Birth Control Side Effects and Menstrual Irregularities

Is this a normal phenomenon?

Hello doctor, I have been taking birth control pills for over a month now.
When I first started taking them, I experienced symptoms like breast enlargement and nausea, which made me think I might be pregnant due to contraceptive failure.
Later, my period came before I finished the 21-day course, and the flow was initially light but then became heavier, which seemed strange.
Is this related to hormones?
Between the two cycles, I had my period, and on the eighth day of my period, I had unprotected intercourse with ejaculation.
This should be considered a safe period, right? In the second cycle, on the ninth day of taking the pills, I experienced bloating, burping, and constipation, which lasted for about a week and gradually subsided by the sixteenth day.

On the eighteenth day of taking the pills, I started experiencing frequent urination and some discomfort while urinating.
However, after applying some ointment, it improved significantly.
That day, due to frequent urination, I noticed a bit of blood on my underwear, which looked like menstrual blood but also seemed different, being a bit transparent and brownish.
I also noticed some blood streaks during urination.
This situation only occurred for one day and was gone by that night.
Is this my period, or is it what people refer to as spotting or breakthrough bleeding?
Are the symptoms of bloating, burping, constipation, frequent urination, and the blood-like discharge signs of pregnancy, or are they effects of the birth control pills, or could they be due to different reasons? I am really worried; if taking birth control pills during the supposed safe period could still lead to pregnancy, I would be extremely distressed.

Additionally, I have another question for you, doctor.
Let's say I finish the last pill of this cycle on the 1st, get my period on the 2nd, and it ends on the 7th.
Should I wait seven days to start the next cycle on the 9th, or should I start taking the pills on the fifth day of my period, which would be the 6th? Will the effectiveness of the medication be the same at both time points? Which option is better? Would the less favorable timing significantly affect the efficacy of the pills?
I apologize for asking so many complicated questions, and I sincerely apologize to the busy doctor for this.
However, I am really anxious and would greatly appreciate your clarification.
Thank you.

Xin, 30~39 year old female. Ask Date: 2007/03/20

Dr. Lin Zhaopei reply Obstetrics and Gynecology

1.
It is likely due to the body not yet adapting to the contraceptive pill.

2.
It should not be menstruation; it is irregular spotting.

3.
It is likely a side effect of the contraceptive pill.

4.
Taking it on the 6th day yields better results.

5.
It is recommended to switch to a lower-dose contraceptive pill; generally, low-dose contraceptive pills are effective, while high-dose pills are often used for treating dysmenorrhea or as emergency contraception.

Reply Date: 2007/03/20

More Info

When it comes to birth control pills, it's important to understand that they can have various side effects and can also lead to menstrual irregularities. The symptoms you experienced, such as breast enlargement, nausea, and changes in your menstrual cycle, are common side effects of hormonal contraceptives. These pills work by altering your hormonal balance to prevent ovulation, which can lead to changes in your menstrual cycle, including lighter or heavier periods, spotting, or breakthrough bleeding.

The fact that you had your period before completing the 21-day cycle of your birth control pills is not unusual. Many women experience changes in their menstrual flow when starting the pill. The initial light bleeding followed by heavier flow can be attributed to the hormonal adjustments your body is undergoing. This is often referred to as "withdrawal bleeding," which occurs when you stop taking the active pills and your hormone levels drop.

Regarding your concern about having unprotected sex during what you believe to be a "safe period," it's important to note that while hormonal contraceptives are designed to prevent pregnancy, they are not 100% effective. If you have been taking your pills consistently and correctly, the risk of pregnancy is significantly reduced, but not eliminated. The timing of your menstrual cycle can also affect your risk of pregnancy, as ovulation can sometimes occur unexpectedly.

The symptoms you described, such as abdominal bloating, belching, constipation, and frequent urination, can be side effects of the birth control pill or could be related to other factors, such as diet or stress. The spotting you noticed could be breakthrough bleeding, which is another common side effect of hormonal contraceptives. It is usually not a cause for concern, especially if it resolves quickly.

If you are worried about the possibility of pregnancy, consider taking a home pregnancy test if your period is late or if you experience any other signs of pregnancy. However, keep in mind that hormonal contraceptives can sometimes cause symptoms that mimic pregnancy, such as nausea and breast tenderness.

As for your question about when to start your next pack of pills, the general recommendation is to start taking the pills again after a 7-day break following your last active pill. If your period starts on the 2nd day after finishing your last pill, you should ideally start your next pack on the 9th day. Starting on the 6th day (the 5th day of your period) is not recommended, as it could lead to inconsistent hormone levels and potentially reduce the effectiveness of the pill.

In summary, while hormonal contraceptives can cause various side effects and menstrual irregularities, they are generally safe and effective when taken as directed. If you have ongoing concerns about your symptoms or the effectiveness of your birth control, it is advisable to consult with your healthcare provider for personalized advice and guidance. They can help address your fears and ensure that you are using your contraceptive method correctly.

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