Abnormal Bleeding After a Year on Birth Control: What to Do?

I have been taking Yaz consistently for almost a year, but recently I have experienced abnormal bleeding?

Hello Doctor, I have been taking Yaz for almost a year now.
Under normal circumstances, my menstrual cycle occasionally starts a few days early or late, but there is no intermenstrual bleeding.
This month, after taking the 14th pill, I noticed some blood in my discharge, and there was a small amount of bleeding.
On the 17th day, I started experiencing headaches, and the bleeding increased, changing from discharge to bright red blood, resembling a menstrual period.
This is not the first time I've experienced abnormal bleeding; last month, during a bout of irritable bowel syndrome with diarrhea, I suddenly had bleeding (my period had just ended two weeks prior), and I mistakenly thought my period had arrived early.
However, after finishing the entire pack last month, my period came on time again.
Should I continue taking the medication? Is the contraceptive effect still effective?

Xiao Hetao, 20~29 year old female. Ask Date: 2018/12/18

Dr. Huang Jianzhong reply Obstetrics and Gynecology

I have been taking YAZ consistently for almost a year.
Under normal circumstances, my period occasionally comes a few days early or late, but there is no bleeding in between cycles.
This month, after taking the 14th pill, I noticed some blood-tinged discharge, and there was a small amount of bleeding.
On the 17th day, I started experiencing headaches, and the bleeding increased, changing from discharge to bright red blood, resembling a menstrual period.
This is not the first time I have experienced abnormal bleeding; last month, during a bout of irritable bowel syndrome with diarrhea, I suddenly had bleeding (my period had just ended two weeks prior), mistakenly thinking my period had arrived early.
However, after finishing the entire pack last month, my period came on time again.
Doctor, should I continue taking the medication? Is the contraceptive effect still effective? Ans: Continue taking the medication; the contraceptive effect is still effective.

Reply Date: 2018/12/18

More Info

Abnormal bleeding while on birth control can be concerning, and it's important to address your symptoms carefully. Based on your description, it seems you have been experiencing irregular bleeding and spotting while taking your birth control pills, which can happen for various reasons.

First, it's essential to understand that breakthrough bleeding or spotting can occur, especially during the first few months of starting a new contraceptive method. However, since you have been on the pill for about a year and are now experiencing these symptoms, it may indicate a need for further evaluation.

The bleeding you described—starting with light spotting that progressed to heavier bleeding resembling a menstrual period—could be due to several factors:
1. Hormonal Fluctuations: Birth control pills work by regulating hormones, but sometimes, the body may still experience fluctuations that can lead to breakthrough bleeding. This is particularly common if you have missed a pill or taken them irregularly.

2. Gastrointestinal Issues: You mentioned experiencing diarrhea due to irritable bowel syndrome (IBS). Gastrointestinal disturbances can affect the absorption of the hormones in the pill, potentially leading to irregular bleeding.

3. Infection or Other Conditions: It's also possible that an underlying condition, such as a urinary tract infection (UTI) or a gynecological issue, could be contributing to the bleeding.
4. Pill Type: Different formulations of birth control pills can have varying side effects. If you are on a low-dose pill, it may not provide enough hormone to suppress ovulation fully, leading to breakthrough bleeding.

Given your situation, here are some recommendations:
- Continue Taking the Pill: Unless advised otherwise by your healthcare provider, you should continue taking your birth control pills as prescribed. Stopping the pill abruptly can lead to further hormonal imbalances and may cause more irregular bleeding.

- Monitor Your Symptoms: Keep track of your bleeding patterns, including the amount and duration of bleeding, as well as any other symptoms like headaches or abdominal pain. This information will be helpful for your healthcare provider.

- Consult Your Doctor: It's crucial to schedule an appointment with your healthcare provider to discuss your symptoms in detail. They may recommend a pelvic exam, ultrasound, or blood tests to rule out any underlying conditions. They can also assess whether your current birth control method is still suitable for you or if a different formulation might be more effective.

- Consider Alternative Contraceptive Methods: If your bleeding continues or worsens, your doctor may suggest switching to a different type of birth control, such as an intrauterine device (IUD) or a different pill formulation that may be better suited to your hormonal needs.

In conclusion, while breakthrough bleeding can be a common side effect of birth control pills, persistent or heavy bleeding warrants further investigation. It's essential to communicate openly with your healthcare provider about your symptoms to ensure you receive the appropriate care and guidance. Remember, maintaining effective contraception is vital, so do not stop taking your pills without consulting your doctor first.

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