Silent Struggles: Nigerian women turn to contraceptives to ease menstrual distress

Every month, Bolanle Oyebamji was tormented by her menstrual cycle—waves of pain from her lower back, down her legs, and through a swollen, throbbing pelvis.

For the recent graduate of Ekiti State University, periods were more than a biological occurrence; they were a disruptive force that derails daily life.

That was until a friend suggested she try Postpill, a contraceptive pill, not for its primary purpose of preventing pregnancy, but for her debilitating cramps.

The outcome was unexpected. Her period became irregular, with a seven-day break before returning with heavier force. Fortunately, the heavy flow came with no menstrual cramps.

“After that, I didn’t see my period for two months, and that got me worried. That was my first time using the drug, and I had no choice but to consult a doctor,” she said.

“I felt a lot of dizziness and headaches when I used the drug, and that affected my academics and daily activities for some days.”

Ms Oyebamji went for a diagnosis and learned she had a ‘simple ovarian cyst.’

Ovarian cysts are found around the pelvic area in premenopausal women. They occur when there is a persistent change in the menstrual cycle. According to the Cleveland Clinic, an online medical report, recurrent infections can cause ovarian cysts.

For Ms Oyebamji, the diagnosis was both a relief and a concern, knowing it wasn’t something more severe but still needed proper treatment.

She was placed on a drip for three days and was administered a metro infusion and normal saline along with drugs like doxycycline, flagyl, and cefuroxime.

Ms Oyebamji’s experience mirrors a growing trend among Nigerian women who are turning to hormonal contraceptives, originally manufactured to prevent pregnancy, to suppress or regulate menstruation.

For some, it’s a last resort to regain control over their lives. For others, it’s a risky gamble, often taken without medical guidance, in a society where both menstrual disorders and contraception remain heavily stigmatised.

Contraceptive usage patterns among Nigerian women

Contraceptive pills, also known as birth control pills, are oral contraceptives that use hormones to prevent pregnancy at a 99 per cent effective rate when used as prescribed.

In Nigeria, contraceptive use among women of reproductive age (15–49 years) remains relatively low, with 31 per cent having either previously used a contraceptive or currently using one, while 12.2 per cent are currently using modern methods.

According to the National Institute of Health, contraceptives can be used to manipulate or shorten menstrual flow, but this practice comes with potential health risks and implications.

Some women use birth control pills, patches, rings, or injections to skip periods or make them lighter and less frequent. This is sometimes called ‘menstrual suppression’ or ‘period manipulation.’

The report added that common methods used for this purpose are combined hormonal contraceptives containing estrogen and progesterone. They work by preventing ovulation and thinning the uterine lining, which leads to lighter, shorter, or no periods.

The effectiveness and satisfaction rates of these methods vary based on the type of contraceptive used and individual experiences.

Hormonal Intrauterine Devices (IUDs) are notably effective for menstrual suppression. Studies indicate that after one year of use, approximately 20 per cent to 50 per cent of women experience amenorrhea (complete cessation of menstruation).

Though another method, Progestin-Only Pills (Mini-Pills), can aid in menstrual suppression, they often lead to irregular bleeding patterns. Up to 70 per cent of users report breakthrough bleeding, and one-third to one-half experience prolonged periods.

A study conducted in a secondary health facility in Kebbi State revealed that among women who used contraceptives, 87.5 per cent reported satisfaction with their chosen method.

However, many women who use contraceptives also express dissatisfaction, primarily due to side effects, complexity of use, or concerns about reliability.

Despite their potential benefits, various factors limit the widespread use of contraceptives for menstrual suppression in Nigeria. Many women remain wary of possible side effects, including weight gain, irregular bleeding, and concerns about long-term fertility.

These fears—often fueled by misinformation or lack of proper medical guidance—discourage women from exploring contraceptives as a solution to menstrual challenges.

In some communities, contraceptive use is still considered taboo or seen as contrary to religious beliefs. These perceptions can significantly influence women’s decisions, especially in patriarchal households where the husband’s opinion takes precedence.

In such settings, a woman’s autonomy over her reproductive health may be restricted, even when faced with debilitating menstrual symptoms.

The Personal Toll: Ayobami’s story

Ayobami*, 26, worked as a food attendant at a hotel, where her daily routine was demanding and physically draining. But each month, her period represented a battle—one that cost her more than just physical comfort.

Her symptoms were extreme: a swollen vagina, aching legs, splitting headaches, overwhelming fatigue, restlessness, and frequent vomiting. These episodes left her barely able to get out of bed, let alone commute to work.

“There are times I find it hard to get out of bed, let alone make it to work, which is about 30-minute journey from my home, and that causes me to miss workdays every month,” she explained.

Over time, her repeated absences strained her relationship with her employer, who grew less tolerant with each episode. “He usually views my absences as a lack of commitment rather than a battle of forces of nature. I can’t explain in full detail my plight,” she said.

Eventually, Ayobami lost her job.

The dismissal came as a devastating blow. Even worse was the feeling of helplessness—despite trying different medications, her pain persisted, her cycle remained unpredictable, and her quality of life declined.

“I had tried several pain relief drugs, from Felvin to diclofenac and paracetamol, and they have only made my periods fluctuate unpredictably.” All the drugs offered little to no relief. In desperation, Ayobami turned to contraceptive pills, hoping they might offer the relief traditional painkillers failed to provide.

While most women find that using contraceptives in this way is generally safe, studies prove that there are potential adverse effects, including irregular spotting, breakthrough bleeding, headaches, nausea, breast tenderness, and mood changes.

