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  • If Bleeding Persists, or If Woman Requests It, Medical Treatment Can Be Considered

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    Chon Chi
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    This document provides guidance on managing bleeding irregularities for women using various contraceptive methods. It recommends that for unscheduled or heavy bleeding, treatment with NSAIDs or hormonal methods like combined oral contraceptives may be used. If bleeding persists or is unacceptable to the woman, counseling on alternative contraceptive methods should be offered. The document also outlines guidelines for managing an IUD for a woman diagnosed with pelvic inflammatory disease, recommending treating the infection while keeping the IUD in place in most cases.

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    This document provides guidance on managing bleeding irregularities for women using various contraceptive methods. It recommends that for unscheduled or heavy bleeding, treatment with NSAIDs or hormonal methods like combined oral contraceptives may be used. If bleeding persists or is unacceptable to the woman, counseling on alternative contraceptive methods should be offered. The document also outlines guidelines for managing an IUD for a woman diagnosed with pelvic inflammatory disease, recommending treating the infection while keeping the IUD in place in most cases.

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    6 views2 pages

    If Bleeding Persists, or If Woman Requests It, Medical Treatment Can Be Considered

    Uploaded by

    Chon Chi
    This document provides guidance on managing bleeding irregularities for women using various contraceptive methods. It recommends that for unscheduled or heavy bleeding, treatment with NSAIDs or hormonal methods like combined oral contraceptives may be used. If bleeding persists or is unacceptable to the woman, counseling on alternative contraceptive methods should be offered. The document also outlines guidelines for managing an IUD for a woman diagnosed with pelvic inflammatory disease, recommending treating the infection while keeping the IUD in place in most cases.

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    © All Rights Reserved
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    Management of Women with Bleeding Irregularities While Using Contraception*

    If bleeding persists, or if woman requests it, medical treatment can be considered.

    Cu-IUD users Injectable CHC users (extended


    LNG-IUD users Implant users
    (DMPA) users or continuous regimen)

    For unscheduled For unscheduled For unscheduled spotting Hormone-free


    spotting or light spotting or light or light bleeding: interval for 3-4
    bleeding or for heavy bleeding or heavy/ • NSAIDs (5-7 days consecutive days
    or prolonged bleeding: prolonged bleeding: of treatment)
    • NSAIDs (5-7 days • NSAIDs (5-7 days
    of treatment) of treatment) For heavy or prolonged Not recommended
    • Hormonal treatment bleeding: during the first 21 days
    (if medically eligible) • NSAIDs (5-7 days of extended
    with COCs or estrogen of treatment) or continuous CHC use
    (10-20 days of • Hormonal treatment
    treatment) (if medically eligible) Not recommended more
    with COCs or estrogen than once per month
    (10-20 days of because contraceptive
    treatment) effectiveness might
    be reduced

    If bleeding disorder persists or woman finds it unacceptable

    Counsel on alternative methods, offer another method, if desired

    *If clinically warranted, evaluate for underlying condition. Treat the condition or refer for care. Heavy or prolonged bleeding, either unscheduled
    or menstrual, is uncommon among LNG-IUD users and implant users.
    Abbreviations: CHC = combined hormonal contraceptive; COC = combined oral contraceptive; Cu-IUD = copper-containing intrauterine device; DMPA = depot
    medroxyprogesterone acetate; LNG-IUD = levonorgestrel-releasing intrauterine device; NSAIDs = nonsteroidal anti-inflammatory drugs.
    Source: For full recommendations and updates, see the U.S. Selected Practice Recommendations for Contraceptive Use
    webpage at http://www.cdc.gov/reproductivehealth/unintendedpregnancy/usspr.htm.
    Management of the IUD When a Cu-IUD or an LNG-IUD User is Found to Have Pelvic Inflammatory Disease

    • Treat PID*.
    • Counsel about condom use.
    • IUD does not need to be removed.

    Woman wants to continue IUD. Woman wants to discontinue IUD.

    Reassess in 24–48 hours. Remove IUD after


    beginning antibiotics.

    • Offer another contraceptive method.


    • Offer emergency contraception.

    Clinical improvement No clinical improvement

    Continue IUD. • Continue antibiotics.


    • Consider removal of IUD.

    • Offer another contraceptive method.


    • Offer emergency contraception.

    Abbreviations: Cu-IUD = copper-containing intrauterine device; IUD = intrauterine device; LNG-IUD = levonorgestrel-releasing intrauterine device; PID = pelvic inflammatory disease
    *Treat according to the CDC Sexually Transmitted Diseases Treatment Guidelines (available at http://www.cdc.gov/std/treatment).
    Source: For full recommendations and updates, see the U.S. Selected Practice Recommendations for Contraceptive Use webpage at http://www.cdc.gov/reproductivehealth/unintendedpregnancy/usspr.htm.

    CS266008-A

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