Spotting Between Periods

This symptom is common during the first month of BCPs, particularly with some of the multiphasic BCPs. It is also commonly seen among women taking birth control pills continuously.

This is not a dangerous condition, but may be a nuisance to the patient. In the presence of a normal Pap smear, this symptom can be safely ignored for two months and more likely than not, it will go away.

If spotting persists, changing to fixed-dose, mono-phasic BCP (such as Ortho Novum 1/35 or LoOvral) will usually solve the problem, particularly if you switch to a different manufacturer with different.

If the bleeding is really more than just light spotting, it more likely is due to break through ovulation followed by a menstrual flow. This is common among newer low dose birth control pills utilizing progestins with relatively short half lives. In this case, changing the patient to a stronger progestin BCP (with a longer half life, such as levonorgestrel) will generally lead to more consistent ovarian suppression, resulting in fewer ovulations and fewer break through menstrual flows.

If inconsistent usage has been a factor in the patient's history, then patient education can sometimes resolve the problem. If not, then switching to a more forgiving OCP (longer half life progestin), may work out better for the patient in the long run.

Various benign conditions can cause spotting, such as endocervical or endometrial polyps, cervical irritation, and uterine fibroid tumors. In an isolated, military setting, none of these pose an immediate threat and can reasonably be ignored for months if necessary until definitive gynecologic consultation can be obtained.

Uterine malignancy in a woman under 35 is extremely rare, particularly if that woman has been on BCPs. Spotting caused by uterine malignancy won't go away if BCPs are discontinued. Cervical malignancy can be reasonably excluded by a recent normal Pap smear and the absence of a visible lesion on the cervix. Vaginal cancer (extremely rare) is ruled out by a normal vaginal exam.