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Birth control bills and spotting


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#21 Sunshine

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Posted 09 August 2007 - 07:19 PM

FYI... I changed the topic title since this has turned into a discussion about more than just Seasonique/Seasonale.

Penny: Think this should be moved to the "Hormone..." forum?

So... I just found a pretty good website that compares all the different bc pills and has a chart with the hormone levels of each. The best part is a table that lists various side effects/problems and lists which pills would be best to address each problem. Here's the website:

http://www.wdxcyber.com/ncontr13.htm

There's one "pill" (the Ortho Evra patch) that is listed as best for 4-5 of the things I want to address: acne, break-through bleeding, depression, mood swings, and headaches (though they specifically say not menstrual migraines, which is my problem, but there isn't a list of pills that are best for menstrual migraines).

Based on what I can tell from this site, the break-through bleeding is probably due to too low estrogen levels - and maybe only during for a week per month because this page on the same site says this:

Assuming a woman is not just missing her pills every couple of days, the most common cause of continuous bleeding is due to low estrogens which make the endometrium atrophic (1). A small amount of estrogen is needed to make the lining of the uterus repair the open blood vessels that result from a menstrual slough. After a menses, estrogen alone in a normally ovulating woman not taking birth control starts the tissue growing again and in effect seals off the bleeding blood vessels. This makes bleeding stop. With birth control pills that have both estrogen (very small doses) and progestin in each pill, the progestin component works opposite the the estrogen and does not allow the endometrial tissue to grow and repair itself. If a woman is on a progestin only birth control pill, or using DepoProvera® which is pure progestin only, the same effect takes place, i.e., the endometrium may not totally repair its entire surface inside the uterus because of a lack of estrogen or the antagonism of the progestin working against any small amount of estrogen present in the woman's body.

...

If you have this continuous spotting on the pills, the estrogen level needs to be raised. This can be done in one of two ways. A very small dose of estrogen can be given during the week when you are not taking active hormone pills. One pill that comes packaged this way is Mircette®. It has 10 mcgm of ethinyl estradiol in 5 of the 7 days of pills in between the 21 days of estrogen with progestin pills. The cycle control of bleeding with Mircette especially in the first two months of use is better than other low estrogen dose (20 mcgm) pills such as Alesse® (2). Instead of using Mircette, a supplemental estrogen of 1 mg estradiol could be given during that week off active pills or even a transdermal patch such as those used for menopausal estrogen replacement therapy.

In addition to being given a supplemental estrogen in between active pills, another solution might be to change to a pill with higher estrogen levels of 30 or 35 mcgm but combined with a progestin that is not as strong as the one you were given in Ovral®. Ovcon 1-35® or Ortho Novum 1-35® or their generics are pills that come to mind and might eliminate the continuous spotting you are having.


There's a lot more... but that's the most critical piece.

Any thoughts, ideas would be greatly appreciated.

ETA note to Penny (top).

Edited by Sunshine, 09 August 2007 - 08:36 PM.

Diagnonsenses: Major Depressive Disorder (recurrent, in remission), ADD (inattentive type), Chronic Insomnia, Migraines, mild Anxiety Disorder (NOS), and a broken heart (also in remission!).
Current Cocktail (as of 11/17/2011):
~Morning: 20 mg Adderall XR, 3 mg Intuniv, and 1 mg Xanax XR
~Bedtime: 8 mg Rozerem, 5-10 mg Ambien, 200 mg Danazol (for PMDD and migraine), 100 mg Aldactone
~PRN: 2.5 mg Amerge (for migraines) and .25 mg IR Xanax
Previous meds: See profile.


#22 Halation

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Posted 10 August 2007 - 01:20 AM

sunshine, i forget: which IUD do you have? i've had a paragard since february, and i still have very regular spotting. no periods anymore, perplexingly, but lots and lots of spotting. that's not reason enough for me to go back on pills, because without the pill, i have no periods at all, but it's irksome nonetheless. if you're taking the pill anyway for other reasons, it might make sense to have the IUD removed. at least then you could rule it out as a factor.

