Prolonged Bleeding After Using Antifungal Cream: What You Need to Know

Abnormal bleeding for more than a week outside of the menstrual period?

Hello Doctor, I have been taking the contraceptive pill for three years without interruption.
On November 24, I visited a dermatologist for a tinea corporis issue, and the doctor prescribed Bifonazole cream (10 mg/g) for me to apply.
The affected areas were on my lower abdomen and entire back, which were quite extensive.
I used the cream for about 9 days, applying it twice daily until the entire tube was finished, and then I stopped using it.
On November 30, I experienced some bleeding, which was minimal and only noticed when using the restroom.
A few days later, the bleeding seemed to increase slightly, requiring the use of sanitary pads, and it has continued until today (December 9).
I had a gynecological examination on December 7, and the doctor said that both the vagina and uterus were normal, prescribing me hemostatic medication.
However, I did not inform the doctor that I had used Bifonazole cream, as I had already stopped applying it by then.
I would like to know if this bleeding is related to the cream, whether it could affect the effectiveness of the contraceptive pill, and if I need additional contraceptive measures.
I have been taking the hemostatic medication for two days, but I am still experiencing bleeding; should I continue taking it? Thank you, Doctor!

Ms. Wu, 20~29 year old female. Ask Date: 2021/12/09

Dr. Zhang Kunmin reply Obstetrics and Gynecology

Hello, the following medications may interact with oral contraceptives: 1.
Antibiotics (Penicillin, Cephalosporins, Erythromycin, Sulfonamides, Bactrim, Chloramphenicol) - Doxycycline can reduce the effectiveness of oral contraceptives, and when taking doxycycline, alternative contraceptive methods should be used as it may decrease the gut flora that aids in absorption, thereby lowering the effectiveness of the contraceptive.
2.
Sedatives (Barbiturates) - Increase the metabolism of contraceptives, reducing their effectiveness.
3.
Antiepileptic drugs (Primidone, Phenytoin, Carbamazepine) - Increase the metabolism of contraceptives, reducing their effectiveness.
4.
Tuberculosis medications (Rifampicin, Isoniazid).
5.
Antidiabetic medications (Rosiglitazone).
6.
Acetaminophen and Ascorbic acid (Vitamin C) - May inhibit the metabolism of estrogen, leading to increased serum concentrations and a higher incidence of side effects.
7.
Oral contraceptives can affect the action of anticoagulants.
8.
Smoking - Increases the metabolism of contraceptives, reducing their effectiveness.
There are many factors that can affect the menstrual cycle or cause intermenstrual bleeding.
It is advisable to consult a gynecologist if symptoms persist or worsen to check for hormonal imbalances or other causes.
Thank you! Wishing you peace and health, Dr.
Zhang.

Reply Date: 2021/12/09

More Info

Prolonged bleeding after using an antifungal cream like Bifonazole can be concerning, especially when you have been on hormonal contraception for an extended period. It’s important to understand the potential interactions and effects of medications on your body, particularly when they involve hormonal balance and skin treatments.

First, let’s address the antifungal cream itself. Bifonazole is primarily used to treat fungal infections and is not known to have systemic effects that would typically cause bleeding. However, individual reactions to medications can vary, and while it is uncommon, some patients may experience localized irritation or allergic reactions that could potentially lead to inflammation. This inflammation could, in theory, affect nearby tissues, but it is unlikely to cause significant bleeding.

The timing of your bleeding, occurring shortly after you finished the antifungal treatment, raises questions. Since you have been taking the contraceptive pill consistently for three years, it is less likely that the bleeding is due to a failure of the contraceptive method. However, it is important to consider that any stress on the body, including skin infections and the use of topical medications, can sometimes lead to hormonal fluctuations. These fluctuations can result in breakthrough bleeding, which is not uncommon for those on hormonal contraceptives.

Regarding your concern about the bleeding affecting the efficacy of your contraceptive pill, it is generally understood that breakthrough bleeding does not indicate a failure of the contraceptive method, especially if you have been taking your pills correctly. However, if you experience significant changes in your bleeding patterns or if the bleeding continues, it is advisable to consult with your healthcare provider. They may recommend additional contraceptive measures as a precaution, particularly if you are concerned about the possibility of pregnancy.

As for the hemostatic medication prescribed by your gynecologist, it is essential to follow their advice. If you have been taking it for two days and still experience bleeding, you should reach out to your doctor for further evaluation. They may need to reassess your situation, especially since you did not inform them about the antifungal cream usage. It’s crucial to provide your healthcare providers with a complete picture of your medications and treatments to ensure they can make the best decisions for your health.

In summary, while it is unlikely that Bifonazole is directly causing your bleeding, the timing and your overall health context suggest that it could be related to hormonal fluctuations or other factors. Continue monitoring your symptoms, keep your healthcare provider informed, and do not hesitate to seek further evaluation if the bleeding persists or worsens. Your health and well-being are paramount, and open communication with your healthcare team is essential for effective management.

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