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Dr. Das, MD
Dr. Das, MD, Doctor
Category: Medical
Satisfied Customers: 2232
Experience:  MBBS, MD, with wide experience in all aspects of medical treatment, including cancer therapy.
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Hi My doctor has given me Norethisterone (http //www.patient.co.uk/medicine/Norethist

Resolved Question:

Hi My doctor has given me Norethisterone (http://www.patient.co.uk/medicine/Norethisterone.htm) to stop spotting caused by Implanon (contraceptive implant)

Ive had implanon in for 7 weeks and feel it may of effected my mood and increased my anxiety levels. I'm going travelling shortly so i will not have the opportunity while i'm away to have it removed as I will be in Africa. I'm not sure whether to have it removed before i go or to take norethisterone. If I don't want any spotting would i have to take NE every month for 10 days with implanon? More importantly if i feel the surge in hormones initially badly effected my mood and anxiety levels will taking NE with implanon increase the negative effects on my mood as its adding more hormones? If i have it removed will my mood return to normal? Do you think leaving implanon in could 'stabilise' my mood and if so how long would you expect this to take?
Submitted: 5 years ago.
Category: Medical
Expert:  Dr. Das, MD replied 5 years ago.
Hello,

My advise would be get the Implanon removed before you go. Implanon contains high levels of progesterone which get released slowly over time. But the progesteron level in the in the blood can become irregular which can cause spotting. High level of progesterone can also cause mood changes.

Norethisterone is also a progesterone. While it can control the spotting, combining Norethisterone wiht implanon can contribute to mood swings.

Having the Implanon removed will help your mood to stabilise.

I hope this helps.

Please feel free to ask for more information if you want any. If not, please accept the answer by clicking on the green 'Accept' button on this page. Leaving a bonus and positive feedback would be much appreciated.



Customer: replied 5 years ago.

Thank you. I will accept your answer after we have finished our discussion. If i did take norethisterone, how many hours between each dosage should i leave and will it ony temporary stop spotting? Is there a possiblity it can improve mood or is it only likely to worsen it and will this effect stop after the 10 days ive been told to take it? I suffer from anxiety and my doctor thinks leaving the implanon in is the best for my mood as it will regulate my hormone levels so I will not get a menstruation cycle. I don't know whether to trust her advice, which is why i am asking you for a second opinion. My anxiety and mood improved after 4-5 weeks, but if theres any doubt in your mind that i'm worse off with keeping the implanon please let me know. What can i expect to happen when its removed and will i be able to roughly predict my next period after my initial period? Should i expect to bleed more only for my first period and how prolonged is it likely to be on implanon removal? Thank you for your time.

Customer: replied 5 years ago.
Where do you currently practice medicine just out of interest?
Expert:  Dr. Das, MD replied 5 years ago.
<p>Norethisterone is usually prescribed either 8 hourly (which is thrice daily) or 12 hourly (which is twice a day). It will stop the spotting but chances are that the spotting will recur once you stop the Norethisterone. This is because the Implanon contains a high dose of progesterone which is gradually released into the blood. This release may not always be regular leading to withdrawal bleeding from time to time.

I doubt that the high progesterone levels will significantly improve your mood - if you are seeing any improvement, it is more likely to be psychological as a placebo effect. Anti-anxiety medicines like xanax is better to control anxiety in the long run.

Hormonal levels are better stabilised by low dose birth control pills which closely mimic the normal blood levels, like Ortho tricyclen Lo. Or if you do not wish to get a period, you can try birth control pills like Seasonale which need to be taken continuously for 3 months. You will get a period every 3 months when the pack of Seasonale is finished.

Once the Implanon is removed, you can expect to get a period within the month, usually within 2 weeks. You can go on a BC pill once you get this period. And the bleeding is likely to be heavy after removal of the Implanon. The duration of bleeding can be different in different women depending on the amount of progesterone secreted by the Implanon at the time of removal.

In my opinion, you should get the Implanon removed, go on an anti-anxiety medicine, wait for your period to occur and start Seasonale or Orthotricyclen Lo after the period.

And I am from India.
Dr. Das, MD, Doctor
Category: Medical
Satisfied Customers: 2232
Experience: MBBS, MD, with wide experience in all aspects of medical treatment, including cancer therapy.
Dr. Das, MD and 6 other Medical Specialists are ready to help you
Customer: replied 5 years ago.

