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DMPA can affect menstrual bleeding. After a year of use, 55% of women experience amenorrhea (missed periods); after two years, the rate rises to 68%. In the first months of use "irregular or unpredictable bleeding or spotting, or, rarely, heavy or continuous bleeding" was reported. [73]
During the week of placebo pills, withdrawal bleeding occurs and simulates an average 28-day menstrual cycle. The placebo pills are not required for pregnancy protection, and with any monophasic COCP the placebo pills may be discarded, and the next pack of active pills may be started to prevent the withdrawal bleeding. [10]
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]
Meant to be taken at the same time every day (some pills can be taken within 2–24 hours and still be effective) [19] Combined contraceptive patch [7] 120-150 μg of norelgestromin and 20-35 μg ethinyl estradiol daily [20] [21] [22] New patch used once a week, after 3 weeks patch is not worn to allow for withdrawal bleeding [19]
Side effects of CICs, besides menstrual bleeding changes, are minimal. [26] The most prominent side effects of CICs are menstrual irregularities during the first 3 to 6 months of use. [1] Dysmenorrhea has been reported in 30 to 65% of women. [26] Other side effects include breast tenderness/pain, headache, and libido changes. [26]
The regimen consists of two pills, each containing a minimum 100 μg of ethinyl estradiol and a minimum of 500 μg of levonorgestrel. [41] The first pill is taken 72 hours after unprotected sex and the second pill is taken 12 hours after the first. [41]
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Hemorrhoids are common in pregnancy as a result of constipation and increased intra-abdominal pressure. Hemorrhoids can cause bleeding, pain, and itching. [32] Treatment is symptomatic, including improving underlying constipation. Symptoms may resolve spontaneously after pregnancy, although hemorrhoids may remain in the days after childbirth. [33]