Womens Health

Birth Control Pills and Abnormal Bleeding

Learn How To Avoid Break Through Bleeding

(and other contraceptive problems)
From Woman's Diagnostic Cyber
Frederick R. Jelovsek MD

Break thru bleeding after a year on pills

I am 20 years old and have been on the pill - Desogen® for over a year. Recently I began bleeding between periods, sometimes light, sometimes heavy. I have been seeing my gynecologist annually and have had no other problems. Is this something to worry about, or something minor?

Probably minor. Breakthrough bleeding is not uncommon on pills. It can be from missing a pill or two or taking them at different times in the day, but it also occurs for no reason at all. My rule-of-thumb is to change the brand of the pill if it happens 3 cycles in a row.

Will long term pill use cause infertility or pregnancy problems?

Can remaining on birth control pills for a long time affect your chances of becoming pregnant or carrying a pregnancy to term in cases where there are no other identified risk factors?

No. Basically pills cover up whatever your body would have done over the time you took them, but they don't alter what your natural history is. For example, if you take pills from age 20 to 35 and then stop, your chances of getting pregnant are the same as any 35 year old who just started trying. At 35 it may be slightly more difficult to get pregnant but the pills don't cause it; age or other intervening disease or circumstances does.  Click here for more information on infertility causes.

When to start birth control pills?

I am 34 years old. I never used any oral contraceptive until recently. My physician gave me a prescription for Levora®. He told me to start it on Sunday, the 5th. My regular period was due on the 8th of this month. I started the medicine on the 5th, and I noticed from about the 5th until right now, that I have had slight cramping and very light spotting. I am very bloated and feel sluggish. Is the Levora® interfering with my period? Is this spotting going to continue until next month when I have my period? Or is the pill going to cause my period to start at a different time of the month all together. I called the pharmacy and the pharmacist said that most women start taking the pill after the period begins.

In general, BC pills are started after the menses starts but not always. Your menses will start when you finish the active pills. Between now and then its difficult to say what will happen. You may have no bleeding, continuous spotting or some combination of the preceding. The bleeding usually will straighten out by the second or third pill cycle.

Bipolar disorder - what pill to use?

Are there any specific birth control pills that are recommended for women with bipolar disorder? I have tried Ortho-tricyclen® and Tri-Levelen®. With both of them, I have had depressions worse than before I ever started on Lithium. I could really use some help.

In general it is felt that the progestogen component of birth control pills has the most effect on aggravating depression. Estrogen has the opposite effect, it usually improves depression. The progestogen in Levlen® is stronger than the progestogen in Tricyclen® milligram per milligram. I would expect Levlen® to be slightly more depressive than Tricyclen® but there is a confounding factor. Both have varying doses of the hormones throughout the cycle. The could conceivably worsen a cyclic process like manic-depression. I would think it would be better to be on a mono phasic pill that had a low progestogen potency such as Orthocyclen®, Norinyl 1/35 ®or Desogen 1/35®. It's possible, however, that any combination could worsen the symptoms. Basically this solution involves trying different pills and giving each one about 2-3 mos before drawing a conclusion. There is almost no scientific investigation in this area, i.e. effect of OCPS on manic-depression that I know of.

Shorter and shorter periods on the pill

I am on the pill and every month when I get my period, it seems to last a shorter time. Last month I had my period for less than one day! This month, I stopped taking my 7/7/7 pill on Saturday, I usually get my period on Wednesday, but I did not get my period. I have had cramping like I was going to get my period, but I never had any bleeding. I am wondering if this is due to the pill or if I am possibly pregnant.

Birth control pills usually decrease the amount of endometrial tissue formed each month. That is the mechanism by which they decrease menstrual flow and usually decrease cramps. Sometimes the amount of tissue formed each month is so little that a day of spotting or no menses at all can be the case. There is no long term problem with having scanty or no flow other than the worry that in any one cycle it could represent pregnancy.

Pregnancy can occur while taking birth control pills but it is usually in the range of less than 1% of women who don't miss any pills. Missing pills raises the rate.

Checking a home pregnancy test will reassure you that the "no flow" represents little tissue formation rather than unintended pregnancy. Even though "no flow" on the pills is not thought to be harmful, women and physicians alike sometimes get "nervous" about that. In that case, switching to a pill with slightly higher estrogen dose or lower progesterone dose/potency may help restore at least light flow.

