Contraception Knowledge Centre
Case Study
LARC: the advantages, bleeding patterns and potential side effects
Resource Text
All LARC methods are extremely effective, long acting and 'forgettable”'so suit your patient, who wants reliable contraception but due to shift work has been having difficulty remembering to take a pill.
Depo-Provera
Bleeding pattern
The usual menstrual bleeding pattern is as follows.
- Irregular bleeding and spotting is common for the first three months.
- No bleeding is common, persistent bleeding may occur.
- Irregular bleeding may continue for some months after stopping the injections.
Side effects
The following side effects may be experienced.
- Patients may gain two to three kilograms in weight over one year.
- There is a small loss of bone mineral density (BMD), largely reversible on stopping. The Committee on Safety of Medicines (CSM) has advised evaluating benefits against risks for all women at two years of use.
- There is potential delay in return to full fertility of approximately a year since the last injection.
- Other possible side effects include headaches, abdominal discomfort and bloating, dizziness, acne, tender breasts, and changes in mood and sex drive. Whilst the Depo-Provera SPC advises that women with a history of depression should be monitored, the National Institute for Health and Clinical Excellence (NICE) concluded that there is little effect on headaches, acne or changes in mood.
Figure 2: Summary of depo provera points for patients.
Depo Provera
-
Bleeding pattern
- irregular for 3 months (may continue)
- no bleeding
- Persistent bleeding
-
Side effects
- weight gain
- small loss of BMD (reversible on stopping)
- delay in return to full fertility
Implanon
Bleeding pattern
The usual menstrual bleeding pattern is as follows.
- Bleeding pattern is likely to remain irregular, 20% have amenorrhoea.
Side effects
The following side effects may be experienced.
- Acne may occur.
- Other possible side effects include headaches, weight gain, tender breasts, bloating, and changes in mood and sex drive. (But again, NICE found no effect on headaches, weight, change in mood or sex drive).
The implant needs a minor surgical procedure with local anaesthetic to have it fitted and removed.
Figure 3: Summary of implanon points for patients.
Implanon
-
Bleeding pattern
- irregular (20% amenorrhoeic)
-
Side effects
- can cause acnen
- debate over headaches, weight gain, change in mood/sex drive
IUS
Bleeding pattern
The usual menstrual bleeding pattern is as follows.
- Irregular bleeding and spotting is common for the first six months.
- Light or no bleeding is likely by 12 months.
Side effects
The following side effects may be experienced.
- Acne may occur.
- There may be temporary side effects such as headaches and breast tenderness for the first few months.
- There may be minimal change in mood or sex drive.
- Ovarian cysts may occur.
- Fitting of an IUS involves risk of perforation, infection and expulsion.
- If a pregnancy occurs with an IUS in place there is a small increased risk of ectopic pregnancy.
Figure 4: Summary of IUS points for patients.
IUS
-
Bleeding pattern
- irregular/spotting for 6 months
- light/no bleeding by 12 months
-
Side effects
- can cause acne
- headaches, breast tenderness (first few months)
- minimal change in mood/sex
- ovarian cysts may occur
- fitting and expulsion risks
- small increase risk of ectopic
IUD
Bleeding pattern
The usual menstrual bleeding pattern is as follows.
- Heavier bleeding and increased dysmenorrhoea are likely.
Side effects
The following side effects may be experienced.
- There may be minimal change in mood or sex drive.
- Fitting of an IUD involves risks of perforation, infection and expulsion.
- If a pregnancy occurs with an IUD in place there is a small increased risk of ectopic pregnancy.
Figure 5: Summary of IUD points for patients.
IUD
-
Bleeding pattern
- heavier bleeding
- increased dysmenorrhoea
-
Side effects
- minimal change in mood/sex
- fitting and expulsion risks
- small increase risk of ectopic
Further Reading
- Long-acting reversible contraception: NICE guideline
- Family Planning Association (fpa)
- IUD (patient information)
- Contraceptive Choices (patient information)
- BMD and Depo-Provera
- Counselling teens and young women on Depo-Provera
- An assessment of the first 3 years' use of Implanon in Luton
- Australian women's experience with Implanon
| Question | Answer | Feedback |
|---|---|---|
| Depo-Provera never causes weight gain. | True False |
Please select an answer. The correct answer is - False [your answer:? ] Users of Depo-Provera may gain two to three kilograms in weight over one year. |
| The BMD loss associated with Depo-Provera is largely reversible when the method is stopped. | True False |
Please select an answer. The correct answer is - True [your answer:? ] There is a small loss of BMD with the use of Depo-Provera which is largely reversible on stopping. The committee on Safety of Medicines (CSM) has advised evaluating benefits against risks for all women at two years of use. See "Further Reading" for more information (BMD and Depo-Provera) |
| What is the rate of amenorrhoea associated with use of Implanon? | 10% 20% 30% 40% |
Please select an answer. The correct answer is - 20% [your answer:? ] The bleeding pattern associated with Implanon is unpredictable; 20% will be amenorrhoeic. |
| When counselling a patient about Implanon it is important to discuss the procedure involved in fitting and removing the implant. | True False |
Please select an answer. The correct answer is - True [your answer:? ] It is important to include this in your counselling process. The fitting and removal are usually straightforward but the patient needs to consent to both before an implant is fitted. |
| Irregular menstrual bleeding and spotting are common with the IUS for how long? | 1 Month 6 Months 12 Months |
Please select an answer. The correct answer is - 6 Months [your answer:? ] Irregular bleeding and spotting are common for the first six months of use with the IUS; it is likely that there will be light or no bleeding by 12 months. |
| The IUS is associated with a reduced rate of ovarian cysts. | True False |
Please select an answer. The correct answer is - False [your answer:? ] Ovarian cysts may occur with the IUS. |
| An IUD is a good contraceptive choice for a woman who is troubled by heavy painful periods | True False |
Please select an answer. The correct answer is - False [your answer:? ] Heavier bleeding and increased dysmenorrhoea are likely with the IUD so it would not be a good contraceptive choice for a woman who is already troubled by heavy painful periods. |
| When counselling a woman about any coil (IUD) insertion it is important to discuss the risks of perforation, infection and expulsion. | True False |
Please select an answer. The correct answer is - True [your answer:? ] Although rare, these potential complications should form part of your routine counselling in all cases. |
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