Research Article| Volume 35, ISSUE 3, P341-345, June 2022

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Tamoxifen for the Treatment of Etonogestrel Implant-Associated Bleeding in an Adolescent Gynecology Practice

Published:November 12, 2021DOI:



      To describe clinical outcomes in a cohort of adolescent female patients using tamoxifen for the treatment of bothersome etonogestrel (ENG) implant-associated bleeding.


      Retrospective chart review


      A tertiary children's hospital


      Adolescent female patients ages 12–21 seen between August 2016 and August 2019 with an ENG implant in place who received a tamoxifen prescription for the indication of implant-associated bleeding.



      Main Outcome Measures

      Main outcome measures were implant continuation rates, average time to implant discontinuation after tamoxifen prescription, reasons for implant removal, number of doses and timing of tamoxifen use, bleeding patterns, and adverse effects.


      A total of 67 patients met the inclusion criteria. The mean age of patients was 16.7 years old. Of the patients with available follow-up data, 49 out of 60 (81.7%) were still using the implant at 12 months, 29 out of 53 (54.7%) at 24 months, and 9 out of 40 (22.5%) at 36 months. The average time from tamoxifen prescription to implant removal was 12.1 months. Bothersome bleeding was the primary reason for ENG implant discontinuation (68.6%). No side effects from tamoxifen use were reported.


      Tamoxifen was well-tolerated among this cohort of patients and can be considered a treatment option to manage bothersome implant bleeding in adolescents.

      Key Words

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        • Funk S
        • Miller MM
        • Mishell DR
        • et al.
        Safety and efficacy of Implanon, a single-rod implantable contraceptive containing etonogestrel.
        Contraception. 2005; 71: 319-326
      1. Information. NexplanonPrescribingWest Orange, New Jersey, Organon USA, Inc, 2021.

        • Obijuru L
        • Bumpus S
        • Auinger P
        • et al.
        Etonogestrel implants in adolescents: experience, satisfaction, and continuation.
        J Adolesc Health. 2016; 58: 284-289
        • Deokar AM
        • Jackson W
        • Omar HA
        Menstrual bleeding patterns in adolescents using etonogestrel (ENG) implant.
        Int J Adolesc Med Health. 2011; 23: 75-77
        • Guazzelli CAF
        • de Queiroz FT
        • Barbieri M
        • et al.
        Etonogestrel implant in postpartum adolescents: bleeding pattern, efficacy and discontinuation rate.
        Contraception. 2010; 82: 256-259
        • Berlan E
        • Mizraji K
        • Bonny AE:
        Twelve-month discontinuation of etonogestrel implant in an outpatient pediatric setting.
        Contraception. 2016; 94: 81-86
        • Guiahi M
        • McBride M
        • Sheeder J
        • et al.
        Short-term treatment of bothersome bleeding for etonogestrel implant users using a 14-day oral contraceptive pill regimen: a randomized controlled trial.
        Obstet Gynecol. 2015; 126: 508-513
        • Mansour D
        • Bahamondes L
        • Critchley H
        • et al.
        The management of unacceptable bleeding patterns in etonogestrel-releasing contraceptive implant users.
        Contraception. 2011; 83: 202-210
        • Glasier AF
        • Wang H
        • Davie JE
        • et al.
        Administration of an antiprogesterone up-regulates estrogen receptors in the endometrium of women using norplant™: a pilot study.
        Fertil Steril. 2002; 77: 366-372
        • Fetih AN
        • Abbas AM
        • Kamel FA
        • et al.
        Tamoxifen for treatment of abnormal uterine bleeding in etonorgstrel implant users: a randomized clinical trial.
        Int J Reprod Contracept Obstet Gynecol. 2019; 8: 4462
        • Simmons K
        • Edelman A
        • Fu R
        • et al.
        A short course of tamoxifen reduces unscheduled bleeding in etonogestrel contraceptive implant users [24].
        Obstet Gynecol. 2016; 127: 9S
        • Simmons KB
        • Edelman AB
        • Fu R
        • et al.
        Tamoxifen for the treatment of breakthrough bleeding with the etonogestrel implant: a randomized controlled trial.
        Contraception. 2017; 95: 198-204
        • Cohen PA
        • Wang Y-.H
        • Maller G
        • et al.
        Pharmaceutical quantities of yohimbine found in dietary supplements in the USA.
        Drug Test Anal. 2016; 8: 357-369
        • Mourits MJ
        • De Vries EG
        • Willemse PH
        • et al.
        Tamoxifen treatment and gynecologic side effects: a review.
        Obstet Gynecol. 2001; 97: 855-866
        • Edelman AB
        • Kaneshiro B
        • Simmons KB
        • et al.
        Treatment of unfavorable bleeding patterns in contraceptive implant users: a randomized controlled trial.
        Obstet Gynecol. 2020; 136: 323-332
        • Mansour D
        • Korver T
        • Marintcheva-Petrova M
        • et al.
        The effects of Implanon on menstrual bleeding patterns.
        Eur J Contracept Reprod Health Care. 2008; 13: 13-28
        • Berenson AB
        • Tan A
        • Hirth JM:
        Complications and continuation rates associated with 2 types of long-acting contraception.
        Am J Obstet Gynecol. 2015; 212 (e1-8): 761
      2. Management of women with bleeding irregularities while using contraception [internet]. 2017. Available: Apr 14 2021.

      3. ACOG Committee Opinion No. 735: adolescents and long-acting reversible contraception: implants and intrauterine devices.
        Obstet Gynecol. 2018; 131: e130-e139
      4. Practice Bulletin No. 186 Summary: long-acting reversible contraception: implants and intrauterine devices.
        Obstet Gynecol. 2017; 130: 1173-1175
      5. World Health Organization: Selected practice recommendations for contraceptive use (third edition). [Internet]. 2016. Available: 21 2021.

        • Abdel-Aleem H
        • d'Arcangues C
        • Vogelsong KM
        • et al.
        Treatment of vaginal bleeding irregularities induced by progestin only contraceptives.
        Cochrane Database Syst Rev. 2013; CD003449
      6. Clinical Effectiveness Unit (CEU) F of S& RH. FSRH Guideline Progestogen-only Implant. 202; Available: Apr 22 2021.

      7. Faculty of Sexual & Reproductive Healthcare (FSRH): Problematic Bleeding with Hormonal Contraception. 2015; Available from: http://04/FSRH/Problematic Bleeding/2015. Apr 22 2021.

      8. United States Food and Drug Administration: Nolvadex (tamoxifen citrate) package insert. 2018