Late with menses after coming off the pill

I started on Tri-Levlen® on April 1. (I had been having breakthrough bleeding for three months in a row.) I was unable to continue the pill because of side-effects. I discontinued it, with doctor's consent, ten days later on April 10. I had a three-day-long period beginning on the 11th. My normal cycle length is about 31 days. I am now (May 18) about a week late. For the past four days I had been bloated(never a problem before) and I had lower abdominal and lower back cramping CONSTANTLY. Today the bloating is gone and I haven't had any cramping. My question is: Should I get a home pregnancy test because I'm late, or is this common when a person stops the pill ten days into it, as I did?

It is common to have a withdrawal bleed (menses) any time you discontinue the pills after taking more than 2 or 3 pills.You have now been off the pills for 38 days and you may be pregnant if you have had unprotected intercourse. The best way to check is the home pregnancy test. On the other hand, delayed ovulation (and thus delayed menses) coming off the pill is not uncommon for up to about 8 weeks. All you can do if the home pregnancy test is negative is wait for awhile. Be sure to use other protection because you have no idea when you might ovulate.

Are expired pills still effective?

I was wondering how soon after the expiration date my birth control pills will lose their effectiveness? Would there be any unusual side effects to taking expired bills and does it matter the brand?

Only the pharmaceutical manufacturer knows for sure. They usually set expiration dates on all meds with quite a margin of safety so I expect they would at least have a margin of 6 months after expiration date but I honestly don't know and the manufacturers don't publish that info that I know of. While no one could officially recommend taking pills that are expired, if they were less than 6 months old I don't think I'd throw them away.

Would there be any unusual side effects to taking expired bills and does it matter the brand?

I would guess the only side effect would be ineffectiveness and if anything, the lower dose pills would loose their effectiveness sooner.

What causes a very light period on the pills?

I am 26, married, and have been on birth control pills for about 5 years. My periods have always been regular, almost to the hour every month. Last period was almost non-existent, a few spots on Day 1, then nothing. Had same amount of spotting afterwards, about 2 1/2 weeks into cycle. Did home preg test immediately after non-existent period, before restarting b/c pills and it was negative. Next period is due this week, and I feel really weird. I have been exhausted all last week and my back aches from top to bottom. Any ideas what could be causing this? No particular stress right now. I am just confused!

A light period on pills can be due to pregnancy. It's possible pregnancy test was just too early to be sensitive to pick it up; it would probably be positive now if you were pregnant.

A light period can also happen just because not much tissue forms when on oral contraceptives. Even though this hasn't happened before doesn't mean something is wrong. Would wait to see what next menstrual flow is like.

No period and negative pregnancy test

Period was due today and didn't come at all, not even spotting. Took a pregnancy test tonight (because I'm paranoid) and it was negative! I'm going to call my doctor tomorrow, but what is going on??!!

The negative test probably means you did not get pregnant the previous cycle. It sounds as if (assuming your menses does not start in the next several days) you may have atrophic changes from the pills. This happens more often then people think. Many women don't mind not having periods as long as they know they are not pregnant. If you skip 3 cycles in a row, you doctor may want to switch your pills although you don't have to.

How to delay menses

Can you tell me how to use my birth control pills to prolong getting a period? I have a vacation coming up and my menstrual is scheduled to occur right in the middle of it.

While birth control pills are normally taken with 21 active hormonal pills followed by 7 placebo or iron pills, there are other ways of taking the pills to control the timing of when you get your menses.

Menses usually starts after no active hormone pills for 3 or 4 days. That is why if you miss more than two birth control pills, a menstrual period often starts prematurely. Then it is best to let it proceed and just start a new pack 7 days after the first missed pill.

You could start your menses earlier than usual by just discontinuing the active pills and starting a new pack 7 days later. Ovulation rarely takes place in less than 10 days after stopping a pill so this should not lead to pregnancy unless you forget to restart them at the correct time.

Rather than having your menses earlier and starting a new cycle, you could start a new pack right after the 21 days of active pills and then your menses would be delayed by 3 weeks.

We know from women who take pills continuously for endometriosis that eventually you may have breakthrough spotting or bleeding if you continue on active pills but that still should not affect getting pregnant.

