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Irregular menstrual bleeding and spotting in individuals taking progestogen-only pills, especially in the first months after starting. [ 47 ] [ 48 ] This side effect may be bothersome but is not dangerous, and most users report improved bleeding patterns with longer usage.
It contains ethinylestradiol, an estrogen, and etonogestrel, a progestin. [2] It is used by insertion into the vagina. [1] Pregnancy occurs in about 0.3% of women with perfect use and 9% of women with typical use. [3] Common side effects include irregular vaginal bleeding, nausea, sore breasts, vaginitis, mood changes, and headache. [4]
Changes in menstrual bleeding may occur, such as a lighter flow or complete stop to the regular monthly menses, or abnormal bleeding throughout the cycle. Others have reported small weight gain, and increase in headaches or mood swings, and a decrease in libido. [6]
Hormonal contraceptives can come in multiple forms including injectables. Depot medroxyprogesterone acetate (DMPA), a progestin-only injectable, has been found to cause amenorrhea (cessation of menstruation); however, the irregular bleeding pattern returns to normal over time. [15] [16] DMPA has also been associated with weight gain. [16]
Etonogestrel is a progestin, or a synthetic progestogen, and hence is an agonist of the progesterone receptor, the biological target of progestogens like progesterone. [16] It works by stopping ovulation , thickening the mucus around the opening of the cervix , and altering the lining of the uterus . [ 17 ]
Progestogen-only pills (POPs) use a progestogen alone with doses taken continuously and no or a short gap between packs taken. People who use them may experience irregular light bleeds, and whilst irregular in the first few months of taking, usually settles to a regular pattern in time. The following progestogens are used:
Intermediate-dose progestogen-only contraceptives, including the progestogen-only pill desogestrel (Cerazette) and the subdermal implant etonogestrel (Nexplanon, Implanon), allow some follicular development but more consistently inhibit ovulation in 97 to 99% of cycles. The same cervical mucus changes occur as with very low-dose progestogens.
Hormonal IUDs have similar side effects to other forms of hormonal contraception, such as combined and progesterone only oral contraceptives. Hormonal IUDs most frequently cause irregular menstrual bleeding. Other side effects include acne, breast tenderness, headaches, nausea, and mood changes. [21] [22]