Management of Breakthrough Bleeding on Enskyce
Do not increase the dose of Enskyce for breakthrough bleeding—this is not an evidence-based approach and combined hormonal contraceptives are formulated with specific hormone ratios that should not be altered. 1, 2
Understanding Breakthrough Bleeding on Combined Oral Contraceptives
Breakthrough bleeding and spotting are common side effects during the first 3–6 months of combined hormonal contraceptive use and are generally not harmful. 1 These bleeding irregularities typically improve with persistent, correct use of the method without any dose adjustment. 1
Recommended Management Approach
First-Line Strategy: Reassurance and Adherence
- Emphasize consistent pill timing: Taking Enskyce (ethinyl estradiol 30 mcg/desogestrel 150 mcg) at the same time every day is critical to minimize breakthrough bleeding. 1, 2
- Continue current regimen: Persistent use of the same formulation typically resolves spotting within 3–6 months without intervention. 1
- Counsel on expected patterns: Enhanced counseling about bleeding irregularities and reassurance that they are not harmful has been shown to reduce method discontinuation. 1
If Bleeding Persists Beyond 3–6 Months
For women using combined hormonal contraceptives continuously or experiencing persistent unscheduled bleeding, consider a hormone-free interval of 3–4 days rather than increasing the dose. 1 This approach has been shown in randomized trials to improve bleeding patterns, with an initial increase in flow followed by abrupt decrease and eventual cessation. 1
What NOT to Do
- Do not add additional hormonal pills (such as norethisterone) to the regimen—combined hormonal contraceptives are designed with specific hormone ratios for optimal efficacy and safety, and altering this balance is not evidence-based. 2
- Do not switch to higher-dose formulations without medical indication—Enskyce already contains 30 mcg ethinyl estradiol, which is a standard low-dose formulation with good cycle control. 3, 4
- Do not use oral doxycycline—a randomized trial showed no improvement in breakthrough bleeding compared to placebo. 1
When to Investigate Further
Rule out other causes of bleeding if:
- Spotting persists beyond 6 months of consistent use 1
- Heavy or prolonged bleeding occurs
- Patient has missed pills or has other risk factors for pregnancy
- New medications have been started that may interact with contraceptives (antibiotics, anticonvulsants, St. John's wort) 1
Clinical Context for Enskyce
Enskyce contains desogestrel, a selective progestin with minimal androgenic effects and excellent cycle control in clinical trials. 3, 4, 5 Studies of this formulation (30 mcg ethinyl estradiol/150 mcg desogestrel) demonstrate low incidence of irregular bleeding that decreases further with consecutive cycles. 4, 5