Is There a Birth Control Pill That Can Stop Spotting?

Understanding the Cause and Knowing When to Switch

Spotting and Birth Control Pills
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Spotting, or breakthrough bleeding, is a common side effect of certain hormonal birth control medications. While the bleeding will typically reduce in severity within three to four months, there are some in whom spotting may persist.

Beyond the drugs themselves, spotting is associated with inconsistent dosing. In fact, research has shown that up to 33 percent of those who miss one or more pills per cycle will experience breakthrough bleeding.

Smoking, unsurprisingly, only adds to this effect.

Spotting can be aggravating for those taking the pill, particularly if the bleeding doesn’t seem to be improving. In some cases, there may be benefits to switching treatment if only to find the drug with the right hormonal balance for you.

Differences in Birth Control Pills

Deciding upon the particular brand of birth control pill can be a process of trial and error. The drugs can often vary by formulation as well as the amount of active ingredient used. Combination pills, the type most commonly prescribed, are those which pair estrogen with one of eight different types of progestins.

Depending on the brand, some pills may as little as 35 micrograms of estrogen while others have up to 50 micrograms. These variations can often make a big difference in the side effects a person may experience.

These same applies to progestin. These synthetic forms of progesterone are broadly classified as estranges (first generation), gonanes (second generation), and spironolactone (the newest form of progestin).

Depending on the type and amount of progestin used—as well as the dosage of estrogen—the side effects may either be minimal or seriously impact a woman's quality of life.

Causes of Spotting

Birth control pills are largely defined by their drug action. This action can vary but involves three, inter-related effects:

  • Progestational effects which reduce menstrual bleeding and prevent ovulation
  • Androgenic effects caused by the excessive production of male hormones which may trigger hair loss, acne, and excess facial hair (hirsutism)
  • Estrogenic effects which aim to counter the androgenic effects while stabilizing the uterus

By and large, spotting is more likely to occur when the birth control method you use has little or no estrogen. But estrogen dosages alone do not predict whether bleeding will occur.

Just as impactful is the type of progestin used. Of the three categories of progestin, gonanes tend to have the greatest progestational effect, making them more suitable if spotting is especially problematic. But, again, this is not always the case.

What is more important is the balance between estrogen and progestin. In the end, the aim of therapy is to maintain an equilibrium between the estrogenic and progestational effects of a pill while tempering any adverse androgen-related side effects. If one or the other is thrown off, problems can occur.

So, even if a drug is made with ethynodiol diacetate, a progestin associated with increased spotting, higher doses of estrogen may effectively counteract this effect.

Best Treatment Options

As a rule of thumb, a combination birth control pill which contains a higher estrogen level, higher progestin potency, and lower androgen effect is less likely to cause spotting. Among the brands most consistent with this profile are:

  • Demulen 1/50
  • Desogen
  • Ortho-Cept
  • Ovcon 50
  • Yasmin
  • Zovia 1/50E
  • Loestrin 1/20

Estrostep FE is another brand that may reduce or stop breakthrough bleeding. This pill does not follow the same profile as the others as it tends to have a high androgenic/low estrogenic effect.  Instead, as a triphasic pill, treatment is delivered in three different phases more in line with the woman’s natural cycle.

Each week of Estrostep FE tablets contains a different amount of hormones, with the final week containing no hormone. By following treatment in the order prescribed, the risk of spotting may be greatly reduced.

If breakthrough bleeding has become a serious problem, speak to your doctor about these options.

A Word From Verywell

While spotting may be distressing, it will often resolve on its own as the body begins to adjust to effects of the drug. Because of this, doctors will usually recommend that you stay on your current medication for at least three months to see if the side effects will improve.

During this time, try to remain fully adherent to your therapy, taking your pill every day without fail. If any side effects become intolerable, speak with your doctor but try not to stop treatment until your doctor tells you it's okay.

Sources:

Hall, K.; O’Connell White, K.; Reame, N.  et al. "Studying the Use of Oral Contraception: A Review of Measurement Approaches." J Wom Health. 2010; 19(12):2203-2210.

Stewart. M. and Black, K. "Choosing a combined oral contraceptive pill." Aus Prescrip. 2015; 38(1):6-11.

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