[Management of bleeding with hormonal contraception]

MANAGEMENT OF BLEEDING WITH HORMONAL CONTRACEPTION, Explaining contraception side effects chosen by a woman, in particular spotting with progestin contraception, would allow for better compliance. Unscheduled bleeding with hormonal contraception need to search of an organic etiology, a drug interaction, infection. A pregnancy must be excluded in the event of poor compliance or clinical suspicion. Persistence of bleeding with 20 _g ethinylestradiol combined oral contraception could be improved by an increase in the dosage. In addition, a change in the type of progestin (switch 2nd to 3rd generation) seems to improve the bleeding profile. Many treatments have been evaluated with an impact of bleeding profile, but due to the heterogeneity of the studies, the data are inconclusive. It appears that tranexamic acid and nonsteroidal anti-inflammatory drugs improve the bleeding profile under etonogestrel subcutaneous contraceptive implant but only transiently. The combination with estrogens does not show any improvement, particularly with the levonorgestrel intrauterine system. Other treatments have been evaluated such as doxycycline or mifepristone with relatively good results in improving bleeding.