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Women's Health

I have the Implanon, but still get periods.

11/02/2007

Question:

I had the implanon put in 2 and 1/2 months ago. I was hoping i would never see my periods again. I didnt have one for 5 weeks. But the last 4 weeks i have had my period. It was very heavy at one stage. Then it will go for a day or two then come back lightly but enough to notice. It just wants to hang around

I chose to implanon so i wouldnt get my periods. Will my body get used to it or is this how it is always going to be with the implanon implanted?

Is there any over options you can suggest so i can skip my periods as i fine them very painful, uncomfortable and would rather not have them at all

Thanks

Answer:

With implantable contraceptives, as with the depo-medroxyprogesterone injections, the timing of placement of the contraceptive in relation to woman's menstrual cycle is critical. Although for fertility control it matters little, best results in minimizing bleeding-related side-effects are achieved when the contraceptive is placed immediately after a menses. The reason for that is that the "old" uterine lining from the previous month has sloughed away and is on its way out, and the new lining has not begun growing yet.

Long-term contraceptives, which are basically progesterone analogues, halt this prospective growth for as long as they will be present in the system, hence eliminating the very substance of menstrual bleeding. They also "turn off" the ovaries at the same time, eliminating ovulation - the very basis of fertility. So, ideally, menses should simply disappear. If, however, the lining is allowed to re-grow even to some degree before an implant or a depo shot is placed, it will be sustained and supported by the progesterone action of the contraceptive. The lining will then grow "old" to a point when it can no longer survive regardless of the hormonal influences. That is where those 2 and 1/2 months come from, give or take.

At that point, the lining will start to slough off by itself. Naturally, what triggers the sloughing and elimination of the lining is the rapid drop in ovarian progesterone level. This makes the process occur evenly in all areas of the uterine lining. But when the ovaries are dormant and there is no synchronizing hormonal "signal to go", the lining will slough and come out in fragments, over longer period of time - sometimes weeks. The uterus will not have a signal to contract and clamp down the bleeding vessels inside of itself either, protracting the bleeding, making it heavy and allowing varying size clots to form.

One way of dealing with this is to create an artificial (via oral medicine) "bump" in the progesterone level - to create a "reset" signal. The other, less predictable way, is to just wait until all of the lining is gone and the process stops on its own. Understandably, this problem should not reoccur in either case for as long as there are no gaps in renewing the contraceptive. How to proceed in your particular situation is probably best decided in discussion between you and your physician.

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Response by:

The Ohio State University Shalva V Kakabadze, MD
Clinical Assistant Professor
Department of Family Medicine
College of Medicine
The Ohio State University
Shalva V Kakabadze, MD