Management of bleeding irregularities among etonogestrel implant users: Is combined oral contraceptives pills or nonsteroidal anti‐inflammatory drugs the better option?

Abstract

Aim This study is to evaluate whether unacceptable bleeding among the etonogestrel implant user could be better alleviated using combined oral contraceptive pills (COCP) or nonsteroidal anti‐inflammation drugs (NSAID). Methods This is a prospective randomized study for evaluation of 84 etonogestrel implant (Implanon) users with prolonged or frequent bleeding. They were assigned to either receiving a COCP containing 20 mcg ethinyl estradiol/150 mg desogestrel for two continuous cycle or NSAID; mefenamic acid 500 mg TDS for 5 days, 21 days apart for two cycles. Bleeding pattern during the treatment was recorded and analyzed. Results A total of 32 women (76.2%) in COCP group and 15 women (35.7%) in NSAID group stop bleeding within 7 days after the initiation of treatment which was statistically significant (P < 0.05). The mean duration of bleeding and spotting days in women treated with COCP was significantly lesser compared to NSAID group (7.29 ± 3.16 vs 10.57 ± 4.14 days (P < 0.05). Conclusion We conclude that COCP is more efficient compared to NSAID in managing bleeding irregularities among etonogestrel implant users.

Safety and Benefits of Contraceptives Implants: A Systematic Review

“…A total of 32 women (76.2%) in the OC group and 15 women (35.7%) in the nonsteroidal anti-inflammatory drugs (NSAID) group stopped bleeding within 7 days after the initiation of treatment (p < 0.05). The mean duration of bleeding and spotting days in women treated with OC was significantly lower compared to the NSAID group (7.29 ± 3.16 vs. 10.57 ± 4.14 days (p < 0.05) [70]. Thus, OCs represent a manageable and effective treatment in order to control irregular bleeding in Implanon users.…”

“…In a prospective cross-sectional study, Lazorwitz et al [66] studied 350 healthy, reproductive-aged women using ENG implants for 12-36 months, showing that 20% received a prescription for OCs [69]. In a prospective randomized study [70], 84 Implanon users with prolonged or frequent bleeding were assigned to receive OCs containing Ethinlestradiol (EE2) 20 mcg/150 mg DSG for two cycles. A total of 32 women (76.2%) in the OC group and 15 women (35.7%) in the nonsteroidal anti-inflammatory drugs (NSAID) group stopped bleeding within 7 days after the initiation of treatment (p < 0.05).…”

Subcutaneous etonogestrel implant combined with endometrial ablation for the treatment of adenomyosis: two case reports

“…10 In another study of 942 women, the implant was removed in 98 patients (10.4%) due to bleeding irregularities. 11 Although some medications, such as oral contraceptives 12 and tamoxifen, 13 have been proven to be helpful in managing bleeding irregularities, they are not effective for all patients, as observed with the second patient in this report.…”

Manejo farmacológico del sangrado irregular no menstrual asociado al uso de implantes anticonceptivos subdérmicos

“…Utilizamos el motor de búsqueda de MEDLINE (PubMed), usando desde términos generales como 'Metrorrhagia' (Mesh) y 'Long-Acting Reversible Contraception' (Mesh) a búsquedas más específicas como 'treatment bothersome bleeding for implant users' e 'Implanon bleeding management', y aplicando los filtros para seleccionar ensayos clínicos aleatorizados (ECA), revisiones sistemáticas y/o metaanálisis. Uno de los artículos resultó ser una revisión Cochrane publicada en el año 2013 1 por lo que, además de seleccionar este trabajo, decidimos enfocarnos luego en publicaciones posteriores a esa fecha y seleccionamos cuatro estudios adicionales [2][3][4][5] . la tasa de embarazos no deseados así como en la tasa de abortos inducidos 6 .…”

“…Objetivo. Comparar la eficacia de los ACO y los AINE en el tratamiento de las irregularidades del sangrado en usuarias de implantes anticonceptivos de etonogestrel 4 .…”