Breakthrough bleeding

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Breakthrough bleeding (BTB) is any of various forms of vaginal bleeding, [1] usually referring to mid-cycle bleeding in users of combined oral contraceptives, [1] as attributed to insufficient estrogens. [1] It may also occur with other hormonal contraceptives. Sometimes, breakthrough bleeding is classified as abnormal and thereby as a form of metrorrhagia, [2] and sometimes it is classified as not abnormal. [1]

Contents

In the context of hemophilia, the term describes a bleeding that occurs while a patient is on prophylaxis. [3]

Presentation

The bleeding is usually light, often referred to as "spotting," though a few people may experience heavier bleeding.

Breakthrough bleeding generally is greatest in the first 3 to 4 months after starting oral contraceptives (OCs), and it steadily declines and stabilizes by the end of the fourth cycle. [4] It is estimated that breakthrough bleeding affects around 25 % of combined oral contraceptive pill (COCP) users during the initial 3 months of use. [5]

Mechanism

Breakthrough bleeding is commonly due to 4 factors: physiologic effects of OCs on the endometrium, OC-related parameters, (dose, formulation, and regimen), patient behavior, (compliance, using concomitant medications, and smoking) and benign or malignant pathology. [4] As for the first factor, studies have shown that an increased estrogen dose in combined OCs leads to a lower incidence of breakthrough bleeding. Studies also reported that the ratio of estrogen/progestin in combined OCs may be more important than the absolute value of estrogen in the incidence of breakthrough bleeding. [4]

Treatment

Breakthrough bleeding that does not resolve on its own is a common reason for women to switch to different pill formulations, or to switch to a non-hormonal method of birth control.

See also

Related Research Articles

Combined oral contraceptive pill Birth control method which is taken orally

The combined oral contraceptive pill (COCP), often referred to as the birth control pill or colloquially as "the pill", is a type of birth control that is designed to be taken orally by women. It includes a combination of an estrogen and a progestogen. When taken correctly, it alters the menstrual cycle to eliminate ovulation and prevent pregnancy.

Levonorgestrel Hormonal medication used for birth control

Levonorgestrel is a hormonal medication which is used in a number of birth control methods. As an emergency birth control, sold under the brand name Plan B among others, it is useful within 120 hours of unprotected sex. The more time that has passed since sex, the less effective the medication becomes, and it does not work after pregnancy (implantation) has occurred. It decreases the chances of pregnancy by 57 to 93%. It is also combined with an estrogen to make combination birth control pills. In an intrauterine device (IUD), such as Mirena among others, it is effective for the long-term prevention of pregnancy. An implantable form of levonorgestrel is also available in some countries.

Vaginal bleeding is any bleeding through the vagina, including bleeding from the vaginal wall itself, as well as bleeding from another location of the female reproductive system, often the uterus. Generally, it is either part of a normal menstrual cycle or is caused by hormonal or other problems of the reproductive system, such as abnormal uterine bleeding.

Progestogen-only pills or progestin-only pills (POP) are contraceptive pills that contain only synthetic progestogens (progestins) and do not contain estrogen. They are colloquially known as mini pills.

Ethinylestradiol chemical compound

Ethinylestradiol (EE) is an estrogen medication which is used widely in birth control pills in combination with progestins. It has also been used as a component of menopausal hormone therapy for the treatment of menopausal symptoms in combination with progestins. In the past, EE was widely used alone for various indications such as the treatment of gynecological disorders and prostate cancer. It is usually taken by mouth.

Extended or continuous cycle combined oral contraceptive pills are a packaging of combined oral contraceptive pills (COCPs) that reduce or eliminate the withdrawal bleeding that would occur once every 28 days in traditionally packaged COCPs. It works by reducing the frequency of the pill-free or placebo days. Extended cycle use of COCPs may also be called menstrual suppression, although other hormonal medications or medication delivery systems may also be used to suppress menses. Any brand of combined oral contraceptive pills can be used in an extended or continuous manner by simply discarding the placebo pills; this is most commonly done with monophasic pills in which all of the pills in a package contain the same fixed dosing of a synthetic estrogen and a progestin in each active pill.

Desogestrel chemical compound

Desogestrel, sold under the brand names Cerazette and Mircette among many others, is a progestin medication which is used in birth control pills for women. It is also used in the treatment of menopausal symptoms in women. The medication is available and used alone or in combination with an estrogen. It is taken by mouth.

Drospirenone chemical compound

Drospirenone is a progestin medication which is used in birth control pills to prevent pregnancy and in menopausal hormone therapy, among other uses. It available both alone under the brand name Slynd and in combination with an estrogen under the brand name Yasmin among others. The medication is taken by mouth.

Norethisterone acetate chemical compound

Norethisterone acetate (NETA), also known as norethindrone acetate and sold under the brand name Primolut-Nor among others, is a progestin medication which is used in birth control pills, menopausal hormone therapy, and for the treatment of gynecological disorders. The medication available in low-dose and high-dose formulations and is used alone or in combination with an estrogen. It is taken by mouth.

Vaginal ring drug delivery device

Vaginal rings are polymeric drug delivery devices designed to provide controlled release of drugs for intravaginal administration over extended periods of time. The ring is inserted into the vagina and provides contraception protection. Vaginal rings come in one size that fits most women.

