Q and A with Ms. Vagina Science: Spotting with Implanon, FAM vs. Rhythm Method and using the Nuvaring with PCOS

This week I’ll be answering reader questions!


Dear Ms. Vagina Science, 

I have the Implanon implant. And while I love it dearly–no maintenance, low dose progestin, happy skin–I have one side effect. I spot. A lot. Sometimes almost as much as a regular period, sometimes not at all, but it sometimes drags on and on and on and on and on. And it can put kind of a damper on sexy times, especially blood! by! surprise! Is there anything I can do to stop bleeding when it drags out like this?

 -Bloody in the Mid-Atlantic

Dear Bloody,

Implanon is a relatively new kind of hormonal birth control on the market, so I want to take a second to explain this to readers who may not have heard of it: Implanon is a progesterone-only form of birth control that delivers it’s anti-baby making hormones via a small, plastic implant that is inserted under the skin, releasing hormones into the blood stream on a timed, continuous doses for up to three years. It protects you from pregnancy in two ways: 1. By inhibiting ovulation and 2. by increasing the viscosity of the vaginal mucous so sperm cannot penetrate an egg should it be released. This birth control does not protect one from Sexually Transmitted Infections; this is a low dose form of birth control, not disease control. Like most forms of hormonal birth control (or any medication for that matter), Implanon comes with a laundry list of possible side effects. The most common side effects for this form of birth control are irregular bleeding; headaches; vaginitis; weight gain; acne; breast pain; viral infections such as colds, sore throats, sinus infections or flu-like symptoms; stomach pain; painful periods; mood swings; nervousness or depression; back pain; nausea; dizziness; pain; and pain at the site of insertion. Some people will experience none of these side effects, while others will experience one or more all at once.

My research into this topic revealed that this is a side effect you’re going to have to learn to live with if you’re going to continue using Implanon. According to the Implanon website, “In studies, about 1 in 10 women stopped using IMPLANON because of bleeding problems. Expect your menstrual periods to be irregular and unpredictable throughout the time you are using IMPLANON. You may have more bleeding, less bleeding, or no bleeding. The time between periods may vary, and in between periods you may have spotting.” Unfortunately, when you manipulate your hormones, it’s not always going to be a consequence-free situation. Hell, even when you’re NOT using hormonal birth control there are consequences (like babies or laborious observation of your fertility to avoid pregnancy). A lot of time, break-though bleeding and spotting will resolve in time with continued use, as your body learns how to be with the birth control. Other times, the issues, be it spotting or nausea or mood swings, don’t resolve at all and you have to decide if that side effect is something you can live with.

So, how exactly does one deal with constant spotting, if one chooses to stick with the birth control that’s causing the spotting? I’d say the first step would be communication with your partner. Most people don’t want to give their partner a mouthful of blood or be in the throes of passion only to realize you’re bleeding all over the place. It’s embarrassing and disruptive, and most of us have come to expect that there won’t be blood until, well…we expect it! My advice would be to do a quick check before you have sex: urinate, have your partner put a finger/penis/object inside your vagina to get the blood forecast. Bloody? Maybe hold off on Cunnilingus and head to the shower. Or, invest in some red towels and accept the mess. If you find that you’ve given your body time to adjust and you’re still bleeding and still annoyed by that bleeding, see your health care provider and go over other options. There are other low-dose methods of hormonal birth control that may not cause break through bleeding.

Good luck!

Dear Ms. Vagina Science,

I dabble in FAM but my cycle has been somewhat inconsistent lately so I don’t know what to do. I’ve been having lots of mood swings and my last cycle was only 21 days long, which is unusual for me. My period ended after four days or so. This morning I was really aroused, the kind of arousal I usually get when I”˜m fertile, and I had unprotected sex. Could I be fertile if I’m only on day seven of my cycle?

-Unsure in Montana

Dear Unsure,

Before I answer your question, I want to refer readers to my article on Fertility Awareness if you’d like to know more about this subject and/or understand the context of this reader’s question fully. Now, for my answer.