How to postpone period for holiday weekend

Going to a nude beach over the holiday weekend!! My period will start about 1 or 2 days into my vacation. I am not on the pill. Is there any safe way to postpone my start date with less than a month to go?

If you were on a BC pill this entire cycle it might be possible by extending the active pills (i.e., using the three week active pills then taking another week of active pills and then discontinuing). If you are much more than a week or so into this cycle, it probably would not work.

Mono phasic vs triphasic pills and amount of flow

I started taking BC Pills a while back and thought that I was on the lower hormone level pills because I am not sexually active and am taking the pills to reduce the flow and the cramps, and also regulate when I get my periods because they would come every 30-50 days which was a pain. I recently found out that I am on a higher level pill---I am on the "mono phasic" (is that the right word?) rather than the triphasic pills and was wondering why I'd be put on such a strong pill. I know people that are married and are on the triphasics, so I guess I'm sort of confused. Does your weight have anything to do with it, because I am overweight. But, the pill (Desogen®) really hasn't helped with the bleeding-- it's sorta heavier, so what kind of pill is better to help bleeding---mono phasic or triphasic? Most everyone I know is on the triphasic pill and they say they hardly bleed at all. Is it just a matter of getting the right combination of hormones and which hormone controls the bleeding and which one controls the regularity? And, is it a higher or lower dose of each that results in better regularity and less bleeding?

I want the least bleeding with the most regularity! Is there anything out there comparing pills and their effectiveness on different problems like bleeding or pain or regularity, etc? Just curious!

Mono phasic pills are not necessarily higher or lower in potency than triphasic pills. Triphasic pills tend to vary the estrogen and progestin dose by a small amount in the different phases of the cycle so many people think triphasics are lower but mono phasic pills such as Loestrin 1/20® and Allesse® would be lower total amounts and potencies than most triphasic pills.

Its hard to say whether bleeding is lessened by raising the progestin potency or the estrogen dose. Sometimes both combinations need to be tried.

The Desogen®you are on is actually a "low" potency progestin so if you are having heavier bleeding, the next likely pill would be one with more progestin potency such as Demulen 1/35® or Levlen®. It might be that you would respond with less bleeding to a triphasic. In these instances it can be a matter of trial and error to get you to the right formulation for how your body responds.

Pill potency to decrease flow on pills even more

Two and a half years ago, I started using Desogen®. I used the Sunday start method and tho I would not spot or have any breakthrough bleeding during the month, when I did get my period during the week of taking the "reminder" pills, it would start anywhere from a Tuesday one month, to a Saturday the next or anywhere in between. My periods had always been irregular so this was one of the reasons I decided to try the pill. Also, I knew they usually lessened the bleeding which was fairly heavy and also helped with cramps. Besides not getting my period on at least approximately the same day each month, they kept getting heavier and heavier each month, and the PMS also increased from one week in advance to having it the entire month. The pill did nothing to help with the cramps, either. I told my gyn and she switched me to LoEstrin 1.5/30® the following year. I also switched the pills to a Friday start so I would get my periods on Sundays.

At first, this pill worked great as far as the bleeding. It lessened it and also shortened the length of time it lasted. I also got it the exact same day (Sunday) each month, which I found very convenient. Unfortunately, it did nothing to help with the cramps and I usually had to take about 24 Advil® within a 24 hour time period for a day or two. Eventually, the Advil® wasn't helping and I switched to using Ultram® which helped much more. But, I noticed a few months after switching pain killers, that the first day of my period became quite heavy---heavier than it even was before I took any BC Pills---and also contained many more clots. For about 12-18 hours on the first day I will bleed very heavily, then it will lessen to average and then go to barely nothing for the next 2-3 days and end. I have since read that using Ibuprofen can lessen the flow and I think that's what happened with me---I stopped taking the Advil® and that's when the periods became heavier. I have become fed up with how heavy it is the first day and have recently asked my doctor what to do.

