Unscheduled vaginal bleeding with progestin-only contraceptive use

Rachel E. Zigler, Colleen McNicholas

Research output: Contribution to journalReview articlepeer-review

36 Scopus citations


Nearly 20% of women using contraception are using progestin-only contraception, including progestin-only pills, depot-medroxyprogesterone acetate, subdermal etonogestrel implants, and levonorgestrel intrauterine devices. This number will continue to grow with the increased provision of long-acting reversible contraception. Although overall satisfaction among women using progestin-only contraception is high, dissatisfaction and discontinuation may be associated with unscheduled bleeding and spotting. The exact etiology of irregular bleeding associated with progestin-containing contraceptives is not completely understood, yet several mechanisms have been suggested. Several therapies targeting these mechanisms have been evaluated with mixed results. This paper will review the physiology and management of unscheduled bleeding with progestin-containing contraceptives.

Original languageEnglish
Pages (from-to)443-450
Number of pages8
JournalAmerican journal of obstetrics and gynecology
Issue number5
StatePublished - May 2017


  • irregular bleeding
  • long-acting reversible contraception
  • progestin-only contraception
  • unscheduled bleeding


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