Thank you for your reply, i am sorry i have taken alongtime to get back to you, i had to go out during the day. I've accept your answer so you will receive payment. If possible though please could you tell me more about these birth control pills you recommend? In your opinion (to clarify) are you better off either having these pills or nothing then implanon in terms of regulating hormones and moods? Also from what you have told me am I right in thinking taking NE to stop spotting is a bad idea? Or would NE even out my progestrone levels as you have mentioned that spotting is caused by the progestrone not being secreted evenly and would that therefore improve mood swings or worsen? I guess what i'm asking is are you saying that i will be better off without implanon and if i do continue to use implanon i'd be better off NOT taking NE with it?

 

Thank you for your help.

Customer: replied 5 years ago.
I live in the UK, am i correct in thinking Microgynon is the same drug as Seasonal that you recommend?
Expert:  Dr. Das, MD replied 5 years ago.
Hello,

In my opinion, you are better off taking a birth control pill to regulate your homrones than taking Implanon. Implanon is neither a good contraceptive nor a good drug simply because it causes the hormone secreted into the blood to be irregular, necessitating more drugs to control the bleeding.

Taking NE is not a bad idea to control the spotting. It will stop the bleeding by supporting te endomterium (inner uterine lining) but is is not effective in controoling the mood. And you cannot take it continuously for a ling time, although 10 days is OK.

As far as I know, Seasonale or similar extended cycle BC pills are not available in the UK. But Microgynon-20 has the exact same composition of the hormones. the only difference is that while Microgynon is a monthly pack containing 21 active pills and 7 inactive pills, Seasonale contains 84 active pills in a single pack. You can easily skip the inactive pills in a Microgynon pack for three months so that you get your periods every 3 months. This will far more effective in controlling your bleeding, your mood as well as giving you contraceptive support.
Customer: replied 5 years ago.
Thank you. If I start a course of NE today to see how it effects me, but do not complete the course (the 10 days) will that cause me further problems? I will not be able to have the implanon removed until tuesday and if i'm to have it removed i don't want it to be done later than tuesday. As i'm still not sure is it ok if I take NE until tues to help me decide - i would have taken half the course, is this a good course of action? Also im not sure if my gp will prescribe me the pill due to the time differences i will experience when travelling around. If i take the pill at slightly different times will it be ineffective?
Expert:  Dr. Das, MD replied 5 years ago.
<p>If you start the NE now and stop it before you complete 10 days, there will be no bad effects. You can start the NE now and continue till Tuesday when you can take a definite decision to get the Implanon removed. Taking the NE for 5 days will not affect you badly in any way. And you can take the microgynon at slightly different times. You can start off by taking the microgynon at the same time the first 2 -3 days and then delay taking it by 2 hours every day until you are at the right time according to the time differences. Please remember that you will need to use condoms during this month since there is a slight risk of pregnancy. From the second month onwards, the contraceptive will be very effective.</p>
Customer: replied 5 years ago.

HI,

I have my doctors appointment tomorrow, in which I either have the implanon removed or not. Thank you for your time so far, i really appreciate your expertise.

To help me decide please could you answer the following questions:

I have been taking NE for 4 days now and it has stopped my spotting. When I stop taking NE after 10days will i have withdrawal bleeding and will this be like a period? After this if my spotting returns can I take more NE and if so how much and how often and will this result in me never having spotting again? Also everytime i stop taking NE will i have withdrawal bleeding so in effect would i be having artifical periods each month? If i am to have artifical periods each month how heavy and long are they likely to be?

 

If I have implanon removed how irregular will my periods be? Am I likely to have a month or so inbetween or could i end up having periods that are only a week or so apart? Can i take NE to delay periods and if i'm not sure when i'm due can i just take (NE) when I know I don't want a period that particular week so i dont bleed at an inconvient time? If i usually bleed for 5 days, when the implant is removed am i likely to bleed for anymore than 1 week?( i've had the implanon in for 2 months now.) If i blled for a prolonged time can i take NE to stop this? Can NE be taken to reduce period pain and if so when would you take it to cause this effect?

