WOMENS-HEALTH Messages for November, 1998: Re: Breakthrough Bleeding On OCs

Re: Breakthrough Bleeding On OCs

From: Samantha (anonymous@obgyn.net)
Tue, 17 Nov 1998 13:38:39 -0600 (CST)

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At Thu, 28 Aug 1997, D. Ashley Hill, M.D. wrote: >
>At Thu, 28 Aug 1997, Pat wrote:
>>
>>Could you identify the reasons some women experience increasing
>>breakthrough bleeding on birth control pills.
>
>Pat-
>My problem is somewhat different in that I have had three pregnancies that delivered four children. I am in my mid thirties and over the last four months have experienced frequent bleeding. After having a period I may bleed again in 2 weeks, 1 week or 3 weeks. If I'm lucky I may go through a full 28 day cycle. I am experiencing pain during and in between these episodes of bleeding. The doctor instructed me to have an ultra sound to determine if I had fibroid tumors. I apparantly do not. Now he has instructed me to take low dosage birth control pills for three months or indefinately "If it is my desire" to control the bleeding. The problem I have with this is that 1. It does not deal with my pain.
2. I have a history of not tolerating the pill very well. 3. I am a smoker 4. It plainly says on the box that if you have unexplained bleeding you should not take this product.

Can you please give me some advice or direction on this. I need some help and do not feel that my doctor has addressed any of my above mentioned concerns. >I have found 2 main types of bleeding on women who take OCPs. The 1st,
>as you mention, is common after starting the pill and usually resolves
>after 3-4 months. This is probably from a destabilized endometrial
>lining as it responds to the change in hormones.
>
>The other type is more troublesome, and occurs after being on the pill
>for many months or even years. I usually see irregular spotting
>throughout the cycle. Since OCPs are a little progestin-dominant the
>progesterone component "wins out" over time, and the endometrium thins
>out so much that it becomes raw (denuded). The raw, exposed vessels
>bleed a little at a time, causing troublesome spotting. The treatment
>is either to add estrogen, say 1.25 mg of conjugated estrogen per day
>for 10-14 days. An easier, but a little "riskier" treatment from a
>contraception standpoint is to simply stop the pill for 10-14 days then
>restart it on a Sunday. Both allow stabilization and regrowth of the
>endometrium.
>
>Thanks,
>
>Ashley
>
>--
>Ashley Hill
>D. Ashley Hill, M.D.
>Associate Director
>Department of Obstetrics and Gynecology
>Florida Hospital Family Practice Residency
>Orlando, FL
>I apologize, but I am unable to answer personal e-mail
>due to time constraints.
>

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