Brief Answer: I would be happy to help... Detailed Answer: First I have a few questions: 1. At what age did her periods begin? 2. Were her cycles ever regular? 3. Were her cycles always or ever heavy before? 4. When exactly did she get the implant? Thank you!

---

Brief Answer: I am sorry about the delay!! Detailed Answer: Given that her cycles were previously regular, and she does not have a history of heavy periods before the implant, then the change in her cycles and recent abnormal bleeding is almost certainly related to an effect of the implant itself. While it is hard to imagine as a possibility (as her father) she MUST check a pregnancy test. I will assume that this is negative. The implant is typically a progesterone only product. It causes her to cease ovulating. It is similar to something called the DepoProver shot, or Depo-shot. It can be associated with "breakthrough" bleeding - this is very common. Sometimes it is related to very irregular ovulation, and sometimes it is related to extreme thinning of the uterine lining (which is not a permanent effect). Hopefully this does not reach you too late, but here is what I would recommend: 1. She needs a pregnancy test 2. I think that she should see an OB/GYN - this is what we deal with on a daily basis 3. Given the lack of a response to combination birth control pills, before adding additional hormones, she needs an ultrasound of the uterus 4. I am not sure what to make of the liver dysfunction, but in patients with liver problems, their ability to stop bleeding can be affected. This would be very rare in a 19 year old female. I would ask for specific clarification of this issue and I would be happy to research it further if you have more specifics for me. With regard to "not taking her very seriously", I am very upset. You deserve the very best care for your daughter, and perhaps you are her very best advocate as she gets this sorted out. None of the Providers that you are dealing with would tolerate the same for their daughters, and you should expect that they should treat her just like they would a member of their own family - or you should take your business elsewhere. Demand good care - you are likely paying for it already!! I hope that this helps you - please give me an update and I will try to help further.

---