She suggested using Levlen® instead because it is a stronger pill than both Desogen® and LoEstrin 1.5/30® were. I am just wondering if you think this will help lessen the bleeding or make things worse like the Desogen® did because my understanding is that Desogen® is a stronger pill than LoEstrin®, yet it caused heavier bleeding. From what my pharmacist said, according to her chart, LoEstrin® is considered a "lower level" pill and Desogen® is an "intermediate level" pill. So, I'm thinking that because Desogen® caused me to bleed heavier and it was a higher level pill than the LoEstrin® (which lessened the bleeding in comparison to the two), then is Levlen® (which is a higher level than both of them) what I need or will it, too, cause heavier bleeding as the Desogen® did? Should I be going to a pill that's even lower than LoEstrin®? I guess I don't understand how you figure which way to switch someone's pills. My gyn said that you can't really compare two pills like Desogen® and LoEstrin 1.5/30® because the types of progestin in the two are completely different. I've read that if you have heavy periods that you want to increase the progestin level, but it seems like going from Desogen® to LoEstrin® was a decrease (at least according to the pharmacist's chart), but it did work in lessening the amount of bleeding compared to what I had on the Desogen®. So, now I'm completely confused whether to try this pill or not. I'm not as concerned with the cramps as I am with the bleeding and I'm hoping that my doctor is basing her choice of new pills on the bleeding factor more than the pain factor, which I tried to stress to her. She said she thinks this will help more with both, but I am still leery because, well, I have to worry about everything!!

Is there more progestin in Levlen® than the other two pills, and do you think it sounds like the right choice---or at least a choice that shouldn't make things worse even if it doesn't make things better?? I believe that the levels of progestin in each are:Desogen®---desogestrel 0.15mg LoEstrin®----1.5mg Norethindrone Acetate Levlen®-----0.15mg Levonorgestrel Is it true that you should increase the progestin level for heavy bleeding?? And, according to you, which is the weakest and strongest of all these pills? They all have the same dose of 30mcg of estrogen (the estradiol kind). I've heard that you can use two tampons at once---do you place them next to each other?? Does this really work?? Sorry this letter is so long, but I'm starting college in June and my period is, of course, due that week and I guess I'm looking for some reassurance that I won't be hemorrhaging at the time like with the Desogen®!! Should I give this pill a try--do you agree with her choice and that a stronger pill is what I need in spite of the bleeding, etc. that the Desogen® caused? Also, will I notice any change the first month or will it take a few? If the bleeding gets heavier on this pill in the first month, then I would think that it's not the right choice and change back or try another new one. If it doesn't get less, but stays the same, then I should try it for a few months, anyway. Does this sound correct? I am hoping that this pill will work like the others in that I will get my period the same day each month---do most pills work like that? Besides my Desogen® experience!! Again, sorry that this letter is so long, but for some reason, this is a big issue with me---what I'd really like is a hysterectomy so I won't have to deal with it anymore, but....

Keep in mind that what follows about pill potency is controversial. Some very prominent experts in the field feel that since there is so much individual variability in how any woman's specific tissue reacts to any specific hormone, you can't assign biologic potencies accurately enough to clinically prescribe different formulations according to different symptoms. That being said, pills are assigned biologic potencies as a combination of both the estrogen and the progestin. Since almost all pills have the same estrogen (ethinyl estradiol), the estrogen potency only varies from a few pills at the 20 ug level (Loestrin 1/20® and Allesse®) to the majority at 30 and 35 ug. In this respect Loestrin 1/20® would be considered -low- but actually Loestrin 1.5/30® I wouldn't consider low. The other component is the progestin. Progestin potency has in the past been measured by a "delay of menses" index, i.e., how well a hormone keeps the endometrium from sloughing. The higher the progestin potency (and it doesn't go mg per mg across different formulations) the more likely to stop heavy bleeding. For example Levlen® (levonorgestrel) mg for mg is more potent than many other progestins such as the one in Desogen® which is actually a very mild progestin. Higher progestin potency also tends to decrease cramps more. To complicate matters more, sometimes a higher estrogen potency (dose) is needed to "stabilize" the endometrium if if the progestin makes the endometrium too atrophic. You went from Desogen®, a low potency progestin, to Loestrin®, an intermediate potency progestin and your doctor has now suggested a higher potency progestin in Levlen. It seems like it would be worth a try. Another slightly higher progestin potency pill would be Demulen® 1/35. You may also need to get a thyroid check and a bleeding time check to rule out other causes of heavy bleeding.

Switching pills and switching back - Will they work the same?

