Breakthrough bleeding

Breakthrough bleeding (BTB) is any of various forms of vaginal bleeding,[1] usually referring to mid-cycle bleeding in users of combined oral contraceptives,[1] as attributed to insufficient estrogens.[1] It may also occur with other hormonal contraceptives. Sometimes, breakthrough bleeding is classified as abnormal and thereby as a form of metrorrhagia,[2] and sometimes it is classified as not abnormal.[1]

In the context of hemophilia, the term describes a bleeding that occurs while a patient is on prophylaxis.[3]

Presentation

The bleeding is usually light, often referred to as "spotting," though a few people may experience heavier bleeding.

Breakthrough bleeding generally is greatest in the first 3 to 4 months after starting oral contraceptives (OCs), and it steadily declines and stabilizes by the end of the fourth cycle.[4] It is estimated that breakthrough bleeding affects around 25 % of combined oral contraceptive pill (COCP) users during the initial 3 months of use.[5]

Mechanism

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.[4] As for the first factor, studies have shown that an increased estrogen dose in combined OCs leads to a lower incidence of breakthrough bleeding. Studies also reported that the ratio of estrogen/progestin in combined OCs may be more important than the absolute value of estrogen in the incidence of breakthrough bleeding.[4]

Treatment

Breakthrough bleeding that does not resolve on its own is a common reason for women to switch to different pill formulations, or to switch to a non-hormonal method of birth control.

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See also

References
  1. Farlex Medical Dictionary > Breakthrough Bleeding, in turn citing:
    • Segen's Medical Dictionary. Copyright 2012
    • McGraw-Hill Concise Dictionary of Modern Medicine. Copyright 2002
  2. Merriam-Webster's Medical Dictionary > Breakthrough bleeding Retrieved on Feb 28, 2010
  3. "Prophylaxis: Barriers and challenges - World Federation of Hemophilia". www.wfh.org. Retrieved 2018-07-05.
  4. Patricia A. Lohr and Mitchell D. Creinin (2006). "Oral contraceptives and breakthrough bleeding: What patients need to know". The journal of family practise. 55 (10): 872–80. PMID 17014753.CS1 maint: uses authors parameter (link)
  5. M. Hickey & I. S. Fraser (2012). "Iatrogenic unscheduled (breakthrough) endometrial bleeding". Rev Endocr Metab Disord. 13: 301–308. doi:10.1007/s11154-012-9227-3. hdl:11343/220598.CS1 maint: uses authors parameter (link)
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