August 2009 · Vol. 21, No. 08UPDATE: CONTRACEPTION
Unpredictable bleeding with progestin-only contraceptives can lead to dissatisfaction and discontinuation. The authors scrutinize the reported experience with bleeding changes to help you better counsel your patients.
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Fast Track
Studies show that changes in menstrual bleeding patterns can cause dissatisfaction with any contraceptive method
The main cause of the irregular and unpredictable bleeding seen with the ENG implant is probably progestin-related changes in the endometrium
80% of users of the ENG implant continue to use it after 1 year, despite unpredictable bleeding
Forty percent of women who use a progestin-only pill have short, irregular cycles; another 10% experience even more markedly irregular cycles—from spotting to amenorrhea
Most women who use progestin-only methods do so because of efficacy and ease of use—not because of any contraindication to estrogen
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Aileen
Gariepy,
MDDr. Gariepy is a Clinical Fellow in Family Planning, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pa. Mitchell
D.
Creinin,
MDDr. Creinin is Director of Gynecologic Specialties and Director of Family Planning, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pa.
Dr. Gariepy reports no financial relationships relevant to this article. Dr. Creinin reports that he is a consultant to, and a speaker for, Schering-Plough.
Progestin-only contraception—a diverse group of oral (progestin-only pills, or so-called minipills), injectable (depot medroxyprogesterone acetate), intrauterine (the levonorgestrel intrauterine system), and implantable (etonogestrel implant) methods—may offer advantages over estrogen-containing contraception:
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