title: Unscheduled vaginal bleeding with progestin-only contraceptive use.
abstract: Nearly 20% of women using contraception are using progestin-only contraception, including progestin-only pills, depot-medroxyprogesterone acetate, subdermal etonogestrel implants, and levonorgestrel intrauterine devices. This number will continue to grow with the increased provision of long-acting reversible contraception. Although overall satisfaction among women using progestin-only contraception is high, dissatisfaction and discontinuation may be associated with unscheduled bleeding and spotting. The exact etiology of irregular bleeding associated with progestin-containing contraceptives is not completely understood, yet several mechanisms have been suggested. Several therapies targeting these mechanisms have been evaluated with mixed results. This paper will review the physiology and management of unscheduled bleeding with progestin-containing contraceptives.
authors.affiliation: Department of Obstetrics and Gynecology, Washington University School of Medicine in St Louis, St Louis, MO; Division of Clinical Research and Family Planning, Washington University School of Medicine in St Louis, St Louis, MO. Electronic address: ziglerr@wudosis.wustl.edu.
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Zigler
authors.affiliation: Department of Obstetrics and Gynecology, Washington University School of Medicine in St Louis, St Louis, MO; Division of Clinical Research and Family Planning, Washington University School of Medicine in St Louis, St Louis, MO.
authors.forename: Colleen
authors.initials: C
authors.lastname: McNicholas
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D003271:Contraceptive Agents, Female / Q000627:therapeutic use; D003278:Contraceptives, Oral, Hormonal / Q000627:therapeutic use; D017135:Desogestrel / Q000627:therapeutic use; D004318:Doxycycline / Q000627:therapeutic use; D004967:Estrogens / Q000627:therapeutic use; D005260:Female; D006727:Hormone Antagonists / Q000627:therapeutic use; D006801:Humans; D007436:Intrauterine Devices, Medicated; D017258:Medroxyprogesterone Acetate / Q000627:therapeutic use; D008796:Metrorrhagia / Q000517:prevention & control*; D015735:Mifepristone / Q000627:therapeutic use; D011372:Progestins / Q000627:therapeutic use; D013629:Tamoxifen / Q000627:therapeutic use; D014148:Tranexamic Acid / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000933:Antifibrinolytic Agents; D003271:Contraceptive Agents, Female; D003278:Contraceptives, Oral, Hormonal; D004967:Estrogens; D006727:Hormone Antagonists; D011372:Progestins; D013629:Tamoxifen; C044815:etonogestrel; D015735:Mifepristone; D014148:Tranexamic Acid; D017135:Desogestrel; D017258:Medroxyprogesterone Acetate; D004318:Doxycycline
keywords: irregular bleeding; long-acting reversible contraception; progestin-only contraception; unscheduled bleeding