Women's Health Community

Dear Anon: Alas, breakthrough bleeding (BTB) can be a common side effect of most types of hormonal birth control (eg pills/patch/ring/shot/Mirena IUD). Among birth control pill users BTB frequently occurs after a missed or late pill. In your case it sounds like you are careful to take pills at the same time daily.

More remotely, BTB in a pill user can arise if she has gotten a chlamydia infection. Yet, if you both are monogamous this is not going to apply.

When a woman uses hormonal birth control it can make the lining of the uterus more unstable--so it is easier to have some of it begin to shed. Sometimes the lining is less stable because the hormones make the lining much thinner (actually this is good as a thin lining is a healthy lining). Sometimes the lining is unstable because the hormones can make parts of the lining out of synch. In your specific case switching the hormonal formulation from one brand of Pill to another may be the culprit.

Bottom line, BTB on hormonal methods of birth control is a nuisance side effect. The protection from pregnancy should be still in effect. If your poor cycle control persists into your next pack (pack # 3) you should return to your GYN or clinic. Often another change in the brand, or formula, of birth control pill will fix the problem. If you have recently started any new medications or herbal products be sure and ask your pharmacist if there are known interactions with birth control pills.

Yours,
Jane

Hi Jane,

I have a question about breakthrough bleeding as well. I have been on birth control for about 3 mos now and I had side effects such as weight gain and changes and changes in my skin pigmentation. So the doctor switched me to the lowest dosage of combination pills. I just began them 2 weeks again and I begain my period the second day which was very unusual. So I ended up switching back to the first set of combination pills. So now I began my period again and Im not even on the placebo weeks pills ( which is usually when my period begins. Ive been bleading for 9 days do far. The first seven days were as if I was having my normal period with cramps and everything and the past two days have been light. I have one more week until I start the placebo set of pills. What do you reccomend? Should I swtich pills again or just go off the pill? The reason I got on the pill in the first place was to decrease my pain and have lighter periods. So I first started taking all the 3 weeks of combination pills and instead of taking the placebo weeks of pills I started a new pack..

Dear An: Gosh, you have several possible triggers for erratic/breakthrough bleeding (switching to the lower dose formulation, switching back to your usual birth control type, then skipping the placebo pills). My advice would be to call the GYN or clinic which prescribed your birth control pills (BCPs) for the most "for sure" answer.

---You might be told to stop all BCPs for seven days then restart a new pack--- either the lower or regular dose pills.
---You might be told to continue on the pack you are on and just go all the way through until you get to the end of your current pack. My best GUESS is that they will pick this option.

You really deserve their feedback about which product they suggest you utilize. It may be that the breakthrough bleeding will subside after you have been on the low dose brand for three packs. In your specific case you should talk with the prescriber of your pills in case they want to make any further changes in your BCPs.

Hopefully the breakthrough bleeding will abate, and you'll be able to use the lower dose for all its benefits.

Yours,
Jane

I have been on the same birth control for the last three years and just recently this month I have had break through bleeding. It's been occurring for the last four or five days. I also had it happen once before about five or six months ago but never at any other time. I've been on the pill for about five years total. My back is cramping as if I were on my period but the bleeding is much lighter than my normal period. I'm not sure as to why I am having this occur at this point as I take my pill at a regular time daily and have not missed any pills. Over the years I have missed a pill here and there but still never had any spotting. I would just like to know why this might be occurring.

I started taking birthcontrol pills about the middle of 2011 and I took them regularly for 4 months. On the 5th month I had a harder time taking them regularly and eventually just stopped taking them becuase I could tell it was causing problems. So I was off of them for about 2 or 3 more months and then I got the depo shot. after I got the shot, i somehow got pregnant(I think becuse I didnt get it right after my period) and I didn't know it until I had a miscarriage. After my misscarriage I was pretty much just spotting the whole time until my next period, which just ended, but I am still spotting. could this be becuase of the depo shot? Or something else? Both me and my partner have never been with anybody else.

I started a birth control 2 months before I got married. Everything was fine until about a month after we got married. I started getting breakthrough bleeding and it has lasted about 2 months and is still happening. My doctor told me to take 2 pills for a few days in a row and see if that stopped the bleeding with my first birth control. Things didn't get any better so they increased my dose to a little bit stronger birth control.
Bleeding still occurred so they told me to double my pills again and I'm still bleeding! I don't know what else to do?

Dear kelly: What a disappointment to have two months with no problems, followed by two months of constant breakthrough bleeding. It sounds like you are doing everything right (taking the pills at the same time every day, and being in a monogamous relationship). It also sounds like your GYN is trying all the right strategies (doubling up pills for a few days, then trying a higher dose).

I would urge you to call the clinic back and tell them that you did as suggested and the bleeding continues. If you were my patient I might have you finish the current pill pack then start a totally different brand/formulation of pills. Some women will do well on almost any formulation; with others we have to try multiple/varied brands. So try not to despair.

In Support,
Jane

I have also been having problems with breakthrough bleeding! I was on ortho tri-cylen lo, and now have switched to seasonique, which has so far fixed that problem. However I have been having some problems with birth control, due to the fact that my body seems to be sensitive to horimones. I have only been on seasonique for not even a week, and already I have noticed I am becoming more moody! Ortho tri-cyclen lo seems to be the best birth control for my mood. However, my breakthrough bleeding seems to occur either at the end or the beginning of my birth control pack! I am starting to believe that this is because it is triphasic. Are there any monophasic birth controls that are similar in horimones to ortho tri-cyclen lo? I have been looking into Desogen, which contains Desogestrel instead of Norgestimate. However, I don't want to make the switch if this will effect my mood again!!

