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What Causes Vaginal Bleeding After Having Birth Control Pills?
Question: Breakthrough bleeding at perimenopause use of birth control pills. I'm not sure if I'm getting too much estrogen, or too little because my symptoms are mixed. My bleeding pattern is confusing to me and I need to better understand what is happening.
Brief Answer:
Breakthrough bleeding is common with low birth control pills and/or HRT
Detailed Answer:
Hello, and I hope I can help you today.
Unfortunately, breakthrough bleeding can be an issue with anyone who has been using hormonal contraception for a long time. Sprintec is still considered a low-dose pill, but it has the highest estrogen dose of the low-dose category. So a lack of estrogen is not the cause of your problem.
The way your bleeding can be properly evaluated is with a transvaginal ultrasound. The ultrasound will evaluate the lining of your uterus, which will show two possibilities- if the lining is thin, it shows that the bleeding is due to a side-effect of the pill you are taking. If the lining is thick, you may have a growth in your uterus, like a polyp or fibroid, which can be causing you to bleed irregularly having nothing to do with your pill.
I hope this adequately answers your question and that information was helpful. If you need further clarification, kindly tell me a little more about your bleeding pattern and how long you have used each product you tried before, and for what symptoms you began hormonal treatment in the first place.
Thank you, and if you need anything further please let me know,
Dr. Brown
Breakthrough bleeding is common with low birth control pills and/or HRT
Detailed Answer:
Hello, and I hope I can help you today.
Unfortunately, breakthrough bleeding can be an issue with anyone who has been using hormonal contraception for a long time. Sprintec is still considered a low-dose pill, but it has the highest estrogen dose of the low-dose category. So a lack of estrogen is not the cause of your problem.
The way your bleeding can be properly evaluated is with a transvaginal ultrasound. The ultrasound will evaluate the lining of your uterus, which will show two possibilities- if the lining is thin, it shows that the bleeding is due to a side-effect of the pill you are taking. If the lining is thick, you may have a growth in your uterus, like a polyp or fibroid, which can be causing you to bleed irregularly having nothing to do with your pill.
I hope this adequately answers your question and that information was helpful. If you need further clarification, kindly tell me a little more about your bleeding pattern and how long you have used each product you tried before, and for what symptoms you began hormonal treatment in the first place.
Thank you, and if you need anything further please let me know,
Dr. Brown
Above answer was peer-reviewed by :
Dr. Raju A.T
Thank you. This is my first time using this site so my original question was too vague. Here is some more history:
I did have a transvaginal ultrasound and it ruled out fibroids, etc. My lining was thin (due to use of IUD). My dr put me on a 21 day course of estrogen (only, stopped using Levora) to "build up" my lining (the thinking here was that fluctuating hormones was causing the breakthrough bleeding which was worse in the morning, during intercourse and while exercising). After 21 days, I was on Levora again for two months with no breakthrough bleeding at all. Despite being consistent with pill taking, the breakthrough bleeding started up again after 2.5 months and persisted (almost daily) for 2 weeks. I was advised to "double up" on the Levora pill for 3 days to see if that would help. It did for a week and then back to breakthrough bleeding for two weeks. I was then told to stop the pill use for 3-4 days to allow flow and switch to Sprintect (more estrogen, a 3rd generation progesterone which is supposed to help). While I was on the pill break the was lots of blood with clots for 5-6 days. When cycle 'ended' I started Sprintec and have been on Sprintec now for six days. During these six days, I had limited breakthrough bleeding and one day of no breakthrough bleeding (yesterday). Now today it's back and worse (heavier) than in past three days. Everything I have read said most birth control related breakthrough bleeding resolves over time but I've been on the pill for 12 months now and no such luck. Likewise, when I was on Mirena IUD I bled every day for 3 months. What does it take to get this resolved? What if the problem is too much estrogen and not enough progesterone?
I did have a transvaginal ultrasound and it ruled out fibroids, etc. My lining was thin (due to use of IUD). My dr put me on a 21 day course of estrogen (only, stopped using Levora) to "build up" my lining (the thinking here was that fluctuating hormones was causing the breakthrough bleeding which was worse in the morning, during intercourse and while exercising). After 21 days, I was on Levora again for two months with no breakthrough bleeding at all. Despite being consistent with pill taking, the breakthrough bleeding started up again after 2.5 months and persisted (almost daily) for 2 weeks. I was advised to "double up" on the Levora pill for 3 days to see if that would help. It did for a week and then back to breakthrough bleeding for two weeks. I was then told to stop the pill use for 3-4 days to allow flow and switch to Sprintect (more estrogen, a 3rd generation progesterone which is supposed to help). While I was on the pill break the was lots of blood with clots for 5-6 days. When cycle 'ended' I started Sprintec and have been on Sprintec now for six days. During these six days, I had limited breakthrough bleeding and one day of no breakthrough bleeding (yesterday). Now today it's back and worse (heavier) than in past three days. Everything I have read said most birth control related breakthrough bleeding resolves over time but I've been on the pill for 12 months now and no such luck. Likewise, when I was on Mirena IUD I bled every day for 3 months. What does it take to get this resolved? What if the problem is too much estrogen and not enough progesterone?
