The ENG implant has data placing it as the most reversible, hormonal contraceptive agent available with a typical use failure rate of 0.05%. Unfavorable bleeding patterns, such as frequent or prolonged bleeding, affect approximately 40% of ENG implant users within the first 3 months but typically improve over time. Nonetheless, it is the main reason for patient discontinuation. In the past, various medications have shown to have at least some short-term reduction in bothersome breakthrough bleeding (BTB). These include doxycycline, ethinyl estradiol (EE), mefenamic acid, combined oral contraceptives (COCs), short term tamoxifen, norethindrone, and ulipristal acetate. In this episode, we will summarize a new RCT (AJOG, released as epub on Jan 7, 2026) which describes the use of TXA for ENG related BTB. Did it work? Listen in for details.

1. Andrade, Maíra Cristina Ribeiro et al. Norethisterone for prolonged uterine bleeding associated with etonogestrel implant (IMPLANET): a randomized controlled trial

American Journal of Obstetrics & Gynecology, Volume 234, Issue 1, 101 - 115

2. Edelman, Alison et al. Treatment of unfavorable bleeding patterns in contraceptive implant users with tranexamic acid: randomized clinical trial. American Journal of Obstetrics & Gynecology, Volume 0, Issue (Articles in Press January 07, 2026)