Oral contraceptives and breakthrough bleeding: what patients need to know.

I n 1982, more than 20% of women surveyed in a nationally representative sample had discontinued oral contraceptives (OCs) on their own or at the recommendation of their physician due to bleeding or spotting. Sadly, the percentage today has not decreased much. Understandable concern, embarrassment, and annoyance lead these women to abandon OCs. What they often don’t know, though, is that breakthrough bleeding generally is greatest in the first 3 to 4 months after starting OCs, and it steadily declines and stabilizes by the end of the fourth cycle. Timely counsel could enable many of these women to cope with the bleeding and stick with an effective contraceptive method. Additional incentives are noncontraceptive benefits of OCs: improved menstrual regularity and decreased menstrual blood loss, dysmenorrhea, and risk of ovarian and endometrial cancer. Women who discontinue OCs on their own switch to less effective methods of birth control or use no method. Consequences may be unexpected pregnancies and increased abortion rates. With patients who are using OCs, it would be appropriate to ask periodically whether they are satisfied with OC use. In this review we discuss the mechanisms and management of breakthrough bleeding in women taking OCs, and provide tips for counseling that may help decrease the risk of discontinuation due to menstrual abnormalities in the initial months of use. Breakthrough bleeding in this review refers to either unplanned spotting or Managing expectations is as important as adjusting formulations Oral contraceptives and breakthrough bleeding: What patients need to know