What are the management options for prolonged bleeding on Nexplanon (etonogestrel)

From the Guidelines

Prolonged bleeding on Nexplanon can be managed with non-hormonal and hormonal treatments, and if bleeding persists, alternative contraceptive methods should be considered. The management of prolonged bleeding on Nexplanon involves several steps, including ruling out underlying gynecological problems, such as interactions with other medications, STDs, pregnancy, or new pathologic uterine conditions, as recommended by the U.S. Selected Practice Recommendations for Contraceptive Use, 2013 1. If no underlying condition is found, treatment options during days of bleeding can include:

• NSAIDs for short-term treatment (5–7 days)
• Hormonal treatment (if medically eligible) with low-dose COCs or estrogen for short-term treatment (10–20 days) Key considerations for managing prolonged bleeding on Nexplanon include:
• Identifying and treating any underlying gynecologic problems
• Offering alternative contraceptive methods if bleeding persists
• Counseling patients on the potential for bleeding patterns to improve after 3-6 months of Nexplanon use It is essential to prioritize the patient's quality of life and consider alternative contraceptive methods if bleeding remains problematic despite interventions, as suggested by the U.S. Selected Practice Recommendations for Contraceptive Use, 2013 1.

From the Research

Management Options for Prolonged Bleeding on Nexplanon (Etonogestrel)

• Prolonged bleeding is a common side effect of hormonal contraception, including Nexplanon (etonogestrel) 2.
• The evaluation of abnormal uterine bleeding in women using hormonal contraception includes an assessment of compliance, a thorough history and complete physical examination to exclude organic causes of bleeding, and a targeted laboratory evaluation 3.
• Management strategies for women with abnormal uterine bleeding who are using progestin-only contraceptive methods, such as Nexplanon, include:
  • Counseling and reassurance 3, 2.
  • Administration of supplemental estrogen and/or a nonsteroidal anti-inflammatory drug (NSAID) during bleeding episodes 3, 4.
  • Possible use of other medications, such as levonorgestrel, to control bleeding 4.
• The bleeding pattern experienced during the first three months of Nexplanon use is broadly predictive of future bleeding patterns for many women 2.
• Effective preinsertion counseling on the possible changes in bleeding patterns may improve continuation rates 2.
• A pragmatic approach to managing unacceptable bleeding patterns in etonogestrel-releasing contraceptive implant users involves a combination of pharmacological treatments and counseling 5.