The management of unacceptable bleeding patterns in etonogestrel-releasing contraceptive implant users

The aim of this guidance is to review the management of unacceptable vaginal bleeding patterns in etonogestrel (ENG)-releasing contraceptive implant users concentrating, where possible, on the evidence for pharmacological treatments and identifying a pragmatic approach where this is not possible. This article was developed in accordance with methodology used for producing Royal College of Obstetricians and Gynaecologists' Green Top Guidelines. The Cochrane Library (including the Cochrane Database of Systematic Reviews, DARE and EMBASE) and Medline (1966-2010) were searched using the relevant MeSH terms, including all subheadings, and this was combined with a keyword search. Search words included "progestogen only contraceptives," "contraceptive implants," "progestogen implants," "etonogestrel implants," "irregular bleeding," "unpredictable bleeding," "bleeding irregularity" and "bleeding pattern," and the search was limited to humans and English language. Enquiries for relevant information were also made to the pharmaceutical industry and researchers for missing studies. Although this is not a systematic review, two of the authors (D.M., I.S.F.), qualitatively assessed those papers reporting quantitative results involving treatments given either to stop or prevent bleeding in ENG or levonorgestrel contraceptive implants users.