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

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If bleeding persists, or if the woman requests it, medical treatment can be considered.

Cu-IUD users

LNG-IUD users

Implant users

Injectable (DMPA) users

CHC users (extended or continuous regimen)

For unscheduled spotting or light bleeding or for heavy or prolonged bleeding: NSAIDs (5-7 days of treatment)

For unscheduled spotting or light bleeding or for heavy or prolonged bleeding:

– NSAIDs (5-7 days of treatment)

– Hormonal treatment (if medically eligible) with COCs or estrogen (10-20 days of treatment)

For unscheduled spotting or light bleeding: NSAIDs (5-7 days of treatment)

For heavy or prolonged bleeding:

– NSAIDs (5-7 days of treatment)

– Hormonal treatment (if medically eligible) with COCs or estrogen (10-20 days of treatment)

Hormone-free interval for 3-4 consecutive days

Not recommended during the first 21 days of extended or continuous CHC use

Not recommended more than once per month because contraceptive effectiveness might be reduced

If bleeding disorder persists or woman finds it unacceptable

Counsel on alternative methods and offer another method, if desired.

Cu-IUD users

For unscheduled spotting or light bleeding or for heavy or prolonged bleeding: NSAIDs (5-7 days of treatment)

If bleeding disorder persists or woman finds it unacceptable

Counsel on alternative methods and offer another method, if desired.

LNG-IUD users

If bleeding disorder persists or woman finds it unacceptable

Counsel on alternative methods and offer another method, if desired.

Implant users

For unscheduled spotting or light bleeding or for heavy or prolonged bleeding:

– NSAIDs (5-7 days of treatment)

– Hormonal treatment (if medically eligible) with COCs or estrogen (10-20 days of treatment)

If bleeding disorder persists or woman finds it unacceptable

Counsel on alternative methods and offer another method, if desired.

Injectable (DMPA) users

For unscheduled spotting or light bleeding: NSAIDs (5-7 days of treatment)

For heavy or prolonged bleeding:

– NSAIDs (5-7 days of treatment)

– Hormonal treatment (if medically eligible) with COCs or estrogen (10-20 days of treatment)

If bleeding disorder persists or woman finds it unacceptable

Counsel on alternative methods and offer another method, if desired.

CHC users (extended or continuous regimen)

Hormone-free interval for 3-4 consecutive days

Not recommended during the first 21 days of extended or continuous CHC use

Not recommended more than once per month because contraceptive effectiveness might be reduced

If bleeding disorder persists or woman finds it unacceptable

Counsel on alternative methods and offer another method, if desired.

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.

Pages in this Report

  1. Table of Contents
  2. US SPR 2016
  3. Introduction
  4. How To Be Reasonably Certain that a Woman Is Not Pregnant
  5. Intrauterine Contraception
  6. Implants
  7. Injectables
  8. Combined Hormonal Contraceptives
  9. Progestin-Only Pills
  10. Standard Days Method
  11. Emergency Contraception
  12. Female Sterilization
  13. Male Sterilization
  14. When Women Can Stop Using Contraceptives
  15. Conclusion
  16. References
  17. Summary Chart of U.S. Medical Eligibility Criteria for Contraceptive Use, 2016
  18. When To Start Using Specific Contraceptive Methods
  19. Examinations and Tests Needed Before Initiation of Contraceptive Methods
  20. Routine Follow-Up After Contraceptive Initiation
  21. ›Management of Women with Bleeding Irregularities While Using Contraception
  22. Management of Intrauterine Devices When Users are Found To Have Pelvic Inflammatory Disease
  23. Participants
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