Breakthrough bleeding
Encyclopedia
Breakthrough bleeding is an abnormal uterine bleeding that occurs between menstrual periods, especially due to irregular sloughing of the endometrium
in women on combined oral contraceptives. It may also occur with other hormonal contraceptives.
Many women find that the breakthrough bleeding ceases after one or two cycles.
(uterine lining). This is not a dangerous condition, though the unpredictable and often lengthy periods of bleeding are unpleasant. Breakthrough bleeding may also be caused by hormonal effects of ovulation
. Breakthrough bleeding may also itself be a symptom of pregnancy
.
Breakthrough bleeding is most common when a woman first begins taking oral contraceptives, or changes from one particular oral contraceptive to another, though it is possible for breakthrough bleeding to happen at any time. Smokers are especially prone to breakthrough bleeding while taking oral contraceptives; though many users experience breakthrough bleeding in the first three cycles of taking the pill, non-smokers tend to see the bleeding dissipate more quickly than smokers.
Breakthrough bleeding is likely due to hormonal fluctuations. The body is pre-programmed to make certain estrogen
levels each day and the estrogen (and some additional hormones like FSH
, LH
and Progesterone
) are responsible for regulating endometrium shedding. Therefore, when new levels of hormones enter the body through oral contraceptives, the body is provided with two ways to receive estrogen. These excess estrogen levels can cause pre-period bleeding (bleeding through). This should be regulated in several months.
According to Lange Gynecology and obstetrics, 8th edition, the most common side effect associated with OC use is breakthrough bleeding. It usually occurs during the first one or two cycles and resolves spontaneously. Another common problem is amenorrhea. Persistent break through bleeding and amenorrhea commonly reflect an atrophic endometrium, which means a thin and not developed endometrium.
Keep in mind that the usage of combined estrogen and progesterone eliminates the normal endogenous hormonal cycling and gradually produces atrophy of the endometrial glands. This is because the dosage of estrogen in the OCs pills is much lower than the quantity produced naturally by the ovaries. Higher quantities produced by the ovaries induce proliferation, but low levels supplied by the pills produce atrophy yet are sufficient to inhibit the endogenous secretion of the gonadotropins.
The exact chain of events that lead from an atrophic endometrium to the spotting between menses is not explained by the text. Yet it is indicated that this condition may be corrected by using a pill with a higher estrogen (which will stimulate further proliferation of the endometrium) or lower progestin content, which will reduce its stability.
.
Endometrium
-Function:The endometrium is the innermost glandular layer and functions as a lining for the uterus, preventing adhesions between the opposed walls of the myometrium, thereby maintaining the patency of the uterine cavity. During the menstrual cycle or estrous cycle, the endometrium grows to a...
in women on combined oral contraceptives. It may also occur with other hormonal contraceptives.
Presentation
The bleeding is usually light, often referred to as "spotting," though a few women may experience heavier bleeding.Many women find that the breakthrough bleeding ceases after one or two cycles.
Mechanism
Breakthrough bleeding is most commonly caused by an excessively thick endometriumEndometrium
-Function:The endometrium is the innermost glandular layer and functions as a lining for the uterus, preventing adhesions between the opposed walls of the myometrium, thereby maintaining the patency of the uterine cavity. During the menstrual cycle or estrous cycle, the endometrium grows to a...
(uterine lining). This is not a dangerous condition, though the unpredictable and often lengthy periods of bleeding are unpleasant. Breakthrough bleeding may also be caused by hormonal effects of ovulation
Ovulation
Ovulation is the process in a female's menstrual cycle by which a mature ovarian follicle ruptures and discharges an ovum . Ovulation also occurs in the estrous cycle of other female mammals, which differs in many fundamental ways from the menstrual cycle...
. Breakthrough bleeding may also itself be a symptom of pregnancy
Pregnancy
Pregnancy refers to the fertilization and development of one or more offspring, known as a fetus or embryo, in a woman's uterus. In a pregnancy, there can be multiple gestations, as in the case of twins or triplets...
.
Breakthrough bleeding is most common when a woman first begins taking oral contraceptives, or changes from one particular oral contraceptive to another, though it is possible for breakthrough bleeding to happen at any time. Smokers are especially prone to breakthrough bleeding while taking oral contraceptives; though many users experience breakthrough bleeding in the first three cycles of taking the pill, non-smokers tend to see the bleeding dissipate more quickly than smokers.
Breakthrough bleeding is likely due to hormonal fluctuations. The body is pre-programmed to make certain estrogen
Estrogen
Estrogens , oestrogens , or œstrogens, are a group of compounds named for their importance in the estrous cycle of humans and other animals. They are the primary female sex hormones. Natural estrogens are steroid hormones, while some synthetic ones are non-steroidal...
levels each day and the estrogen (and some additional hormones like FSH
FSH
FSH may refer to:* Follicle-stimulating hormone* Fox Sports Houston, a regional Fox Sports Net affiliate station for the Houston, Texas area* Facioscapulohumeral muscular dystrophy* International Civil Aviation Organisation code for Flash Airlines...
, LH
LH
LH, Lh, or lh may stand for:*Laurel and Hardy*Leasehold *Left-handed or left hand*Letterhead, the heading at the top of a sheet of letter paper*lh, a digraph for many languages...
and Progesterone
Progesterone
Progesterone also known as P4 is a C-21 steroid hormone involved in the female menstrual cycle, pregnancy and embryogenesis of humans and other species...
) are responsible for regulating endometrium shedding. Therefore, when new levels of hormones enter the body through oral contraceptives, the body is provided with two ways to receive estrogen. These excess estrogen levels can cause pre-period bleeding (bleeding through). This should be regulated in several months.
According to Lange Gynecology and obstetrics, 8th edition, the most common side effect associated with OC use is breakthrough bleeding. It usually occurs during the first one or two cycles and resolves spontaneously. Another common problem is amenorrhea. Persistent break through bleeding and amenorrhea commonly reflect an atrophic endometrium, which means a thin and not developed endometrium.
Keep in mind that the usage of combined estrogen and progesterone eliminates the normal endogenous hormonal cycling and gradually produces atrophy of the endometrial glands. This is because the dosage of estrogen in the OCs pills is much lower than the quantity produced naturally by the ovaries. Higher quantities produced by the ovaries induce proliferation, but low levels supplied by the pills produce atrophy yet are sufficient to inhibit the endogenous secretion of the gonadotropins.
The exact chain of events that lead from an atrophic endometrium to the spotting between menses is not explained by the text. Yet it is indicated that this condition may be corrected by using a pill with a higher estrogen (which will stimulate further proliferation of the endometrium) or lower progestin content, which will reduce its stability.
Treatment
Breakthrough bleeding that does not resolve on its own is a common reason for women to switch to different pill formulations, or to switch to a non-hormonal method of birth controlBirth control
Birth control is an umbrella term for several techniques and methods used to prevent fertilization or to interrupt pregnancy at various stages. Birth control techniques and methods include contraception , contragestion and abortion...
.