title: Vaginal bleeding disturbances and implantable contraceptives.
abstract: Implantable contraceptives allow safe and effective fertility regulation for up to 5 years. Currently available devices release low doses of progestogens. Disruption of vaginal bleeding patterns is almost inevitable, particularly during the initial months of use. Irregular and prolonged bleeding as well as amenorrhea are common. Irregular bleeding is unpopular with most women and unacceptable to some. This review describes the vaginal bleeding disturbances induced by modern implantable contraceptives and discusses the implications of these in terms of method use and discontinuations. The cause of the irregular bleeding is not fully understood, but recent evidence suggests that an increase in endometrial vascular fragility might precipitate vessel breakdown and, hence, breakthrough bleeding. This review discusses this evidence and outline the possible mechanisms underlying breakthrough bleeding associated with implantable contraceptives. In addition, therapies for bleeding disturbances are described and their efficacy reviewed.
authors.affiliation: Department of Reproductive Science and Medicine, Imperial College School of Medicine at St. Mary's, London W2 1PG, UK. m.hickey@ic.ac.uk
authors.forename: Martha
authors.initials: M
authors.lastname: Hickey
authors.forename: Catherine
authors.initials: C
authors.lastname: d'Arcangues
mesh_terms: D003271:Contraceptive Agents, Female / Q000009:adverse effects*; D004343:Drug Implants; D004717:Endometrium / Q000098:blood supply / Q000187:drug effects* / Q000502:physiology; D004967:Estrogens / Q000627:therapeutic use; D005260:Female; D006487:Hemostasis / Q000187:drug effects; D006801:Humans; D008599:Menstruation Disturbances / Q000139:chemically induced; D018919:Neovascularization, Physiologic / Q000187:drug effects; D010053:Ovary / Q000187:drug effects / Q000502:physiology; D045167:Progesterone Congeners / Q000009:adverse effects*; D014592:Uterine Hemorrhage / Q000139:chemically induced* / Q000188:drug therapy / Q000473:pathology; D014654:Vascular Patency / Q000187:drug effects
chemical_list: D003271:Contraceptive Agents, Female; D004343:Drug Implants; D004967:Estrogens; D045167:Progesterone Congeners