Irregular Bleeding While Taking Birth Control Pills

Bleeding after taking emergency contraceptive pills?

Hello Doctor, I had my regular menstrual cycle on May 4th.
However, on May 17th and 18th, I experienced slight brown discharge and bleeding, which increased on May 19th along with mild abdominal pain (similar to premenstrual syndrome symptoms).
I initially thought it was ovulation bleeding, but by May 21st, it turned into a normal menstrual flow lasting about 5-7 days.
I visited a doctor that day, who suspected that the abnormal bleeding was due to adenomyosis and prescribed Medroxyprogesterone to control the bleeding and prevent the worsening of adenomyosis.
I started taking Medroxyprogesterone on the evening of May 21st, but even after the abnormal menstrual cycle ended, I continued to have intermittent slight brown discharge and bleeding.
By early June, I also experienced mild abdominal pain (similar to premenstrual syndrome symptoms, for which I took painkillers).
During my follow-up on June 5th, the doctor mentioned that the hormonal fluctuations due to the contraceptive pill were still unstable.
On that day, I received two more boxes of Medroxyprogesterone.
I began the second box on June 11th, but the brown discharge (sometimes pink) and bleeding did not improve.
Therefore, on June 15th, I consulted another doctor for an examination.
The ultrasound showed a shadow in the left ovary and three fibroids, but the doctor believed that the irregular menstrual cycle was not due to adenomyosis.
Due to the intermittent bleeding, I was prescribed hemostatic medication, which I took from June 15th to June 19th, and the bleeding stopped.
However, on June 23rd, I started experiencing brown discharge and brown bleeding again, accompanied by mild abdominal pain (similar to premenstrual syndrome symptoms).
At this point, I had already been on the second box of Medroxyprogesterone for 12 days.
I would like to ask the doctor: 1.
Is the brown discharge and bleeding due to hormonal fluctuations caused by the contraceptive pill, leading to an unstable uterine environment? 2.
Is it normal to have lower abdominal pain accompanying the bleeding? 3.
Could there be other underlying conditions causing this? Should I schedule another appointment with a gynecologist for further examination? Thank you for your response, Doctor.

Ms. Li, 30~39 year old female. Ask Date: 2021/06/24

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, if you are taking menstrual regulation medication and are still experiencing bleeding, it is a bit unusual.
I recommend visiting a hospital for an examination.
Wishing you good health.

Reply Date: 2021/06/24

More Info

Irregular bleeding while on birth control pills can be a concerning issue for many women, and it is essential to understand the underlying causes and potential implications. Based on your description, it seems you have experienced a series of abnormal bleeding episodes, which have been attributed to various factors, including hormonal fluctuations and potential underlying conditions like adenomyosis and fibroids.

1. Hormonal Fluctuations and Irregular Bleeding: Birth control pills work by regulating hormones to prevent ovulation and stabilize the menstrual cycle. However, when starting or changing birth control methods, it is common for some women to experience irregular bleeding or spotting. This is often due to the body adjusting to the new hormone levels. The presence of brown discharge or light bleeding can indicate old blood being expelled from the uterus, which is typically not a cause for concern. However, if the bleeding persists or becomes heavier, it may indicate that the hormonal balance is still not stable, which could be exacerbated by conditions like adenomyosis or fibroids.

2. Abdominal Pain and Its Relation to Bleeding: Experiencing abdominal pain alongside irregular bleeding can be concerning. While some cramping or discomfort can be normal, especially during hormonal changes, persistent or severe pain should not be overlooked. It could be related to the underlying conditions you mentioned, such as adenomyosis, which can cause significant discomfort due to the thickening of the uterine lining and inflammation. If the pain is severe or accompanied by other symptoms like heavy bleeding, it is crucial to seek medical attention.

3. Other Potential Causes: While hormonal fluctuations from birth control pills are a common cause of irregular bleeding, other factors should also be considered. The presence of fibroids, as noted in your ultrasound, can lead to abnormal bleeding patterns and pain. Fibroids can distort the uterine cavity and affect menstrual flow. Additionally, other conditions such as endometriosis or pelvic inflammatory disease could also contribute to these symptoms. If your symptoms persist despite treatment, further evaluation may be necessary to rule out these conditions.

4. Follow-Up and Further Evaluation: Given your ongoing symptoms, it is advisable to follow up with your healthcare provider. They may recommend additional tests, such as a pelvic ultrasound or hysteroscopy, to get a clearer picture of your uterine health. Monitoring your symptoms and keeping a detailed record of your bleeding patterns, pain levels, and any other symptoms can be helpful for your doctor in determining the best course of action.

In summary, while hormonal fluctuations from birth control pills can lead to irregular bleeding and discomfort, it is essential to consider other underlying conditions that may be contributing to your symptoms. Regular follow-up with your healthcare provider is crucial to ensure that any potential issues are addressed promptly and effectively. If you experience any significant changes in your symptoms, such as increased pain or heavy bleeding, do not hesitate to seek medical attention. Your health and well-being are paramount, and addressing these concerns early can lead to better outcomes.

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