The primary purpose of this study is to describe bleeding patterns on the LNG-IUS and the ENG implant following DMPA use, and to compare this with prior bleeding patterns on DMPA. Secondary objectives are to explore whether bleeding pattern on subsequent progestin LARC is associated with the duration of prior DMPA use, and will characterize satisfaction and continuation rates of progestin LARC after DMPA. A third and final exploratory objective is to develop a Composite Uterine Bleeding (CUB) score to allow for meaningful translation of bleeding pattern into a clinically useful descriptor.
The prospective cohort study design will enroll women already on DMPA who switch to the LNG-IUS or ENG implant. A retrospective assessment of bleeding patterns on DMPA will be collected at enrollment, and then a prospective text message bleeding diary will be collected daily for two 90-day reference periods following LARC insertion. Previous studies using prospective text message bleeding diaries successfully obtained a significant amount of high quality data. Survey assessments of LARC satisfaction and continuation will be collected after each 90-day reference period. This study will address a critical deficit in the literature, and will facilitate the proactive counseling of women about expected bleeding patterns on progestin LARCs after switching from DMPA.