I am switching from Loestrin 1.5/30® to Levlen® to try and lessen the amount of bleeding on the first day of my period, and also, to help some with the cramps. I will be starting these new pills this week. I am still a little leery about switching pills thinking I may end up worse off than I am now, but I am willing to give it a shot. My main concern is that if I take these new pills and I am not happy with the results the first month for some reason, will I be able to go back to taking the LoEstrin® and have it work exactly like it was working before I made the switch, or will it be like starting a whole new pill in that there may be breakthrough bleeding, spotting, and I may not get it on the exact same day as I used to (it was always 3 days after my last hormone pill). I am just asking this as I know that with other meds I've taken (like anti-depressants...I suffer from panic/anxiety disorder and depression) that you may take them once and have no side effects and they may work fairly well, but then if you stop that med for whatever reason and try and re- start it maybe a month or several months later, your body chemicals have now changed and the med either no longer works on you or you experience side effects this time around.

What do you think the chances are of me being able to re-start the LoEstrin® after being off of it for one month and having it work exactly like it used to?

80-90% - pure guess

I am sure there is always a risk that it will not work the same, but how large is that risk?? I have taken LoEstrin® for about 2 years. Does the risk increase the longer I am off of it?

Not over the course of less than a year, but after that I would think the chance is more that there might be change. Again pure guess -- no scientific studies I know of.

Obsession about switching pills and control of period

I guess basically, before I switch, I just want to make sure that if this new pill does not work out that I will not be stuck with nothing---that I will be able to go back to my LoEstrin® either after one month of taking the Levlen®, or three, and have it resume working just as if I'd never come off of it. I would, of course, continue on the same pill schedule as I have been on and not re-start the LoEstrin® in the middle of a pack or something like that! I am hoping that the Levlen® will work and all of this will be a moot point, but just in case, I like to cover all bases. If need be, I could live on LoEstrin® if I had to, I just prefer to try something new and see if it can help lessen the bleeding and cramps because I'd be much happier with less blood loss each month. But, I don't want to switch if there's a high risk that I can't go back to my old pill and have it work.

In your experience, when people have stopped taking their BC Pills for whatever reason (want to get pregnant or have to stop them because of surgery or some other medical reason) and then start them up again, do they usually work the same way they did before they stopped them??


And, if they do work the same way, do they work this way the very first month, or do you have to give it a few months to readjust?

one to two months

I know when I started on LoEstrin® I was switching from Desogen®, but it worked right away and there was no adjustment period needed (there was no spotting, etc and I got my period the same day each month from the very start of the new pill and the bleeding was less compared to the previous pill on the very first month), so I'm hoping that that would mean that if I did have to switch back that chances would be good that my old pill would resume working as normal in the very first month I went back on it. Any thoughts on this?

Your concerns remind us that if symptoms are tolerable it may be better not to change. Only you can determine the severity of the symptoms.

That statement is something I've been struggling with for the past week. As far as the severity of symptoms, the pain is bad, but I can take pain meds for that, so that's not so much of an issue as is the amount of bleeding I have on the first day of my period. I know that sounds like "big deal", but for me, it is because it is keeping me from doing anything on that day. But, if I had to live with it because another pill wouldn't provide all the benefits I am looking for, then I could, but I figure that if I can lessen the bleeding AND have all the benefits of my current pill then why not try it?

This seems reasonable, to try it since adverse consequences are not very likely.

If you have not figured it out yet, I suffer from obsessive- compulsive disorder (OCD) ---more the O than the C---and that is why I have to obsess on this issue and make sure that I know everything about changing from one pill to another and how it will affect everything. This is why I ask a zillion questions. I apologize for that. I have tried to get my Dr. to answer things, but she does not have the time and when I have spoken to her nurses, they seem unsure about their answers. I guess I just want to be able to weigh all the pros and cons BEFORE I make a decision and then it's too late to correct it.

If you would please humor me and answer some more of my concerns I would appreciate it greatly. On my current pill, since day one back about 2.5 years ago, I have always been very regular--I always get my period exactly three days after stopping my pills. Do most people that take BC Pills get their periods on the same exact day each month?


Since I always have with LoEstrin 1.5/30®, what are my chances of this being the same case with Levlen®?

