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Forum Name: Gynecology

Question: Long Period


 cRaziedNconFused2 - Wed Feb 08, 2006 2:06 pm

im 19 and been on birth control for over a year now...i got my period 3 days eariler than expected and im been bleeding longer than normal...normal for me is like 5 or 6 days but ive been bleeding for 7 days now...is it from the pill or stress or is there a medical problem...need help!!!!
 Dr. Tamer Fouad - Sat Feb 11, 2006 6:56 pm

User avatar Hello,

If you have missed a pill or have taken your pills irregularly you should exclude pregnancy.

As the dose and potency of both estrogen and progestin decreases in the contraceptive pill, the incidence of breakthrough bleeding increases.[1,2] This happens because the lower doses of estrogen in OCPs are insufficient to sustain endometrial integrity.[1] The most frequent cause of breakthrough bleeding with OCPs is progestin-induced decidualization and endometrial atrophy, which result in menstrual breakdown and irregular bleeding.

Factors increasing the incidence of abnormal uterine bleeding in women taking combination OCPs include cigarette smoking and C. trachomatis infection.[3,4,5] One study[4] showed that smokers were 47 percent more likely to experience abnormal uterine bleeding than nonsmokers. Cigarette smoking is associated with antiestrogenic effects and may lower estrogen levels. Another study[5] found that 29 percent of women taking OCPs who experienced new abnormal uterine bleeding had asymptomatic chlamydial cervicitis or chronic endometritis.

References:
==========
1. Kaunitz AM. Oral contraceptive estrogen dose considerations. Contraception 1998;58(3 suppl):S15-21.
2. Sulak P, Lippman J, Siu C, Massaro J, Godwin A. Clinical comparison of triphasic norgestimate/ 35 micrograms ethinyl estradiol and monophasic norethindrone acetate/20 micrograms ethinyl estradiol. Contraception 1999;59:161-6.
3. Thorneycroft IH. Cycle control with oral contraceptives: a review of the literature. Am J Obstet Gynecol 1999;180(2 pt 2):280-7.
4. Rosenberg MJ, Waugh MS, Stevens CM. Smoking and cycle control among oral contraceptive users. Am J Obstet Gynecol 1996;174:628-32.
5. Krettek JE, Arkin SI, Chaisilwattana P, Monif GR. Chlamydia trachomatis in patients who used oral contraceptives and had intermenstrual spotting. Obstet Gynecol 1993;81(5 pt 1):728-31.

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