Do you have any suggestions? Should I give the seasonique more time to work, or will my symptoms persist? Should I just put up with the breakthrough bleeding on the ortho tri-cyclen lo? Also.. I am going down south on vacation in 10 days, and the ortho tri-cyclen lo being triphasic doesn't give me the option to miss my period, where a monophasic birth control pill would!

how long does breakthrough bleeding normally last?
I missed at the end of my first week of active pills because I forgot to take the pack with me over the weekend but I made up the pill the next day. for the past couple of days I've been bleeding a fair amount - almost as much as during a regular period, much heavier than any breakthrough bleeding I've had in the past. I've been taking my pills at a regular time each day in hopes that this will help remedy the situation. In the past I have experienced BTB a couple of times when I wasn't taking my pills at the same time each day - usually it would start in the middle of the second week and continue until the beginning of a new pack of pills. Is there anything I can do to make the bleeding stop? I would really prefer not to have to deal with this for the next three weeks, until my "scheduled" period ends.

Dear Anon: Wow, it's amazing to see how long a thread can be retrieved and revived. Your question is an excellent one, and yes you could get something close to Ortho Tricyclen Lo in a monophasic version.

Ortho Tricyclen Lo has 25 micrograms of estrogen in all active pills, and three amounts of norgestimate (synthetic progesterone) including:.18/.21/.25 mg. OrthoCyclen has 35 micrograms of estrogen and .25 mg of norgestimate in all the active pills. These higher doses of hormones might improve cycle control as well as eliminating the up and down of the norgestimate doses.

You are correct, desogestrel is a different type of synthetic progesterone from norgestimate. It is used in several 30 micrograms of estrogen birth control pills ( BCPs). There is no way to know for sure its effects on your moods without a couple months trial.

As to what BCP would be the "right" choice for you--that is a hard thing to predict. It would depend which was the least offensive side effect profile. If Seasonique is controlling the breakthrough bleeding you might want to give it a couple of months trial.

Lastly, one can "skip" a period using almost any type of BCP. Just skip the inactive/placebo pills and open a new pack of active pills and start in. If only there was a secure way to predict if breakthrough bleeding would result. It's worth a try.

Have a great vacation.

Yours,
Jane

Dear kaibro:One POSSIBLE way to short cut this menstrual-like bleeding is to stop active pills at the end of the week. Either jump down and take the placebo pills (or take nothing) for a week, then restart active pills like this thing never happened. You could either restart active pills in a completely new pack (save the extras at your weekend site), or finish the actives in the partial pack.

The rationale for trying this is that your are having a disordered shed of uterine lining (ie bits and parts). By stopping active hormones you should induce an orderly shed within 72 hours where all the lining sheds down to the base layer--a fresh start hopefully.

None of this interrupts your contraceptive protection. The greatest risk for lapse in protection was the two days of missed pills early in this pack.

Yours,
Jane

Hello Jane I have a question as well. I have been dealing with stress for the past 2 months and my cycles have been all messed up. I missed my period for the month of April. With me being regular I went to the store and bought many pregnancy tests, which came back negative. From there I started my new birth control, which is named Reclipsen. I started spotting on the 22nd for two days, stopped, then back spotting on the 25th. A continuous light flow of blood has now been happening since 27th up to now. Which is 11 days I'm guessing. This freaks me out because I am usually 5 days without birth control and like 3-4 with it. The colors go from red to brown to maybe a pink. What is wrong? Is this breakthrough bleeding to the extreme?

Dear Unijet: Our Mod Squad Queen Caprice alerted me to your question (it can be hard to find new questions in older posts). So you were not using a birth control pill (BCP) in April when you had the missed period. After getting a negative pregnancy test result you began taking your new BCP Reclipsen. Since that time you have had continued bleeding/spotting.Hope I am tracking you correctly.

You actually utilized a newer way to start BCPs called "Quick Start." To do "Quick Start" one first has to be assured that they are not pregnant. The BCP can be started at anytime but must be followed by a seven day usage of a reliable back up method. If there was any any unprotected sex within the two weeks prior to Quick Start, one needs to do a pregnancy test two weeks after starting the "Quick Start" regimen.

So do get another pregnancy test just to rule out an undetected pregnancy. If the result is negative (which I would hope and expect it would be) then you are likely experiencing the culprit of worsened breakthrough bleeding during the initial three packs of BCP use. I was personally dubious, thinking that Quick Start would create worsened, initial breakthrough bleeding due to starting in the middle of "who knows where" in a woman's own hormones. Surprisingly, later studies showed no increase in initial breakthrough bleeding when Quick Start was compared to first Sunday or first day of flow start regimens.

In your specific case, your dastardly breakthrough bleeding MIGHT be due to Quick Start. Alternatively it MIGHT be due to your BCP (which is a generic form of Desogen or OrthoCept). I would suggest continuing to take your BCP as prescribed. If the poor cycle control does not improve after two full packs, let your GYN or clinic know. They may have you take yet another month. Usually after three months of poor cycle control we will change the brand or formulation.

Yours,
Jane

I have a question about birth control pills. I recently started my first round of pills (Tri Sprintec) and I thought I had started my period so I went ahead and took the first pill, but apparently I was only spotting so I asked my doctor and she said it was ok just keep taking them because the pill will probably change my cycle anyway as my body gets used to it. Well, I started my period about a week or week and a half after I started taking the pill and its lasted about 9 days. I say about because at first the discharge was brown and spotty for 2 days and then it started turning red. So is this normal or should I call my doctor and consider other forms of birth control?