Bleeding While on Birth Control: Your Symptoms and Next Steps

Bleeding while taking contraceptive pills?

Hello, I have been experiencing vaginal bleeding for some time, and previous consultations did not reveal a clear cause.
At the end of last year, I discovered four uterine fibroids, one endometrial polyp, and one cervical polyp.
During an outpatient visit, the cervical polyp was removed, but I still have occasional light bleeding or dark red discharge.
On March 29, I had the endometrial polyp removed, and the biopsy results were normal.
However, I continued to have light bleeding and yellowish-red discharge every month.
On August 11, my doctor suggested trying "Yaz" birth control pills.
In the first month, I started experiencing light spotting four days before my period, which occurred from September 2 to September 10.
After that, during ovulation, I had lower abdominal discomfort and light bleeding until my next period started (September 29 to October 5).
I am now on my third pack of birth control pills, and on October 11, I began experiencing lower abdominal bloating and pain, with bright red spotting that requires a panty liner.
This has continued to today, occasionally resembling the amount seen two days before my period, with mild cramping in the lower abdomen.
I am still taking the birth control pills.
Should I return to the obstetrics and gynecology department?

Bing, 30~39 year old female. Ask Date: 2022/10/14

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, if something seems off, you can finish the current pack of birth control pills and consider trying a higher dosage next month.
Wishing you good health.

Reply Date: 2022/10/14

More Info

Bleeding while on birth control can be a concerning symptom, especially when there is a history of uterine fibroids and polyps. It’s important to understand the potential causes of this bleeding and the appropriate next steps to take.

First, it’s essential to recognize that breakthrough bleeding is a common side effect of hormonal contraceptives, including birth control pills like "Yaz" (悅姿). This type of bleeding can occur, especially during the first few months of starting a new contraceptive method, as your body adjusts to the hormones. Breakthrough bleeding is typically lighter than a regular period and may occur at unexpected times. However, if the bleeding is heavy or accompanied by significant pain, it may warrant further investigation.

Given your history of uterine fibroids and polyps, it’s crucial to monitor your symptoms closely. Fibroids can sometimes cause irregular bleeding, and while you have had polyps removed, they can recur. The fact that you are experiencing abdominal discomfort along with the bleeding could indicate that there is still some underlying issue that needs to be addressed.
The symptoms you describe—persistent light bleeding, dark red discharge, and abdominal pain—could be due to several factors:
1. Hormonal Fluctuations: As mentioned, starting a new birth control pill can lead to irregular bleeding as your body adjusts. This is often temporary.

2. Uterine Fibroids: These benign tumors can cause heavy or prolonged menstrual bleeding and may not be fully resolved even after treatment.
3. Endometrial Changes: The presence of polyps or fibroids can lead to changes in the endometrial lining, which may cause irregular bleeding.

4. Infection or Other Conditions: If there is an infection or another gynecological condition, it could also lead to abnormal bleeding.

Given that you are experiencing ongoing symptoms, it is advisable to return to your gynecologist for a follow-up appointment. During this visit, you can discuss your symptoms in detail, and your doctor may recommend further evaluation, such as an ultrasound or a hysteroscopy, to assess the status of your fibroids and any other potential causes of your bleeding.

In the meantime, keep track of your bleeding patterns, any associated symptoms (like pain or changes in discharge), and how long the bleeding lasts. This information will be helpful for your healthcare provider in determining the best course of action.

In summary, while some bleeding can be a normal side effect of birth control, your history of fibroids and polyps, along with the nature of your symptoms, suggests that further evaluation is warranted. Don’t hesitate to reach out to your healthcare provider to ensure that you receive the appropriate care and management for your symptoms.

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