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Date of last update: 10/14/2017.

Forum Name: Gynecology

Question: Break through bleeding on Zovia for over 5 years


 beth1234 - Tue Oct 04, 2005 2:22 am

HI, I am taking Zovia 1/35 E continuously to stop my periods. The problem is that I have been on it for about 5 1/2 years, and I am still having Break through bleeding.
To help you, here is some of my back ground information. I started taking Ortho Tri Cyclin when I was 15, to regulate my periods, then I decided to switch to Zovia to stop them. My family has had a history of heavy bleeding during periods, and ovarian cysts. As far as I know I have never had cysts. I go to a Gynecologist every year, and my pap smears have always been perfectly fine. I have never had an STD. I currently do not have a sexual partner, and have only been with one man.
Before starting any birth control pills, I always had mood swings, migraines, felt faint, and had to miss school during my periods which lasted 7 days. Usually 12 hours before I would start my period I would have diarrhea. I also had a lot of pain, which would start two days before my period, and was worst the first 2 to 3 days of my period. All of my joints would ache, the muscles in my back and thighs hurt, I had bloating, cramping, and abdominal pain, and my genitals would feel like it was burning and aching.
The idea of stopping my periods all together sounded great. My Gynecologist told me when I began taking Zovia that there would be break through bleeding during the first year. Since then the btb has not stopped. Although my discomfort has been somewhat decreased, because I can go longer between periods. I have asked the doctor what I can do about the btb, and she said some people will always have btb. I have asked her if I should switch to a different pill, and she has said no. She told me that I could take two pills a day for three days in a row, and maybe that would help make the bleeding stop. I found that after the 3 days my bleeding would just get worse, and so would my mood swings. So after 2 years of trying that, I decided to stop taking the extra pills when I was having heavy btb. This helped decrease the amount of times I had btb a little bit, but never stopped the problem. I take the pill at the same time every night, 10:00 PM, and I never miss a pill. I do not have any eating disorders, bulimia, or abuse of laxatives. I do not smoke, drink, or abuse drugs. At this time I am 21 years old, 5' 9" and 150 pounds.
I know that some people will use the pill to have just 3 or 4 periods a year, but if at all possible, I would like to stop them all together, but hopefully not have problems with btb.
This is usually how my cycle goes... About three days to a week after my period stops I have slight btb for 2 to 3 days, then I can go about 2 to 3 months with minimal to no bleeding at all, but then I start bleeding fairly heavy and have to use tampons. The bleeding is not as heavy as a regular period, although I do have the same pain as I would with a regular period, that does not go away until the bleeding stops. If I continue using my pills after I start having heavy bleeding, then I will bleed like this for several weeks, then the bleeding may lessen but not go away for several more weeks, and then back to heavy bleeding. Usually I get fed up with the pain and bleeding, and decide to stop the pills for a week, and have a period, so the bleeding will stop for a few months. The longest I have gone without any heavy bleeding was about 6 months. I have found that the btb sometimes starts when I am more stressed out than usual, but most of the time I am unsure of anything that might be causing it.
After researching what I can find on the Internet, I have decided I need to switch to a different pill, but am unsure about what one might work better for me. I am hoping that you will have a few suggestions that I can ask my Gynecologist to switch me to?
I also know that if you get sick and throw up, you should take the pill vaginally... I have never had to try this, but I just read that taking fiber supplements may interfere with the pills effectiveness. I have been taking Dual Action Cleanse for a month, and am wondering if taking the pill vaginally all the time will increase it's effectiveness while I am taking fiber supplements or not?
l also read that maybe my other medications, and vitamins could be interacting with the Zovia. Here is a list of what I am taking...

Prescriptions: Wellbutrin 100 mg twice daily, Neurontin 800 mg twice daily (for anxiety), Clonazepam 0.5 twice daily.

The others are all vitamins. Minerals and other supplements. Please tell me if you think I should discontinue use of any of these...
Flaxseed Oil, Fish Oil, Multi Vitamin, Amino Acids, Stress B-Complex, Potassium, Calcium, Magnesium, Co Q10, Selenium, Ginkgo Biloba, Triple energy Ginseng, Bromelain and Papain, Total Bee Plus (royal jelly, bee pollen, propolis, honey), and Dual Action Cleanse.

I don't know if this has anything to do with the problem, but while I was having regular sexual intercourse, I would have spotting, for about two days after sex, and my vaginal tissue was really sore. While having sex, the tissue was very painful, and it felt like I was being scraped with sand paper. I talked to my Gynecologist about this and she said she couldn't find any reason for the problem, but that maybe the BC pills had changed my hormones, and I should get a prescription cream to use on my vaginal tissue. Is there a diagnostic name for what I have, or is this just normal while on BC pills?
Also, when she does my yearly exams, I always start having btb during the exam, and for a few days later.

So just to review, my questions are..

1. Should I switch to a different BC pill, and if so, can you give me a few suggestions on what ones?

2. Should I ask my doctor to do any additional medical tests to see if there is another problem?

3. Do you have any other suggestions on how to decrease my break through bleeding?

4. When I am having heavy btb should I stop the pill and have a period, or continue, and hope it stops?

5. Do you ever see me being able to stop my periods, or should I give up and use something like seasonale to have a couple periods a year?

