Management of Unscheduled Bleeding in Women Using Hormonal Contraception (PDF)
This guidance brings together evidence and expert opinion on the management of unscheduled bleeding (breakthrough bleeding, spotting, prolonged or frequent bleeding) in women using hormonal contraception.
The guideline was produced by the Faculty of Sexual and Reproductive Healthcare (FSRH) Clinical Effectiveness Unit in collaboration with the RCOG.
The management of women who present with unscheduled bleeding while using hormonal contraception is challenging. For many women unscheduled bleeding will be due to the contraceptive method itself, and the pattern and duration of bleeding and the likelihood of this settling will vary with the method used. Women may consider that the contraceptive benefits of a method may outweigh the inconvenience of unscheduled bleeding. After reassurance that there is no serious underlying cause they may be happy to continue use.
The management of women with unscheduled bleeding in the initial months (i.e. 3–6 months) after starting a new method of hormonal contraception may differ from that of women who continue to have unscheduled bleeding in the longer term or who present with a change in bleeding pattern. A clinical history should highlight possible underlying causes and provide a guide to the most appropriate examination, investigation and treatment options required.
This guideline provides a management plan is outlined that can be tailored to the individual woman, together with evidence to support the management plan. This management plan is provided as a guide only and can be used to develop a local care pathway taking account of local expertise or ease of referral/access to specialist services and investigations.
Recommendations are provided where evidence exists. Good practice points have been given where no evidence exists but are based on the clinical judgment and opinion of the expert multidisciplinary group developing this guidance.