 

My mood seems to have settled now on the implanon, is it likely to stay settled now? If i have it removed is my mood likely to be disrupted again and how long would you predict it would take for my mood to settle afterwards? If i used to suffer PMS, but my last 2 periods before implanon was put in were not bad and didnt suffer bad PMS are they likely to go back to that after the initial bleed?

 

Sorry to ask so many questions, i am just anxious about making the right descion.

Expert:  Dr. Das, MD replied 5 years ago.
What you decision you take will depend on whether you want to take a contraceptive to avoid pregnancy. if you do, you can stop NE the same day that you ge the Implanon rmeoved and start off on Microgynon 20. This will prevent any spotting, any withdrawal bleeding from stopping the NE and also help stabilise your mood. You will get your period again after the pack of microgynon is finished.

If you do not want a contracpetive, then you can stop NE on the same day as you get the Implanon removed. You should get your period within 7-10 days later and this should be heavier than normal. You will get irregular periods for the frst 3 -4 months after the Implanon is removed with spotting in between. If you wish to take NE to sotp the spotting, please remember that youw ill need to take it for at least 14 days so that you get your next period after stopping the NE.

NE can delay periods but it cannot stop period pain.

It is difficult to say if you will suffer from bad moods again. If you start Microgynon, you will not. If you do not take Microgynon, you may or may not get a bad mood again - it varies from women to women.

I hope this helps.

Please feel free to ask for more information if you want any. If not, please accept the answer by clicking on the green 'Accept' button on this page. Leaving a bonus and positive feedback would be much appreciated.
Customer: replied 5 years ago.
My doctor does not seem to want to prescribe me the pill because i'm travelling for a whole year through multiple time zones and the risk of DVT. Do you think if i took at at irregular time though iut could be effective for period management? I am not bothered about contraception just inconvient bleeding and moods. Do you think this would be best controlled now by leaving the implanon in as my mood seems to have settled? If i keep the implanon in can my spotting be controlled permently with NE? I have been taking NE for 4 days now and it has stopped my spotting. When I stop taking NE after 10days will i have withdrawal bleeding and will this be like a period? After this if my spotting returns can I take more NE and if so how much and how often and will this result in me never having spotting again? Also everytime i stop taking NE will i have withdrawal bleeding so in effect would i be having artifical periods each month? If i am to have artifical periods each month how heavy and long are they likely to be? Do you think the bleeding will be harder to control if i have implanon removed? Am i likely to end up with almost frequent bleeding or do you just mean by irregular that one month my cycle may be 20 days and another 30 with somne spotting inbetween? Can you take NE for 28 days to try and regulate your periods if i had implanon removed? What do you think is the safest option in terms of bleeding and mood for me, i doubt my doctor will not let me have the pill so its implanon or nothing unless you strongly advise the pill icould try and persuade her? But out of the 2 options implanon with NE or implanon without NE what do you feel would be best fr me at this stage?
Customer: replied 5 years ago.

Basically I think I would be happiest if I had the implanon out and my periods could still be controlled/managed. Can this be done just with NE? If you think this is impossible than i guess i'm best off keeping it in if you think my spotting can be permanently managed.

 

What do you recommend?

Expert:  Dr. Das, MD replied 5 years ago.
Although your periods can be controlled with NE, it is too strong to be taken for a long time. It would be better if you were to take another progesterone like medroxyprogesterone. This is similar to NE but much milder and more similar to the body's own hoemones. You will need to take a pill every day for 21 days and then stop for your periods to occur - just like BC pills.

If you kept the Implanon in, you will continue to have spotting from time to time.
Dr. Das, MD, Doctor
Category: Medical
Satisfied Customers: 2232
Experience: MBBS, MD, with wide experience in all aspects of medical treatment, including cancer therapy.
Dr. Das, MD and 6 other Medical Specialists are ready to help you
Customer: replied 5 years ago.

My doctor has given me NE which she says i can take to try and control the spotting for 10 days, but not more often than once a month. Does this mean I must leave it 4 weeks after day 10 of taking it before i take it again if i continue with this treatment or can i take it 4 weeks after day 1 of taking the treatment?

 

I am confused as to whether you are recommending me to take medroxyprogesterone instead of the implanon or with the implanon as an alternative to control spotting. Is this drug avaliable worldwide (uk, thailand, Austrailia) and how many times a day do you need to take it?

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