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March 13, 2000

Do Certain Family Planning Methods Make Anemia Worse?

Anemia is an important problem for women in my country, and I am worried that the menstrual changes caused by hormonal methods such as Depo-Provera, Norplant implants, and even oral contraceptives might make the problem worse. Do these methods make anemia worse?

Actually, on average hormonal methods have a beneficial effect on anemia. For example, a recent WHO multi-country study looked at the blood count (hemoglobin and ferritin) of users of OCs, DMPA, and Norplant implants and found that the levels were better for users of these methods than for the comparison group of noncontraceptors. Moreover, another group of anemic OC and DMPA users were followed over time and had significant improvements in their blood hemoglobin. Importantly, the greatest improvement in blood occurred in women who were the most anemic at the outset.

The hormonal methods probably improve anemia in at least two ways -- first through preventing pregnancy and second by reducing the actual total amount of blood lost during menstruation. (Clearly, a small percentage of women can have very heavy bleeding with DMPA and Norplant implants, especially at the outset of use, but this problem tends to improve. For management of bleeding problems, see guidance in "The Essentials of Contraceptive Technology" and other clinical guides.

References:
WHO task force for epidemiologic research on reproductive health. Effects of contraceptives on hemoglobin and ferritin. Contraception 1998;58:261-273.

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The "Pearls" offer answers to commonly asked questions about family planning. These "Pearls" are prepared by Dr. James D. Shelton, Senior Medical Scientist, Office of Population, United States Agency for International Development (USAID)

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