Womens Health

More Contraceptive Bleeding and Problems

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


On BCPs but condom broke

I just started my 4th month on the Alesse® BCP, didn't miss any pills the previous month. In fact, the only pill missed since I've been on the pills altogether was in my first month, which was lost due to a bout of vomiting. Under doctor's advice the next day, I was advised to make up the pill (which I did) and change my starting date back one day for all following packs (i.e.,began first month on a Sunday, now I start all packs on a Saturday).

My partner and I have always used spermicidally lubricated condoms in addition to the pill, but tonight some semen leaked out while he was pulling out, landing about a drop or two on the area between my vaginal opening and anus--closer to my anus. We immediately wiped it away, but this is the first time that semen has actually touched me there, and so I'm terrified! I've never had sex without using a condom, so technically semen has never even been on my vaginal area.

Should I panic, or should my pills be protecting me enough to keep me safe? I have heard of the "morning after pill", but I'm not sure if it can be used in those women who are already on the pill regularly. Anyone (esp. those with any kind of medical experience) have any advice about what to do?

The pill should be enough to protect you from pregnancy. I wouldn't recommend taking a morning after pill, just continue with your pills. I assume it's pregnancy you are worried about and not sexually transmitted diseases. In the case or STD's, you probably are still ok if the semen was only on the outside of the vagina and you had no open sore areas.


Cumulative contraception failure over 5 years

While surfing tonight, found this site on birth control, including the following paragraph:

"If your method of contraception has an average failure rate of 18%, over five years your likelihood of pregnancy is greater than fifty percent. During those five years, figure 63 out of 100 women using a diaphragm will have gotten pregnant at least once. The average woman using reversible contraception can expect two unintended pregnancies in her lifetime... Even a low annual risk of contraceptive failure implies a high risk of becoming pregnant during a lifetime of use."

Of course, there are contraceptive failures, but to me that's as though the person who manages this website is saying that a woman who uses even effective contraceptives (pill, depo) WILL become pregnant in a few years or so time, even if using it correctly!! This goes against what I have been taught about contraception...the whole point, after all, is to prevent pregnancy! I know that women can use the pill for 10 years or more and never have a pregnancy, or depo for a year or two. In fact, I always thought that the longer a woman uses her method, especially if it's a hormonal method, will only decrease her chances of getting pregnant on her method.

Is this just some misleading info put on the net?

This seems to be a non-sequitur. The statement about an 18% failure rate applies to a birth control method such as withdrawal (which isn't a very good method). If the failure rate is as high as 18%, the author is right. The cumulative pregnancy rate over 5 years will be over 50% and by probability, actually 63%.

For all methods of birth control, there is a theoretical pregnancy rate (assumes perfect use) and an actual rate (imperfect use by humans who forget). Of the major contraceptives only diaphragms and cervical caps approach 18% failure rate in actual use. Depo-Provera® runs 0.3% in actual use while birth control pills run 3%.

The longer a woman uses a method, presumably she gets more perfect in its use and therefore her pregnancy rate approximates that of "perfect use" which for pills would be 0.1% and for Depo-Provera® is about the same.

I agree that the statement is misleading.


Pill brand change - will I get starting side effects again?

I just switched my brand of BC pills from Alesse® to Nordette®. Should I expect to experience side effects similar to those I had on the Alesse® when I first started them (light nausea, breast tenderness, etc.) where I am starting a new brand, even though there were no breaks in between packs? (i.e.) finished placebos on last Alesse® pack and then started new Nordette® pack as told.)

It's hard to say but I do not think so. The nausea and breast tenderness that you describe are usually general effects that women get in starting pills in general. If your body has already adjusted to those you probably won't get them again.

Alesse® and Nordette® have the same two components in them, levonorgestrel and ethinyl estradiol. The doses are slightly different, however with Nordette® having slightly more estrogen and less progestin. The net result is a more estrogenic pill (but not probably by much).


Nausea on the pills

I'm into my third pack of pills (7th pink pill tonight), and for the past few weeks in this cycle I have been experiencing some strange gassy-nausea pains in my stomach. This isn't classic nausea--a good belch or...uh..from the other end will alleviate it, as will eating something. When I wake up, it seems that instantly I have to burp to stop it. It's particularly aggravating if I don't eat a meal, especially breakfast. Plus, it is more of a queasy feeling in my stomach rather than fall-down sick. I do not feel as though I have to vomit.

Could the pills be causing some kind of GI irritation? I take them at 9:00 p.m. without food, could this night time schedule be involved? I have not missed any pills this cycle and use condoms with the pill every time.

Yes. Pills can cause this. It is thought to be a direct irritation of the stomach. Often we will have women switch to taking in morning because for some reason the meals make them less irritating. Taking the pills in the evening can be sort of like having "morning sickness".


Side effects when going off the pill

I am planning on going off of the pill next month. What can I expect as far as side effects. I'm on Ortho Novum® 1/35. I have a an occasional thyroid problem too..(sometimes its high, sometimes low, sometimes just fine. I never know what is going to trigger it). Will going off of the pill effect my thyroid and my PMS? (I'm taking progesterone trouches for my PMS).

