problematic bleeding with hormonal contraception

Question 1

what is the definition of ‘frequent bleeding’

Answer 1

> 5 bleeding episodes within reference period (90 day period during use of hormone)

Question 2

what is definition of infrequent bleeding?

Answer 2

<3 bleeding episodes within reference period (90 day period during use of hormone)

Question 3

what is the definition of prolonged bleeding?

Answer 3

bleeding episode lasting more than 14 days

Question 4

how much LNG does the mirena contain?

What percentage of women experience decreased menstrual loss in 1 year of its use?

Answer 4

mirena = 52mg LNG.

90% women have reduced menstrual loss over 12/12

Question 5

what percentage women become amenorrhoeic with mirena coil after 3 years of use?

Answer 5

24%

Question 6

ho much LNG does jaydess coil contain?

Answer 6

13.5mg

Question 7

with the Jaydess coil, what % women become amenorrhoeic after 3 years use?

Answer 7

13%

Question 8

in the first 3 months of use, what percentage women will have irregular bleeding with combined hormone contraceptive?

Answer 8

20%

Question 9

with regards to combined hormone contraceptive (pill/patch/ring) which may provide better cycle control (reduce unscheduled bleeding)

Answer 9

nuvaring

Question 10

which type of estrogen in the combined pill is associated with shorter lighter bleeds?

Answer 10

estradiol assoc with shorter lighter bleeds compared with EE

Question 11

after 1 year using DSG POP, what percentage of women are amenorrhoeic/ infrequent bleeding?

Answer 11

50%

Question 12

after 1 year using DSG POP, what percentage have bleeding/spotting lasting more than 14 days?

Answer 12

20%

Question 13

what percentage women are amenorrhoeic after 12/12 wth the depot injection?

Answer 13

50%

10% women may become amenorrhoeic within 3/12 of using

Question 14

with regards to implant, what does the initial bleeding pattern tell you about long term use?

Answer 14

bleeding pattern in first 3/12 is predictive of future bleeding

Question 15

what percentage women become amenorrhoeic with the implant?

what percentage get infrequent bleeding?

Answer 15

20%

30% women get infrequent bleeding

Question 16

if woman experiences unscheduled bleeding after 3/12 use with CHC containing EE, what could be done to help this?

Answer 16

increase dose of EE up to 35mcg

Question 17

if woman experiences unscheduled bleeding with the implant/ injectable / IUS, what 3 things could be tried?

Answer 17

1. add in a first line COC containing 30-35mcg EE, for up to 3 months- continuous or cyclical
2. if using depot injection, could consider 10 week interval instead of 12 weeks
3. could try mefanamic acid/ tranexamic acid for short term relief with depot injection

Question 18

under what circumstances would you undertake pipelle biopsy for irregular bleeding?

Answer 18

1. persistent intermenstrual bleeding
2. Age >45 with treatment failure/ change in bleeding pattern
3. age <45 with persistent bleeding problems + risk factors for endometrial ca (obesity, T2DM, PCOS)