Ask a doctor on the topic of Gynecology

Spotting under Pill

April 4, 2013 | 20,00 EUR | answered by Dr. med. Ralf Berg

Which pill does not cause breakthrough bleeding?
Is breakthrough bleeding common with Belara? (Please provide personal experience, not what is stated in the leaflet)
Can breakthrough bleeding while on the pill be stopped, for example with medication, and how long does it take for the bleeding to stop?
Can you determine at which point in the cycle breakthrough bleeding is most likely to occur while on the pill?

Dr. med. Ralf Berg

Dear questioner,

Spotting is possible with any pill. The experience shows that the lower the hormone dose (mini-pill), the more likely spotting is. The higher the hormone levels in the pill, the less likely spotting is, but if it does occur, it can be heavier than with the mini-pill. With Belara, which is a low-dose pill, spotting is more common.

Medically, you cannot influence spotting that is already happening. The cause of spotting is believed to be the fluctuation in hormone levels (progestogens/estrogens). Even in healthy women who do not take the pill, spotting can occur around the time of ovulation due to natural hormone changes. Most spotting occurs in the middle of the cycle or around the time of ovulation.

Based on this information, there are two possibilities:
1. Try a different higher-dose pill.
or
2. If the spotting is very bothersome or occurs with every pill, you can try so-called monophasic pills. The hormones are adjusted in a way that prevents ovulation, simulating the first phase of the cycle. As long as you take the pill, you will not have a period. This method is frequently used in America and can be practiced for several months.

Please discuss with your gynecologist if this option is suitable for you. I hope I could help you.

Kind regards,
Dr. R. Berg