What is the best treatment for intermenstrual bleeding on the combined oral contraceptive pill (OCP)?
Reassurance is often the best approach to this common concern, as break through bleeding usually disappears by the third pill cycle. If breakthrough bleeding persists beyond three months the clinician should rule out infection or cervical disease and ensure correct use. If breakthrough bleeding still persists it might be worthwhile to try a combined OCP with another category of progestin or change to a 50ug estrogen combined OCP. Unfortunately, no good evidence supports any of the numerous published recommendations for the management of intermenstrual bleeding. A short course of exogenous estrogen such as conjugated estrogen, 1.25 mg conjugated estrogen or estradiol 1-2 mg can be administered when the bleeding is present no matter where a woman is in her cycle. A woman should continue to adhere to the schedule of pill taking. Doubling up or tripling up on the pill increases the risk of estrogen related side effects without altering the ratio of estrogen to progestin that may be respons
