From the Research
For patients experiencing persistent breakthrough bleeding on a progesterone-only pill, switching to a pill containing drospirenone, as suggested by the most recent evidence 1, may help reduce the bleeding. This approach is based on the latest study from 2024, which provides an algorithm for treating abnormal uterine bleeding in individuals using various hormonal contraceptive methods, including progestin-only pills. The study suggests that changing to drospirenone progesterone-only pills can help reduce bleeding in patients using norethindrone progestin-only pills. Other options to consider include switching to a different progestin delivery method, such as the levonorgestrel IUD or the etonogestrel implant, which can provide a higher local concentration of progestin or steady hormone levels, respectively. It's essential to rule out other causes of breakthrough bleeding, such as missed pills, drug interactions, or underlying pathology, before making any changes to the contraceptive method. Additionally, a study from 2022 2 found that adding 5 mg norethisterone acetate to progesterone-only pills can significantly reduce bleeding and spotting associated with these contraceptives. However, the most recent and highest-quality evidence 1 supports the use of drospirenone as a potential solution for breakthrough bleeding. Key points to consider when addressing breakthrough bleeding in patients using progestin-only pills include:
- Identifying and addressing any underlying causes of bleeding
- Considering alternative progestin delivery methods, such as IUDs or implants
- Switching to a different progestin-only pill, such as one containing drospirenone
- Temporarily adding a low-dose estrogen supplement to stabilize the endometrium, if necessary.