Unanticipated bleeding with the etonogestrel implant: advice and therapeutic interventions

New Zealand women’s experience during their first year of Jadelle® contraceptive implant

“…10 Clinicians need to demonstrate a proactive approach to the management of bleeding problems by recommending medication as soon as a woman indicates there is a problem. 11 The best approach is to prescribe the combined oral contraceptive pill. 12 Women with no contraindications to oestrogen can take a pill containing ethinylestradiol 30 mg and levonorgestrel 150 mg (Ava 30®) either cyclically or continuously, for a few months or throughout the lifetime of the implant.…”

Strengthening implant provision and acceptance in South Africa with the ‘Any woman, any place, any time’ approach: An essential step towards reducing unintended pregnancies

“…[48][49][50] Intervene as soon as possible when bleed ing is presented as a problem. Often, when women do return to the clinic for advice about side-effects, they are simply told to 'persevere' or 'wait and see'; [44,51] yet, these encounters are critical, as they may be the final chance for supporting continuation of the method. The large majority of patients who present with problems subsequently remove the device.…”

Comment on ‘Unanticipated bleeding with the etonogestrel implant: advice and therapeutic interventions’: author's response

“…I note that when they prepared their training and interventions, they advised either use of the combined oral contraceptive pill (COC) or the progestogen-only pill (POP) for the management of troublesome bleeding. Both Faculty of Sexual & Reproductive Healthcare guidance3 and our commentary1 cite the use of the COC but not the POP as the main intervention for implant bleeding. There is no evidence that the POP used in this manner is effective, even though anecdotally it is occasionally used.…”

“…I would like to thank Drs Ronghe and Welsh for their response to our commentary1 and for sharing their audit results 2. I note that when they prepared their training and interventions, they advised either use of the combined oral contraceptive pill (COC) or the progestogen-only pill (POP) for the management of troublesome bleeding.…”