Brief Answer:
If there was too much estrogen, you would have a thicker uterine lining.
Detailed Answer:
Estrogen is what normally makes tissue grow in your uterus, which covers the raw surface and helps to stabilize the endometrium. Progesterone keeps that lining stable, which keeps you from bleeding during your normal menstrual cycle until the correct time, or keeps you from bleeding at all while you are pregnant.
We (GYN's) even use IV estrogen to treat heavy vaginal bleeding as it will cause bleeding to stop, even if it is caused by non-hormonal conditions like uterine fibroids.
Normally, in a woman just starting the pill with a normal uterine lining, the pill will help with cycle control and breakthrough bleeding will resolve because it has a different cause . But there is not enough estrogen in the pill to rebuild a uterine lining that was already thinned enough to make you bleed with the Mirena.
Your uterine lining is more like that of a woman who has been taking the birth control pill for 5-10 years, and breakthrough bleeding is very difficult to treat in those cases.
The main issue at this point is- why are you taking hormones now in the first place? Do you need it for contraception, or for hormonal symptoms like hot flashes? And what was your cycle like before you got the Mirena?
Because the best way to rebuild your uterine lining, and the best source of estrogen, is your own ovaries, if they function normally. So going off hormones completely will help your symptoms, unless you are menopausal.
Anyway I hope that clarifies things for you about how the hormonal cycle works on the endometrium. If you can tell me a little more about how this all got started and why you got the Mirena in the first place, that may help me get a better idea of your needs.
Thanks for using healthcaremagic and my services, and please provide me with this bit more information so I hopefully can help find you a solution.
Regards, Dr. Brown
If there was too much estrogen, you would have a thicker uterine lining.
Detailed Answer:
Estrogen is what normally makes tissue grow in your uterus, which covers the raw surface and helps to stabilize the endometrium. Progesterone keeps that lining stable, which keeps you from bleeding during your normal menstrual cycle until the correct time, or keeps you from bleeding at all while you are pregnant.
We (GYN's) even use IV estrogen to treat heavy vaginal bleeding as it will cause bleeding to stop, even if it is caused by non-hormonal conditions like uterine fibroids.
Normally, in a woman just starting the pill with a normal uterine lining, the pill will help with cycle control and breakthrough bleeding will resolve because it has a different cause . But there is not enough estrogen in the pill to rebuild a uterine lining that was already thinned enough to make you bleed with the Mirena.
Your uterine lining is more like that of a woman who has been taking the birth control pill for 5-10 years, and breakthrough bleeding is very difficult to treat in those cases.
The main issue at this point is- why are you taking hormones now in the first place? Do you need it for contraception, or for hormonal symptoms like hot flashes? And what was your cycle like before you got the Mirena?
Because the best way to rebuild your uterine lining, and the best source of estrogen, is your own ovaries, if they function normally. So going off hormones completely will help your symptoms, unless you are menopausal.
Anyway I hope that clarifies things for you about how the hormonal cycle works on the endometrium. If you can tell me a little more about how this all got started and why you got the Mirena in the first place, that may help me get a better idea of your needs.
Thanks for using healthcaremagic and my services, and please provide me with this bit more information so I hopefully can help find you a solution.