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#23 Sunshine

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Posted 18 August 2007 - 10:21 PM

sunshine, i forget: which IUD do you have? i've had a paragard since february, and i still have very regular spotting.

I also have a Paragard. Inserted in January. No spotting from the time it was inserted until I went on the BCPs in April or May (just regular, albeit heavier, periods). I had a Paragard for seven years (had it taken out about three years ago) and had regular periods then, too.

if you're taking the pill anyway for other reasons, it might make sense to have the IUD removed. at least then you could rule it out as a factor.

I'm hoping it doesn't come down to that because I paid (out of pocket) $450 to have the damn thing inserted (my insurance doesn't cover it). I would hate to have it removed only to discover that it's not the cause of the break-through bleeding. I absolutely cannot afford to have it put back in and need some form of birth control. So I'm holding out on that as a last-resort solution.

Anyway... here's a little update:

I called my OB/GYN after reading that article. I was on vacation last week and she's on vacation next week, so it was going to be over two weeks before I could get an appointment. I still had a bunch of Seasonique pills. They have 30 mcgm of estrogen and Yaz has 20 mcgm - for a total of 50 mcgm. Since that's the dosage in many BCPs, I decided it probably couldn't hurt to see what would happen if I took both of them for a few days.

Based on the article, it seemed like you only needed to do this for a few days - long enough to seal off the blood vessels, so I only took both pills for four days (Saturday - Tuesday). Sure enough... spotting/bleeding completely by Tuesday. But then last night (Friday), I started spotting again and today it's more along the lines of bleeding.

I've got an OB/GYN appointment next week. But I just started seeing her and I'm not sure yet if she's the type of doctor who a) can tolerate patients who research/educate themselves; or b) is willing to take less than conventional treatment approaches. I don't want to spend months and months trying to resolve this.
Diagnonsenses: Major Depressive Disorder (recurrent, in remission), ADD (inattentive type), Chronic Insomnia, Migraines, mild Anxiety Disorder (NOS), and a broken heart (also in remission!).
Current Cocktail (as of 11/17/2011):
~Morning: 20 mg Adderall XR, 3 mg Intuniv, and 1 mg Xanax XR
~Bedtime: 8 mg Rozerem, 5-10 mg Ambien, 200 mg Danazol (for PMDD and migraine), 100 mg Aldactone
~PRN: 2.5 mg Amerge (for migraines) and .25 mg IR Xanax
Previous meds: See profile.

#24 borzage

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Posted 19 August 2007 - 12:31 PM

I thought I posted about my experience with the three-day-off method mentioned above, but I don't see my post so I will write it again.

Just for clarity:

- I was using Levora continuously (that's active hormone pills only, no breaks, no sugar pills) and had spotting/bleeding for about three months straight.

- Tried the method whereby you discontinue the hormone pills for three days. This worked like a charm for me. Your body withdraws from the hormones and you bleed as though you were having a period. Then when you resume the pills, the bleeding and spotting stops. I tried it a couple of months ago, and the bleeding stopped completely and so far has not returned.

Only downside is that if you're using the pills to control PMDD, you might have some rough days while you're off the pill.

#25 Sunshine

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Posted 19 August 2007 - 12:35 PM

MG...

You sent me the info about the three-day hiatus method via PM. I tried it... it worked like a charm (didn't even have any issues with mood or migraines)... but after about a week, I started bleeding again.
Diagnonsenses: Major Depressive Disorder (recurrent, in remission), ADD (inattentive type), Chronic Insomnia, Migraines, mild Anxiety Disorder (NOS), and a broken heart (also in remission!).
Current Cocktail (as of 11/17/2011):
~Morning: 20 mg Adderall XR, 3 mg Intuniv, and 1 mg Xanax XR
~Bedtime: 8 mg Rozerem, 5-10 mg Ambien, 200 mg Danazol (for PMDD and migraine), 100 mg Aldactone
~PRN: 2.5 mg Amerge (for migraines) and .25 mg IR Xanax
Previous meds: See profile.

