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    An_248227 posted:
    Hi, I was using Apri and ran out around the first week of august. I went back to the doctor and switched to Aviane around September, last month. I started taking the pills but after a week realized I had forgotten to take 4 of them. I probably should have thought it through but I just ended up taking the 4 I missed. Around the time I noticed I had missed 4 days I started spotting. Well it's been about 2 weeks now and I went from spotting to a full period that has yet to end. I tried to ask my doctor but she just said to come in. (I don't understand why she couldn't just tell me whether to stop taking them or not over the phone.) It will be going on 3 weeks soon and I need to know if this is normal or if I should stop taking them.
    Jane Harrison Hohner, RN, RNP responded:
    Dear An: There are a couple of POSSIBLE components involved in your breakthrough bleeding. First, your former birth control pill (BCP) had 30 micrograms of an estrogen and 0.15 mg of desogestrel your newer BCP has 20 of the estrogen and 0.1 mg of another type of synthetic progesterone (levonorgestrel). Thus you were switched to a lower dose with a different formulation.

    Second, there were the four missed pills sometime in the first or second week of the new pack. You did take those missed pills, but often after even two missed pills erratic or breakthrough bleeding will be triggered. At this point in time, it sounds like you are almost done with the active pills so you could just finish out this pack as prescribed. Hopefully when the next pack is started all this will abate.

    My best GUESS as to why she prefers to see you is both to rule out an unintended pregnancy (four missed pills early in the pack) and to reconsider about the choice of BCPs if your breakthrough persists. If she wants to see you I would make that appointment as there may be some other factor that I am not aware of. ...Sorry you have had to have a month of period like bleeding--how annoying!


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