Unpredictable bleeding is typically light, and not painful when women use the Nexplanon for contraception. But it is not a treatment failure. Unwanted bleeding, in most cases, is not a reason for removal. It is the leading cause of discontinuation. If this is occurring for you and bothersome here’s some advice.
Expected bleeding patterns on Nexplanon
The biggest study looked at 11 international trials in 923–942 implant users. In those users over a 90-day reference periods, found about 1/3 of women have infrequent light periods. About 1/5 will have no bleeding. Only about 15% of women have bleeding which is prolonged, for 14 or more days. And fewer than 5% will have bleeding off and on frequently. Even those episodes that are quiet irregular overall, the mean number of bleeding/spotting episodes was lower than in normal menstrual cycles, and dysmenorrhea or crampy periods is significantly decreased. It would not be common to be anemic and actually the total blood lost when bleeding is unpredictable/ The total blood loss narrative is favorable even when predictability is poor.
Bleeding will decrease in about 30% of those who have bleeding at 3 months out, and in almost half of patients at 6 months out. So relief is coming. Unfortunately about 30% of women will have slight increased bleeding.
Predictability and natural history
What occurs in the first-3-month pattern is broadly predictive of subsequent years. Favorable early patterns tend to persist through 2 years; those with an unfavorable early pattern have roughly a 50% chance of improvement. Whether you have had children, or are overweight doesn’t seem to predict whether this method will cause you irregular bleeding. Getting the Nexplanon immediately post partum has the same risk factors for irregular bleeding once the uterus returns to it’s normal size. Getting insertion at any time during a menstrual cycle is also at risk. Unlike DMPA, where most users see reduced bleeding within a year, some implant users never get a normal bleeding or a complete lack of periods. So hang in for 3 months, then come in to discuss what you are experiencing, as irregular bleeding is more a side effect of the method not infection or pregnancy. Take a pregnancy test at home if you have any concerns in regard to pregnancy. Removal is rapid, and you are welcome to come for removal at any time if it’s not working out.
Medications for Treating Irregular Bleeding on Nexplanon
We do like to see clients to evaluate whether they need treatment when the bleeding pattern is abnormal, we would screen for an STD if appropriate, and if overdue for a pap this can be done as well. For women reporting heavy or prolonged bleeding if bleeding is heavy or prolonged, complete blood counts can identify iron deficiency or the need to treat with iron. Routine endometrial sampling (biopsy) or pelvic ultrasound is not indicated for typical implant-associated unscheduled bleeding. Recommended first-line options (ACOG/CDC) include one of the NSAIDs for 5–7 days (e.g., mefenamic acid has trial support for shortening bleeding episodes). Adding in a low dose combined oral contraceptive or estrogen for 10–20 days in patients medically eligible for estrogen can work as well. Progesterone only contraceptives can be effective as an add in to halt that unpredictable bleeding in some cases.
