Does Implanon Cause Amenorrhea?
Yes, Implanon (etonogestrel implant) commonly causes amenorrhea in approximately 22% of users, and this is a normal, expected side effect that requires no medical treatment—only reassurance. 1
Understanding Amenorrhea with Implanon
Amenorrhea is one of the most common bleeding pattern changes associated with the etonogestrel implant and should be discussed during pre-insertion counseling:
- Approximately 22% of Implanon users will experience amenorrhea, making it a frequent occurrence rather than an abnormal finding 1, 2
- Amenorrhea is generally not harmful and represents the implant's effect on the endometrium rather than a pathological condition 1
- The bleeding pattern experienced during the first 3 months broadly predicts future patterns for many women, though patterns may or may not change with continued use 1, 2
Clinical Management Algorithm
When Amenorrhea Develops:
1. Rule out pregnancy if the pattern changes abruptly:
- If a woman's regular bleeding pattern suddenly shifts to amenorrhea, consider pregnancy testing if clinically indicated 1
- This is particularly important if amenorrhea develops after a period of regular bleeding
2. Provide reassurance:
- Amenorrhea does not require any medical treatment—only patient education and reassurance 1
- Explain that this is an expected side effect affecting roughly 1 in 5 users 1
3. Address patient concerns:
- If amenorrhea persists and the woman finds it unacceptable despite reassurance, counsel her on alternative contraceptive methods and offer another method if desired 1
Pre-Insertion Counseling is Critical
Enhanced counseling before insertion about expected bleeding patterns has been shown to reduce discontinuation rates:
- Discuss that bleeding changes—including amenorrhea, infrequent bleeding, and irregular spotting—are common, especially during the first year 1
- Emphasize that 64% of women experience amenorrhea or infrequent bleeding in clinical trials, representing favorable bleeding patterns for most users 3, 2
- Explain that these changes are not harmful and do not indicate contraceptive failure 1
Common Pitfall to Avoid
The most common mistake is inadequate pre-insertion counseling about bleeding changes. Women who are not prepared for amenorrhea may become anxious about pregnancy or perceive it as abnormal, leading to unnecessary discontinuation of an otherwise highly effective contraceptive method 1, 2. Always discuss the full spectrum of possible bleeding patterns—from amenorrhea to irregular spotting—before insertion to set appropriate expectations.