READER! Do not fall into the very easy trap of relying on how predictable you believe your cycle to be when you are using FAM. It happens, sure. I’ve done it. But, guess what happened when I got lazy and didn’t actively observe my signs of fertility and instead assumed I wouldn’t be fertile on a certain day because I wasn’t fertile that day last cycle? I got pregnant. My second pregnancy, which ended in a miscarriage (my first pregnancy was planned and created the coolest person I’ve ever met), was a failure on my and my partner’s part to diligently observe and be aware of my fertility.

I cannot stress enough the distinction between The Rhythm Method and Fertility Awareness Method. RM assumes your body operates in a clock-like way, on a 28 day cycle with no variability –

This method of birth control is not very reliable at preventing pregnancy, since a woman’s body is not, in fact, a clock. Even the most predictable cycle is subject to change at any time, and since you aren’t observing or looking for signs of fertility, you have no idea if this month is the month you have a 35 day cycle and ovulate on day 22. When using the rhythm method, you would have stopped using a barrier method and risked pregnancy if you had sex on day 22 of that cycle. So, to answer your question, did you ovulate on day 7 of your cycle? Probably not, but if you were using FAM correctly you wouldn’t need to ask me. You would have known. If you’re going to really use FAM to prevent pregnancy, you absolutely need to look for signs of fertility daily. FAM is not something you can dabble in or use half-assed. I mean, unless you want to become pregnant.

Dear Ms. Vagina Science,

I’ve had ovarian cysts in the past, and uterine fibroids run rampant all over my family so, I suspect that I have PCOS but I haven’t found out for sure because I don’t have health insurance. I haven’t had my period in months. Sometimes I go through months of horrible heavy bleeding with giant clots…just…almost incapacitating. Sometimes there’s no period for a while, and sometimes its crazy heavy for a couple weeks. Here’s the question –I’ve begun using the Nuvaring, which I’ve used and loved for years in the past but I don’t know if I should use it. Would it help to regulate my period or could I be causing more harm than good? 

-Concerned in New Hampshire

Dear Concerned,

My short answer is maybe. Hormonal Birth control has been and is still used to regulate the cycles of women with PCOS, but usually what physicians use are progesterone and estrogen combination pills. The Nuvaring is a very low dose combo of both hormones, so would it have a therapeutic effect? Perhaps. Would it harm you? Probably not, even if you do have PCOS.

It would also be helpful to review what PCOS is and the symptoms of PCOS since you are not diagnosed as having it:

1. PCOS is a sex hormone imbalance. It affects normal menstruation, causing irregular period and fertility issues.

2. Symptoms usually begin in your teen years

3. Symptoms include acne, weight gain, trouble loosing weight, thinning hair, depression, irregular bleeding and infertility.

Additionally, just because you’ve had ovarian cysts it doesn’t necessarily mean you have or are going to develop PCOS. While it’s true that there is a connection (women with PCOS will often have pearl-sized cysts in their ovaries) between the two issues, there are several different kinds of ovarian cysts. Most ovarian cysts are “functional,” meaning they are harmless and most women will have them from time to time. I would strongly encourage you to hit up your local family planning clinic and find out for sure if you have PCOS. That’s information you should really know anyway, and then you can go ahead and get some proper birth control counseling if you do have it (I’m fun and all, but what you really need is health care, not my advice). Since you are uninsured, here is a list of family planning clinics in NH that provide affordable reproductive health services. Please go get evaluated! Your reproductive organs will thank you.


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By msvaginascience

Feminist, Mother, Lover, Fat Babe, Student and Case Worker Extraordinaire, serving high risk women and families in Seattle. My background is in Midwifery, Public Health Research, Sexual Education and Childbirth Education.

3 replies on “Q and A with Ms. Vagina Science: Spotting with Implanon, FAM vs. Rhythm Method and using the Nuvaring with PCOS”

Thanks for the heads-up on Implanon. I’ll be getting it when my pill supply runs out, and bleeding is a big thing for me. I was on the Depo shot for three years without any breakthrough bleeding past the first couple of months, and I’m hoping I’ll have a similar experience with Implanon.

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