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What Causes Breakthrough Bleeding While On Oral Contraceptives?

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Posted on Fri, 22 Jul 2016
Question: I am currently taking an ultra low birth control pill, continuously and not taking the placebo. I have breakthrough bleeding on this pill. In August I will be going on a trip and will be having sex. I cannot be bleeding during this time. I've talked to 3 different gynecologists all with different answers here. 2 have told me to continue taking my current pill then 2 days before I go, to take a 5mg progesterone pill along with my current pill and take it the entirety of the trip and I won't have any bleeding. They are from XXXXXXX The other one, is from the United states and she told me to go on a higher level birth control pill and i may or may not have breakthrough bleeding, but definately do not go on the 5mg progesterone pill. She said it is common practice in XXXXXXX , but not in the United States. The XXXXXXX Gynecologists said it works but the XXXXXXX gynecologist said it doesn't and now im really confused. If it does work...why does the United States not practice it....I honestly don't know what to do now, I just know that I cannot be bleeding while im with him. And, if I go on a higher level pill what are the odds of breakthrough bleeding?
doctor
Answered by Dr. Manisha Jain (29 minutes later)
Brief Answer:
Progesterone addition is a better option

Detailed Answer:
Hello, good to talk to you again.

Yes, you are right that there are plenty of practice differences between various countries and frankly here in XXXXXXX we don't support continuous regimen of estrogen either as usually females here don't feel comfortable with breakthrough bleeding and thus not advocated.

But as regards your priority of no bleeding during those days on top, I would like you to take progesterone support along till you are there on trip.

This is a standard regimen here and very effective.
Rest is completely your decision but I want to guide you that in case you increase the dose of estrogen instead of adding progesterone then chances of breakthrough bleeding will still persist and thus defeat the very purpose of increasing the dose.

All the best and enjoy your trip (hopefully free from bleeding)
Regards
Dr Manisha Jain
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Manisha Jain (17 minutes later)
well i have a few more packs before I go on my trip , so I think that what i will do , is continue with this, and then the last week, when I normally would get the breakthrough bleeding, take the progesterone, just to see if it works before I head on vacation :) thank you so much


I might also add, that these ultra low level bc pills im on are monophasic, have the same level of hormones all month long. and I only get the breakthrough bleeding during the last part of the pack. Would that still apply that I need more progesterone that week? or would it seem I would need more all month?...
doctor
Answered by Dr. Manisha Jain (1 hour later)
Brief Answer:
Good option

Detailed Answer:
Yes dear indeed that is even more suggestive of expected positive response of addition of progesterone.
I hope all goes fine as expected
Take care
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Manisha Jain (2 hours later)
unfortunately, in the United States, they will not prescribe progesterone 5mg for a woman that is on BC pills, for this use. :( ..If i were not on birth control...they would prescribe me 35mg Progesterone pills, but not the 5mg to cover for breakthrough bleeding :(
doctor
Answered by Dr. Manisha Jain (4 hours later)
Brief Answer:
Escalate estrogen dose

Detailed Answer:

Then you can just escalate the dose of estrogen pills from 0.02 to 0.05 a day and I really hope that will serve the purpose.

All the best dear.
Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Manisha Jain (1 hour later)
I am on levonorgestrel .1mg ethinyl estradiol .02mg (orsythia) and have been for 2 cycles, continuously. I have breakthrough bleeding. My doctor thinks this is because the estrogen level is too low. So she prescribed me levonorgestrel .15mg ethinyl estradiol .03mg extended birth control (camrese) to stop the breakthrough bleeding. I know breakthrough bleeding is common during the first 3 cycles.

1. since these are the SAME hormones, only higher levels, would this count as the 3rd cycle...since my body already has these hormones.....and the breakthrough bleeding should be reduced.

2. Will upping the dosage reduce the chance of breakthrough bleeding.

3. It says to start Camrese Sunday after my period..but I don't have a period since I take this continuously, can I just start after my last active pill, which is this Sunday, without any ill effects

4. I am going on a trip August 19-29, since I will be at the end of my 2nd tray and beginning of 3rd on the Camrese, what are the odds of there being breakthrough bleeding.

5. My doctor prescribed me premarin 1.25 mg to take during the time im on my trip to prevent the occurance of breakthrough bleeding should there be any.. Will this work? and what are the side effects and how do I prevent them?

Im also on topomax , LOW dose, 25mg morning and 25mg night time, the neurologist said this is really a low low dose, would this affect the pill and cause any breakthrough bleeding?


Sorry so many questions lately, I just want to get this figured out before I go in August.
doctor
Answered by Dr. Manisha Jain (15 hours later)
Brief Answer:
Right regimen

Detailed Answer:
You are most welcome dear.
Yes you are on right medications and most likely up scaling of this dose will eliminate chances of breakthrough bleeding while you will be on your trip.
Start that this Sunday and as advised take Premarin while on trip and I'm sure you will be bleeding free during those and thus enjoy it all.
Your neurologist is right that it is very low a dose so keep taking it as advised.
You must be knowing if already but don't miss any pill and try to XXXXXXX them well on same time and hopefully all will be according to the plan.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Manisha Jain

OBGYN

Practicing since :2007

Answered : 5136 Questions

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What Causes Breakthrough Bleeding While On Oral Contraceptives?

Brief Answer: Progesterone addition is a better option Detailed Answer: Hello, good to talk to you again. Yes, you are right that there are plenty of practice differences between various countries and frankly here in XXXXXXX we don't support continuous regimen of estrogen either as usually females here don't feel comfortable with breakthrough bleeding and thus not advocated. But as regards your priority of no bleeding during those days on top, I would like you to take progesterone support along till you are there on trip. This is a standard regimen here and very effective. Rest is completely your decision but I want to guide you that in case you increase the dose of estrogen instead of adding progesterone then chances of breakthrough bleeding will still persist and thus defeat the very purpose of increasing the dose. All the best and enjoy your trip (hopefully free from bleeding) Regards Dr Manisha Jain