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Contraception - Management
What advice should I give about menstrual irregularity to women using a progestogen-only pill (POP)?

  • Menstrual irregularities are common. Some women have frequent or prolonged bleeding, whilst some experience amenorrhoea.
  • Identify and manage causes for bleeding irregularities such as missed pills, drug interactions, vomiting, severe diarrhoea, pregnancy.
  • 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. Provided there is consistent and correct use of contraception, speculum examination is warranted:
      • For persistent bleeding beyond the first 3 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 POP treatment (at least 6–8 weeks).
      • If there are other symptoms such as pain, dyspareunia, or post coital bleeding. (Note that these symptoms also warrant pelvic examination.)
  • If frequent or prolonged bleeding occurs, consider the use of a different progestogen-only pill (POP).
  • If the woman experiences amenorrhoea, exclude pregnancy. The POP can then be continued.

In depth

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