#26 Sunshine

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Posted 29 August 2007 - 09:11 PM

I don't think I posted this article before. There are several others on the same site about breakthrough spotting/bleeding. They are the ones that got me thinking my problem is that my estrogen levels are too low.

I saw my OB/GYN yesterday. I'm not sure yet that I like her (she's new - this was my second visit). Why is finding a really good doctor (of anything) always so hard? I think she was annoyed that I've done a little (okay a lot) of research on my own. I hate doctors like that.

Anyway... she put me on Yasmin. Which is pretty much the same as Yaz, but with 30 mcg of estrogen (Yaz has 20 mcg). This was one of the things I was considering, but what I was really hoping is that she'd just prescribe 10 mcg of estrogen 1-3x per day so I could experiment with the dosage a little bit. Plus I have two packs of Yaz left and I hate wasting meds like that.

I also found a really good medical journal article that suggests menstrual migraines are caused by low estrogen levels and indicate 10-20 mcg of estrogen for 1-2 weeks (starting 2-3 days before your period starts).

But she wouldn't go for it because "estrogen isn't indicated for migraines." She wouldn't even look at the article. ;)

She is open, however, to letting me take the Yasmin continuously for 3 months at a time. So there's at least that.

Keep your fingers crossed that this one will work! I'm so happy with this medication in all other regards.

Edited by Sunshine, 29 August 2007 - 09:11 PM.

Diagnonsenses: Major Depressive Disorder (recurrent, in remission), ADD (inattentive type), Chronic Insomnia, Migraines, mild Anxiety Disorder (NOS), and a broken heart (also in remission!).
Current Cocktail (as of 11/17/2011):
~Morning: 20 mg Adderall XR, 3 mg Intuniv, and 1 mg Xanax XR
~Bedtime: 8 mg Rozerem, 5-10 mg Ambien, 200 mg Danazol (for PMDD and migraine), 100 mg Aldactone
~PRN: 2.5 mg Amerge (for migraines) and .25 mg IR Xanax
Previous meds: See profile.

#27 Sunshine

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Posted 26 January 2008 - 07:56 PM

Update because someone posted another topic related to the same issue...

At some point last fall/summer, I switched to Yasmin (due to my suspicion that the BTB was due to not getting enough estrogen and Yasmin has a slightly higher dose of estrogen). Still had the BTB problem. Did lots of research and determined that what I needed was even a little more estrogen, but new OB/GYN was too conventional to try it. She wouldn't even look at the research I brought with me.

Fortunately, my pdoc is not conventional. He not only pored over the research I found, but was genuinely interested in my theory and didn't see any harm in adding in a touch more estrogen (through the patches that are used for hormone replacement therapy). When I started spotting, I added a patch, and the spotting stopped. I eventually stopped spotting completely and don't need the extra estrogen anymore.

The only drawbacks I've experienced so far are a slight decline in mood and a significant decline in sex drive. Both problem enough that I decided to try going off it. Bad idea. The insomnia came back with a vengeance. So next week I'm going back on Wellbutrin... which I haven't been on in years and never as part of a bigger cocktail for severe depression. Should be interesting to see what happens.
Diagnonsenses: Major Depressive Disorder (recurrent, in remission), ADD (inattentive type), Chronic Insomnia, Migraines, mild Anxiety Disorder (NOS), and a broken heart (also in remission!).
Current Cocktail (as of 11/17/2011):
~Morning: 20 mg Adderall XR, 3 mg Intuniv, and 1 mg Xanax XR
~Bedtime: 8 mg Rozerem, 5-10 mg Ambien, 200 mg Danazol (for PMDD and migraine), 100 mg Aldactone
~PRN: 2.5 mg Amerge (for migraines) and .25 mg IR Xanax
Previous meds: See profile.