Educated guess 92.5%

Also, I have always been able to adjust my pills when needed (for vacations, holidays, etc). I have been able to take anywhere from one to seven extra hormone pills or even take one days less per month and I will still ALWAYS get my period three days after stopping the hormone pills. I like this a lot because I am able to plan things around it--or I should say, it around things! Anyway, is this normal for most mono phasic BC Pills---can most people adjust them as exact and to the day as I am able to do with these?

Yes, especially with mono phasic pills.

(ie--if they always get their period 4 days after their last pill and they take 2 extra pills in that pack, will they get their period 4 days after they take the extra two just as they normally get it 4 days after the last pill?

Will it always be the same amount of time between taking the last pill in the pack and the day they start their period?

Yes, unless you start trying to alter it by less than 2 weeks.

I would really like this feature to stay the same with my new pill. If my new pills are always regular to the day, what are the chances of me being able to adjust them and have me get my period on the exact day I plan it like I am able to do with my current pill?

92.5% with the two pills you describe.

If I take 4 extra days of hormone pills, then will I most likely get my period four days later than normal, or could it vary between say, three to five, etc?

Almost always 4 days later.

I really like the fact that if I were to take 4 extra days now, I would get my period exactly four days later than normal. What are the chances of that staying the same with this pill??

Very good. It seems your questions are repeating.

Right now I have it set so that I get my periods on Saturday and that's how I would like to keep it, but I don't know how that will work once I start this new pill--I may get it anywhere from 3 to 5 days after I stop the pills, and therefore, need to do some adjusting to get it back to having it come on Saturdays. How soon after I start taking the new pills can I try and adjust them if I have to?

Give it two cycles.

I would like to make sure that this new pill is very regular (ie- -I get it the EXACT same day each month) before I decide to continue with it. I am not sure the best way to go about determining that. The most obvious way would be to take them for at least 2 months and see if I get my period the same day on each of those months. Three months would probably even be a better sign of their regularity.

But, I would like to get them "on track" as soon as I can if this new pill does not have me get my period on a Saturday. Would it be okay and just as accurate in determining their regularity if I took them the first month and got it, say, on a Sunday which would be four days after the last pill, and then for the next month just stopped the pills a day sooner (take one less) and if I DID get it again four days later--which should be a Saturday this time--then would that tell me that they will in all likelihood, always cause me to get my period four days after the last pill??

Yes that would be ok.

Which would be the best way to go about this?

As you indicated.

I still would like to do a test as far as trying to adjust them by a day or two just to see if it works and comes out to the exact day like it does now. If it doesn't, then I would prefer to go back to my previous pill. How soon can I do this test, or what is the best time to do it so that I make sure I get proper results---I don't want to d it too soon and then find out that the pills were still adjusting and it was just a fluke that it worked out okay.

Would wait until after the 2nd cycle if the time of menses was different from the old pill, and wait until after the 1st cycle if the time to menses was the same as first pill.

I am concerned that if I wait too long to decide whether or not to stay on this pill that I will not be able to go back to my current pill and get the same results. How long do I have, if any time at all, to be able to switch back to my current pill and still get the exact same results out of them as I am getting now?

Guessing -- 6 months.

I want to be able to switch back to them and have things work as if I had never stopped them. Hopefully, tho, I would not have to switch back, but just in case, I want to know what my chances of doing so are.

How long would it take for me to notice a difference in the bleeding once I start these new pills?

1st cycle should give an indication but wait to 2nd cycle to draw a more certain conclusion.

Right now, I get my period very heavy on day one (about 24 hours), and then after that I only have it very light for one or two more days. Do you think that this new pill could make it last longer or even make me bleed heavier??

I would expect the opposite (higher progestin potency) but anything is possible.

If so, are the chances very high of each of those things happening?

Low, less than 10%

Again, I am very sorry to ask so many questions, some of which may be redundant, but for me this is a very big issue and I just want everything to be exact, or at least to have as much knowledge as I can before I make this decision--and I have to decide by tomorrow night for the next am.

Basically, I want all the perks of my current pill to also come with my new pill, but also have the added bonus of less bleeding and even less cramps would be nice. I guess my overall question is how close do you think the two pills will be as far as all these benefits?

I think the new pills may work better, at least its worth a try.

