Unscheduled or breakthrough bleeding (BTB) is a common short-term side
effect of hormonal
contraception. Nevertheless it can be unexpected and disturbing to patients, who will
often prematurely abandon their prescribed method without a back-up plan
or notifying their physician. BTB occurs with contraceptive pills, patches,
vaginal rings, injections, implants, and hormonal IUDs. For instance 10
to 30% of oral contraceptive users will experience BTB during their first
month. This drops to less than 10% by the third month, and almost disappears
thereafter.
Women who understand in advance that unscheduled bleeding commonly occurs
during the first few months of hormonal contraceptive use are more likely
to accept this transient nuisance without dissatisfaction and therefore
less likely to discontinue use prematurely. This becomes even more important
with extended use oral contraceptive regimens (eg. Seasonique®) where
expectations run high, but reality falls short. Even with the new pill
Lybrel®, the everyday “no period” pill, approximately
50% of women achieve perfection of no bleeding, but many experience unscheduled
spotting amounting to far less bleeding than they would if they were spontaneously
menstruating.
Let us remind you to call your doctor before discontinuing any prescription
medications. BTB does not compromise safety or efficacy. One tip that
helps many of our patients, especially busy teenagers,
is to place pills by your tooth brush to associate taking them with an
established evening habit. If you only miss one pill, one day, then take it ASAP, and contraceptive
effectiveness will not be compromised. However, if you should miss two
consecutive days you should not only take your missed pills, but also
use a backup method (e.g., Condoms with spermicide) for the remainder
of your cycle.
Together we can help you meet your family planning goals.