Is There a Birth Control Pill Brand That Stops Spotting?

Why Does Breakthrough Bleeding Even Occur?

Pill Brand to Stop Spotting
Stop Spotting on the Pill. Photo © 2014 Dawn Stacey

Question: Is there a birth control pill brand that can stop spotting? Does the progestin, ethynodiol diacetate cause breakthrough bleeding?

Deciding upon a particular brand of birth control pill can take some trial and error. Besides offering excellent pregnancy protection, certain combination birth control pills can offer some additional non-contraceptive benefits. Keep in mind, when switching to a different pill brand, side effects may occur.

Studies have shown breakthrough bleeding rates in the first three months of pill use can range from 10%-55%. Because of this, you should stay on your new pill brand for at least three months to allow time for this side effect to resolve.

Answer: Having a basic understanding about combination birth control pills may help assist you, along with your doctor, in deciding upon a pill brand that may work best for you. Combination pills are made up of estrogen and one of eight types of progestins. Because the available birth control pill brands contain different types and amounts of progestin, it makes it more difficult to compare pill brands to one another. Progestins are also classified under one of three categories:

  • Estranges: these include norethindrone, norethindrone acetate, and ethynodiol diacetate.
  • Gonanes: including levonorgestrel, norgestrel, desogestrel, and norgestimate.
  • Spirolactones: drospirenone.

    The effects of progestin on your body are usually described in terms of progestational, estrogenic, and androgenic effects. Simply stated:

    • Progestational Effects: indicate how the progestin stimulates the progesterone receptors -- resulting in lower amounts of menstrual bleeding and the prevention of ovulation.
    • Estrogenic Effects: describe how the amount of synthetic estrogen in the birth control pill brand counters androgen-related side effects.
    • Androgenic Effects: refer to male hormone side effects like hirsutism (unwanted hair growth), acne breakouts and slowing down the body's carbohydrate metabolism.

    The extent to which these progestational, estrogenic, and androgenic side effects show up (typically as side effects) is dependent on the:

    1. Combination/ratio of the type of progestin and estrogen found in the pill brand.
    2. The specific dosages of progestin and estrogen in the pill.

    It becomes more complicated because women may also respond differently to the same hormone combination of various pills.

    Spotting, or breakthrough bleeding, is considered a possible side effect of the birth control pill. There are some behavioral reasons why spotting may occur. Forgetting to take your pill (or taking it at different times each day) can cause breakthrough bleeding; 25-33% of women miss one or more pills per cycle. So if you are experiencing spotting because of missing pills, this can be stopped by remembering to take your pill at the same time, every day. Smoking, while using the birth control pill, can also lead to breakthrough bleeding.

    Additionally, it is commonly thought that pill brands that contain lower amounts of estrogen may be more likely to account for breakthrough bleeding. With that being said, however, estrogen amounts may not solely predict whether or not spotting will occur. Research seems to indicate that the balance (or ratio) between the estrogen and progestin in a pill brand may be a better indicator to predict spotting. Breakthrough bleeding may also be due to the type of progestin in your pill brand. Gonanes have greater progestational activity, so some doctors may switch you from a pill containing an estrane progestin to a gonane progestin in order to stop breakthrough bleeding.

    Research also shows that the progestin, ethynodiol diacetate may be associated with increased incidences of breakthrough bleeding and spotting. Pill brands that have the right estrogen/progestin balance can help counteract this effect. This means that pill brands that contain ethynodiol diacetate but also include higher levels of estrogen can alleviate this side effect (and thus minimize spotting).

    In general, though, combo birth control pill brands that contain a higher estrogen level, higher progestin potency, and lower androgen potency tend to be less likely to produce the side effect of spotting. The following is a list of some pill brands that follow this profile, so they may be most helpful in reducing your chances of breakthrough bleeding:

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

    Estrostep FE is another pill brand that may stop breakthrough bleeding. This pill brand does not follow the same profile -- it tends to have a high androgenic/low estrogenic pattern. But it is a triphasic pill that was actually designed to help prevent spotting while also attempting to keep hormone exposure as low as possible.

    Regardless of the type of progestin or amount of estrogen, spotting is a typical pill side effect that generally decreases with successive pill cycles. You may also be more likely to experience breakthrough bleeding if you are using an extended-cycle pill. If spotting continues (and is bothersome to you) after three months of pill use (and is not due to skipping pills or smoking), you can talk to your doctor about switching to a different pill brand that has a progestin profile and progestin/estrogen ratio that is less likely to cause breakthrough bleeding.


    Jelovsek, R. (2003). Accurate Answers to Questions About Birth Control Pills. [e-book].

    Kiley J, Cassing H. "Oral contraceptives: A comprehensive review." Clinical Obstetrics and Gynecology. 2007 Dec; 50(4):868-877.Accessed via private subscription.

    Lohr PA, Creinin MD. "Oral contraceptives and breakthrough bleeding: What patients need to know." Journal of Family Practice. 2006 Oct; 55(10):872-880. Accessed via private subscription.

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