From the Research
Oral contraceptives with higher estrogen content, such as Tri Cyclen 28, do not typically cause longer or heavier withdrawal bleeding, and in fact, may lead to lighter and shorter withdrawal bleeding during the hormone-free interval. This is because the estrogen component helps build and stabilize the endometrial lining, resulting in more controlled shedding during withdrawal bleeding 1. The study published in The Cochrane database of systematic reviews in 2013 found that low-dose estrogen COCs resulted in higher rates of bleeding pattern disruptions, but higher estrogen doses may lead to more stable bleeding patterns 1.
Key Points to Consider
- Higher estrogen content in birth control pills generally leads to lighter, shorter withdrawal bleeding during the hormone-free interval
- Tri Cyclen 28 contains 35 mcg of ethinyl estradiol, which is considered a moderate dose in today's formulations
- Women who experience heavy or prolonged withdrawal bleeding on higher estrogen pills may have other underlying factors affecting their bleeding patterns
- If experiencing problematic bleeding on Tri Cyclen 28, it's worth discussing with a healthcare provider, as switching to a different progestin type or adjusting the estrogen dose might help
- Bleeding patterns typically stabilize after 3-4 months on a new contraceptive, so giving the body time to adjust is important before making changes 2, 3, 1
Management of Withdrawal Bleeding
- Counseling and reassurance are adequate during the first three months of OCP use, as bleeding is common during this time period 2
- If bleeding persists beyond three months, it can be treated with supplemental estrogen and/or a nonsteroidal anti-inflammatory drug (NSAID) 2
- Other options are to change to an OCP with a higher estrogen content or to a different formulation (i.e., a low-dose OCP containing a different progestin) 2