The management of irregular bleeding in women using contraception

The pattern of menstrual bleeding seen in women during their reproductive years is the result of a finely tuned balance be-tween endogenous oestrogens, which stimulate the endometrial lining, and progesterone, which temporarily maintains that lining in anticipation of a pregnancy. Many women have expectations of a 'normal monthly' cycle, and may be wary of any-thing that has the potential to disrupt its regularity. From a clinical perspective, any alteration in vaginal bleeding may indicate underlying pathology, and lead to further investigation and management.

The aim of this article is to provide a practical approach to the investigation and management of altered vaginal bleeding patterns in women using various methods of contraception.

Around 70% of Australian women of reproductive age use some form of contraception. Any discussion of 'normal bleeding' becomes even more complex given that modern contraceptive methods almost inevitably modify the pattern of bleeding experienced by the user.