In the grips of growth
Sherman, D.
Zpg Reporter 24(2): 1; 4
1992
ISSN/ISBN: 0199-0071 PMID: 12285219 Document Number: 320106
This article examines the issue of breakthrough bleeding, the leading complaint among oral contraceptive users, and strategies developed to combat the problem. In its annual oral contraceptive survey, Contraceptive Technology Update asked clinicians about the most common side effect reported by patients. 73% cited breakdown bleeding. Breakthrough bleeding can be disruptive, frightening, and bothersome for patients. In the survey, about 1/2 of the physicians reported that only a few of their patients find side effects such as breakthrough bleeding bothersome enough to discontinue use of oral contraceptives. The other 1/2 of the physicians, however, reported that up top 25% of the side effects. Due to the decreased estrogen in today's low-dose oral contraceptives, breakthrough bleeding occurs most often in new pill users, usually during the first 4 months of use. Among long-term oral contraceptive users, breakthrough bleeding should be investigated carefully, since it could signal a serious problem, such as a reduction in the efficiency of the oral contraceptive, a spontaneous abortion, an ectopic pregnancy, pelvic inflammatory disease, endometrial cancer, etc. The article goes on to describe several of the strategies used by physicians to stop or minimize breakthrough bleeding. These strategies include switching the types of oral contraceptives, instructing patients to temporarily double up on pills, or prescribing extra estrogen. While no consensus exists on the most appropriate strategy, it is clear that the treatments can be effective. Furthermore, physicians agree that the first and most important step in dealing with breakthrough bleeding is to counsel all new patients on the likelihood of the problem.