PIP: Menstrual cycle irregularities are common during the first few months of use of hormonal contraception and the IUD. Although most contraception-related menstrual problems are not clinically significant, they can lead to erratic method use or even discontinuation. This article presents guidelines for the assessment and management of bleeding problems related to use of combined oral contraceptives (OCs), progestin-only pills, subdermal progestin implants, injections, and IUDs. Much of the patient dissatisfaction that results from these menstrual changes can be averted by careful counseling prior to method selection. Candid dialogue regarding the potential for bleeding disturbances is critical before a method is prescribed in order to avert the interrupted contraceptive practices that place women at risk of unintended pregnancy.