Is There a Birth Control Pill to Stop Breakthrough Bleeding?

I love to receive emails from my readers, so I thank all of you for your support. I am commonly asked to suggest which pill brand would be the best choice given somebody’s particular situation. Just to clarify, I am not a medical doctor, so although I can provide you with information about a given brand of birth control pills, this information should not be taken as medical advice. It is always best to discuss pill brand concerns and side effects with your health-care provider.

That being said, Angel asks, “I am 22 years old. I take oral contraceptives to reduce acne and regulate my period. I have tried 4 different OCs in the past 2 years, but I have spotting days 10 through to menstruation. Could you suggest some brands that could cure my acne and spotting? … Oh and I'm a bit confused about ethynodiol diacetate. Does it actually CAUSE spotting?”

Combination birth control pills are made up of estrogen and one of eight types of progestins. Each progestin has a different potency in terms of progestational, estrogenic, and androgenic effects. The result of these effects (which may be experienced as a side effect) is dependent on the combination of the type and dosages of progestin and estrogen. Women may also respond differently to the combination effects of various pills.

Combo birth control pills that contain a higher estrogen level, higher progestin potency, and lower androgen potency tend to be less likely to produce the side effects of spotting and acne. The following pills have been shown to reduce the chances of breakthrough bleeding: Demulen 1/50, Desogen, Ortho-Cept, Ovcon 50, Yasmin, Zovia 1/50E, Estrostep FE. As a side note, Demulen 1/50 has also been shown to minimize problems with acne.

Estrostep FE, on the other hand, follows more of a high androgenic/low estrogenic pattern (which differs from the “suggested” combination pattern associated with reducing spotting). This brand, though, is a triphasic pill that was actually designed to help prevent breakthrough bleeding while attempting to keep hormone exposure as low as possible.

Just to quickly address Angel’s confusion about the progestin, ethynodiol diacetate. This progestin is typically associated with increased early or mid-cycle breakthrough bleeding and spotting. It is actually the estrogen dose (rather than the specific progestin) that is most associated with breakthrough bleeding. This means that higher estrogen dosages can counteract the likelihood of spotting. So in pills containing ethynodiol diacetate, the brands that also include higher levels of estrogen can alleviate this side effect (and thus minimize spotting).

• Progestational, Estrogenic, and Androgenic Effects of Progestin
• Monophasic, Biphasic and Triphasic Pills
• Minimizing Pill Side Effects

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