Is it common to not get a period when using a birth control implant, such as Nexplanon (etonogestrel)?

Amenorrhea with Birth Control Implants

Yes, it is very common to not get a period when using a birth control implant like Nexplanon (etonogestrel). Approximately 22% of women using etonogestrel implants experience amenorrhea (absence of menstrual periods) 1, 2.

Understanding Bleeding Patterns with Implants

• Implants like Nexplanon cause various bleeding pattern changes, with amenorrhea being one of the most common patterns 3
• According to pooled data from 11 clinical trials, women using etonogestrel implants experience:
  • Amenorrhea (no bleeding): 22.2% 2
  • Infrequent bleeding: 33.6% 2
  • Frequent bleeding: 6.7% 2
  • Prolonged bleeding: 17.7% 2
• In 75% of reference periods, the number of bleeding/spotting days with implants is fewer than or comparable to those during a natural menstrual cycle 2

Why Amenorrhea Occurs

• The etonogestrel in Nexplanon primarily works by suppressing ovulation 4
• This hormonal effect can lead to thinning of the endometrial lining, resulting in light bleeding or no bleeding at all 3
• The bleeding pattern experienced in the first three months of use is broadly predictive of future patterns for many women 2

Is Amenorrhea Harmful?

• Amenorrhea with implant use is generally not harmful and does not require medical treatment 3, 1
• Healthcare providers should provide reassurance to patients experiencing amenorrhea 3, 1
• Only if a woman's regular bleeding pattern changes abruptly to amenorrhea should pregnancy be ruled out (if clinically indicated) 3

Management of Amenorrhea with Implants

• Before implant insertion, healthcare providers should counsel patients about potential changes in bleeding patterns, including the possibility of amenorrhea 3
• No routine follow-up visit is required specifically for amenorrhea 3
• If amenorrhea persists and the woman finds it unacceptable, providers should:
  • Provide reassurance that it is a common and expected side effect 1
  • If the patient remains concerned, counsel on alternative contraceptive methods 3
  • Offer another contraceptive method if desired 3

When to Consider Further Evaluation

• If amenorrhea is accompanied by other concerning symptoms 1
• If there are abrupt changes in bleeding patterns that might suggest other pathologies 1
• If symptoms like pelvic pain or abnormal vaginal discharge are present 1

Important Considerations

• Proper counseling before insertion about possible bleeding changes can improve continuation rates 1, 2
• Bleeding patterns may or may not improve with continued implant use 3
• Unlike some other continuous hormonal methods, it is not clear that implant users experience improved bleeding patterns over time 3
• Individual bleeding experiences are highly variable 3

Remember that while amenorrhea is common and generally not harmful, any abrupt change in bleeding patterns should be evaluated to rule out pregnancy or other gynecological conditions if clinically indicated 3, 1.