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Breakthrough Bleeding

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It is strange. You have never experienced this kind of mid-cycle vaginal bleeding. The timing is unusual; the vaginal spotting or bleeding is abnormal. You are concerned. Could this have something to do with the birth control pills you are on?

It could well be breakthrough bleeding. Understand how pertinent it is to address the issue promptly. Find what to do and check ways to cope with breakthrough bleeding.

Breakthrough bleeding

Breakthrough bleeding, vaginal bleeding breakthrough and vaginal bleeding due to hormones all mean the same. Menstrual bleeding outside normal menstruation when a hormonal method of birth control is used is referred to as breakthrough bleeding. The hormones can be either estrogen or progesterone or a combination of both. There are different forms of taking these hormones. They can be taken orally (oral contraceptives or the pill), implanted into body tissue, injected under the skin (birth control injection), absorbed from a patch of skin (the patch) or placed in the vagina (vaginal ring).

Breakthrough bleeding can take place at various stages - when starting to use a birth control method, while switching brands or changing regimen and in most cases this stops on its own; probably after the first cycle or two. For some, the bleeding can be light spotting, for some it can be a heavy flow. Breakthrough bleeding needn't necessarily be experienced by all women who use a birth control method. But, smokers are more prone. Also, as compared to non smokers, higher percentage of smokers are likely experience breakthrough bleeding in the first three cycles of taking the pill.

The bleeding or spotting occurs when the body is in the process of adjusting to the hormone dosages that enter the body through contraceptives. For some, the body metabolizes hormones fast and for some it is slow. The pattern of bleeding is largely influenced by the birth control method. Other causes of breakthrough bleeding are:

  • Possible miscarriage

  • The effects of hormonal fluctuations

  • Starting, stopping or missing oral contraceptives or estrogens

  • Declining thyroid levels

  • Effects of stress

  • Recent change of diet.

  • Body weight gain or loss.

  • Displaced intra uterine device

  • Injury to vagina caused by insertion of objects

  • Taking anticoagulant drugs

  • Gynecology procedures like cone biopsy or cervical cauterization

  • Vaginal dryness

  • Malignant cancers

Coping with breakthrough bleeding

As such breakthrough bleeding is not considered a dangerous condition. Here are tips to cope with normal breakthrough bleeding which usually settles down by itself mostly after the first cycle or after two menstrual cycles.

Accept: Understand and accept that it is not dangerous and is a temporary condition only.

Prepare: Though a nuisance, get ready to handle both physically and mentally.

Manage: If using tampons, change frequently and stop using tampons as soon as the bleeding stops. Tampons in vagina for too long can lead to potential serious health condition.

Carry on: Missing doses or changing time result in breakthrough bleeding. Don't stop, continue and it will help minimize bleeding and reduce duration.

Check out: Taking medications like antacids, antibiotics, certain OTC digestive medications, herbal remedies like St. John's Wort can affect absorption of pill. There are medications such as anticonvulsants, anti-tuberculosis and antifungal medications that can increase the metabolism of birth control pills. Discuss with health care provider to decide further use of medication.

Consider: Quit smoking or seriously consider reducing as smoking can lead to excessive breakthrough bleeding.

But, if marked by a high degree of irregularity and lengthy periods of bleeding with symptoms like fever and fainting, it indicates a serious medical condition. It is best to seek medical help. Also, if breakthrough bleeding continues after the first three months or after several years of using contraceptive methods, it requires further evaluation. Contact health care provider without further delay.

Fix up an appointment with your gynecologist and take along medical history reports. Remember last menstrual date and take along list of medications being taken. The following course of action may be recommended.

  • If the bleeding is a result of using a birth control method, a prescription adjusting the amount of hormones or trying an altogether different method of contraception might be recommended.

  • If the bleeding between periods is accompanied by a vaginal discharge (yellow or brown mucus) or pain, it indicates an infection in the uterus. It requires immediate treatment.

  • If the bleeding is due to sexually transmitted disease, treatment to reduce further spread of infection will be followed.

  • If it is due to pregnancy, depending on the body condition and stage of pregnancy future course of treatment will be planned.

  • A blood count test may be recommended to ensure you are not anemic.

  • A thyroid test to check thyroid levels and or a blood test to check clotting abnormalities may be required.

  • An ultrasound to check if internal polyps, fibroids or ovarian masses are visible may be conducted.

  • A Pap smear test to examine the cervix for signs of irritations, polyps or tumors is likely to be recommended.

  • If in perimenopause stage, a wait and see approach advising to consult whenever there is a change in frequency and flow may be suggested.

Test your knowledge about Breakthrough Bleeding Facts

1. Is breakthrough bleeding a sign of pill failure ?

Cause of Breakthrough Bleeding

Is breakthrough bleeding a sign of pill failure ?

Not at all. Breakthrough bleeding is not indicative of pill failure. In fact in the first couple of months of pill usage, it is not abnormal to notice breakthrough bleeding. It takes the body time to adjust to the synthetic hormones. Late cycle bleeding often suggests that the woman needs a pill with higher progestin, either in dose or strength. It could also mean that a pill with lesser estrogen is better suited. Rare cases of early cycle bleeding usually indicate that your pill does not contain enough estrogen. But if this second bleed every month doesn't stop in a couple of months, do consult your doctor.

2. Does smoking increase your chances of breakthrough bleeding?

Does smoking increase your chances of breakthrough bleeding?

Breakthrough bleeding is most often the result of fluctuating hormones due to contraceptive pills. This happens when the endometrial walls of the uterus start thinning due to the lower hormone levels in the pill. Smokers who are on the pill are at increased risk for breakthrough bleeding as smoking has anti-estrogen effects and increases the estrogen metabolism. While most women might notice breakthrough bleeding in the first 2 months of starting the pill, smokers might notice it for nearly 6 months or so.

3. Do thinner women have a increased risk of breakthrough bleeding?

Do thinner women have a increased risk of breakthrough bleeding ?

After all, breakthrough bleeding mostly happens due to fluctuations in the body hormones. Most often this happens to women who are on contraceptive pills. Lower estrogen levels tend to cause bleeding mid cycle. Thinner women are noticed to have lower estrogen levels. Natural ways to increase estrogen intake or slow down estrogen metabolism include taking Vitamin C or grapefruit juice along with your daily pill.

4. Do medications affect breakthrough bleeding ?

Do medications affect breakthrough bleeding ?

When you are on the pill, your body is getting used to the hormonal variations. This most often leads to breakthrough bleeding in between the monthly period. Some medications can have an effect on breakthrough bleeding. Antacids, digestive medicines and some herbal medications can increase hormone metabolism in the liver. Steroids, anti-fungal and anti-tuberculosis medications also have a similar effect.

5. What are the possible causes for breakthrough bleeding, other than hormonal contraceptive pills ?

Possible causes for breakthrough bleeding

Breakthrough bleeding can occur to women who are not on the pill too. Infections or Sexually transmitted diseases can be probable causes. If you are pregnant a few weeks, it is not uncommon to notice a little bleeding. Some women notice mild bleeding during ovulation. Your doctor might suggest an ultrasound to check for internal polyps, fibroids or ovarian mass.

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