(This comes from D. Mansour et al, Contraception 2011: 83: 202 – 10, which I have as a handout from a recent course.)
There is very little in the way of hard evidence as to what the batting order should be when it comes to trying treatment for irregular bleeding as an Implanon side-effect. However, this article offered a pragmatic approach, which was:
- COC, given on usual cycle (with 7-day breaks) for up to three months
- Cyclical progestagen – medroxyprogesterone 10 mg bd or norethisterone 5 mg bd, 21 days on and 7 off, for 3 months
- POP, especially Cerazette, for up to three months
- NSAIDs, especially Cox-2 inhibitors, daily for 5 – 10 days (is this the anti-prostaglandin effect? The table didn’t say, but, interestingly, it seemed to be almost the only one that had some actual published evidence supporting its use)
- Tranexamic acid 500 mg bd for 5 days
The idea behind treating irregular bleeding, by the way, is to render the endometrium too atrophic to bleed – a partly atrophic endometrium causes irregular bleeding, which is why POPs tend to cause this pattern of irregular bleeding for a few months which then stops.