There are questions from chat rooms and web boards about taking birth control pills. Uncle Doctor would like to answer.
Question: I have vaginal bleeding similar to menstruation, but my period has already ended. The bleeding has been going on for 13 days, and I am taking monthly birth control pills. I am still taking them today. I would like to know what is happening.
Answer: Vaginal bleeding caused by taking birth control pills can be divided into two types:
- Bleeding occurs after finishing a pack of birth control pills (21 pills) or after taking 21 pills (28-pill pack, the last 7 pills are hormone-free). This is considered normal.
- Bleeding that occurs during the use of birth control pills can happen in either the first half or the second half of the menstrual cycle. The cause needs to be identified and addressed, but don’t panic. Listen further: Type 2 vaginal bleeding can occur in two forms:
- Heavy bleeding requiring the use of sanitary pads (breakthrough bleeding)
- Spotting, which is light bleeding that does not require the use of sanitary pads
The mechanism of bleeding is not clearly understood, but it can be explained that taking combined hormonal birth control pills, which contain both estrogen and progestin, continuously introduces these hormones into the body. This affects the uterine lining and blood vessels, causing them to thicken or thin, and affects the atrophy or expansion of various glands within the lining. Therefore, the cause of bleeding is due to both the fragility of blood vessels and changes in the uterine lining in response to hormones.
Spotting while taking pills can occur in those who have just started taking birth control pills, especially in the first 2-3 months. This is a common side effect, occurring in 20-30% of cases, but it is not dangerous. After 3 months of use, the bleeding usually improves on its own or occurs in less than 10% of cases.
Uncle Doctor recommends continuing to use this birth control for about 3 months without changing it to maintain contraceptive effectiveness.
Here are guidelines for preventing and managing bleeding while using birth control pills:
- Take the pills every day without missing any doses, as this is the main cause of bleeding. Take them at the same time every day to maintain stable hormone levels in the body.
- For smokers, it is recommended to quit smoking because it interferes with the effects of estrogen and affects the menstrual cycle.
- Using birth control pills in conjunction with other medications that may interact, such as antibiotics like ampicillin, sulfa drugs, penicillin, sleeping pills, tranquilizers, and rifampicin, can reduce the effectiveness of birth control and cause bleeding. If you need to take these medications, it is recommended to use birth control with higher hormone levels.
- Low-estrogen combined hormonal birth control pills (e.g., 20 micrograms) are a significant cause of more bleeding compared to higher hormone pills. It is recommended to switch to pills with higher estrogen levels, such as 30 or 35 micrograms. If bleeding persists with 30 micrograms, switch to 50 micrograms.
Different brands of birth control pills with different progestin hormones do not have different effects on spotting.
Uncle Doctor recommends that if there is heavy bleeding, stop the current pack and start a new one. If there is prolonged and abnormal bleeding, stop taking birth control pills to find the cause of the bleeding other than the pills.
There are conditions that can cause abnormal bleeding, such as sexually transmitted diseases, chlamydia, or abnormal vaginal discharge, intrauterine or ectopic pregnancy, or it could be cervical cancer, endometrial cancer, cervical polyps, uterine fibroids, or ovarian tumors.
In summary, if you are a new user of monthly birth control pills, you may experience bleeding during the first 3 months, but it will improve on its own afterward. If bleeding persists after 3 months, review whether you are using the pills correctly. If you are using them correctly but still have bleeding, you may need to adjust the hormone dosage. Importantly, if there is excessive abnormal bleeding, it may not be caused by the birth control pills, and you should see a doctor.
With love and care, Uncle Doctor Ruangkit
Dr. Ruangkit Sirikanchanakul