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US Selected Practice Recommendations for Contraceptive Use, 2016

Appendix E: Management of Women with Bleeding Irregularities While Using Contraception*

  Appendix E shows a flow chart describing the management of women with bleeding irregularities while using contraception.

Abbreviations: CHC = combined hormonal contraceptive; COC = combined oral contraceptive; Cu-IUD = copper-containing intrauterine device; DMPA = depot medroxyprogesterone acetate; LNG-IUD = levonorgestrel-releasing intrauterine device; NSAIDs = nonsteroidal antiinflammatory drugs.

*If clinically warranted, evaluate for underlying condition. Treat the condition or refer for care. Heavy or prolonged bleeding, either unscheduled or menstrual, is uncommon among LNG-IUD users and implant users.