What is the approach to intermenstrual bleeding in a woman taking a combined oral contraceptive?
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Causes of bleeding not related to combined oral contraceptive (COC) pill use should be considered first (SOR: C, expert opinion). If the bleeding is directly related to the COC, changing to a COC that contains >20 mcg ethinyl estradiol (EE) or a newer generation progestin may cause less intermenstrual bleeding. Altering the phasic formulation of progestin or changing between continuous and cyclic COC does not improve intermenstrual bleeding (SOR: B, systematic review with heterogeneous RCTs).
Evidence Based Practice 15(12): 29-30.