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Contraception - Management
What should I advise women about menstrual irregularities when they use the progestogen-only implant?
- A woman who experiences heavy or prolonged bleeding may be treated by:
- Treating with a combined oral contraceptive (either cyclically or continuously) for up to 3 months
- Changing another contraceptive method.
- Amenorrhoea is a common adverse effect of the implant, and is not harmful.
- Exclude or manage other situations which could result in unscheduled bleeding, such as:
- Sexually transmitted infections.
- Risk of STI if the woman is under 25 years, or has a new sexual partner, or more than one partner in the last year.
- Pregnancy.
- Gynaecological conditions such as cervical cancer. Speculum examination is warranted:
- For persistent bleeding beyond the first 3–6 months of use.
- For new symptoms or a change in bleeding after at least 3 months of use.
- If the woman has not participated in a National Cervical Screening programme.
- If requested by the woman.
- After a failed trial of modification of treatment.
- If there are other symptoms such as pain, dyspareunia, or post coital bleeding. (Note that these symptoms also warrant pelvic examination.)
In depth
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