#28 Sunshine

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Posted 06 February 2008 - 10:21 PM

Would you mind sharing your age (or thereabouts)? I'm in my late 30s... this all started when I was 33. Before that, I never had PMS and had never had a migraine.
Diagnonsenses: Major Depressive Disorder (recurrent, in remission), ADD (inattentive type), Chronic Insomnia, Migraines, mild Anxiety Disorder (NOS), and a broken heart (also in remission!).
Current Cocktail (as of 11/17/2011):
~Morning: 20 mg Adderall XR, 3 mg Intuniv, and 1 mg Xanax XR
~Bedtime: 8 mg Rozerem, 5-10 mg Ambien, 200 mg Danazol (for PMDD and migraine), 100 mg Aldactone
~PRN: 2.5 mg Amerge (for migraines) and .25 mg IR Xanax
Previous meds: See profile.

#29 borzage

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Posted 06 February 2008 - 11:56 PM

The way my docs and I dealt with the massive anxiety and mood changes around menses were to increase the pill strength (from Mircette to Yasmin), and to add 1mg of estradiol to the 7 "off days". As long as I remember to take the estradiol it works ok. Also, if I feel really crappy I'll double up on the estrogen for a day or two and that helps immensely. In fact, I'd like to be on an even stronger pill, because I feel best on the days that I miss a pill and then have to double up to catch up. But I get really, really, really suicidal if I don't get enough estrogen, like right now.


How fascinating. I get really, really suicidal with premenstrual moodswings, but i never tied it to anything other than "hormonal fluctuations" (then again, I can't afford to see decent doctors so I get all my information from reading websites).

How did you find out it was lack of estrogen causing it? And where does one get estradiol?

#30 Sunshine

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Posted 09 February 2008 - 04:24 PM

It's by prescription only (at least in the U.S.). As far as I know, it's only available in patch form. There are no generics, so it's probably not cheap (yet). But since hormone therapy replacement has been around for a while, there must be some inexpensive alternatives. I just don't know what they are.
Diagnonsenses: Major Depressive Disorder (recurrent, in remission), ADD (inattentive type), Chronic Insomnia, Migraines, mild Anxiety Disorder (NOS), and a broken heart (also in remission!).
Current Cocktail (as of 11/17/2011):
~Morning: 20 mg Adderall XR, 3 mg Intuniv, and 1 mg Xanax XR
~Bedtime: 8 mg Rozerem, 5-10 mg Ambien, 200 mg Danazol (for PMDD and migraine), 100 mg Aldactone
~PRN: 2.5 mg Amerge (for migraines) and .25 mg IR Xanax
Previous meds: See profile.

#31 mghalt

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Posted 17 April 2008 - 08:59 PM

Thanks for posting that website with the comparisons on pills! I was on Mirena IUD and then had it taken out, thinking it might have been messing with my mood and now went on Seasonale but it's generic - Quasense. I've read so many people having problems with it and boy have I! I was fine the first 2 months but then had a period for about 4 weeks until I read online that you could stop it by taking 2 pills every 12 hours for 3 days to stop the bleeding. Now I have to do that every time I get breakthrough bleeding! My doctor told me to stay on this pack and see how it goes then we'll discuss changing if things aren't better.

I wish I woulda left the Mirena in! The things for me are acne, weight gain, moods, and oh yeah, I hate periods. I'd go for Depo if I didn't think it would kill my weight and mood.

Damn damn.
Official dx: Severe major depression without psychotic features, mood disorder NOS aka bipolar II, rule out obsessive compulsive disorder, hypothyroidism, severe obesity, obstructive sleep apnea, and apparently worst mother in America!!! Thank you, I'll accept my crown later.

Current meds: Paxil 20 mg, Zyprexa 2.5 mg as needed, Xanax 0.5 to 1 mg as needed, Synthroid 50 mcg a day. Also on CPAP therapy. Yay.

Ex RXs: Cymbalta, Celexa, Prozac, Lexapro, Seroquel, Risperdal, lithium, Lamictal, Elavil, Buspar, Ativan, Klonopin.

#32 Guest_Guest_beetle_*_*

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Posted 18 April 2008 - 07:47 PM

I started Seasonique (same thing as Seasonale - the birth control pill that you take continuously for 3 months so you only have 4 periods a year) on May 6... 4 days after starting my last real period. I stopped bleeding the next day. 10 days later, I started "spotting" and haven't stopped since (except for maybe 2 or 3 non-consecutive days). On several days (at least 5-7), the spotting was on the heavy side. But even on the light days I need at least a pantyliner (and often that's not enough).

