If I want to continue taking birth control pills, how do I get around all this bleeding?
If you have this continuous spotting on the pills, the estrogen level needs to be raised. This can be done in one of two ways. A very small dose of estrogen can be given during the week when you are not taking active hormone pills.
One pill that comes packaged this way is Mircette®. It has 10 mcgm of ethinyl estradiol in 5 of the 7 days of pills in between the 21 days of estrogen with progestin pills. The cycle control of bleeding with Mircette especially in the first two months of use is better than other low estrogen dose (20 mcgm) pills such as Alesse® (2).
Instead of using Mircette, a supplemental estrogen of 1 mg estradiol could be given during that week off active pills or even a transdermal patch such as those used for menopausal estrogen replacement therapy.
In addition to being given a supplemental estrogen in between active pills, another solution might be to change to a pill with higher estrogen levels of 30 or 35 mcgm but combined with a progestin that is not as strong as the one you were given in Ovral®. Ovcon 1-35® or Ortho Novum 1-35® or their generics are pills that come to mind and might eliminate the continuous spotting you are having.
If I want to stay on DepoProvera® but do not have continuous spotting, what can I do?
The principle here is the same as that needed with oral contraceptive pills. Estrogen needs to be added to the DepoProvera® regimen. Added estradiol of 1 mg per day by mouth for about two weeks each 3 months may be enough to stop the bleeding pattern.
There are not good studies on this right now so the doctor will need to work with you to try to stop the bleeding problem. It would probably be better to used the estradiol than one of the other estrogens such as conjugated estrogens (Premarin®), estrone or estriol which do not stimulate the endometrium as well as estradiol. Again, using an estradiol transdermal skin patch of 0.1 mg/day for 1-2 weeks might also be enough to stop the continuous spotting.
Another choice might be an injectable contraceptive called Lunelle®. It is a shot that has both estrogen and progestin so there should be less problems with breakthrough bleeding. Ask your doctor about it.
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