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No. Amenorrhea is unusual in CIC users. Also, amenorrhea is not a contra-indication to continuing use of CICs, even in the case of extended amenorrhea. However, some women may choose to stop CICs and their wishes should be respected.
Emphasis should be on counseling, including reassurance that amenorrhea with combined injectables is safe.
If symptoms or other reasons to suspect pregnancy exist, evaluate accordingly.
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Amenorrhea is expected to occur in up to 3% of CIC users.
Even when amenorrhea is present, pregnancy is an unlikely possibility provided that the injections have been given at the appropriate interval. In Latin America, the experience with Cyclofem showed no pregnancies in more than 10,000 women-months of use, and only 2 pregnancies in more than 10,000 women-months of use with Mesigyna. In Egypt, there were 2 and 4 pregnancies in over 10,000 women-months of use in women using Cyclofem and Mesigyna, respectively.
Bleeding variations tend to decrease with time. Approximately 70% of combined injectables users experience regular monthly vaginal bleeding by the end of 1 year of use.
- Fraser I. Vaginal bleeding patterns in women using once-a-month injectable contraceptives. Contraception 1994;49(4):399-420.
- World Health Organization, Task Force on Long-acting Systemic Agents for Fertility Regulation, Special Programme of Research, Development and Research Training in Human Reproduction. A multicentred phase III comparative study of 2 hormonal contraceptive preparations given once-a-month by intramuscular injection: I. contraceptive efficacy and side effects. Contraception 1988;37:1-20.
- Koetsawang S. Once-a-month injectable contraceptives: efficacy and reasons for discontinuation. Contraception 1994;49(4):387-98.
- World Health Organization. Facts about once-a-month injectable contraceptives: memorandum from a WHO meeting. Bulletin of the World Health Organization 1993;71(6):677-89.
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