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From the Woman's Diagnostic Cyber - Frederick R. Jelovsek MD
Bleeding from the morning after pill
I'm a 21 y.o. with no GYN problems except perhaps single
ovarian cysts giving a little pain and irregular periods for
which I am about to start the pill. A week ago, following a
condom breakage, I took the morning-after pill. I was told I may
have bleeding about 5 days later. I'm not sure whether what I had
would count as a "bleed" (it was very light and lasted less than
one day). What I want to know is: does any bleeding count as a
period?
Yes it counts. Actually it's not usually a period but rather
just bleeding or spotting like you had.
The other night, the condom broke again (an old pack- I
should know better!) - so am I likely to be day 3 or day 18 of my
cycle, in which case I may need another MAP (especially since my
abnormal period length)? and is it wise to take 2 in one month?
Any advise would be gratefully received.
It's not wise, but it is necessary. Go ahead.
Is light period on pills same as a missed one?
I've been taking low-dose BC pills for several months now,
and while skimming over the little pamphlet that comes with each
refill, I noticed the paragraph that discusses missed periods.
Assuming that one takes all their pills correctly, it says to
continue as normal, and to get checked out if you miss 2 periods
in a row.
My question is: Do lighter-than-what-one-is-used-to-on-the-
pill periods count as "missing a period"? I have heard that such
is counted as a miss, and I have also heard that any bleeding you
get providing that it is at the correct time and you haven't
missed any pills or taken any late, or not had any other
situations that would have hampered the effectiveness, can be
considered a period. In other words, the only time a miss would
"count" is if a period was COMPLETELY skipped. My pill packet
insert isn't really clear on this. Which is correct?
It is only counted as a missed menses if you have NO bleeding
at all. A light or very light period is still a period on the
pills.
Rarely, a very light period can be associated with a pregnancy
if you missed more than one or two pills in a month.
Are low dose (20 mcg) pills less effective?
I am taking the new BC pill, Alesse®--it is a 20 mcg low dose
pill and I am using it for birth control. However, I have heard
people say that these lower dose pills are more "accident prone"
in terms of failure than the 35 mcg pills. Is this true, or do
all BC pills have pretty much the same effectiveness? I'm 20 and
don't want to get pregnant!!
If you don't miss pills, the 20 mcg dose is as effective as
the 35 mcg dose. The lower dose does give you more of a chance
of breakthrough bleeding. You are still protected from pregnancy
but more likely to spot. If you try them and don't have any
breakthrough spotting, then you should do just fine and would not
be more likely to get pregnant.
When you're on the pill (5 full months) and you have a period
on time, should you worry if it is scanty and lighter than your
others on the pill, or is this normal? I have not missed any
pills and take them at the same time each and every day.
Scanty or light periods on the pill are common and shouldn't
cause worry. Sometimes you skip periods altogether.
Stopped pills because spotting, now no withdrawal bleeding
I wrote a while ago about being on continuous Ortho Novum
® 1/35 with no break, and having spotting. My doctor took me off
the pills for a week for a withdrawal bleed. It's been four days
with no pills and NO bleeding. Is this normal? (I have a history
of ovarian cancer with one ovary remaining)
Most of the time you have some withdrawal spotting but not
always. Since you have been on continuous pill therapy, the
lining of the endometrium is probably very atrophic (thin with
little tissue). There was enough thinness to spot but now that
you are off the pills, there is not tissue left to slough and the
lining is starting to get more stable under your own body's
estrogen. You will probably need to be off the pills for a month
or so to have a normal cycle.
Another alternative for the spotting on the pills is to resume
the pills but take an estrogen supplement to "stabilize" the
lining of the uterus. I'm assuming you are not pregnant. Check
that out if you need to.
Period month after month and still pregnant?
I heard something on the net the other day that said that a
woman could have a period month after month and still be
pregnant. I know that you can have implantation spotting that may
be mistaken for a period the first month and still be pg, but how
about a normal period for months at the same, normal time? Assume
that this is in a normal reproductive system (not a double or
bicornuate (sp?) uterus....how is this possible? Is this rare or
common?
This is rare but some women swear they had cyclic bleeding
while they were pregnant. This usually is not reported past the
first 4 months. As best I can tell, these cases have never been
documented well and are thought to represent bleeding rather than
menses except in the instances you mentioned.
Failure rate of birth control pills
When using the pill, everyone knows that there is a slight
failure possibility even if used correctly, but I have heard
conflicting info on the stats. (assume perfect use)
I have heard:
1) 1 in 100 women failure rate
2) 1 in 1,000 women failure rate
Which is correct? There's a pretty big difference between those
numbers!
From scientific studies where individuals have been highly
motivated to comply, the pregnancy rate for the pills is 0.1% or
1 per 1000. Overall, however, the pregnancy rate in actual use is
3% or 30 per 1000. You are correct that this is a large
difference.
Source for these numbers is Speroff et al, Clinical Gynecologic
Endocrinology and Infertility, 5th edition, 1994, p. 689.
Breakthrough spotting on continuous pill therapy
I've been having spotting for awhile. It
happened for about 4 days and then stopped for a week. Now I've
been having heavier spotting for the past two days. My doctor
said that he wasn't worried about spotting before, does that mean
I shouldn't worry about it happening again, only a week later
than the last time? I'm on Ortho-Novum 1/35 with no break
(constant with no placebos taken). Does this mean I should be on
heavier birth control? The reason I'm on it is because of
constant ovarian cysts that don't go away, even after a year.
