In a recent study, rates of abnormal bleeding among etonogestrel contraceptive implant users did not differ between a curcumin and a placebo group.
According to a recent study published in the American Journal of Obstetrics and Gynecology, daily curcumin use does not improve bleeding patterns in etonogestrel (ENG) contraceptive implant users.
The ENG subdermal contraceptive implant has strong efficacy for preventing pregnancy but is associated with abnormal bleeding patterns which lead to discontinuation. As the implant is 20 times more effective than oral contraceptives at preventing pregnancy, increasing satisfaction may reduce unplanned pregnancy rates.
Tomoxifen has been shown to reduce bleeding after contraceptive implant but is associated with an increased risk of venous thromboembolism (VTE) in long term exposure. Alternatively, curcumin has been deemed safe by the FDA and is effective against cancer, cardiovascular disease, and autoimmune and inflammatory conditions.
Curcumin has not been formally studied for uterine bleeding. Its safety and biological plausibility for improving bleeding showcased a need to associate its effects in implant users. To determine the effects of curcumin in ENG contraceptive implant users, investigators conducted a study at Oregon Health & Science University in Portland.
Participants were aged 15 to 45 years, had been using the ENG 68-mg subdermal contraceptive implants for 30 days or more, and met the criteria for frequent or prolonged bleeding or spotting in the past month. Frequent bleeding was 2 or more separate episodes while prolonged bleeding was episodes lasting 7 days.
Exclusion criteria included being less than 6 months after delivery, less than 6 weeks after abortion, allergic to the study medication, currently breastfeeding, using anticoagulation, having bleeding dyscrasia or undiagnosed abnormal uterine bleeding, VTE history, using P540 pathway–inducing drug, active cervicitis, or current implant use more than 2 years and 8 months.
An in-person screening visit was performed to confirm implant use and conduct an implant examination. Urine pregnancy tests were performed at baseline, enrollment, study exit, and when there was a concern for pregnancy. Baseline bleeding patterns were established with help from study staff using a calendar to estimate bleeding and spotting days.
Satisfaction with bleeding patterns and implant use were determined using a visual analogue scale (VAS) at baseline and study exit. The VAS was also used to collect information on plans for future implant use, desire to continue using the study drug, and beliefs about randomization.
The primary outcome of the study was the number of days without bleeding or spotting since initiation of the study drug, the 600-mg Theracurmin HP (Immunovites, Las Vegas, NV). Secondary bleeding outcomes were also evaluated, including number of bleeding free days, number of bleeding or spotting days, number of spotting days, number of bleeding days, and number of bleeding episodes.
There were 58 individuals included in the analysis, 54 of which completed all 30 days of treatment. Participants were aged a mean 24 years and had a mean body mass index of 24 kg/m2. Implant use length was 579 days for the placebo group and 431 days for the curcumin group.
A significant difference in the number of days without bleeding or spotting was not found between both groups, with a mean 16.7±6.9 days for the curcumin group and a mean 17.5±4.8 days for the placebo group. Secondary outcomes also did not differ between the curcumin and placebo groups.
Sixty-five percent of participants said they would recommend the ENG implant to a friend, with rates not significantly changing between groups. The groups also did not significantly differ in satisfaction measured by VAS.
Of participants, 72% overall, 82% of the placebo group, and 62% of the curcumin group said they would keep the implant. A desire to continue using the study drug was reported by 81% of the curcumin group and 39% of the placebo group.
These results did not indicate an improvement in bleeding patterns for ENG implant users. Investigators recommended further research on bleeding associated with progestin-only contraception.
Edelman A, Boniface E, Schrote K, et al. Treatment of unfavorable bleeding patterns in contraceptive implant users: a randomized clinical trial of curcumin. American Journal of Obstetrics & Gynecology. 2023;229(2):145.E1-145.E9.