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Management of Unscheduled Bleeding in Women Using Hormonal Contraception

On the federal level, three agencies regulate ART. The Centers for Disease Control and Prevention (CDC) collects and publishes data on ART procedures. The Food and Drug Administration (FDA) controls approval and use of drugs, biological products, and medical devices and has jurisdiction over screening and testing of reproductive tissues, such as donor eggs and sperm. The Centers for Medicare and Medicaid Services (CMS) is responsible for implementation of the Clinical Laboratory Improvement Act to ensure the quality of laboratory testing | -------FACULTY-------- -----OF SEXUAL------ REPRODUCTIVE HEALTHCARE Royal College of Obstetricians and Gynaecologists Setting standards to improve women s health Faculty of Sexual Reproductive Healthcare Clinical Guidance Management of Unscheduled Bleeding in Women Using Hormonal Contraception Clinical Effectiveness Unit May 2009 ISSN 1755-103X Published by the Faculty of Sexual and Reproductive Healthcare Registered in England No. 2804213 and Registered Charity No. 1019969 First published in 2009 Faculty website version updated in September 2009 Copyright Faculty of Sexual and Reproductive Healthcare 2009 Permission granted to reproduce for personal and educational use only. Commercial copying hiring and lending are prohibited. --------FACULTY-------- ------OF SEXUAL------ REPRODUCTIVE ----HEALTHCARE---- Royal College of Obstetricians and Gynaecologists Faculty of Sexual and Reproductive Healthcare Clinical Effectiveness Unit in collaboration with the Royal College of Obstetricians and Gynaecologists Setting standards to improve women s health FSRH Guidance May 2009 Management of Unscheduled Bleeding in Women Using Hormonal Contraception Date of planned revision 2014 Purpose and scope This Guidance brings together evidence and expert opinion on the management of unscheduled bleeding in women using hormonal contraception i.e. combined oral contraceptive pill COC transdermal patch progestogen-only pill POP injectable implant or intrauterine system IUS . The term unscheduled bleeding in this Guidance refers to breakthrough bleeding spotting prolonged or frequent bleeding Box 1 .1 The management of women who present with unscheduled bleeding while using hormonal contraception is challenging. For many women unscheduled bleeding will be due to the contraceptive method itself and the pattern and duration of bleeding and the likelihood of this settling will vary with the method used Table 1 .2-13 Women may consider that the contraceptive benefits of a method may outweigh