Can Tri Lo Marzia (triphasic oral contraceptive) cause breakthrough bleeding?

From the Guidelines

Yes, Tri Lo Marzia can cause breakthrough bleeding, which is a common side effect of triphasic oral contraceptives. Breakthrough bleeding refers to unexpected vaginal bleeding that occurs between menstrual periods while taking birth control pills. This side effect is particularly common during the first three months of starting Tri Lo Marzia as your body adjusts to the changing hormone levels. Tri Lo Marzia contains varying doses of ethinyl estradiol (an estrogen) and norgestimate (a progestin) throughout the 28-day cycle, which can sometimes lead to endometrial instability.

Key Points to Consider

• If breakthrough bleeding persists beyond three months or is particularly heavy, you should consult your healthcare provider, as it might indicate the need for a different contraceptive formulation with different hormone levels 1.
• Taking your pill at the same time each day can help minimize breakthrough bleeding.
• Remember that even with breakthrough bleeding, the contraceptive effectiveness remains intact as long as you continue taking the pills as prescribed.

Management of Breakthrough Bleeding

According to the U.S. Selected Practice Recommendations for Contraceptive Use, 2024, if the patient wants treatment for bleeding irregularities, the following treatment options may be considered, depending on the patient’s preferences, treatment goals, and medical history 1:

• Hormonal treatment (e.g., 20–30 μg ethinylestradiol combined oral contraceptives or estrogen)
• Antifibrinolytic agents (e.g., tranexamic acid), 5 days
• Nonsteroidal anti-inflammatory drugs (NSAIDs) (e.g., celecoxib, ibuprofen, or mefenamic acid), 5–7 days
• Selective estrogen receptor modulators (SERMs) (e.g., tamoxifen), 7–10 days It is essential to explore patient goals, including continued method use or method discontinuation, and to consider an underlying health condition, such as interactions with other medications, sexually transmitted infections, pregnancy, thyroid disorders, or new pathologic uterine conditions (e.g., polyps or fibroids) 1.

From the FDA Drug Label

Breakthrough bleeding and spotting are sometimes encountered in patients on oral contraceptives, especially during the first three months of use Breakthrough bleeding, spotting, and amenorrhea are frequent reasons for patients discontinuing oral contraceptives.

Yes, Tri Lo Marzia, a triphasic oral contraceptive, can cause breakthrough bleeding. This is a known side effect of oral contraceptives, and it is especially common during the first three months of use 2 2. If breakthrough bleeding occurs, non-hormonal causes should be considered and adequate diagnostic measures taken to rule out malignancy or pregnancy.

From the Research

Breakthrough Bleeding and Tri Lo Marzia

• Tri Lo Marzia, a triphasic oral contraceptive, can cause breakthrough bleeding, as evidenced by several studies 3, 4, 5, 6, 7.
• A study published in Fertility and Sterility in 1991 found that the incidence of breakthrough bleeding in new users of a triphasic oral contraceptive was 24.9%, 17.5%, and 15.3% in the first three months, respectively 3.
• Another study published in the Journal de gynecologie, obstetrique et biologie de la reproduction in 2008 noted that all combined estrogen-progestin contraceptives, including triphasic oral contraceptives like Tri Lo Marzia, may be associated with abnormal bleeding, including breakthrough bleeding 4.
• A 2024 study published in CPT: pharmacometrics & systems pharmacology found that breakthrough bleeding is significantly increased upon initiation of combined oral contraceptive use, but subsides over time, with the time needed to return to baseline depending on the ethinyl estradiol dose and progestin used 5.
• A 2005 study published in Contraception found that breakthrough bleeding was a common side effect reported by patients using triphasic oral contraceptives in a continuous use regimen, although the overall incidence of side effects was low 6.
• A 2011 Cochrane review comparing triphasic and monophasic oral contraceptives found that several trials reported favorable bleeding patterns, including less spotting and breakthrough bleeding, in triphasic users, but the evidence was insufficient to determine whether triphasic oral contraceptives differ from monophasic oral contraceptives in effectiveness, bleeding patterns, or discontinuation rates 7.

Factors Influencing Breakthrough Bleeding

• The incidence and pattern of breakthrough bleeding may vary depending on the specific formulation of the triphasic oral contraceptive, including the dose of estrogen and progestin 3, 5.
• The time needed for breakthrough bleeding to return to baseline may depend on the ethinyl estradiol dose and progestin used 5.
• Individual factors, such as prior oral contraceptive use and medical history, may also influence the risk of breakthrough bleeding 6.