Priority 5 from the Contraception PSP

UNCERTAINTY: Which interventions are safe and effective for women who have irregular bleeding on long-acting hormonal contraception? (JLA PSP Priority 5)
Overall ranking 5
JLA question ID 0049/5
Explanatory note The use of LARCs is increasing, the most commonly used LARC is the implant (12.9%), Irregular bleeding is most com The included RCTs did not include the etonogestrel implant which is currently used in the UK.  Many women using progestin-only methods experience unacceptable bleeding disturbances, discontinue use, and are left without contraceptive protection or switch to a less effective method. The development of common outcome reporting measures should be developed to ease the synthesis and comparison of studies, RCTs should include interventions currently used in clinical practice such as the etonogestrel implant, combined hormonal contraception and alternative treatment options. (Some overlap with research priority 2)

FSRH guideline- Problematic  Bleeding with Hormonal contraception 2015.

Treatment of vaginal bleeding irregularities induced by progestin only contraceptives Hany Abdel‐Aleem, Catherine d'Arcangues, Kirsten M Vogelsong, Mary Lyn Gaffield, A Metin Gülmezoglu. October 2013. 

Health Research Classification System category Reproductive Health and Childbirth
Extra information provided by this PSP
Original uncertainty examples

“If bleeding too heavily with an implant how long would you leave before removal. And should the pill be along side to control the bleeding. More Info would be great” (HCP). “  ~  Which is the best COC for managing unscheduled bleeding with an implant or IUS and is the POP or DMPA effective ?” (both)

Submitted by Healthcare Professionals x 7~Patients x 0~Both x 8
PSP information
PSP unique ID 0049
PSP name Contraception
Total number of uncertainties identified by this PSP. 57  (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 21 April 2017