What is the best approach to intermenstrual bleeding in a woman taking an oral contraceptive?
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Intermenstrual bleeding is a common occurrence, and it is important for providers to educate their patients that spotting can be expected during the first 3 months of starting a new oral contraceptive (OC). Also, a possible pregnancy and drug interactions should be considered as sources of bleeding. (SOR C, based on expert opinion.) Other causes of bleeding include cervicitis, inconsistent pill use, and smoking. OCs with higher doses of estrogen and later generation progestins are less prone to significant bleeding. (SOR A, based on 2 systematic reviews.)
Evidence Based Practice 12(4): 09.