Hi, Breakthrough bleeding, spotting, and changes to menstrual flow are some of the most common side effects during the first year of use. Ibuprofen and other non-steroidal anti-inflammatory drugs (NSAIDs) can help reduce the inflammation and pain that may come with abnormal uterine bleeding. While abnormal bleeding can be irritating and alarming, keep in mind that some irregular bleeding or spotting during the early months of therapy typically means that the body is adjusting to the medication. Hormonal pills or injections can alter the vaginal ph and increase the risk of vaginal infections in some women. Hence, in case of such infections,treatment may be required. Take care. Hope I have answered your question. Let me know if I can assist you further. Regards, Dr. Saranya Ramadoss, General & Family Physician