What You Need To Know About Breakthrough Bleeding On The Pill
The following are some of the most common causes of breakthrough bleeding during use of hormonal contraceptives:
1) Heavy menstrual flow (menstrual blood loss).
If you have been experiencing heavy bleeding for several weeks or months, it may indicate that your body is trying to regulate its own fertility. A healthy woman’s monthly cycle lasts 28 days with ovulation occurring around day 14. During this time, menstruation occurs every month.
Menstrual blood is shed from the endometrium (lining of the uterus), which is a thin layer of tissue that lines the inside of the womb. This shedding of blood helps maintain a balance between estrogen and progesterone levels in your body. When there isn’t enough estrogen or too much progesterone present, uterine contractions cause bleeding.
2) Ovarian cysts.
These are benign growths that develop within the lining of the ovaries. They often cause no symptoms and can even be found without any signs of menses. However, if they cause excessive bleeding, then it could signal other problems such as cancer or infection.
Cysts can also grow in other organs including the lungs, liver, brain, kidneys and heart. For these reasons they should always be checked out by a doctor before treatment is attempted.
How to Stop Breakthrough Bleeding on the Pill Immediately
1) Estrogen-containing hormonal contraceptives such as combined birth control pills, ‘mini-pills’, implants, and the vaginal ring all have actions that can trigger a tablet.
These can be reversed or reduced with one of these three things:
a) another dose of hormonal contraception. In general, this is not considered to be a good idea since it can mask an underlying medical problem. If you’re not having your period, it’s important to see your gynaecologist in order to check for possible problems like ovarian cysts.
b) taking non-hormonal medication for 7 days. This can be given by mouth or inserted into the uterus. The most common medication of this type is a progestin called LNG (levonorgestrel).
This is also used as a ‘morning after pill’.
c) non-hormonal medication. This works by reducing the effects of the hormone oestrogen. It can be given by mouth or inserted into the uterus and is most appropriate for women who are not pregnant or breastfeeding.
The most common medication of this type is called nafarelin.
2) Progestin-only hormonal contraceptives such as the ‘mini-pill’, injection, implant, and intrauterine device (IUD), do not contain estrogen.
Breakthrough bleeding is less common with these types of contraception but a small number of women will experience changes in their periods. Such changes are most commonly an increase but can also be a decrease. Breakthrough bleeding on progestin-only contraceptives usually can be managed in the same way as for combined hormonal contraceptives.
3) Other causes of breakthrough bleeding:
a) Pregnancy. If a woman has bleeding in the first 10 weeks of pregnancy, an ultrasound scan should be done to look for an ectopic pregnancy (a pregnancy outside of the womb), which is a medical emergency. After 10 weeks, an ultrasound scan is not needed as the bleeding has moved into the uterus (womb).
b) Some women have minor spotting or breakthrough bleeding on and off throughout their monthly cycle. This can be caused by hormonal fluctuations that alter the lining of the womb. Breakthrough bleeding is more common with progestin-only contraceptives.
c) Structural abnormalities of the womb, such as fibroids and polyps, can cause breakthrough bleeding.
d) Infections in the reproductive system such as pelvic inflammatory disease (PID) and uterine or ovarian cysts may also cause breakthrough bleeding.
e) Fibroids and polyps: these are noncancerous (benign) tumours that can grow inside the wall of the womb or on its surface. A small number of women with fibroids or polyps have breakthrough bleeding because these growths are close to the wall of the womb.
f) Pregnancy: Unexpected bleeding in a woman who is not using birth control is often due to a missed abortion, an ectopic pregnancy, or a miscarriage. An ultrasound scan can differentiate these.
g) Uterine or ovarian cancer: bleeding in a woman who is not using birth control is a rare sign of uterine or ovarian cancer. In this case, further tests and examinations are needed to exclude or diagnose the cancer.
h) Noncancerous (benign) tumours: These are rare in the reproductive organs but can cause breakthrough bleeding.
i) Cervical cancer: bleeding in a woman who is not using birth control can be caused by cervical cancer. This is very rare and in this case, further tests are needed to exclude or diagnose the cancer.
j) miscarriage: vaginal bleeding in a woman who is not using birth control and does not wish to become pregnant should be suspected as being a miscarriage (a spontaneous abortion). An ultrasound scan and/or medical test can be done to diagnose an unwanted pregnancy. If the pregnancy is not present, it is likely that a miscarriage has occurred.
k) Ectopic Pregnancy: breakthrough bleeding may be due to an ectopic pregnancy, a potentially life-threatening condition. An ultrasound scan can be done to diagnose an ectopic pregnancy. In this case, medical treatment is necessary to stop the bleeding and to save the mother’s life.
The pregnancy will most likely need to be removed surgically.
l) Uterine Prolapse: uterine prolapse occurs when the lining of the womb drops into the Vagina (birth canal). This can sometimes cause breakthrough bleeding. It can usually be corrected with surgery.
Your gynaecologist may also give you a hormone replacement therapy and/or birth control pills to regulate your bleeding and help to prevent uterine cancer.
m) Other causes: heavy or painful periods can sometimes be caused by other conditions such as fibroids or other benign tumours, endometriosis, or pelvic inflammatory disease (PID). In these cases, you will need further tests and examinations to find the cause of your bleeding.
If you are not on hormonal contraceptives, try to identify the cause of the breakthrough bleeding. Your gynaecologist will examine you and perform some tests to identify the cause.
Sources & references used in this article:
Oral contraceptives and breakthrough bleeding: What patients need to know: Managing expectations is as important as adjusting formulations by PA Lohr, MD Creinin – Journal of family practice, 2006 – go.gale.com
Women’s attitudes to withdrawal bleeding and their knowledge and beliefs about the oral contraceptive pill by W Rutter, C Knight, J Vizzard, M Mira… – Medical Journal of …, 1988 – Wiley Online Library
What women believe about oral contraceptives and the effect of counseling by LM Gaudet, S Kives, PM Hahn, RL Reid – Contraception, 2004 – Elsevier
Headache and female hormones: what you need to know by SD Silberstein – Current opinion in neurology, 2001 – journals.lww.com
The virility solution: everything you need to know about Viagra, the potency pill that can restore and enhance male sexuality by S Lamm, GS Couzens – 1999 – books.google.com
The pill and women’s sexuality by CA Graham – 2019 – bmj.com
Comparison of efficacy, cycle control, and tolerability of two low-dose oral contraceptives in a multicenter clinical study by J Endrikat, B Düsterberg, A Ruebig, C Gerlinger… – Contraception, 1999 – Elsevier