So I'm now almost two weeks into the second pack of pills (6 weeks total). According to the PI sheet, 29% of women in the clinical trials experienced 20 or more days of spotting during the first 90 day cycle. It went down to 16% during the second 90 days, and then 10% during the third and fourth 90 day cycles.

I guess I should at least stick with it for the first full cycle (another 6 weeks), but if I'm already at 30 days halfway through the first 90 day cycle, I can't help but wonder what the odds are that I'm not going to end up in that 10% group six months from now.

I had pretty much the same problem when taking Yasmin 3-4 years ago, but I think I only stayed on it for two months. Does anyone take this (I think they call it "Yaz" now) for three months consecutively (no placebo week)?

BTW... the main reason I went on it was to regulate PMDD and menstrual migraines and it seems to be helping (but hasn't completely cured - especially the latter) in that regard. Otherwise, I'd be off this stuff for sure!

Any thoughts/experiences/ideas?

Edited to change topic title.

I'm a little confused about your timeline. Did you mean you started taking them on March 6th?

Anyway, I spotted off and on through the first pack and a little less through the second. It has gotten better as time goes by and now I seem to be regular, as intended... with a period once every three months and no spotting in between (knock on wood).

I will say that anecdotal evidence on the internet suggests that some women believe that the generic makes them spot more and that it's better on the name brand. I was initially on the generic and since my insurance paid the same either way, I asked specifically for the name brand. My gyno also gave me an additional hormonal pill to take for just a short time to lessen the spotting.

Also, I am taking Seasonale as opposed to Seasonique. I thought there was a slight difference between the two or is it just a patent extender? I don't know.

Stick with it awhile. I have heard it can take up to three packs before everything gets regulated.

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Posted 18 April 2008 - 07:51 PM

I started Seasonique (same thing as Seasonale - the birth control pill that you take continuously for 3 months so you only have 4 periods a year) on May 6... 4 days after starting my last real period. I stopped bleeding the next day. 10 days later, I started "spotting" and haven't stopped since (except for maybe 2 or 3 non-consecutive days). On several days (at least 5-7), the spotting was on the heavy side. But even on the light days I need at least a pantyliner (and often that's not enough).

So I'm now almost two weeks into the second pack of pills (6 weeks total). According to the PI sheet, 29% of women in the clinical trials experienced 20 or more days of spotting during the first 90 day cycle. It went down to 16% during the second 90 days, and then 10% during the third and fourth 90 day cycles.

I guess I should at least stick with it for the first full cycle (another 6 weeks), but if I'm already at 30 days halfway through the first 90 day cycle, I can't help but wonder what the odds are that I'm not going to end up in that 10% group six months from now.

I had pretty much the same problem when taking Yasmin 3-4 years ago, but I think I only stayed on it for two months. Does anyone take this (I think they call it "Yaz" now) for three months consecutively (no placebo week)?

BTW... the main reason I went on it was to regulate PMDD and menstrual migraines and it seems to be helping (but hasn't completely cured - especially the latter) in that regard. Otherwise, I'd be off this stuff for sure!

Any thoughts/experiences/ideas?

Edited to change topic title.

I'm a little confused about your timeline. Did you mean you started taking them on March 6th?

Anyway, I spotted off and on through the first pack and a little less through the second. It has gotten better as time goes by and now I seem to be regular, as intended... with a period once every three months and no spotting in between (knock on wood).

I will say that anecdotal evidence on the internet suggests that some women believe that the generic makes them spot more and that it's better on the name brand. I was initially on the generic and since my insurance paid the same either way, I asked specifically for the name brand. My gyno also gave me an additional hormonal pill to take for just a short time to lessen the spotting.

Also, I am taking Seasonale as opposed to Seasonique. I thought there was a slight difference between the two or is it just a patent extender? I don't know.

Stick with it awhile. I have heard it can take up to three packs before everything gets regulated.

lol, nevermind. I just looked up at the datestamp on the OP. Mods feel free to delete both of my posts.9





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