Therapeutic Options for Unscheduled Bleeding on Hormonal Contraception.

Unscheduled bleeding is a common side effect of hormonal contraceptives, often leading to discontinuation. Comprehensive counseling before starting hormonal methods is crucial for improving user satisfaction. For persistent bleeding, common treatments include non-steroidal anti-inflammatory drugs (NSAIDs) and estrogen alone or with progestin in oral contraceptives. Small studies suggest that doxycycline, mifepristone, tranexamic acid, tamoxifen, ulipristal acetate, and clomiphene citrate may reduce bleeding in various contraceptive users. Mifepristone and tranexamic acid show promise for users of depot medroxyprogesterone acetate, implants, and intrauterine devices. While NSAIDs and combined oral contraceptives are commonly used, alternative therapies offer potential, though evidence remains limited.