Does Nexplanon (etonogestrel) decrease Premenstrual Syndrome (PMS) symptoms?

Nexplanon's Effect on Premenstrual Syndrome (PMS)

Nexplanon may help reduce PMS symptoms in some women, though it is not specifically FDA-approved for this indication. The etonogestrel implant can alter hormonal fluctuations that contribute to PMS symptoms by providing continuous progestin release and suppressing ovulation.

Mechanism of Action and PMS

Nexplanon (etonogestrel implant) works primarily by:

• Suppressing ovulation
• Thickening cervical mucus
• Thinning the endometrial lining

These mechanisms, particularly ovulation suppression, can reduce the cyclical hormonal fluctuations that trigger PMS symptoms in many women.

Evidence for PMS Symptom Reduction

The evidence regarding Nexplanon's specific effect on PMS is limited but promising:

• Research indicates that Nexplanon may be useful for the symptomatic treatment of PMS 1
• Progestin-only contraceptives like Nexplanon can alter menstrual patterns and potentially reduce PMS symptoms by modifying the hormonal cycle

Expected Effects on Menstrual Patterns

When counseling patients about Nexplanon's potential impact on PMS, it's important to note the following bleeding pattern changes:

• 22% of women experience amenorrhea (absence of periods)
• 34% experience infrequent spotting
• 7% report frequent bleeding
• 18% report prolonged bleeding 2

These changes in bleeding patterns often correlate with changes in PMS symptoms, as the hormonal fluctuations responsible for both are modified.

Comparison to Other Hormonal Options for PMS

For severe PMS or PMDD (Premenstrual Dysphoric Disorder), other options have more robust evidence:

• Combined oral contraceptives containing drospirenone have been specifically studied for PMDD and show significant improvement compared to placebo 3, 4
• GnRH agonists (without add-back) have high-certainty evidence for improving global PMS symptoms but have significant side effects 5

Common Side Effects of Nexplanon

When considering Nexplanon for PMS management, patients should be informed about potential side effects:

• Irregular bleeding patterns (most common)
• Emotional lability
• Weight gain
• Headache
• Acne 6, 7

Clinical Approach to Using Nexplanon for PMS

1. Assess PMS symptom severity

   • Determine if symptoms are mild, moderate, or severe (PMDD)
   • Consider tracking symptoms prospectively over 2-3 cycles

2. Consider Nexplanon if:

   • Patient desires long-term contraception (3 years)
   • PMS symptoms are mild to moderate
   • Patient prefers a non-estrogen containing option

3. Monitor response:

   • Evaluate PMS symptoms after 3-6 months of use
   • If bleeding irregularities are bothersome and contribute to symptoms, consider short-term treatments:
     • NSAIDs for 5-7 days during bleeding episodes
     • Low-dose combined oral contraceptives for 10-20 days if medically eligible 2

Important Considerations and Limitations

• Individualized response: Not all women will experience PMS symptom improvement with Nexplanon
• Bleeding irregularities: These may be bothersome for some women and could potentially worsen certain aspects of PMS for some individuals
• Limited direct evidence: More research specifically on Nexplanon's effect on PMS is needed

Conclusion

While Nexplanon is not specifically indicated for PMS treatment, its mechanism of action suggests it may help reduce symptoms in many women by suppressing ovulation and altering hormonal fluctuations. For women seeking both contraception and PMS symptom relief, Nexplanon represents a reasonable option, though responses will vary between individuals.