From the Guidelines
For breakthrough bleeding on progesterone-only birth control, I recommend taking a non-steroidal anti-inflammatory drug (NSAID) like ibuprofen 600-800mg three times daily with food for 5-7 days to help reduce bleeding. This approach is supported by the latest guidelines from the U.S. Selected Practice Recommendations for Contraceptive Use, 2024 1. According to these guidelines, NSAIDs can be considered for spotting or light bleeding, as well as heavy or prolonged bleeding, in users of various contraceptive methods, including progesterone-only birth control.
The mechanism of action of NSAIDs in reducing menstrual flow is by decreasing prostaglandin production, which can help alleviate breakthrough bleeding. It's essential to note that if bleeding persists beyond 1-2 weeks or is very heavy, a healthcare provider should be consulted, as they might consider changing the contraceptive method or adding supplemental estrogen temporarily. Breakthrough bleeding is common with progesterone-only methods, especially in the first 3-6 months of use, and usually improves over time as the body adjusts.
Key considerations for managing breakthrough bleeding include:
- Continuing to take the progesterone-only pill at the same time each day for both contraceptive effectiveness and to help minimize irregular bleeding.
- Monitoring for signs of complications, such as severe pain, dizziness, or soaking through a pad/tampon every hour, which require immediate medical attention.
- Exploring patient goals and preferences, including the option to continue or discontinue the current contraceptive method, as outlined in the guidelines 1.
Overall, the use of NSAIDs for breakthrough bleeding on progesterone-only birth control is a recommended approach based on the most recent and highest quality evidence available 1.
From the Research
Breakthrough Bleeding on Progesterone-Only Birth Control
- Breakthrough bleeding is a common side effect of progesterone-only pills (POPs), affecting approximately 40% of women 2.
- This side effect can be reduced to 10% with combined hormonal contraceptives (CHCs) 2.
- Supplementing POP with norethisterone can also reduce breakthrough bleeding 2.
Management of Breakthrough Bleeding
- There is no specific "pill" mentioned in the studies to stop breakthrough bleeding, but CHCs are considered a viable alternative to POPs, even during lactation 2.
- CHCs are safe during lactation and do not reduce milk production or impede infant development 2.
- The exact etiology of irregular bleeding associated with progestin-containing contraceptives is not completely understood, but several mechanisms have been suggested, and therapies targeting these mechanisms have been evaluated with mixed results 3.
Hormonal Relationship to Breakthrough Bleeding
- Serum estradiol concentrations have been identified as an independent factor in the occurrence of breakthrough bleeding during continuous combined hormone replacement therapy 4.
- The relative risk for the occurrence of breakthrough bleeding was 2.7 for serum estradiol concentrations greater than 40 pg/mL 4.
- Further studies are needed to test the hypothesis that estrogen is a major factor in the incidence of bleeding during postmenopausal hormone replacement therapy 4.