Some are also concerned that suppressing long-term menstruation could mask underlying conditions like endometriosis or uterine fibroids.

A gynaecologist, Unimke Agim, said hormonal contraceptives prescribed by a gynaecologist to treat women with diagnosed menstrual disorders have similar side effects when used for contraceptive purposes.

Mr Agim added that the side effects can include nausea, vomiting, diarrhoea, abnormal menstrual bleeding, mood changes, headaches, migraines, breast tenderness and enlargement, and weight gain, among others.

“For those diagnosed with menstrual abnormalities by a gynaecologist, the use of hormonal contraceptives prescribed to them is effective in regulating and inducing menstruation,” he said.

“Also, access to menstrual health can be limited by several factors, such as finance, religion, and the unavailability of gynaecologists.”

He stated that apart from the use of contraception to space childbirth and give the woman time to return to her baseline state before another pregnancy fully, other situations where contraceptives can be used include patients with endometriosis and polycystic ovarian syndrome.

Other cases are patients undergoing treatment for cancer, and patients with renal disease, where pregnancy is contraindicated.

However, he cautioned that contraceptives should not be used without consulting a doctor, as they can interact with certain medications and have higher failure rates in some cases.

Prevalence of dysmenorrhea

Menstrual pain, also known as dysmenorrhea, is a widespread condition with serious implications for women’s daily lives. In Nigeria, studies show that 70 per cent of adolescent girls and women of reproductive age experience dysmenorrhea, and it is a leading cause of absenteeism.

An online research conducted at a private university revealed that 69.8 per cent of female students suffered from menstrual pain, with 54.5 per cent rating it as moderate and 4.7 per cent experiencing it as severe.

The consequences of this pain go far beyond discomfort. In the same studies, 50.2 per cent reported that the pain disrupted their normal work, 44.8 per cent withdrew socially, and 38.8 per cent struggled to sleep.

Another study emphasised the importance of addressing physical aspects like poor access to water, sanitation, and hygiene facilities, lack of privacy, and inadequate menstrual materials, as well as psychosocial factors related to cultural taboos and stigmas surrounding menstruation, which can lead to embarrassment, stress, and reduced confidence among girls in school.

Elaborating on the causes of menstrual disorders, Idoko Sunday, a reproductive health expert, noted that some causes of irregular menstrual flow include submucous fibroids, which are associated with heavy menstrual flow or bleeding, and endometriosis.

Mr Sunday explained that Combined Oral Contraceptive (COC) pills, implants, and devices inserted in the uterus prevent ovulation and menstruation, and if a woman doesn’t menstruate, then she won’t feel any pain associated with menstrual cramps.

“There are lots of medications that can be used to correct problems associated with menstruation irregularities. Contraceptive devices, including pills containing estrogen and progesterone, can regulate menstrual cycles and reduce pain,” he added.

More cases

Just like Ms Oyebamji, Oluwanifemi, a 25-year-old serving corps member, shared her experience with PREMIUM TIMES. While in camp, she began to notice light spotting a week earlier than expected, attributing it to stress.

Oblivious at first, she only became aware of the spotting when a fellow camp member pointed out the stains on her clothes. Surprised, Ms Oluwanifemi realised the bleeding was real, though she initially thought she was imagining it, feeling just a slight slipperiness.

“The little spotting went on for four days, and it was then that I knew I needed to see a doctor. Before then, I thought it was because the flow was coming in early, but it didn’t show up as a full menstrual flow.”

By the end of camp, Ms Oluwanifemi’s bleeding intensified and persisted all day, stretching over 10 days. Concerned, she went to the hospital, where doctors diagnosed her with a hormonal imbalance. They prescribed a five-day medication to halt the bleeding and planned additional treatment once it stopped.

“The drugs were expensive. I used the drugs, but the bleeding didn’t stop; it was more blood I was seeing. It was more like the drugs increased the volume of blood. It was already 20 days into the bleeding, nonstop.

“After I finished the drugs, it had been over 20 days already, and I went back to the hospital. I did a scan, and they realised it was polyps.”

She explained that the bleeding was the only symptom of the infection, which is around her uterus lining, and required surgery for its removal.

“By the time I had the surgery, I was already 30 days into the bleeding. After the surgery, I had only a little bleeding, and since then, my menstrual flow has become normal,” she added.

READ ALSO: NAFDAC warns against falsified Postinor-2 contraceptives in circulation

Cervical Cancer risk

Speaking on the effects of using contraceptives for menstrual purposes, Mr Agim, the gynaecologist, noted that combined oral hormonal contraceptives have been linked to the risk of cervical cancer when used for longer periods, but also have some protective effects against ovarian cancer.

He advised that both government and non-governmental organisations in the field of reproductive medicine should educate and create awareness about menstrual disorders, their implications, and how to get help.

“Sex education should be introduced in schools, and menstruation and menstrual disorders should be emphasised. This will help women with such problems seek healthcare on time without letting it affect their socio-economic lives.”

Just like Mses Oyebamjia and Oluwanifemi, and countless other Nigerian women, the search for relief from debilitating menstrual symptoms often leads down a complicated, and sometimes risky, path.

Whether it’s turning to contraceptives out of desperation or enduring prolonged bleeding and pain in silence, many women are simply trying to reclaim their bodies and their lives.

Yet, in a country where menstrual health is still wrapped in stigma and misinformation, and where access to accurate information and professional care remains a privilege, not a right.

Until there is widespread education, accessible reproductive healthcare, and a shift in societal attitudes, women will continue to navigate this struggle largely alone—resorting to whatever means they can to find comfort in a system that too often ignores their pain.