It's hard to say. Most of the time you return to how you were doing before you went on the pill. If you have been on pills more than 5 years though, it may be different just because your body has changed over that time. You sort of have to wait and see.


The chances of being pregnant but having periods

I have been reading on the issue of having a period when pregnant. I have a couple of questions about it. It is making me paranoid. What are the chances of being pregnant with a period if:

1.) you haven't had sex for 4, almost 5, months
2.) Are on the BCP, not missed any pills
3.) Had three on-time periods since last intercourse (middle one lighter, but ones before and after that one were normal--not time yet for 4th)

0.1% (1:1000), actually I wish I could be that exact but it is an extremely low chance.

I guess the core question is, how many normal bleeds on the pill would a woman need to have before she could reasonably be assured??

It depends upon the definition of reasonably. I would say one normal period if NO pills have been missed but as you know it can rarely happen. 3 menses after would be almost certain in my book.

I just wanted to know some info so I wouldn't have to waste money on a test if I didn't need to...I need information!

Well, the cost of a home pregnancy tests seems like a small price to pay to put your mind at ease, rather than worry for months about whether you may or may not be pregnant. If you are in this situation now, are you having any symptoms of pregnancy? If so, you need to have a test to be sure, and also to ease your mind.


Late menses changing pill brands

This past month I have changed my BC pill brand from Alesse® (20mcg estrogen, 1.0 mg progestin) to Nordette® (30 mcg estrogen, 1.5 mg progestin). Today was the day that my period was supposed to start, but is hasn't yet. I have not had sex for 5 months, and have not taken any other medications, nor have I missed any pills or taken them late. In fact, the only differences in the month have been the brand change and a new diet and exercise program I started.

Does anyone have any idea what could be delaying my period? Could it be the changing of brands?

Changing the pill can result in the period being different by a day or at most two. Also, sometimes a higher progestin pill can cause less bleeding during menses, almost to the extent of skipping bleeding altogether or just spotting.


Can birth control pills cause night sweats?

Can birth control pills cause night sweats?

Generally they do not do this but the only way to tell for sure is to stop them for a cycle. Progestins can raise the basal body temperature slightly so I don't want to say absolutely that they don't.

More likely culprits are: room temperature is warmer than you are used to, increased evening meal/calories, ingestion of substances that vasodilate (alcohol, medications, hot peppers, caffeine). Medical problems include low grade fevers, hyperthyroidism.

I am on the pill but have been having night sweats. Now I want to go off of the pill but am afraid that my night sweats may get worse. I am only in my early 30's. This isn't premenopausal is it?

It is unlikely to be premature menopause since the pills would be functioning as estrogen replacement even if you were in premature menopause.


Increased mucous discharge after 4 year IUCD use

I have an IUD (four years old) and have not had any problems with it. My last period was about 3 weeks ago, and now I'm having a mucous discharge unlike anything I've ever had, except when I was pregnant and beginning to lose my mucous plug - it's shot-through with blood. There hasn't been a whole lot of it, but I'm concerned. There's no pain, just a tiny bit of cramping or "heaviness". I have a strange feeling that something is wrong - could there be a problem with my IUD, or a failed pregnancy? Or something going on with my cervix?

It's difficult to say. Be sure to check a pregnancy test because that could explain it. However, it is not that likely that you are pregnant. This may be a symptom that persists for only a short time and then goes away after the next menses or it could be more permanent. The bleeding can come from IUD irritation (even after 4 years), cervical inflammation, or even uterine bleeding secondary to hormonal fluctuation. It actually doesn't sound like a pregnancy. As long as the mucous is not yellowish in color and there is no pain associated, you might just wait to see the next cycle if this persists.


Will the doctor do a tubal even if I have no children?

I am a twenty-year-old manic-depressive. My fiance and I will be marrying within the next two years and neither of us wants children. My reasons are partially because of the manic-depression, but mainly just a personal preference. My question is: Would a doctor have a moral/ethical issue with tying the tubes of a young, married woman with no children? I cannot take birth-control pills because they cause me to go into severe depressions and I would be terrified to try an injectable form of birth control because it is still hormonal, like the pill. It seems that the only option I have to make love spontaneously (i.e. without condoms) is by having my tubes tied. (Diaphragms are out of the question-I would rather use a condom.)

There are always some doctors who might have a moral objection to tying tubes so young, but for the most part, doctors will perform the

procedure as long as they are convinced that this is a well thought out decision and that you are unlikely to change your mind about it and "regret" having it done. Most "regret" rates at having tubal ligation are in the 2-3% range for all women (circumstances change later in life, e.g. a new medicine comes along that totally keeps manic-depression under control with no worsening from hormones). Women who have a higher "regret" rate approaching 5-10% are those less than 25 years of age and those women having marital/partner discord.

While you are under 25 years of age and might have a slightly higher regret rate, talk to your gynecologist about all the reasons you have to want this. It may take more than one visit, but most doctors understand this; you are not the first woman who has had these problems and made these decisions. They are tough decisions but you can get a tubal ligation done if that's what you think is best for you.


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