title: Management of etonogestrel subdermal implant-related bleeding.
abstract: OBJECTIVE
  To determine removal rates for unacceptable bleeding in etonogestrel subdermal implant (ESI) users treated with reassurance alone as well as in those receiving reassurance plus medical interventions including doxycycline and ibuprofen, and to compare removal rates between ESI users treated with reassurance alone with those receiving the medical interventions listed above in addition to reassurance.
  
  
  METHODS
  Medical records of 391 women receiving ESI for contraception within the period June 2007-April 2011 were abstracted for patient characteristics and interventions including reassurance, doxycycline, and ibuprofen. Removal rates were compared between intervention groups using the chi2 test and multivariable logistic regression.
  
  
  RESULTS
  Contact for bleeding occurred in 128 women (32.7%). Of those, 83 women (21.2% of entire cohort) requested removalfor bleeding (median, 381 days; range, 29-1,078 days). Of 53 women receiving reassurance alone, 40 (75.5%) requested removal, whereas fewer (15 of 33 [45.5%]) women receiving reassurance plus doxycycline requested removal (p = 0.005), even after adjusting for prior contraception use and body mass index at ESI insertion (p = 0.006). Of 10 women receiving ibuprofen and 19 women receiving doxycycline plus ibuprofen, 7 (70.0%) and 11(57.9%), respectively, requested removal for bleeding.
  
  
  CONCLUSIONS
  Reassurance plus doxycycline is associated with lower removal rates for ESI-related bleeding than is reassurance alone.
authors.forename: Petra M
authors.initials: PM
authors.lastname: Casey
authors.forename: Margaret E
authors.initials: ME
authors.lastname: Long
authors.forename: Linda B
authors.initials: LB
authors.lastname: Drozdowicz
authors.forename: Mary L
authors.initials: ML
authors.lastname: Marnach
authors.forename: Amy L
authors.initials: AL
authors.lastname: Weaver
mesh_terms: D000328:Adult; D003271:Contraceptive Agents, Female / Q000008:administration & dosage* / Q000009:adverse effects*; D003376:Counseling; D017135:Desogestrel / Q000008:administration & dosage* / Q000009:adverse effects*; D020878:Device Removal; D004318:Doxycycline / Q000627:therapeutic use; D004343:Drug Implants; D005260:Female; D006801:Humans; D007052:Ibuprofen / Q000627:therapeutic use; D014592:Uterine Hemorrhage / Q000139:chemically induced* / Q000628:therapy*
chemical_list: D003271:Contraceptive Agents, Female; D004343:Drug Implants; C044815:etonogestrel; D017135:Desogestrel; D004318:Doxycycline; D007052:Ibuprofen