Self-reported bleeding patterns during extended etonogestrel implant use beyond 3 years

To describe self-reported bleeding patterns among etonogestrel implant users beyond 3 years of use and assess perceived changes compared withthe first 3 years. We conducted a cross-sectional study at University State of Campinas, Brazil, among women who continued using the same etonogestrel implant beyond 3 years after insertion. Participants completed a structured questionnaire assessing their usual bleeding characteristics during extended use, including bleeding/spotting episodes per month, bleeding/spotting days per month, and bleeding flow. They also reported perceived changes in these characteristics compared with the first 3 years of use. We included 153 women. The median age was 32 years (IQR 26–37), and the median body mass index (BMI; kg/m2) was 26.6 (IQR 23.8–30.1). The median duration of implant use was 3.9 years (IQR 3.40–5.08). Amenorrhoea was reported by 24.2%, and the median number of bleeding/spotting episodes and days per month was 1 (IQR 0–2) and 4 (IQR 0–7), respectively. Compared with the first 3 years, 62.7% reported unchanged or fewer bleeding episodes, 62.1% reported unchanged or fewer bleeding days, and 58.8% reported unchanged or reduced bleeding flow. Among women who continuied etonogestrel implant use beyond 3 years, approximately one-quarter reported amenorrhoea, and most perceived no increase in bleeding frequency, duration, or flow compared with the first 3 years. However, these findings should be interpreted with caution because of the retrospective assessment and potential selection bias. Among women continuing etonogestrel implant use beyond 3 years, approximately one-quarter reported amenorrhoea. Unchanged bleeding characteristics were more frequently reported than either increases or decreases, although retrospective assessment and selection bias limit interpretation.