Oral Presentation

Combined oral contraceptive pills ( COCPs ) versus nsaids in management of bleeding irregularities among implanon users

Mohd Faizal Ahmad (MY)


ABSTRACT Objectives: Implanon is a long-acting reversible contraceptive option that is becoming more accepted among Malaysian population. Prolonged and irregular bleeding is the significant adverse effect causing discontinuation. This study is to evaluate whether unacceptable bleeding among the Implanon user could be better alleviated using oral contraceptive pills (COCPs) compared to NSAIDs. The side effect of both treatments given was analyzed in this study. Methods: This is a prospective randomized comparative study for evaluation of eighty-four implanon users with prolonged or frequent bleeding. They were assigned to either receiving a combined oral contraceptive pill containing 20 mcg Ethinyl estradiol / 150 mg Desogestrel for two continuous cycle or Mefenamic acid 500 mg TDS for five days, 21 days apart for two periods. Bleeding pattern during the treatment was recorded and analyzed. Results: The cessation of an unacceptable bleeding pattern was significantly in COCPs group compared to NSAIDs group. A total of 32 women ( 76.2%) in COCPS group and 15 women ( 35.7%) in NSAIDs group stop bleeding within seven days after the initiation of treatment which was statistically significant ( p < 0.05). The mean duration of bleeding and spotting days in women treated with COCPs was significantly lesser compare to NSAIDs group ( 7.29 ± 3.16 vs. 10.57 ± 4.14 days ; p < 0.05). One case of severe gastritis was reported in NSAIDs group which required discontinuation of the treatment whereas there were five patients in COCPs group complaining of a mild headache, mastalgia, acne and reduced breastmilk production which didn’t lead to discontinuation of the treatment. Conclusion: We conclude that COCPs is more efficient compared to NSAIDs in managing prolonged or frequent bleeding among Implanon users. Careful selection of the patient is the utmost importance. For those who are contraindicated to use estrogen, NSAIDs can be offered although the efficacy is lesser.