Hormonal Contraception and Regulation of Menstruation: a study of young women’s attitudes towards ‘having a period’. Short running title: young women’s attitudes towards hormonal contraception and menstrual regulation

Background: Irregular bleeding is one of the most common side-effects of hormonal contraception and a key reason for the discontinuation of hormonal methods. Study Design: A qualitative study in which twelve young women were interviewed in-depth, along with six focus group discussions. The study had two main research objectives: to document and investigate what young women think and feel about menstruation and contraception, and to explore young women’s preferences regarding the intersection of contraceptives and bleeding patterns. Results: Although participants held a broad view that menstruation can be an inconvenience, they did ascribe positive values to having a regular bleed. Bleeding was seen as a signifier of non-pregnancy and also an innate part of being a woman. A preference for a ‘natural’ menstruating body was a strong theme, and the idea of selecting a hormonal contraceptive that might stop the bleeding was not popular, unless the young woman suffered with painful natural menstruation. Contraceptives that mimicked the menstrual cycle were acceptable to most suggesting that cyclic bleeding still holds a symbolic function for women. Conclusions: When counselling young women about the effect of different contraceptive modalities on their bleeding, practitioners should explore how the women feel about their bleeding, including how they might feel if their bleeding stopped or if they experienced erratic bleeding patterns. Practitioners also need to recognise the subjective understanding