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With all extended-cycle COCPs, breakthrough bleeding is the most common side effect, although it tends to decrease over time. [18] In a 12-month study of a continuous COCP regimen, 59% of women experienced no bleeding in months six through twelve and 79% of women experienced no bleeding in month twelve. [19]
Breakthrough bleeding is commonly due to 4 factors: physiologic effects of OCs on the endometrium, OC-related parameters, (dose, formulation, and regimen), patient behavior, (compliance, using concomitant medications, and smoking) and benign or malignant pathology. [9]
The most common side-effects of combined hormonal contraceptives include headache, nausea, breast tenderness, and breakthrough bleeding. Vaginal ring use can include additional side-effects including vaginal irritation and vaginal discharge. Contraceptive skin patch use can also include a side-effect of skin irritation around the patch site. [39]
Different sources note different incidence of side effects. The most common side effect is breakthrough bleeding. Combined oral contraceptive pills can improve conditions such as dysmenorrhea, premenstrual syndrome, and acne, [105] reduce symptoms of endometriosis and polycystic ovary syndrome, and decrease the risk of anemia. [106]
While unpredictable breakthrough bleeding is a possible side effect for all hormonal contraceptives, it is more common with progestogen-only formulations. [16] Most regimens of COCPs, NuvaRing, and the contraceptive patch incorporate a placebo or break week that causes regular withdrawal bleeding.
Breakthrough bleeding (requiring more than one pad or tampon per day) was reported by: 4% in cycle 1, 3% in cycle 3 and cycle 6, and 1% in cycle 13. [12] Overall, side effects that tend to go away after two or three months include bleeding between periods, breast tenderness, and nausea and vomiting.
Rare side effects may include high potassium levels and blood clots (when taken as a combined oestrogen-progestogen pill), among others. [ 4 ] [ 12 ] Drospirenone is a progestin, or a synthetic progestogen , and hence is an agonist of the progesterone receptor , the biological target of progestogens like progesterone . [ 1 ]
Common side effects include irregular vaginal bleeding, nausea, sore breasts, vaginitis, mood changes, and headache. [6] Rare but serious side effects may include blood clots, toxic shock syndrome, anaphylaxis, gallstones, and liver problems. [6] Use is not recommended in those who both smoke and are over the age of 35. [6]