Review articleThe management of unacceptable bleeding patterns in etonogestrel-releasing contraceptive implant users☆
Introduction
ENG contraceptive implants are becoming an increasingly popular birth control choice with approximately six million women using this method worldwide (data on file, Merck, Sharp, Dohme). This safe, highly effective, long-acting and reversible contraceptive is suitable for most women of reproductive age, with recent guidelines supporting its use in women with a history of venous thromboembolism or congenital and acquired cardiovascular disease [1], [2].
Section snippets
How effective is the ENG contraceptive implant?
Recent data have shown that the ENG implant is one of the most effective reversible contraceptives with a method failure rate of 0.01 per 100 implants fitted [3].
Recent reanalysis of initial trial data and postmarketing reporting figures show ENG implants to be one of the most effective female contraceptives with overall typical failure rates of 0.049 per 100 implants fitted (method failure rate−0.01 per 100 implants fitted) [3]. This has led to some health insurance schemes fully reimbursing
Future directions and areas for research
Future research aimed at understanding the disturbed endometrial mechanisms in women with more extreme, persistent and troublesome symptoms (compared with those who develop amenorrhea or light, infrequent periods) will be critical to eliminate this common cause of premature discontinuation of implant use. A number of theories have been proposed including estrogen withdrawal or estrogen fluctuation but most have concentrated on molecular and cellular mechanisms at the endometrial level. It is
Conclusion
This guidance has reviewed the practical management of unacceptable vaginal bleeding in ENG contraceptive implant users and provided an approach to investigating and stopping a specific episode of troublesome bleeding. Preventing such episodes is more difficult. If progestogen-only implants are to be more widely accepted and continuation rates improved, research must focus on understanding the underlying mechanisms provoking unscheduled endometrial breakdown. This must be allied with the study
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Tamoxifen for the Treatment of Etonogestrel Implant-Associated Bleeding in an Adolescent Gynecology Practice
2022, Journal of Pediatric and Adolescent GynecologyCitation Excerpt :A 2015 randomized control trial similarly found that after a 14-day course of OCPs, 85.7% of patients had implant-associated bleeding recurrence within 10 days after treatment.7 However, there remain few current standardized treatment algorithms to address bothersome bleeding.8 The Centers for Disease Control and Prevention proposes the following for unscheduled spotting, light bleeding, or heavy/prolonged bleeding: NSAIDs for 5–7 days or hormonal treatments with combined oral contraceptives (COCs) or estrogen for 10–20 days.18
The Etonogestrel Implant in Adolescents: Factors Associated With Removal for Bothersome Bleeding in the First Year After Insertion
2021, Journal of Pediatric and Adolescent GynecologyWhich contraceptive side effects matter most? Evidence from current and past users of injectables and implants in Western Kenya
2020, Contraception: XCitation Excerpt :Our findings show that self-reported method-related menstrual bleeding problems are high among both current and past users of injectables (range 69%–79%) and only slightly less common for implants (range 55%–60%). Similar patterns have been observed in several studies in both high- and low-income settings [1,4,6,25]. Injectable or implant use was associated with changes in regular menstrual patterns (heavy bleeding, irregular bleeding and amenorrhea) that may influence method satisfaction, adoption or continuation and, indeed, may impact women's well-being [6,11].
Reproductive Health: Options, Strategies, and Empowerment of Women
2019, Obstetrics and Gynecology Clinics of North AmericaUnscheduled vaginal bleeding with progestin-only contraceptive use
2017, American Journal of Obstetrics and Gynecology
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Competing interests: The authors have received an educational grant from Merck Sharp & Dohme Limited to cover their time and expenses in writing this article. The content is the total responsibility of the authors, and the MSD Company has had no input into any aspect of the review. All authors have been members of national and international pharmaceutical advisory boards and received honoraria for lecturing, expenses for attending scientific conferences and research grants from a number of pharmaceutical companies.