If bleeding persists, or if the woman requests it, medical treatment can be considered.^*

Cu-IUD users

LNG-IUD users

Implant users

Injectable (DMPA) users

CHC users (extended or continuous regimen)

For unscheduled spotting or light bleeding or heavy/prolonged bleeding:

NSAIDs (5 to 7 days of treatment)
Hormonal treatment (if medically eligible) with COCs or estrogen (10 to 20 days of treatment)

For unscheduled spotting or light bleeding or for heavy or prolonged bleeding:

NSAIDs (5 to 7 days of treatment)

If bleeding disorder persists or woman finds it unacceptable

Counsel on alternative methods and offer another method, if desired.

End

For unscheduled spotting or light bleeding:

NSAIDs (5 to 7 days of treatment)

For heavy or prolonged bleeding:

NSAIDs (5 to 7 days of treatment)
Hormonal treatment (if medically eligible) with COCs or estrogen (10 to 20 days of treatment)

Hormone-free interval for 3 to 4 consecutive days

Not recommended during the first 21 days of extended or continuous CHC use

Not recommended more than once per mo because contraceptive effectiveness might be reduced

^*If clinically warranted, evaluate for underlying condition. Treat the condition or refer for care. Heavy or prolonged bleeding, either unscheduled or menstrual, is uncommon among LNG-IUD users and implant users.