|April 2007 · Vol. 19, No. 04
OCs, breakthrough bleeding, and patients’ need to know
Managing expectations is as important as adjusting formulations
Low-level estrogen in combination with a progestin is excellent for contraception but may not sustain endometrial integrity in some women
Regardless of the type of progestin or amount of estrogen, breakthrough bleeding generally decreases with successive cycles
Though a patient may experience more breakthrough bleeding on an extended-cycle regimen, the number of planned and unplanned bleeding days may still decrease
Skipping pills, smoking, and taking certain medications and herbal supplements are common causes of breakthrough bleeding
Tell the patient that bleeding is common, and usually declines after 3 or 4 months
An OC user who still has bleeding after 3 or 4 cycles should have other causes ruled out with a pregnancy test, Pap smear, endometrial biopsy, or other test
Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pa
Dr. Lohr reports no financial relationships relevant to this article.
Dr. Creinin receives grant and research support from, and is a member of the speakers’ bureau of, Berlex, Organon, and Wyeth. He serves as consultant to Berlex and is a member of the speakers’ bureau for Organon.
In 1982, more than 20% of women surveyed in a nationally representative sample had discontinued oral contraceptives (OCs) on their own or at the recommendation of their physician due to bleeding or spotting.1 Sadly, the percentage today has not decreased much.
Understandable concern, embarrassment, and annoyance lead these women to abandon OCs.1,2 What they often don’t know, though, is that breakthrough bleeding generally is greatest in the first 3 to 4 months after starting OCs,3 and it steadily declines and stabilizes by the end of the fourth cycle.4 Timely counsel could enable many of these women to cope with the bleeding and stick with an effective contraceptive method. Additional incentives are noncontraceptive benefits of OCs: improved menstrual regularity and decreased menstrual blood loss, dysmenorrhea, and risk of ovarian and endometrial cancer.