In some women, menstrual spotting between periods occurs as a normal and harmless part of ovulation. Some women experience acute mid-cycle abdominal pain around the time of ovulation (sometimes referred to by the German term for this phenomenon, mittelschmerz). This may also occur at the same time as menstrual spotting.
The term breakthrough bleeding (or breakthrough spotting) is usually used for women using hormonal contraceptives, such as IUDs or oral contraceptives. It refers to bleeding or spotting between any expected withdrawal bleeding, or at any time if none is expected. If spotting continues beyond the first 3–4 cycles of oral contraceptive use, a woman should have her prescription adjusted to a pill containing higher estrogen:progesterone ratio by either increasing the estrogen dose or decreasing the relative progesterone dose.[4]
Breakthrough bleeding (BTB) is any of various forms of vaginal bleeding, usually referring to mid-cycle bleeding in users of combined oral contraceptives as attributed to insufficient estrogens.[5] It may also occur with other hormonal contraceptives. Sometimes, breakthrough bleeding is classified as abnormal and thereby as a form of IMB.[6]
In the context of hemophilia, the term describes a bleeding that occurs while a patient is on prophylaxis.[7]
Presentation
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]
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.[9]
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.[citation needed]
12Bacon, JL (June 2017). "Abnormal Uterine Bleeding: Current Classification and Clinical Management". Obstetrics and Gynecology Clinics of North America. 44 (2): 179–193. doi:10.1016/j.ogc.2017.02.012. PMID28499529.
↑Smith, Roger P. (2023). "60. Postcoital bleeding". Netter's Obstetrics and Gynecology: Netter's Obstetrics and Gynecology (4thed.). Philadelphia: Elsevier. pp.139–140. ISBN978-0-443-10739-9.
12Patricia A. Lohr; Mitchell D. Creinin (2006). "Oral contraceptives and breakthrough bleeding: What patients need to know". The Journal of Family Practice. 55 (10): 872–80. PMID17014753.
