Menstrual bleeding patterns in Norplant®-2 implant users

Abstract

The objective of the present study was to analyze the patterns of menstrual bleeding in Singaporean women using Norplant-2 contraceptive implants over a five-year period. Of the 100 women recruited for the study, 62 were still using the implant at the end of five years. Only 9 women discontinued for menstrual reasons and they did so within the first 21 months of implant use. Although a normal menstrual bleeding pat tern was uncommon during the first three months of use, 69.4% had normal menstruation at the end of five years. Irregular bleeding was the most common form of menstrual abnormality throughout the study period. Infrequent periods and amenorrhoea were distinctly uncommon, especially after the first two years of use. The pattern of bleeding with Norplant-2 was not significantly different from that previously observed with Norplant.

To investigate the menstrual bleeding patterns among long-term users of Norplant-2 implants, 100 Singaporean women were followed for 5 years. All participants had delivered at least one child prior to implant insertion and had a history of regular menstrual periods. Monthly menstrual diaries indicating days of bleeding or spotting were collapsed into successive 90-day reference periods and analyzed for evidence of amenorrhea, prolonged bleeding (10 days or more), frequent bleeding (over four bleeding/spotting episodes per month), infrequent bleeding (less than two episodes), and irregular bleeding (bleeding-free interval exceeding 17 days). At the end of the 5-year study period, 62 women still had their implants, 9 had discontinued within 21 months after insertion for menstruation-related reasons, while 24 requested removal to achieve pregnancy. There were no pregnancies during Norplant use. Although only 9% of users experienced normal menstrual bleeding in the first three months of use, this statistic increased to 32.6%, 43.6%, 37.8%, 52.3%, and 69.4% after 1, 2, 3, 4, and 5 years of use, respectively. The most common menstrual irregularities were irregular bleeding and prolonged bleeding. Although more women had regular cycles with time, there was only minimal improvement in intraindividual variability in those who continued to have irregular bleeding. Overall, the bleeding disturbances recorded by Norplant-2 acceptors did not differ substantially from those found among users of the original Norplant delivery system.