Bleeding on POP Cerazette

[GigglesMG]

I was prescribed Cerazette in January at 6wks post partum to stop my heavy and painful periods. It’s the first time for me using hormonal contraception to stop my periods (although hormones aren’t a stranger to me as I did IVF to have my baby). I had one period a week after starting the pill and then only a few days of spotting here and there until August. However, since August, I’ve been constantly bleeding, sometimes heavily. I had an ultrasound and check up after 3wks of bleeding which ruled out anything urgently serious. On my doctor’s advice, I tried doubling my pill dosage for a week which reduced but didn’t stop the bleeding. I was then advised to stop the pill completely for one week and then restart it again. I stopped bleeding for five days, but it started again one week after restarting the pill. I’m now on my sixth week of bleeding since August. My questions are:

1. Could this current period bleeding be because of the one week break from the pill?
2. Could the fix be as simple as switching brands?
3. Is there anything else which could be causing such prolonged bleeding?
4. Is it normal for the POP to just stop working suddenly when I hadn’t had any issues for several months?

FYI, my PAP smears have always been normal, including the one I had post partum in January.

[Dr Varsha Jain]

Thank you for your questions. Let me take them in order:

1) This is unlikely.

2) You may wish to try switching brand, but again you would ideally need a few months on the new brand to see if anything changed. I am uncertain if this would solve the problem.

3) When hormonal contraception has been successful at reducing bleeding in the past, but the same preparation is now causing you to bleed abnormally, it is important to understand why you are having abnormal uterine bleeding (AUB). There are many causes of AUB - subdivided into structural and non-structural. Please see: https://www.ed.ac.uk/centre-reproductiv ... -disorders for further details.
The ultrasound scan has likely ruled out the obvious structural causes, but the non-structural causes would require some further questioning and possible investigation.

I think it is important to be referred to a "menstrual problems" clinic/gynaecology services at your local hospital. At these appointments, they may want to investigate further with asking you more detailed questions about your AUB/bleeding problems and perhaps also taking a tissue sample from the lining of your womb (endometrium) in order to make sure the cells of your endometrium are healthy.

4) Different people respond to hormonal preparations in different ways. Also what may be normal for you now, may not be normal for you in a few years time. Unfortunately, at the moment, there is no way of knowing how a person will respond to a hormonal preparation until they have trialled it, and as in your case, this can change with time. I would suggest further investigation before being able to class this as "normal" or not.

[GigglesMG]

Thank you so much for the detailed reply The take away as I understand is that I need to get more investigations done. Under normal circumstances, I wouldn’t have waited this long but with Covid (I’m in a vulnerable group) I’ve been very reluctant to go anywhere away from home unless absolutely necessary