| a) For prolonged spotting or
moderate bleeding (equivalent to normal menstruation but longer in duration), the
first approach should be counseling and reassurance. It should be explained that in the
absence of evidence for other diseases, irregular bleeding commonly occurs with NORPLANT®
Implants. If counseling and reassurance are not
sufficient for the woman and the woman wishes to continue NORPLANT® Implants use, the
following management approaches may be tried:
- short term (for 7 to 21 days) combined oral contraceptives
(COCs) or estrogen or
- ibuprofen (or similar non-steroidal anti-inflammatories
other than aspirin).
b) Heavy bleeding (greater than normal
menstruation) is very uncommon with NORPLANT® Implants; it can usually be controlled by
administration of increased doses of COCs or estrogen.
c) If suspected, abnormal conditions which cause prolonged
or heavy bleeding should be evaluated and treated as appropriate.
d) Some prolonged or heavy bleeding may fail to be
corrected. Some women will require removal of NORPLANT® Implants due to medical reasons
for excessive bleeding or due to client's preference.
e) Evaluate and address anemia, as appropriate. Give
nutritional advice on the need to increase the intake of iron containing foods.
f) Do not perform uterine evacuation unless another
medical condition is suspected (vacuum aspiration is generally the preferred method of
uterine evacuation). |
a) NORPLANT® Implants may cause
increased bleeding in some women and decreased bleeding in others, and changes in bleeding
patterns tend to decrease over time.
- NORPLANT® Levonorgestrel
Implants: A Summary of Scientific Data. Monograph. New York, The Population Council,
1990.
- Croxatto HB. Norplant:
Levonorgestrel-releasing contraceptive implant. Annals of Medicine 1993;25:155-160.
- Wang SC, Wu SC, Xin XM, Chen JH, Gao
J. Three years' experience with levonorgestrel-releasing intrauterine device and
Norplant-2 implants: a randomized comparative study. Advances in Contraception
1992;8(2):105-111.
a-b) Bleeding is managed by rebuilding the endometrium
with COCs, or by taking ibuprofen* which blocks prostaglandin synthesis and thus decreases
uterine contractions. (COCs are preferred over estrogen because NORPLANT® Implants
deliver such a low dose of progesterone that the contraceptive effect on the cervical
mucus may be reduced by the addition of estrogen only.)
- Injectable Contraceptives: Their
Role in Family Planning Care. Geneva, World Health Organization, 1990.
- Diaz S, Croxatto HB, Davez M, Belhadj
H, Stern J, Sivin I. Clinical assessment of treatments for prolonged bleeding in users of
NORPLANT® Implants. Contraception 1990;42(1):97-109.
* NOTE: Nonsteroidal anti-inflammatory drugs (e.g.,
ibuprofen) should be used instead of aspirin because of aspirin's stronger and
longer-lasting inhibitory effects on platelet aggregation (aspirin promotes bleeding).
- American Hospital Formulary Service
Drug Information. Bethesda, MD, American Society of Hospital Pharmacists, 1994, p
1208.
- Field CS. Dysfunctional uterine
bleeding. Primary Care 1988;15(3):561-574.
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