6. Do you think that my meds. vitamins, minerals, or other supplements are interfering with my BC pills, and should I consider stopping any of them, or is there a type of BC pill that will work with what I am taking?

7. Should I take my BC pills vaginally, and see if it will help to absorb more of the medication?

8. What do you think about having pain, and bleeding during intercourse, is this some type of medical disorder? If so, can you give me some more information about what it is, and how to treat it?

9. Should I shcedual an appointment to see my Gynecologist now, or wait 4 months for when I have my yearly exam?

Thank you so much for your time, and reading all of this, I know it's long ... sorry. I would greatly appreciate any advice you could give me.
 Dr. Tamer Fouad - Tue Jan 10, 2006 7:55 am

User avatar Hello,
Zovia is a combined oral contraceptive pill (OCP) that contains 1 mg ethynodiol diacetate/35 mcg ethinyl estradiol.

Combined oral contraceptives commonly decrease the number of days of bleeding and blood loss, with menstrual flow decreasing by 60 percent or more. However, missed periods, very scanty bleeding, spotting or breakthrough bleeding may occur and upset many women. Amenorrhea also may be a side effect, especially in women using low-estrogen pills.

The term "breakthrough bleeding" refers to bleeding at an unexpected time during the menstrual cycle, with the bleeding sufficient to require use of a tampon or sanitary napkin. "Spotting" refers to unexpected bleeding that does not require any protection.[1] The term "intermenstrual bleeding" simply relates to the timing of abnormal bleeding, not its amount.

Regarding contraceptive pills, as the dose and potency of both estrogen and progestin decreases, 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.[1,2,3] One study[2] 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[3] found that 29 percent of women taking OCPs who experienced new abnormal uterine bleeding had asymptomatic chlamydial cervicitis or chronic endometritis.

If bleeding persists beyond three months, it can be treated with supplemental estrogen and/or a nonsteroidal anti-inflammatory drug (NSAID).

If this strategy fails then change to an OCP with a higher estrogen content or to a different formulation (ie, a low-dose OCP containing a different progestin). Multiphasics were developed in an effort to reduce hormone levels to their lowest effective dose, in hopes of reducing side effects such as breakthrough bleeding, spotting, and amenorrhea (the lack of a menstrual cycle).

Management strategies for women with abnormal uterine bleeding who are using progestin-only contraceptive methods include counseling and reassurance, as well as the administration of supplemental estrogen and/or an NSAID during bleeding episodes.

If bleeding persists beyond three months, it can be treated with supplemental estrogen and/or a nonsteroidal anti-inflammatory drug (NSAID). Other options are to change to an OCP with a higher estrogen content or to a different formulation (ie, a low-dose OCP containing a different progestin).

Nonsteroidal anti-inflammatory drug such as ibuprofen (e.g., Advil, Motrin) can be taken at a dose of 800 mg three times daily for 1 to 2 weeks or until bleeding stops.

Supplemental estrogen can be taken on a daily basis for one to two week and includes conjugated equine estrogens (Premarin) taken at a dose of 0.625 to 1.25 mg per day, or ethinyl estradiol (Estinyl) 20 mcg per day, or estradiol (Estrase) 0.5 to 1 mg per day for 1 to 2 weeks.[3,4]

Multiphasics were developed in an effort to reduce hormone levels to their lowest effective dose, in hopes of reducing side effects such as breakthrough bleeding, spotting, and amenorrhea (the lack of a menstrual cycle).[3,4] They include drugs such as Estrostep Fe, Jenest, Ortho-Novum 7/7/7, Ortho-Novum 10/11, Ortho Tri-Cyclen, Tri-Levlen, Tri-Norinyl, Triphasil, Trivora.

Changing to a 50-mcg OCP increases the dose of both estrogen and progestin. Side effects, including nausea and breast tenderness, may increase. Adding a second OCP on a daily basis is not a good option, because this doubles the estrogen and progestin doses, further increasing side effects. When OCPs are doubled, the progestin component tends to dominate; therefore, endometrial atrophy and subsequent irregular bleeding increase. [3,4]

Management strategies for women with abnormal uterine bleeding who are using progestin-only contraceptive methods include counseling and reassurance, as well as the administration of supplemental estrogen and/or an NSAID during bleeding episodes.[3,4]

References:
==========
1. Thorneycroft IH. Cycle control with oral contraceptives: a review of the literature. Am J Obstet Gynecol 1999;180(2 pt 2):280-7.
2. Rosenberg MJ, Waugh MS, Stevens CM. Smoking and cycle control among oral contraceptive users. Am J Obstet Gynecol 1996;174:628-32.
3. 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.
4. Approach to common side effects. In: Wallach M, Grimes DA, Chaney EJ, et al., eds. Modern oral contraception: updates from The Contraception Report. Totowa, N.J.: Emron, 2000:70-6.
 beth1234 - Tue Jan 10, 2006 4:34 pm

Dr. Tamer Fouad, thank you for the reply. My Doctor finally switched me to a new OCP on 11-16-05, called Junel 1.5/30 28. So far I haven't had any bleeding at all, and no side effects that I know of. I've have never smoked, and I have a early exam, and Pap. My Doctor has never told me that anything is wrong with me before, although my family has a history of ovarian cysts, and needing to have hysterectomies. I'm hopeful that this pill will continue to work for me. Thanks a lot!

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