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This table provides an overview of considerations and management strategies for problematic bleeding associated with progestogen-only injectable contraception as recommended by FSRH , for clinicians in UK
| Aspect | Key Information | Explanation/Recommendation |
|---|---|---|
| Gynaecological Pathology | Persistent problematic bleeding or bleeding post-amenorrhoea | Exclude gynaecological pathology; review cervical screening history and perform cervical cytology test if needed based on screening guidelines. |
| Bleeding Management | Management of unscheduled bleeding | Use of estrogen supplementation or tranexamic acid can reduce bleeding short term. Insufficient evidence for routine long-term use. |
| Use of COC | COC can be offered for 3 months for eligible women. If bleeding recurs after 3 months, the decision to restart COC is based on clinical judgement. | |
| Mefenamic acid | Offer 500 mg mefenamic acid up to three times daily for 5 days to manage unscheduled bleeding. | |
| Injection Interval | Reducing injection interval | No solid evidence that reducing interval helps with bleeding. FSRH suggests injection can be given from 10 weeks after the last shot for certain situations. |
| Special Populations | Women with epilepsy, learning disabilities, or HIV | DMPA efficacy is unaffected by antiepileptic or antiretroviral drugs. Care needed with certain antiepileptics due to risk of osteopenia and osteoporosis. |
| Women taking specific antiepileptics | Increased risk of osteopenia, osteoporosis, and fractures.... |
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