Problematic Bleeding

Question 1

What is classed as frequent bleeding

Answer 1

More than 5 bleeding episodes within 90 days

Question 2

What is classed as infrequent bleeding

Answer 2

Fewer than 3 bleeds in 90 days

Question 3

What classifies as prolonged bleeding

Answer 3

Bleeding for 14 days or more

Question 4

What is spotting

Answer 4

Vaginal discharge containing blood that may not require the use of sanitary protection

Question 5

What is classed as amenorrhoea

Answer 5

No bleeding within 90 days

Question 6

What percentage of women have irregular bleeding within the first 3 months of starting COCP CTP CVRs

Answer 6

Up to 20%

Question 7

What bleeding pattern is expected longer term with combined hormonal contraception

Answer 7

• Irregular bleeding usually settles
• No significant difference between COCP and CTP users
• CVR may have less problematic bleeding compared to COC
• Oestradiol COC such as Qlaira or Zoely have reported shorter lighter bleeds and higher rate of absent withdrawal bleeds

Question 8

What bleeding pattern is expected with POP in first 3 months

Answer 8

Unpredictable
Traditional POP 1/3 have a change in bleeding
Desogestrel more likely to cause frequent or prolonged and infrequent bleeding

Question 9

Pop longer term bleeding pattern

Answer 9

May not settle with time
Traditional pop: frequent and irregular bleeding common. Prolonged bleeding and amenorrhoea are less likely

DSG pop: after 12 months of use
Over a 3 month period:
~ 5:10 can expect to be amenorrhoeic or have infrequent bleeding
~4:10 3-5 bleeds or spotting episodes
~ 1:10 can =/>6 bleeding or spotting episodes
~2:10 prolonged bleeding or spotting >14 days

Question 10

What is the likely bleed pattern with PO Injections in first 3 months

Answer 10

Bleeding disturbance (spotting light heavy or prolonged) are common
~1:10 may be amenorrhoeic

Question 11

What is the expected bleed pattern long term with PO Injections

Answer 11

Amenorrhoea rates increase with increase in duration of use and similar between SC and IM

~50% or more are amenorrhoeic at 12 months

Question 12

PO implants likely bleeding pattern in first 3 months

Answer 12

Bleeding disturbance common
Bleed pattern in first 3 months is broadly predictive of future bleeding patterns for many women

Question 13

PO implants likely bleeding pattern long term:

Answer 13

~ 2:10 amenorrhoeic
3:10 infrequent bleeding
<1:10 frequent bleeding
2:10 have prolonged bleeding
75% bleeding/spotting days are fewer than or comparable to those in natural cycle but they occur at unpredictable intervals

Question 14

In what percentage of women that have an IUD/IUS have irregular bleeding after 1 year use

Answer 14

20%

Question 15

Persistent problematic bleeding for more than 3 months or an altered bleeding pattern on established method warrants further assessment using…

Answer 15

History
Examination
Investigation