I really want this to work out. I don't want to switch pills and then the new ones not work, the old ones not work anymore and ultimately be left with nothing.

I was so sure that I was going to switch until this past month when I read an article saying that taking ibuprofen could lessen bleeding so I decided to give that a try. In fact, that is when I noticed that my bleeding on this pill became heavier---I used to take Advil for cramps, then switched to Rx pain killers and that's when I noticed a change, but didn't make the connection back then. Anyway, I took the Advil this month (about 13 in 24 hours) to lessen the bleeding, and still had to take my Ultram (8 in 24 hours--50mg each) for the pain, but it did lessen the bleeding. Tho, it was a pain having to take a pill every hour or two. I talked to my gyn's nurse about this and she said that that wasn't a smart thing to do because Advil can cause ulcers. Well, honestly, I am willing to take that chance at this point!! But, then again, I did adjust my pills this month by taking one less and maybe that's why it was lighter, tho it wasn't a whole lot lighter, but still, it was an improvement. What do you think about this idea?

Advil usually would either not affect or it would increase bleeding. Its main use would be to decrease the cramps associated with the bleeding. Ultram shouldn't affect bleeding.

Do you think taking all that medication is okay and safe or would it be preferable to try the new pill?

Would try new pill.

I am thinking that maybe I am being greedy as far as what I am asking for out of these pills. Maybe one heavy day isn't such a bad thing. Right now I use a super plus tampon and have to change it about every one to two hours because it will start to leak--- is that considered heavy?

Not too excessive for one day.

I even set my alarm to wake up during the night to change tampons so that I don't have a major leakage when I wake up! Kinda a pain.

I hear so many people on BC Pills saying that their periods are so light that I guess I'm comparing myself to them. I'm not sure exactly what they are considering light, I guess. I did tell my gyn how much I bleed on the first day and she pretty much agreed that it was heavy and that the Levlen should help with that. I just never thought about all the other perks that I get with my current pill and whether they are pretty much standard perks will all pills or I just lucked out.

One last thing---I always look at people like athletes, etc and wonder how do they manage with their periods?

I don't really know.

How come they don't seem to have to worry about leakage and stuff?

I think they do but maybe our readers will answer.

I mean, how often do you see a figure skater, swimmer or gymnast wearing a pad??

Don't know.

(Please, don't mention Cathy Rigby!!) I know most pro athletes may not even get their periods because of the lack of body fat, etc, but what about the amateurs and college level athletes---or even just the person on the weekend softball league?! Even police women and other jobs where you are "on call" and don't have time to keep going to the bathroom---what is their secret?

I think it is difficult for many. Readers ?

Another woman responds: When I have a heavy day or know I won't be near a bathroom to soon I always double up with a super tampon. Insert end to end just make sure the first one is in deep enough or you'll be uncomfortable plus wear a thin ultra pad. This isn't something you'd want to do to often but could get you through a few hours maybe.

Anyway, I know this is VERY long, but if you could please take the time to answer each of my individual questions (yes, there are many), I would appreciate it greatly as I do not know where else to turn for advice and all of the things I asked--even the little stupid questions--are very important issues to me even tho to the average person they are not. I realize that most women would just take the new pill no questions asked and just wait and see, but I cannot do that. So, if you could, please try not to skip over answering anything--I know that sounds demanding, but I do not mean it that way--I am just trying not to have a stroke over this stupid decision. Thank you so much for your time!--- Boy, do I feel like a dork after all of these posts!! Well, please try and answer everything that's in each post if you can-- -I would really, really appreciate it if you would and I am sorry that I had to post it this way--I know it's a pain! Thanks again!!

Let us know later how this works out for you.

Thank you so much for your help in answering all of my posts/follow-ups from the other day titled "HELP! Need help by .... I did take the Levlen after 24 straight agonizing hours of deliberation....now I'm thinking I should have just left well enough alone because there's too much anxiety with taking a new pill---will it work, won't it and how long will it take to know for sure!! I may just switch back next month unless I see a HUGE improvement that makes it worth the anxiety this is causing. Do you think that would be a problem to do---would it be too soon to change pills again because it would be too "confusing" to my hormones or is it perfectly fine to change back after just one month if I feel I have to? If so, should I adjust back to the old pill right away in all likelihood?

