Managing Irregular Periods and Breakthrough Bleeding with Birth Control Pills

Oral contraceptives, abnormal bleeding, menstrual irregularities?

Last month, I took oral contraceptives to induce my delayed menstruation.
Since moving abroad for studies, my menstrual cycle has become irregular, and I haven't had a period for over four months (there has been no sexual activity or chance of pregnancy; the main issue is excessive stress, along with cystic acne covering my entire face).
Therefore, I used the contraceptive pill to trigger my period.
After completing the first pack (Yasmin 21 days), my period started two days later.
I stopped the first pack for seven days, and on the eighth day, I began the second pack.
However, my period arrived earlier than expected (14 days after the last one).
Initially, I thought it was just abnormal bleeding, but my period has now lasted for ten days (previously, it would last a maximum of six days).
Throughout this time, I have not stopped taking the second pack.
This week, I am about to finish the second pack (Yasmin 21 days), and I would like to know if I should normally take a seven-day break before continuing to the next pack, or should I go straight to the third pack? This time, my period has lasted for ten days without stopping, with intermittent bright red and dark red blood, but the flow has decreased significantly.
How long should I continue taking the contraceptive pills? (The purpose is solely to regulate my menstrual cycle and reduce cystic acne caused by hormonal imbalance.) Thank you.

Miss Chen, 30~39 year old female. Ask Date: 2019/01/23

Dr. Huang Jianzhong reply Obstetrics and Gynecology

Last month, I took oral contraceptives to induce my delayed menstruation.
After moving abroad for my studies, my menstrual cycle became irregular, and I haven't had a period for over four months (there has been no sexual activity or chance of pregnancy; the main issue is excessive stress, along with cystic acne covering my entire face).
Therefore, I took the contraceptive pills to induce menstruation.
After completing the first pack (Yasmin 21 days), my period started normally two days later.
I stopped the first pack for seven days, and on the eighth day, I began the second pack.
However, my period came early (14 days after the last one).
Initially, I thought it was just abnormal bleeding, but my period has now lasted for ten days (previously, it would last a maximum of six days).
During this time, I did not stop taking the second pack of pills.
This week, I am about to finish the second pack (Yasmin 21 days), and I would like to know if I should normally take a seven-day break before continuing to the next pack, or should I directly continue to the third pack?
Answer: Since your menstrual cycle is disrupted, it is advisable to consult a physician or take a break from the medication for seven days.
As of now, your period has lasted for ten days, with intermittent bright red and dark red blood, but the flow has decreased significantly.
How long should I continue taking the contraceptive pills? (The purpose is just to normalize my menstruation and reduce cystic acne caused by hormonal imbalance.)
Answer: 2-3 months.

Reply Date: 2019/01/23

More Info

Managing irregular periods and breakthrough bleeding can be a complex issue, especially when using birth control pills to regulate menstrual cycles. Based on your situation, it sounds like you have been using the birth control pill (specifically, the "Yueji" 21-day pill) to induce a period after experiencing several months of amenorrhea (absence of menstruation). This can often be a result of stress, hormonal imbalances, or other underlying health issues.

When you started taking the birth control pills, you experienced a withdrawal bleed, which is a common response when stopping the pill after the first cycle. However, it seems that after starting your second pack, you encountered unexpected bleeding that has now lasted for 10 days. This can be concerning, but it is not uncommon for individuals who are adjusting to hormonal contraceptives, especially after a period of irregular cycles.

Recommendations:
1. Continue the Current Pack: It is generally advisable to complete the current pack of pills as prescribed, even if you are experiencing breakthrough bleeding. This is because stopping the pills mid-cycle can lead to further hormonal fluctuations and may exacerbate the irregular bleeding.

2. Monitor Your Symptoms: Keep track of the bleeding pattern. If the bleeding is light and not accompanied by severe pain or other concerning symptoms (like dizziness or heavy clotting), it may be a normal adjustment to the hormonal changes. However, if you experience heavy bleeding or severe discomfort, it would be wise to consult a healthcare provider.

3. Consult Your Healthcare Provider: Given that you have been experiencing prolonged bleeding, it is important to discuss this with your healthcare provider. They may want to evaluate your overall health, including checking for any underlying conditions that could be contributing to the irregular bleeding, such as polycystic ovary syndrome (PCOS) or other hormonal imbalances.

4. Consider a Different Formulation: If breakthrough bleeding continues to be an issue, your healthcare provider may suggest trying a different formulation of birth control pills or another method of hormonal regulation. Some formulations have a higher estrogen content, which can help stabilize the endometrial lining and reduce breakthrough bleeding.

5. Lifestyle Modifications: Since you mentioned that stress has been a significant factor in your irregular cycles, consider incorporating stress-reducing activities into your routine, such as yoga, meditation, or regular exercise. These can help improve your overall hormonal balance.

6. Follow-Up: After completing the current pack, schedule a follow-up appointment with your healthcare provider to discuss your experience and any necessary adjustments to your treatment plan.

Conclusion:
In summary, it is important to complete your current pack of birth control pills while monitoring your symptoms. If the bleeding persists or worsens, or if you have any other concerning symptoms, seek medical advice promptly. Hormonal contraceptives can take time to regulate your cycle, especially after a period of irregularity, so patience and close communication with your healthcare provider are key to managing your situation effectively.

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