When Contraceptives Change Monthly Bleeding

Counseling Aid: Typical Bleeding Patterns With Selected Contraceptive Methods

How to use this tool: Family planning providers can use this chart to help clients consider typical bleeding changes with certain contraceptive methods. (Other bleeding changes may occur but are less common. For detailed information about each method, see the forthcoming Family Planning: A Global Handbook for Providers; ordering information) If a client has a specific method in mind, the provider can quickly identify the typical bleeding changes she might experience, both in the first few months and in the long-term. If a client wants a contraceptive method that does not change bleeding patterns, she can consider female or male sterilization, barrier methods (male and female condoms and diaphragms), spermicides, or fertility-awareness based methods.

Typical Bleeding Patterns

First Few Months

Long-Term

Contraceptive Method

Lighter, regular, and predictable bleeding

Infrequent, extremely light¹, or no monthly bleeding

Bleeding or spotting at unexpected times

Heavy or prolonged bleeding

Lighter, regular, and predictable bleeding

Infrequent, extremely light¹, or no monthly bleeding

Bleeding or spotting at unexpected times

Heavy or prolonged bleeding

Combined Oral Contraceptives

Combined (Monthly) Injectables

Progestin-Only Injectables

Progestin-Only Oral Contraceptives

Implants²

Hormonal IUD

Copper IUDs

¹ The client may have just a small stain on her underclothing and not recognize it as vaginal bleeding.

² Implanon^® implant less often causes prolonged bleeding than Norplant^® and Jadelle^® implants in the first few months. Also, users of Implanon implants are more likely to have infrequent or no bleeding in the long-term than users of Norplant or Jadelle implants.