What birth control options can help stop prolonged menstrual bleeding in a 22-year-old female taking spironolactone (aldactone) and sertraline (zoloft)?

From the Guidelines

For a 22-year-old female experiencing prolonged menstrual bleeding while taking spironolactone and sertraline, the most effective option to stop the period would be to start a combined hormonal contraceptive (CHC) containing estrogen and progestin, such as a birth control pill, for a few days, as recommended by the latest guidelines 1.

Key Considerations

• The patient's current medications, spironolactone and sertraline, do not have significant interactions with hormonal birth control methods, although sertraline may slightly increase the risk of bleeding.
• The goal is to reduce or eliminate prolonged menstrual bleeding, and hormonal birth control methods can achieve this by stabilizing the uterine lining and regulating hormone levels.
• According to the 2024 U.S. Selected Practice Recommendations for Contraceptive Use, combined hormonal contraceptives are a recommended option for managing bleeding irregularities while using contraception 1.

Options for Birth Control

• Combined hormonal contraceptives (CHCs) containing estrogen and progestin, such as birth control pills (like Yaz, Ortho Tri-Cyclen, or Loestrin), the vaginal ring (NuvaRing), or the patch (Xulane).
• Progestin-only options like the hormonal IUD (Mirena, Kyleena, or Liletta), the implant (Nexplanon), or the depo-provera injection.

Management of Bleeding Irregularities

• The American College of Obstetricians and Gynecologists (ACOG) recommends medical treatments for abnormal uterine bleeding associated with ovulatory dysfunction, including progestin-only contraception and combined hormonal contraception 1.
• The 2024 guidelines provide a management algorithm for bleeding irregularities while using contraception, which includes exploring patient goals, providing reassurance, and offering treatment options such as NSAIDs, hormonal treatment, or antifibrinolytic agents 1.

From the FDA Drug Label

Breakthrough bleeding, spotting, and amenorrhea are frequent reasons for patients discontinuing oral contraceptives. In breakthrough bleeding, as in all cases of irregular bleeding from the vagina, non-functional causes should be borne in mind In undiagnosed persistent or recurrent abnormal bleeding from the vagina, adequate diagnostic measures are indicated to rule out pregnancy or malignancy. If both pregnancy and pathology have been excluded, time or a change to another preparation may solve the problem Changing to an oral contraceptive with a higher estrogen content, while potentially useful in minimizing menstrual irregularity, should be done only if necessary since this may increase the risk of thromboembolic disease

Birth Control Options to help stop prolonged menstrual bleeding in this patient may include:

• Ethinyl Estradiol (such as in oral contraceptives) with a higher estrogen content, but this should be done with caution due to the increased risk of thromboembolic disease 2
• Other Options may include a change to another oral contraceptive preparation, but the patient should be evaluated to rule out pregnancy or malignancy before starting any new treatment
• It is essential to note that the patient is already taking Spironolactone and Sertraline, and any new treatment should be considered in the context of potential interactions with these medications The patient should be evaluated by a healthcare provider to determine the best course of treatment for her prolonged menstrual bleeding.

From the Research

Birth Control Options for Prolonged Menstrual Bleeding

The user is seeking birth control options to help stop prolonged menstrual bleeding in a 22-year-old female taking spironolactone and sertraline. The following options are considered:

• Combined Oral Contraceptives (COCs): COCs have been shown to reduce heavy menstrual bleeding (HMB) in women with unacceptable HMB, with a success rate of 77% compared to 3% in women taking placebo 3. A novel combination oral contraceptive product containing estradiol valerate and dienogest has also been shown to significantly reduce HMB, with an average 65% reduction in mean blood loss 4.
• Contraceptive Vaginal Ring (CVR): The CVR has been compared to COCP in two trials, with no evidence of a benefit for one treatment compared to the other for response to treatment, MBL, or participant satisfaction with treatment 3.
• Low-Dose Ethinylestradiol/Levonorgestrel: This combination oral contraceptive has been shown to prevent pregnancy primarily by inhibiting ovulation, with a Pearl index of 0.88 and a cumulative pregnancy rate of 1.9% at the end of a 3-year open-label trial 5.
• Drospirenone-Containing Oral Contraceptives: These have been shown to relieve premenstrual symptoms in women with premenstrual dysphoric disorder (PMDD), but their effectiveness in reducing HMB is not well established 6.

Key Considerations

When choosing a birth control option to help stop prolonged menstrual bleeding, the following factors should be considered:

• Efficacy: The ability of the birth control option to reduce HMB.
• Safety: The potential side effects and risks associated with the birth control option.
• Convenience: The ease of use and administration of the birth control option.
• Contraindications: The presence of any medical conditions or medications that may interact with the birth control option, such as spironolactone and sertraline.

Potential Interactions

The user is taking spironolactone and sertraline, which may interact with certain birth control options. For example:

• Spironolactone: May increase the risk of hyperkalemia when used with certain birth control options, such as drospirenone-containing oral contraceptives.
• Sertraline: May interact with certain birth control options, such as COCs, by increasing the risk of bleeding or altering the efficacy of the birth control option.

It is essential to consult with a healthcare provider to determine the best birth control option for the user's specific needs and medical history.