Regards, Dr. Brown
Above answer was peer-reviewed by :
Dr. Raju A.T
Thank you for your detailed reply. To answer your questions: I had a history of heavy monthly bleeding with clots. At 45, my time between periods lessoned to about 24-26 days and the bleeding lasted longer, 7-9 days. On a routine OBGYN visit, I mentioned this to a nurse who advised Mirena IUD but did not mentioned the possible side effects of bleeding for so long. After 3 months (July - Sep) of daily bleeding on IUD (and being told it could be 6 - 9 mo), I had it removed and Levora birth control pills were suggested as an alternative (I had been on same pills for several years but had not taken any for 3 years). When I used them in the past, never a problem, never spotting. The out of cycle bleeding continued Oct and Nov (maybe, 1-2 occurrences a week, on average, but sometimes a stretch of 5 days in a row) so I went back to the dr in December; that's when I had the transvaginal exam and was told my lining was low (from IUD use, then going on pills) so I might consider a uterine ablation to reduce/eliminate monthly cycle bleeding. I decided against this (too many possible bad side effects, not always effective, etc). Some of that was my fault - not taking the pill at the same time of day, missing a pill and taking two the next day, etc). At end of February, the breakthrough bleeding got worse so on doctor's advise, I stopped the pill for a few days and re-started and was very diligent on use. A month later, the breakthrough started again. In April, I visited the doctor and did the 21-day course of estrogen and once complete, started the Levora again. After that, I had 2.5 months with no breakthrough bleeding. This was wonderful and gave me hope that things were "stabilized". At the end of August, the breakthrough bleeding resumed. Twice I was able to stop it by doubling up on my pills for 3 days (on dr's advice). But it doesn't last and I now think trying to use the pill continuously doesn't work for me, which is why I had a withdrawl bleed and tried the Sprintec pill on advise of doctor (again, more estrogen and a different progesterone). My perimenopausal symptoms are out of cycle bleeding, some difficulty sleeping, some (mild) rise in temperature while sleeping. No breast tenderness, no anxiety attacks; some depression but I attribute that to this bleeding problem. While looking for 'alternative' solutions, I have read that "estrogen dominance" and low progesterone may be the problem...yet the 21 days course of estrogen made things better and so much literature states "contraceptive pills" as a solution for bleeding problems. But at 46 (now), maybe that doesn't apply to me? I will literally do anything to stop this (now, I drink apple cider vinegar, take ibuprofen, eat lemons - - I don't take herbal supplements, yet, because I'm not sure if I should, in case I have too much estrogen? I would consider hysterectomy (despite pain and recovery - anything buy this!). Do blood or saliva tests work at my age for measuring hormone levels? Thank you for listening; I look forward to your response.
Brief Answer:
You do not have high estrogen, this is why it helped you.
Detailed Answer:
Hello again, and thank you for your complete history.
Your menstrual pattern (shorter, heavier cycles) is a classic perimenopausal pattern, which is caused by low estrogen levels.
And remember- in the history you gave, the only thing that stopped the bleeding and made you feel better was taking estrogen.
Regarding the saliva and blood tests for the levels of all the types of estrogen in your body, there is no correlation of any of these levels to severity of symptoms. Bioidentical estrogen is considered homeopathy and is not regulated by the FDA, so this type of testing is very expensive and I do not believe it will help solve your problem.
I personally think you should try cyclic hormone replacement therapy- taking estrogen three weeks a month and adding progesterone for one week a month. This should give you regular, light periods because it mimics your natural cycle pattern. It will also help any hot flashes or similar symptoms. You will need to discuss this with your treating physician, but this is what I think will have the best chance of working.
You also really shouldn't consider hysterectomy for essentially a hormonal problem, it is major surgery and has unnecessary risks. I agree with your doctor that endometrial ablation could also be a very good and safe option in your case. It is most effective with a thin uterine lining it only completely stops bleeding on 45 percent of patients but over 90 percent see a reduction in flow and are satisfied with their procedure. So until your period stops on its own it will be more manageable.
Well I hope this advice was helpful
and please share my recommendation with your treating physician so he/she may be able to give you their opinion and
treat you.
Thank your for using my services and healthcaremagic.com. If you are satisfied with my service, kindly rate our interaction when you close the question.
Take care, Dr. Brown
You do not have high estrogen, this is why it helped you.
Detailed Answer:
Hello again, and thank you for your complete history.
Your menstrual pattern (shorter, heavier cycles) is a classic perimenopausal pattern, which is caused by low estrogen levels.
And remember- in the history you gave, the only thing that stopped the bleeding and made you feel better was taking estrogen.
Regarding the saliva and blood tests for the levels of all the types of estrogen in your body, there is no correlation of any of these levels to severity of symptoms. Bioidentical estrogen is considered homeopathy and is not regulated by the FDA, so this type of testing is very expensive and I do not believe it will help solve your problem.
I personally think you should try cyclic hormone replacement therapy- taking estrogen three weeks a month and adding progesterone for one week a month. This should give you regular, light periods because it mimics your natural cycle pattern. It will also help any hot flashes or similar symptoms. You will need to discuss this with your treating physician, but this is what I think will have the best chance of working.
You also really shouldn't consider hysterectomy for essentially a hormonal problem, it is major surgery and has unnecessary risks. I agree with your doctor that endometrial ablation could also be a very good and safe option in your case. It is most effective with a thin uterine lining it only completely stops bleeding on 45 percent of patients but over 90 percent see a reduction in flow and are satisfied with their procedure. So until your period stops on its own it will be more manageable.
Well I hope this advice was helpful
and please share my recommendation with your treating physician so he/she may be able to give you their opinion and
treat you.
Thank your for using my services and healthcaremagic.com. If you are satisfied with my service, kindly rate our interaction when you close the question.
Take care, Dr. Brown
Above answer was peer-reviewed by :
Dr. Yogesh D
Answered by
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