Can anyone recommend a BC pill to reduce mid-cycle bleeding?

In My Humble Opinion
1

I started my BC career on Triphasil* (Tri-Levlen / Enpress* / Trivora-28 ) when I was 18, and took it for years without problems. (For all the pills, I’m listing their generic equivalents in parentheses, with an asterisk by the one I actually took.)

A couple of years ago, I had some trouble with high blood pressure, so they yanked my birth control :frowning: to see if it was the estrogen. It wasn’t; my BP remained just as high, and I developed mid-to-late-cycle spotting and a 12-day-long period.

Still wary of the estrogen thing, my primary care physician put me on Alesse, a low-estrogen preparation. This didn’t make a dent in the bleeding.

Losing 30 pounds got my blood pressure down, and got my GYN to put me back on Triphasil, and which improved the bleeding problems somewhat, but didn’t clear them up. I’ve been working with my GYN to try to find something that works. I’ve tried Ortho TriCyclen ( TriNessa / Tri-Previfem / Tri-Sprintec* ), which worked about the same as Triphasil for me, and Yasmin, which was about the same as Triphasil on bleeding, but was amazing for my skin. I basically had no zits to speak of on this stuff. Also (sorry for the TMI) it did Good Things for my sex drive, which has been kind of depressed through all this dinking around of my hormones. I’m almost tempted to ask to go back on it and just put up with all the bleeding . . .

Right now I’m on Lo/Ovral ( Cryselle* / Low-Ogestrel ), which my GYN said was recommended to help mid-cycle bleeding, and damned if it isn’t the worst of everything I’ve tried. The bleeding is as bad as it was on Alesse, and my face is all broken out. :mad: It sucks bad enough that I’m bailing after my second pack, instead of doing the usual three-month trial.

I printed out a chart that compares the hormones and dosages in the different pills to try to see if I can detect any patterns, but it’s not helping me much. As far as the estrogen component (ethinyl estradol), I’ve had bad bleeding with everything from Alesse, at 20 mcg, all the way up to the triphasics with up to 45 mcg at midcycle. And I can’t make heads or tails of the progestin component, because each formulation I’ve tried has a different artificial hormone and it doesn’t look like you can compare them mcg-to-mcg. What I’d really love to try would be a variation on Yasmin, but unfortunately it’s the only formulation available that uses that form of progestin (drospirenone).

(BTW, I’ve had several annual pelvic exams through this, and there’s nothing physically abnormal that would be causing the bleeding.)

Does anyone have any suggestions for when I call my GYN this week?

2

Progesterone-only?

3

Progesterone-only pills are supposed to make breakthrough bleeding worse, aren’t they?

4

Well, I’ve never actually been on progesterone-only pills - I’m on Depo, which produces no bleeding at all after a little while.

It may have been a dumb suggestion, but since clearly the combo pills aren’t working for you, a different avenue might.

5

Keep in mind that I am not a licensed medical professional (nurse or doctor), I work as a clinic assistant at Planned Parenthood. Many of our pill adjustments happen due to breakthrough bleeding.
I don’t have the pill grid memorized, but from what I recall, the solution to early to mid-cycle breakthrough bleeding is to up the estrogen component in small increments until you find one that works without causing other estrogenic side effects. Alesse is a very nice pill, but definitely not one to correct BTB, from what I know of the matter.
If you formerly liked Triphasil and OrthoTriLo, with the exception of the BTB, I’d ask your doc about a 30-35 mcg monophasic, like Mircette or Desogen. Steer clear of the triphasics. Mircette (we don’t carry it anymore, it’s been discontinued, but you might be able to get a generic version) is a 20 mcg pill (again, if I recall correctly, always an iffy proposition) but it seems to do very, very well with clearing up breakthrough bleeding.

Call up your local Planned Parenthood and see if you can’t get some good advice. I’m totally biased, admitted, but in my experience many or most GPs don’t know much about birth control pills… as the saying goes, they know a little about everything, while specialists know everything about a little. That’s us.

6

Sorry, Helen, didn’t mean to sound dismissive. I didn’t realize that Depo is progestin-only. I’m sooooo jealous of my friends. One is on Depo, and another is on Seasonale. Three months without bleeding . . . sigh I’d love to go TWO WEEKS.

And thanks for the suggestions, MixieArmadillo. I’ll ask about higher estrogen. BTW, I’m not seeing my PCP for birth control. My gynecologist is actually a nurse practitioner, and I loves her dearly. I really liked Planned Parenthood when I was going there, too, but my GYN has been great, and she has taken my concerns very seriously and worked with me to try to help.

7

Sorry-didn’t mean to imply anything about your GYN, somehow I’d gotten the idea you were seeing your PCP/GP about the issue. We see a whole lot of folks on the pill given very dubious :dubious: advice by their PCP.

8

Good thread! I was prescribed BCP for a different issue, and the particular kind I was prescribed was terrible. Luckily I only had to take them for three months. When I go to see if I can get back on BCP long-term, I definitely know what pill I should not be on. It was pretty much all bleeding, all the time, cramps, and grouchiness.

9

I always had a lot of problems with oral pills - spotting sometimes, but horrible mood problems and a general feeling of being sick. If I wasn’t on the pill, I got the most painful, heavy bleeding, and it seemed to get worse every month. I went on NuvaRing about a year and a half ago and adjusted in about two months. It’s extremely low-dose, since it’s internal. I can’t feel it except very occasionally; it cleared up my skin; I have no mood problems, etc. I really can’t say anything negative about it at all. The only “problem” I have is that my Gyn told me about 4 months ago to use it for 28 days, then change, rather than 21-and-a-week-off so I won’t have periods, but it doesn’t seem to work for me. I get a period about 3 or 4 days into the next ring, and one can’t use tampons with the ring. So, I do the week off and have a very mild period. I’m really thrilled with it and would suggest it to anyone looking for easy BCP.