Intermenstrual bleeding, previously known as metrorrhagia, is uterine bleeding at irregular intervals, particularly between the expected menstrual periods. It is a cause of vaginal bleeding.

Hormonal contraception refers to birth control methods that act on the endocrine system. Almost all methods are composed of steroid hormones, although in India one selective estrogen receptor modulator is marketed as a contraceptive. The original hormonal method—the combined oral contraceptive pill—was first marketed as a contraceptive in 1960. In the ensuing decades many other delivery methods have been developed, although the oral and injectable methods are by far the most popular. Altogether, 18% of the world's contraceptive users rely on hormonal methods. Hormonal contraception is highly effective: when taken on the prescribed schedule, users of steroid hormone methods experience pregnancy rates of less than 1% per year. Perfect-use pregnancy rates for most hormonal contraceptives are usually around the 0.3% rate or less. Currently available methods can only be used by women; the development of a male hormonal contraceptive is an active research area.

Mestranol/noretynodrel chemical compound

Mestranol/norethynodrel was the first combined oral contraceptive pill (COCP) being mestranol and norethynodrel. It sold as Enovid in the United States and as Enavid in the United Kingdom. Developed by Dr. Gregory Pincus at G. D. Searle & Company, it was first approved on June 10, 1957 by the U.S. Food and Drug Administration for treatment of menstrual disorders. The FDA approved an additional indication for use as a contraceptive on June 23, 1960, though it only became legally prescribable nationwide and regardless of the woman's marital status after Eisenstadt v. Baird in 1972. In 1961, it was approved as a contraceptive in the UK and in Canada.

Birth control pills come in a variety of formulations. The main division is between combined oral contraceptive pills, containing both estrogens and synthetic progestogens (progestins), and progestogen only pills. Combined oral contraceptive pills also come in varying types, including varying doses of estrogen, and whether the dose of estrogen or progestogen changes from week to week.

Ethinylestradiol/drospirenone/levomefolic acid pharmaceutical combination

Ethinylestradiol/drospirenone/levomefolic acid (EE/DRSP/LMF), sold under the brand names Beyaz and Safyral, is a combination of ethinylestradiol (EE), an estrogen, drospirenone (DRSP), a progestogen, antimineralocorticoid, and antiandrogen, and levomefolic acid (LMF), a form of vitamin B9, which is used as a birth control pill to prevent pregnancy in women. The formulation contains folate as the calcium salt of levomefolic acid to lower the risk of complications such as fetal neural tube defects should the medication fail as a form of birth control. EE/DRSP/LMF was approved for use by the United States Food and Drug Administration on 24 September 2010.

Combined birth control pills that contain natural estradiol or an estradiol ester include:

Ethinylestradiol/etonogestrel pharmaceutical combination

Ethinylestradiol/etonogestrel, sold under the brand names NuvaRing among others, is a hormonal vaginal ring used for birth control and to improve menstrual symptoms. It contains ethinylestradiol, an estrogen, and etonogestrel, a progestin. It is used by insertion into the vagina. Pregnancy occurs in about 0.3% of women with perfect use and 9% of women with typical use.

Estrogen (medication) Female Hormones

An estrogen (E) is a type of medication which is used most commonly in hormonal birth control and menopausal hormone therapy. They can also be used in the treatment of hormone-sensitive cancers like breast cancer and prostate cancer and for various other indications. Estrogens are used alone or in combination with progestogens. They are available in a wide variety of formulations and for use by many different routes of administration. Examples of estrogens include bioidentical estradiol, natural conjugated estrogens, synthetic steroidal estrogens like ethinylestradiol, and synthetic nonsteroidal estrogens like diethylstilbestrol. Estrogens are one of three types of sex hormone agonists, the others being androgens/anabolic steroids like testosterone and progestogens like progesterone.

Combined hormonal contraception

Combined hormonal contraception(CHC), or combined birth control, is a form of hormonal contraception which combines both an estrogen and a progestogen in varying formulations.

Menstrual suppression refers to the practice of using hormonal management to stop or reduce menstrual bleeding. In contrast to surgical options for this purpose, such as hysterectomy or endometrial ablation, hormonal methods to manipulate menstruation are reversible.

References

  1. 1 2 3 4 Farlex Medical Dictionary > Breakthrough Bleeding, in turn citing:
    • Segen's Medical Dictionary. Copyright 2012
    • McGraw-Hill Concise Dictionary of Modern Medicine. Copyright 2002
  2. Merriam-Webster's Medical Dictionary > Breakthrough bleeding Retrieved on Feb 28, 2010
  3. "Prophylaxis: Barriers and challenges - World Federation of Hemophilia". www.wfh.org. Retrieved 2018-07-05.
  4. 1 2 3 Patricia A. Lohr and Mitchell D. Creinin (2006). "Oral contraceptives and breakthrough bleeding: What patients need to know". The journal of family practise. 55 (10): 872–80. PMID   17014753.CS1 maint: uses authors parameter (link)
  5. M. Hickey & I. S. Fraser (2012). "Iatrogenic unscheduled (breakthrough) endometrial bleeding". Rev Endocr Metab Disord. 13: 301–308. doi:10.1007/s11154-012-9227-3.CS1 maint: uses authors parameter (link)