Should I be worried about some kind of endometrial abnormality?
Breakthrough spotting and bleeding on continuous pill therapy
happens to almost everyone sooner or later. Rather than switch
pills, I would discuss with your doctor whether or not you could
come off of the pills for a week (to have a withdrawal bleed) or
even one month (to have a natural cycle withdrawal bleed). Then
resume the pills. This is more likely to prevent further
breakthrough bleeding for awhile.
Can you have a pill withdrawal period and be pregnant?
I know that when you're on the pill, the bleeding
you have during your placebo week is in fact withdrawal bleeding
and not a "true" period, of course, the blood is
real, but there is some difference.
Since this is true, is it also correct that if one became
pregnant while on the pill, they would not have withdrawal
bleeding at all during their placebo week, or it would be very
spotty/light? (assuming that no pills were missed). I have
heard that this withdrawal bleeding each month, when it is on
time, normal, etc. is "proof" that the woman is not pregnant and
the pills are working correctly--is this correct?
If you were to become pregnant on birth control pills, a normal
withdrawal period would not occur because progesterone production
from the corpus luteum gland on the ovary overrides the drop in
progesterone from finishing the active pills. Occasionally a
woman could have some spotting while pregnant but usually it
isn't a full period.
Effect of diarrhea on pill effectiveness
While on my last pack of BC pills (Alesse®) I had an instance of
loose stools--not quite diarrhea. It was solid, but a lot coming
out fairly fast. This was quick and happened only once, I wasn't
sick, but I do think that this may have been due to the fact that
my pill period was on its way--it came the next day.
So, my questions are:
1) I worry about my pills' effectiveness. It was at least a
day after I had taken my last pink active pill, and I was on the
placebo pills the night of this incident. My pill pack says if
you have vomiting or diarrhea the pills may not work as well, but
was this really diarrhea? Would my pill's effectiveness have been
hampered by this incident, based on the info I've provided?
No, a single episode of loose stool would not have altered the
pill's effectiveness.
I'm not sure if the pill makers mean severe, continuous "runs"
(like you'd get with food poisoning or the flu) or if solid but
loose stools are covered under that definition.
Continuous diarrhea for 1 -2 days
2) If this is covered under that definition, how long should
one use backup? (If this happens again so close to my period,
should I use it until the period, or through the first 7 days of
the next pack?)
In this case you don't need backup.
If you do develop continuous diarrhea for 2 days, continue your
BCP's and use additional backup while the diarrhea persists and
for 7 days after it has stopped.
Thyroid assessment on birth control pills
I tried going off of birth control pills a few years back. Six
months later my hair was falling out, I felt heavy and sluggish,
and my face was broken out. My doctor did a blood test and I had
a very low thyroid. They were surprised how low it had become.
They put me back on the pill and my thyroid is fine. They said if
I ever went off of the pill again, I'd need to take thyroid
pills. Now I can't find a birth control pill that doesn't make
me feel bloated and irritable so I just want to go off of them.
But, I have a new doctor since then and I get the feeling she
doesn't think the birth control pill and my thyroid are related.
What do I do? Can going off the pill effect your thyroid or was
that a fluke thing?
Sounds like you are describing pretty severe hypothyroidism.
This degree of thyroid dysfunction is unlikely to have been due
to your OCP's. It is possible with the old tests of just
measuring T4 that a low T4 (hypothyroidism) off pills could have
a higher value when on pills, but you are still low on thyroid.
We used to measure T4 and T3 while on birth control pills because
of these false readings. Now a serum TSH (thyroid stimulating
hormone) is accurate whether or not you are on pills.
You need to have your TSH measured now.
Breakthrough bleeding after starting a cycle late
While I was taking my last pack of pills, I missed a pill on two
separate occasions, and had to take two pills at a time twice.
At the end of of the pill pack, I did not begin my period. Afraid
that I was pregnant, I did not begin a new pack. Two home
pregnancy tests were negative, and I called my gynecologist who
told me to resume taking my pills. I began spotting a week and a
half after my period should have started, and spotted for 8 days.
Now I am beginning the 3rd week of the new pill pack, and have
begun spotting again. Should I be concerned, or is this okay?
You are protected now from pregnancy since you have been back on
the pill for more than a week. The breakthrough bleeding won't
stop until your next period and sometimes it continues into the
next cycle. It should be over after that.
Basal body temperatures (BBTs) as backup to pills
Can you (reliably) take BBT temperatures while you're taking
birth control pills? I'd like to do this as a back up method to
my pills, but don't want to if it will alter the temps either
way...
That's an interesting question I don't think I've ever had
asked before. I'm not sure, but I suspect the progestin in the
pill would alter the early temps to make them higher. On the
other hand, if you had a breakthrough ovulation on the pill it
could well show a biphasic curve. If you took BBTs for two months
and they were flat, I would quit taking them.
The failure rate of BC pills is about 1-3% overall but if there
is perfect use (no pills missed) the failure rate is only about
3/1000. It seems if you are compulsive enough to take BBT temps,
it's unlikely you would miss a pill. It therefore seems to be a
bit of overkill to take BBTs while taking the pill.
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