Continuous Bleeding on Birth Control
Frederick R. Jelovsek MD, MS
Questions And Answers
"I started taking Ortho-Tricyclen® about 2 years ago. I would have my normal period for 5-7 days, and then the following year I started continual bleeding for 2-4 weeks out of each month in addition to my normal week period. Last year, I had my period for five weeks straight, and was rushed to the hospital, where I was put on highest estrogen pill (beige w/ butterflies) and taken off Ortho-Tricyclen® , until about 8 months ago. I experienced the same irregular bleeding with this pill, so they put me on the lowest estrogen pill for the next several months. No results from this pill either, they next tried Depo. "
" I've been on Depo since then, and have experienced continual bleeding for 9 months, until recently I was put on another low dose pill (could be Ortho Novum 777®, not sure), while still on Depo. The bleeding stopped within a day after taking the pill. I don't know whether to get off Depo or the pill? My doctors can't tell me what's wrong, and I am getting no answers where ever I go. I have a history of cancer in my family, and am afraid that this might be a factor? Please help me out with any answers, suggestions, or advice. "
You can either discontinue the pill and take some periodic added estrogen along with your DepoProvera® or you can discontinue the DepoProvera® and switch to a pill regimen that raises the estrogen component or gives you added estrogen in the week you are off of active pills.
The bleeding you are experiencing is most likely atrophic bleeding due to low estrogen. The only question in the history you give is why the bleeding did not improve when they gave you a higher estrogen pill for several months. The progestin in that pill (Ovral) is also a very potent one and probably counteracted the higher estrogen. When you were given estrogen again in the form of a low dose birth control pill while the DepoProvera was 'onboard,' your bleeding stopped.
What causes the prolonged bleeding when a woman is on birth control pills or Depo Provera® ?
Assuming a woman is not just missing her pills every couple of days, the most common cause of continuous bleeding is due to low estrogens which make the endometrium atrophic.
A small amount of estrogen is needed to make the lining of the uterus repair the open blood vessels that result from a menstrual slough. After a menses, estrogen alone in a normally ovulating woman not taking birth control starts the tissue growing again and in effect seals off the bleeding blood vessels. This makes bleeding stop.
With birth control pills that have both estrogen (very small doses) and progestin in each pill, the progestin component works opposite the the estrogen and does not allow the endometrial tissue to grow and repair itself. If a woman is on a progestin only birth control pill, or using DepoProvera® which is pure progestin only, the same effect takes place, i.e., the endometrium may not totally repair its entire surface inside the uterus because of a lack of estrogen or the antagonism of the progestin working against any small amount of estrogen present in the woman's body.
If you are a smoker, that lowers your body's estrogen levels and may explain why you are having a problem with this low estrogen level when many others on the same contraceptives may not. If you are thinner and have less body fat than other women your age, that may also play a role in having less estrogens.