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The bleeding is usually light, often referred to as "spotting," though a few people may experience heavier bleeding. [citation needed] It is estimated that breakthrough bleeding affects around 25% of combined oral contraceptive pill (COCP) users during the initial 3 to 4 months of use, it then usually resolves on its own. [8] [9]
Most people who use combined hormonal contraception experience breakthrough bleeding within the first 3 months. [15] Other common side effects include headaches, breast tenderness, and changes in mood. [16] Side effects from hormonal contraceptives typically disappear over time (3-5 months) with consistent use. [16]
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]
[4] [5] [12] [13] It is available as an implant placed under the skin of the upper arm under the brand names Nexplanon and Implanon. It is a progestin that is also used in combination with ethinylestradiol , an estrogen , as a vaginal ring under the brand names NuvaRing and Circlet . [ 14 ]
Unscheduled bleeding that occurs during such hormonal treatment is termed "breakthrough bleeding" (BTB) Breakthrough bleeding may result from inconsistent use of hormonal treatment, although in the initial months after initiation of a method, it may occur even with perfect use, and may ultimately affect adherence to the medication regimen. [27]
The withdrawal bleeding that occurs during the break from active pills has been thought to be reassuring, a physical confirmation of not being pregnant. [48] The withdrawal bleeding is also predictable. Unexpected breakthrough bleeding can be a possible side effect of longer term active regimens. [49]
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