Unscheduled bleeding and contraceptive choice: increasing satisfaction and continuation rates

Abstract

Approximately half (51%) of the 6.6 million pregnancies in the US each year are unintended and half of those pregnancies (54%) occur among women not using contraception. Many women discontinue their contraceptives due to method dissatisfaction. Bothersome unscheduled bleeding is one of the main reasons cited by women for stopping a birth control method. Improving counseling and management of these side effects will aide in increasing satisfaction with contraceptive methods. The following review will discuss the bleeding profiles associated with the contraceptive options available in the US. A valuable resource from the Centers for Disease Control and Prevention, the US Selected Practice Recommendations for Contraceptive Use, will be introduced. Definitions of the types of unscheduled bleeding are included, as well as strategies for treatment for each contraceptive method. The evidence whether or not anticipatory counseling increases continuation rates will also be reviewed.

Keywords: contraception; drug treatment; patient satisfaction; unscheduled uterine bleeding.

Figure 1

Management of women with bleeding irregularities while using contraception. Notes: ^#If clinically warranted, evaluate for underlying condition. Treat the condition or refer for care. *Not recommended during first 21 days of extended or continuous pill or ring use; not recommended more than once per month because contraceptive effectiveness may be reduced. Adapted from: cdc.gov [homepage on the Internet]. U.S. Selected Practice Recommendations for Contraceptive Use, 2013: Centers for Disease Control and Prevention; 2013. Available from: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6205a1.htm. Accessed February 5, 2016. Abbreviations: Cu-IUD, copper intrauterine device; LNG, levonorgestrel; DMPA, depot medroxyprogesterone acetate; CHC, combined hormonal contraceptive; NSAIDs, non-steroidal anti-inflammatory drugs.