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Management of Irregular Bleeding in Women on Contraception

While it’s quite normal for many women to experience menstrual bleeding when they have reached the end of a packet of birth control pills or other hormonal contraceptive methods, some women may notice irregular or breakthrough (uterine) bleeding. Other birth control methods may also cause occasional irregular bleeding.

Monthly menstrual cycles fit within the realm of normal for vaginal bleeding when taking traditional birth control pills. Any other bleeding is considered abnormal uterine bleeding, with the irregularity depending on the uterine lining’s reaction to the hormones in the pill.

In Australia, the oral contraceptive pill is the most common form of contraception.  Progesterone (a class of steroid hormones) provide the contraception, estrogen is included to control bleeding.

During the first three to four weeks of starting an oral contraceptive program light bleeding or spotting may occur. If bleeding continues for more than a few days or becomes heavier, it is suggested to keep taking the pill though it is best to consult with your health care provider to discuss a future course of action.

Breakthrough Bleeding

Any bleeding that occurs outside a normal menstrual cycle, is referred to as breakthrough bleeding and can occur for a number of different reasons including:

  • Switching brands of pills which contain different hormones or dosage levels.
  • Change to a different type of hormonal contraceptive.
  • Delaying or missing a daily dose of the pill causing the endometrium to break down and start bleeding. As more doses get missed the chance of breakthrough bleeding increases, and the heavier it may be.
  • Different parts of the endometrium may have different reactions to the hormone, causing some areas to break down at different rates.
  • The brand or dosage level may not be optimal for you, and cause your endometrium to shed early.
  • The endometrium might be volatile and break down during your body’s adjustment to the contraception.

Intrauterine contraceptives may also be responsible for irregular bleeding due to the irritation of the endometrium membrane lining the inside of the uterus. In addition the hormone progesterone, which is contained in some versions of intrauterine hormonal contraception devices, can thin out the endometrium membrane resulting in breakthrough bleeding for some individuals.

Other Causes of Breakthrough Bleeding

Age can be a factor in abnormal bleeding. Young girls who have just started having their periods may have irregular cycles, whilst women in their mid-40s – during a condition known as perimenopause – may notice a change in their usual menstrual cycle or you may skip your period entirely.

Bleeding may also occur because of problems with ovulation, uterine fibroids, polyps, endometriosis, infection, neoplasm cervicitis (an abnormal growth or tumour in the cervix), and an unforeseen pregnancy. Hormonal abnormalities and blood diseases such as leukaemia can also bring about episodes of breakthrough bleeding.

Managing Persistent Irregular Bleeding While on Contraception

All breakthrough bleeding should be monitored carefully, but should not be a cause for immediate concern. If spotting or light bleeding occurs, keeping records for three months before a doctor’s visit is suggested. If the bleeding continues for longer than three months, an appointment with your doctor is recommended.

It is advised to book a medical examination if you experience any of the below symptoms:

  • Moderate or heavy bleeding over an extended duration.
  • You fill one or more pads over an hour for two continuous hours.
  • You experience episodes of dizziness or light-headedness.
  • You think you might be pregnant.
  • Light or spotted bleeding has continued for over three months.

Seek medical attention immediately if you experience heavier than normal bleeding. Furthermore, if you experience breakthrough bleeding and suspect that you may be pregnant, do not delay having an examination, as there is a chance that you may have an ectopic pregnancy or could have miscarried.

If you are experiencing irregular bleeding, spotting or have any concerns regarding your menstrual cycle, please do not hesitate to get in contact with our friendly and professional staff at https://gcaus.com.au/contact-gca/ , who can book you in for an appointment at your earliest convenience.

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