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What causes breakthrough bleeding while on Triquilar?

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Posted on Tue, 27 Sep 2016
Question: I have been taking Triquiliar tablets for about more than a decade to avoid pregnancy. Has it any effect in small bleeding for a very short duration during monthly period? Can I stop taking this medicine without harming my health/
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Answered by Dr. Saumya Mittal (1 hour later)
Brief Answer:
Information requested

Detailed Answer:
Hi,
I am Dr Mttal.
I have read your message.
I think I can help you.
Triquillar is a combination medicine.
It has two components 0.05 mg levonorgestrel and 0.03 mg ethinyl estradiol tablets.
Now this is a common contraceptive used.
This medicine does have effect on bleeding.
It reduces the bleeding,not increase it.
It basically makes clotting faster and therefore bleeding is less.
Withdrawal from the medicine is usually quite safe.
However, till your normal hormonal cycle is reset you may have some symptom like heavy menses etc.
This will become normal overtime.
Unfortunately, after a prolonged use, it is difficult to predict how long it will tke for the Hormonal cycle to return to normal.
A period of 6 months to 1.5 years is usually expected.
I have tried to make it as simple as possible.
Feel free to contact me for any related information or any clarification on the above information.
Best of luck
Dr Mittal
Above answer was peer-reviewed by : Dr. Priyanka G Raj
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Follow up: Dr. Saumya Mittal (8 hours later)
I need some clarification.Although my monthly period occurs exactly after every 28 days most of the time,the amount of bleeding is negligble and that also remains for 1 or 2 days and within 3 days all bleeding becomes completely clear.During my last period on 2nd September,2016 the amount of bleeding was minimum i.e about 2 or 3 drops of blood and that also vanished within 1 day. Was it my actual period? Is it normal? Should I stop taking Triquilar tablets completely now ,after my taking this medicine for 10 or 15 years in the past? Taking this tablet continuously for so many years -is it harmful for my health in future? Please advise me in detail.
Ms XXXXX.
doctor
Answered by Dr. Saumya Mittal (1 hour later)
Brief Answer:
Clarification

Detailed Answer:
Hi, Welcome back,
Thanks for your response.

First, yes, the reduced menstrual bleed and the reduced duration can well be attributed to the medicine. It is a well known effect. What you had may have been a true menses.

Second, yes, if you are no longer looking for the contraceptive effect of the medicine, you can stop it. As I said before, it will take almost 6 months to 1.5 years for the hormonal cycles to return to normal. So you can surely stop the medicine.

Third, like all medicines, it has side effects too.
An increased risk of the following serious adverse reactions has been associated with the use of oral contraceptives:
• arterial and venous thromboembolic events
• being diagnosed with breast cancer
• benign and malignant hepatic tumors
• cerebral hemorrhage
• cerebral thrombosis
• congenital anomalies
gallbladder disease
• hypertension
• mesenteric thrombosis
• myocardial infarction
• neuro-ocular lesions (eg, retinal thrombosis)
• pulmonary embolism
• thrombophlebitis
abdominal pain
• amenorrhea during and after treatment
• angioedema (exogenous estrogens may induce or exacerbate symptoms of angioedema in women with hereditary angioedema)
• auditory disturbances
• breakthrough bleeding
• breast changes (tenderness, enlargement, and secretion)
• cataracts
• changes in appetite
• change in corneal curvature (steepening)
• changes in glucose tolerance or effect on peripheral insulin resistance
• changes in libido
• change in menstrual flow
• change in weight (increase or decrease)
• chloasma or melasma which may persist
• cholestatic jaundice
• chorea
• Crohn’s disease
• cystitis-like syndrome
• mental depression
• diarrhea
• dizziness
• dysmenorrhea
• edema
• endocervical hyperplasia
• erythema multiforme
• erythema nodosum
• gallstone formationa
• gastrointestinal symptoms (such as abdominal cramps and bloating)
• headache
• hemolytic uremic syndrome
• hemorrhagic eruption
• herpes gestationisa
• hirsutism
• hypersensitivity
• hypertension
hypertriglyceridemia (increased risk of pancreatitis when using COCs)
• impaired renal function
• increase in size of uterine leiomyomata
• intolerance to contact lenses
• jaundice related to cholestasisa
• liver function disturbances
• loss of scalp hair
• migraine
• nervousness
• optic neuritis
• otosclerosis-related hearing lossa
• pancreatitis
• porphyria
• possible diminution in lactation when given immediately postpartum
• premenstrual-like syndrome
• pruritus related to cholestasisa
• rash (allergic)
• Raynaud’s phenomenon
• reduced tolerance to carbohydrates
• retinal thrombosis
• rhinitis
• spotting
• Sydenham’s choreaa
• Systemic lupus erythematosusa
• temporary infertility after discontinuation of treatment
• ulcerative colitis
• urticaria
• vaginal candidiasis
• vaginal discharge
• vaginitis.
This is a brief list of the few adverse effects that the manufacturers of the medicine have noted in what is known as a product monograph, which gives all the information about the medicine.
This is freely downloadable. If you need it, it can be downloaded-
http://www.bayerresources.com.au/resources/uploads/CMI/file9650.pdf

I have tried to make it as simple as possible.
Please feel free to contact us for any further clarification needed.
I will try my best to help you.
Dr Mittal
Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Follow up: Dr. Saumya Mittal (12 hours later)
I am very sorry to tell you that I forgot to ask you two more important questions.
1.If I continue to take this triquiliar medicine for a further period,will my menstrual bleeding ultimately stop completely?In that case how can I detect my actual menstrual discharge?
2.After discontinuing this medicine for several years from now till my menstrual cycle becomes completely normal, can I start taking triquiliar again without harming my health?
I shall be glad if you please give me your residential address in XXXXXXX Thanking you,
XXXX.
doctor
Answered by Dr. Saumya Mittal (6 hours later)
Brief Answer:
Select information

Detailed Answer:
Hello,
Thank you for your response.

First, complete stoppage of menses is usually not a common occurrence with the tablets. Still amenorrhoea is possible in which case it's clinically not possible to differentiate the menses.

Second, yes you can restart the medicine at a later date, the side effect profile remains as I suggested in the last message.

Lastly, I am currently not in XXXXXXX will let you know when I return.
Best of luck. Dr Mittal
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Dr. Saumya Mittal

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What causes breakthrough bleeding while on Triquilar?

Brief Answer: Information requested Detailed Answer: Hi, I am Dr Mttal. I have read your message. I think I can help you. Triquillar is a combination medicine. It has two components 0.05 mg levonorgestrel and 0.03 mg ethinyl estradiol tablets. Now this is a common contraceptive used. This medicine does have effect on bleeding. It reduces the bleeding,not increase it. It basically makes clotting faster and therefore bleeding is less. Withdrawal from the medicine is usually quite safe. However, till your normal hormonal cycle is reset you may have some symptom like heavy menses etc. This will become normal overtime. Unfortunately, after a prolonged use, it is difficult to predict how long it will tke for the Hormonal cycle to return to normal. A period of 6 months to 1.5 years is usually expected. I have tried to make it as simple as possible. Feel free to contact me for any related information or any clarification on the above information. Best of luck Dr Mittal