From the Guidelines
It is normal to experience bleeding after stopping combined oral contraceptive pill (COC) therapy.
Reasons for Bleeding
- The body's hormonal balance is altered when stopping COC therapy, leading to changes in menstrual bleeding patterns 1.
- The evidence suggests that bleeding irregularities, including unscheduled spotting or bleeding, are common side effects of COC use, especially during the first 3-6 months of use 1.
Management of Bleeding
- According to the US Selected Practice Recommendations for Contraceptive Use, 2024, if a patient desires removal or discontinuation of the COC method, counseling on alternative contraceptive methods should be offered, and another method initiated if desired 1.
- The guidelines also recommend exploring patient goals, including continued method use or method discontinuation, and providing reassurance that bleeding irregularities are generally not harmful 1.
Key Points
- Bleeding after stopping COC therapy is a common occurrence and is usually not harmful 1.
- Counseling on expected bleeding patterns and reassurance can help reduce method discontinuation 1.
- There is no specific treatment recommended for bleeding after stopping COC therapy, but patients should be advised to contact their provider if they experience heavy or prolonged bleeding 1.
From the FDA Drug Label
Unscheduled or Breakthrough Vaginal Bleeding Or Spotting Unscheduled vaginal bleeding or spotting may occur while you are taking the pills If you have taken your pills regularly and miss one menstrual period, continue taking your pills for the next cycle but be sure to inform your health-care provider before doing so
It is normal to experience unscheduled or breakthrough vaginal bleeding or spotting while taking the pills. However, the label does not directly address bleeding after stopping COC therapy. Therefore, based on the available information, no conclusion can be drawn about bleeding after stopping COC therapy 2.
From the Research
Bleeding After Stopping Combined Oral Contraceptive Pill (COC) Therapy
- Bleeding patterns after stopping COC therapy are not explicitly discussed in the provided studies, which primarily focus on bleeding patterns during COC use 3, 4, 5, 6, 7.
- However, it is known that COCs can affect the menstrual cycle, and stopping their use can lead to changes in bleeding patterns 3, 4, 5, 6, 7.
- The studies suggest that bleeding irregularities are common during the first few months of COC use, but the frequency and intensity of bleeding can decrease over time 4, 5, 6.
- Factors such as regularity of pill use, type of COC, and individual characteristics can influence bleeding patterns during COC use 5, 6, 7.
Factors Influencing Bleeding Patterns
- Regularity of pill use is a significant factor influencing bleeding patterns, with irregular use leading to a higher frequency of intermenstrual bleeding 5.
- The type of COC, including the dose and type of estrogen and progestin, can also affect bleeding patterns 4, 6, 7.
- Individual characteristics, such as body weight and blood pressure, do not appear to be significantly affected by COC use 5.
Management of Bleeding Irregularities
- Counseling and reassurance are essential for managing bleeding irregularities during COC use 3, 6.
- Supplemental estrogen and/or nonsteroidal anti-inflammatory drugs (NSAIDs) may be used to treat bleeding episodes 3.
- Changing to a different COC or formulation may also be considered if bleeding irregularities persist 3, 6.