What options are available to treat irregular bleeding in women who are using the contraceptives etonogestrel (Implanon) or levonorgestrel (Mirena)?—GINA SAPP, ARNP, Perry, Fla.

First, reassure her that this irregular bleeding is normal and not dangerous, which may be sufficient treatment. If not, initiate combined oral contraceptives for one to three months to help to stabilize the uterine lining. The only other option is to remove the Mirena or Implanon and replace with a different form of birth control.—Sharon Demeter, MSN, CNM, WHNP, assistant clinical professor, department of family health care nursing, University of California, San Francisco (149-7)