Not saying for sure that's what I'll do--I may start to feel more comfortable and less anxious with my decision as the month goes by, but as it stand I am quite nervous about the change.

This anxiety is because of the "O" in the OCD. It will get better as month goes on and decision to switch back or not will be obvious by the improvement or lack of improvement of the symptoms. It will be ok to switch back if that is what you want to do. Are you on any medicine for the OCD?

Also, yes, I have thought of some more questions now that I have started on this pill (cringe). For the past two years on the LoEstrin 1.5/30®, I have had it set to get my periods on Sundays. This past month I adjusted it to get it on Saturdays as I will be starting college in June and that would just be easier. So, now I am wondering if adjusting my pills last month will have any affect on how these new Levlen® pills will adjust because I "fiddled" with my pills and hormone level last month---do you think it will take any longer for them to adjust or would last month really have no affect on this month and these new pills??

No effect.

I've just heard that your body gets used to certain hormone levels and I didn't know if my messing with my previous pills by one day last month (I took one less) would have any bearing at all on these new pills and how long it will take them to adjust now that I sort of changed the hormone level last month. What is your opinion?

Shouldn't affect it. The body doesn't really change its inherent nature due to pills.

Is it true that taking the 7 days of the iron pills that are at the end of the LoEstrin® pack can cause you to bleed heavier?? A pharmacist mentioned that to me. I never took them, but am just curious in case I go back to that pill. I thought it would be the opposite if anything, but what do I know??

I've never heard of this and it doesn't make any physiological sense to either increase or decrease flow.

Is there things you can do to lessen your bleeding or things you shouldn't do because it will cause heavier bleeding??

Avoid aspirin products which cause heavier bleeding. They may help cramps but they often increase amount or days of bleeding.

I've heard that lessening the cramps or prostaglandins (is that the right word for what causes pain?) can lessen it somewhat. I read that the spasms can "force" the blood out more than if the uterus was relaxed. True or false??

I don't think cramps cause flow to be heavy but rather heavy flow causes more cramps. The uterus cramps to empty itself completely.

Also, what about exercise during the month before your period-- would that have any effect on the amount of bleeding when you get your period?

Not that I know of.

How about exercise during your period---I've heard that lessens cramps, but could cause heavier bleeding. Can exercise make the bleeding heavier or is it better to be active?

Exercise lessens the pain of cramps by producing endorphins which is a natural painkiller. I don't think exercise increases or decreases flow.

Last question (phew!) is about Depoprovera®. I heard that it often causes amenorrhea because it stops you from ovulating so therefore, your uterus eventually gets used to no egg being released and stops building up the lining in preparation for fertilization. Makes sense, but you don't ovulate on BC Pills, either, so why don't they also cause amenorrhea??

With DepoProvera® (progestin) the blood level of progestin is always present. It counteracts any body estrogen stimulation of the endometrium and thus growth. Therefore endometrium doesn't grow and the level of progesterone never drops to allow a withdrawal bleed. (Actually its not that perfect, only about 65% of women have no bleeding on DepoProvera®.) With birth control pills, you have a progestin withdrawal (the seven days of placebo/non hormonal pills) to allow sloughing of what endometrium is present as well as allowing 7 days of your body's natural estrogen to stimulated some uterine lining growth. If you were to take birth control pills continuously, as we sometimes prescribe for women with endometriosis, you would have little or no bleeding also.

You may want to discuss with your doctor a regimen in which you are only off the active pills for 4 days instead of 7 days. That might help decrease the flow and cramps you have on the first few days. Of course that will alter when your period comes each month unless you lengthen each cycle by three days which you could do.



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I've been on the birth control for probably a year by now. I've read that it is common for a woman to miss their period at least once. I have had sexual intercourse, but each time I do I make sure my partner uses a condom just to be extra safe. It is currently the fourth day of my placebo pill and I still haven't gotten my period. I usually get my period on the third day of my placebo pill and I'm scared that I may be possibly pregnant? During this months pack I also missed taking my pill twice, but I took it the very next morning and later that night at 8:00 PM(my usual time) which was the pill for that day. I'm not sure if it's pregnancy or just one of these "common" missed periods that woman get while on the birth control. I need advice. Please help me out I am worried.
1 year ago
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