Contraceptive Bleeding and Problems

From the Woman's Diagnostic Cyber - Frederick R. Jelovsek MD

• Bleeding from the morning after pill
• Is light period on pills same as a missed one?
• Are low dose (20 mcg) pills less effective?
• Stopped pills because spotting, now no withdrawal bleeding
• Period month after month and still pregnant?
• Failure rate of birth control pills
• Breakthrough spotting on continuous pill therapy
• Can you have a pill withdrawal period and be pregnant?
• Effect of diarrhea on pill effectiveness
• Thyroid assessment on birth control pills
• Breakthrough bleeding after starting a cycle late
• Basal body temperatures (BBTs) as backup to pills

Yes it counts. Actually it's not usually a period but rather just bleeding or spotting like you had.

The other night, the condom broke again (an old pack- I should know better!) - so am I likely to be day 3 or day 18 of my cycle, in which case I may need another MAP (especially since my abnormal period length)? and is it wise to take 2 in one month? Any advise would be gratefully received.

It's not wise, but it is necessary. Go ahead.

Is light period on pills same as a missed one?

I've been taking low-dose BC pills for several months now, and while skimming over the little pamphlet that comes with each refill, I noticed the paragraph that discusses missed periods. Assuming that one takes all their pills correctly, it says to continue as normal, and to get checked out if you miss 2 periods in a row.

My question is: Do lighter-than-what-one-is-used-to-on-the- pill periods count as "missing a period"? I have heard that such is counted as a miss, and I have also heard that any bleeding you get providing that it is at the correct time and you haven't missed any pills or taken any late, or not had any other situations that would have hampered the effectiveness, can be considered a period. In other words, the only time a miss would "count" is if a period was COMPLETELY skipped. My pill packet insert isn't really clear on this. Which is correct?

It is only counted as a missed menses if you have NO bleeding at all. A light or very light period is still a period on the pills.

Rarely, a very light period can be associated with a pregnancy if you missed more than one or two pills in a month.

Are low dose (20 mcg) pills less effective?

I am taking the new BC pill, Alesse®--it is a 20 mcg low dose pill and I am using it for birth control. However, I have heard people say that these lower dose pills are more "accident prone" in terms of failure than the 35 mcg pills. Is this true, or do all BC pills have pretty much the same effectiveness? I'm 20 and don't want to get pregnant!!

If you don't miss pills, the 20 mcg dose is as effective as the 35 mcg dose. The lower dose does give you more of a chance of breakthrough bleeding. You are still protected from pregnancy but more likely to spot. If you try them and don't have any breakthrough spotting, then you should do just fine and would not be more likely to get pregnant.

When you're on the pill (5 full months) and you have a period on time, should you worry if it is scanty and lighter than your others on the pill, or is this normal? I have not missed any pills and take them at the same time each and every day.

Scanty or light periods on the pill are common and shouldn't cause worry. Sometimes you skip periods altogether.

Stopped pills because spotting, now no withdrawal bleeding

I wrote a while ago about being on continuous Ortho Novum ® 1/35 with no break, and having spotting. My doctor took me off the pills for a week for a withdrawal bleed. It's been four days with no pills and NO bleeding. Is this normal? (I have a history of ovarian cancer with one ovary remaining)

Most of the time you have some withdrawal spotting but not always. Since you have been on continuous pill therapy, the lining of the endometrium is probably very atrophic (thin with little tissue). There was enough thinness to spot but now that you are off the pills, there is not tissue left to slough and the lining is starting to get more stable under your own body's estrogen. You will probably need to be off the pills for a month or so to have a normal cycle.

Another alternative for the spotting on the pills is to resume the pills but take an estrogen supplement to "stabilize" the lining of the uterus. I'm assuming you are not pregnant. Check that out if you need to.

Period month after month and still pregnant?

I heard something on the net the other day that said that a woman could have a period month after month and still be pregnant. I know that you can have implantation spotting that may be mistaken for a period the first month and still be pg, but how about a normal period for months at the same, normal time? Assume that this is in a normal reproductive system (not a double or bicornuate (sp?) uterus....how is this possible? Is this rare or common?

This is rare but some women swear they had cyclic bleeding while they were pregnant. This usually is not reported past the first 4 months. As best I can tell, these cases have never been documented well and are thought to represent bleeding rather than menses except in the instances you mentioned.

Failure rate of birth control pills

When using the pill, everyone knows that there is a slight failure possibility even if used correctly, but I have heard conflicting info on the stats. (assume perfect use)

I have heard:

1) 1 in 100 women failure rate
2) 1 in 1,000 women failure rate
Which is correct? There's a pretty big difference between those numbers!

From scientific studies where individuals have been highly motivated to comply, the pregnancy rate for the pills is 0.1% or 1 per 1000. Overall, however, the pregnancy rate in actual use is 3% or 30 per 1000. You are correct that this is a large difference.

Source for these numbers is Speroff et al, Clinical Gynecologic Endocrinology and Infertility, 5th edition, 1994, p. 689.

