
sign of being healthy and productive. For this reason amenorrhea was observed as
the central disadvantage of progestin-only injectables. Women were hesitating
that their fecundity would come back after quitting the use of the contraceptive.
Also amenorrhea was perceived as causing weight gain and stress. Although these
women had counseling services they did not have adequate knowledge concerning the menstrual
Conclusions One of the
main needs of disadvantaged women is to understand the cycle and the physiology
of menstruation. The low rate of progestin- only injectable contraceptive use
among this population might be related to misconceptions about amenorrhea.