Breakthrough spotting on continuous pill therapy

I've been having spotting for awhile. It happened for about 4 days and then stopped for a week. Now I've been having heavier spotting for the past two days. My doctor said that he wasn't worried about spotting before, does that mean I shouldn't worry about it happening again, only a week later than the last time? I'm on Ortho-Novum 1/35 with no break (constant with no placebos taken). Does this mean I should be on heavier birth control? The reason I'm on it is because of constant ovarian cysts that don't go away, even after a year. Should I be worried about some kind of endometrial abnormality?

Breakthrough spotting and bleeding on continuous pill therapy happens to almost everyone sooner or later. Rather than switch pills, I would discuss with your doctor whether or not you could come off of the pills for a week (to have a withdrawal bleed) or even one month (to have a natural cycle withdrawal bleed). Then resume the pills. This is more likely to prevent further breakthrough bleeding for awhile.

Can you have a pill withdrawal period and be pregnant?

I know that when you're on the pill, the bleeding you have during your placebo week is in fact withdrawal bleeding and not a "true" period, of course, the blood is real, but there is some difference.

Since this is true, is it also correct that if one became pregnant while on the pill, they would not have withdrawal bleeding at all during their placebo week, or it would be very spotty/light? (assuming that no pills were missed). I have heard that this withdrawal bleeding each month, when it is on time, normal, etc. is "proof" that the woman is not pregnant and the pills are working correctly--is this correct?

If you were to become pregnant on birth control pills, a normal withdrawal period would not occur because progesterone production from the corpus luteum gland on the ovary overrides the drop in progesterone from finishing the active pills. Occasionally a woman could have some spotting while pregnant but usually it isn't a full period.

Effect of diarrhea on pill effectiveness

While on my last pack of BC pills (Alesse®) I had an instance of loose stools--not quite diarrhea. It was solid, but a lot coming out fairly fast. This was quick and happened only once, I wasn't sick, but I do think that this may have been due to the fact that my pill period was on its way--it came the next day.

So, my questions are:

1) I worry about my pills' effectiveness. It was at least a day after I had taken my last pink active pill, and I was on the placebo pills the night of this incident. My pill pack says if you have vomiting or diarrhea the pills may not work as well, but was this really diarrhea? Would my pill's effectiveness have been hampered by this incident, based on the info I've provided?

No, a single episode of loose stool would not have altered the pill's effectiveness.

I'm not sure if the pill makers mean severe, continuous "runs" (like you'd get with food poisoning or the flu) or if solid but loose stools are covered under that definition.

Continuous diarrhea for 1 -2 days

2) If this is covered under that definition, how long should one use backup? (If this happens again so close to my period, should I use it until the period, or through the first 7 days of the next pack?)

In this case you don't need backup. If you do develop continuous diarrhea for 2 days, continue your BCP's and use additional backup while the diarrhea persists and for 7 days after it has stopped.

Thyroid assessment on birth control pills

I tried going off of birth control pills a few years back. Six months later my hair was falling out, I felt heavy and sluggish, and my face was broken out. My doctor did a blood test and I had a very low thyroid. They were surprised how low it had become. They put me back on the pill and my thyroid is fine. They said if I ever went off of the pill again, I'd need to take thyroid pills. Now I can't find a birth control pill that doesn't make me feel bloated and irritable so I just want to go off of them. But, I have a new doctor since then and I get the feeling she doesn't think the birth control pill and my thyroid are related. What do I do? Can going off the pill effect your thyroid or was that a fluke thing?

Sounds like you are describing pretty severe hypothyroidism. This degree of thyroid dysfunction is unlikely to have been due to your OCP's. It is possible with the old tests of just measuring T4 that a low T4 (hypothyroidism) off pills could have a higher value when on pills, but you are still low on thyroid. We used to measure T4 and T3 while on birth control pills because of these false readings. Now a serum TSH (thyroid stimulating hormone) is accurate whether or not you are on pills.

You need to have your TSH measured now.

Breakthrough bleeding after starting a cycle late

While I was taking my last pack of pills, I missed a pill on two separate occasions, and had to take two pills at a time twice. At the end of of the pill pack, I did not begin my period. Afraid that I was pregnant, I did not begin a new pack. Two home pregnancy tests were negative, and I called my gynecologist who told me to resume taking my pills. I began spotting a week and a half after my period should have started, and spotted for 8 days. Now I am beginning the 3rd week of the new pill pack, and have begun spotting again. Should I be concerned, or is this okay?

You are protected now from pregnancy since you have been back on the pill for more than a week. The breakthrough bleeding won't stop until your next period and sometimes it continues into the next cycle. It should be over after that.

Basal body temperatures (BBTs) as backup to pills

Can you (reliably) take BBT temperatures while you're taking birth control pills? I'd like to do this as a back up method to my pills, but don't want to if it will alter the temps either way...

That's an interesting question I don't think I've ever had asked before. I'm not sure, but I suspect the progestin in the pill would alter the early temps to make them higher. On the other hand, if you had a breakthrough ovulation on the pill it could well show a biphasic curve. If you took BBTs for two months and they were flat, I would quit taking them.

The failure rate of BC pills is about 1-3% overall but if there is perfect use (no pills missed) the failure rate is only about 3/1000. It seems if you are compulsive enough to take BBT temps, it's unlikely you would miss a pill. It therefore seems to be a bit of overkill to take BBTs while taking the pill.