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Q. I missed taking the birth control pill and now have severe bleeding. Please guide me.

Answered by
Dr. Balakrishnan. R
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Aug 15, 2017 and last reviewed on: Aug 04, 2022

Hello doctor,

I was prescribed a birth control pill to stop an ovarian cyst about two months ago. I have been taking the pill regularly, but I missed a day. I have been sexually active. I have now been bleeding for three weeks without a stop. My doctor told me to stop taking the pill until the bleeding stops. Even though I did, to this day, it has not stopped. In addition to the bleeding, I have nausea, bloating, fatigue and cramps. What should I do?

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Hello,

Welcome to icliniq.com.

How are you doing? Please do not get stressed out. You are fine. All this while, you have been trying to control the symptoms of the cyst, when the real cause of this cyst, which is anovulation is still present. Let me explain.

You are not pregnant. I say this because, just by missing a single pill, you cannot get pregnant. These pills suppress the hormones from the body and thereby the ovulation. So, for these hormones to be released, you have to miss at least two pills, that is, 48 hours of no pills. Also, you are continuously bleeding, and this rules out pregnancy.

The problem here is your weight. You are trying to stop the cysts with the pills. But, they can only prevent further cyst formation and not those which are already there. From your history, I presume you to have PCOD (polycystic ovarian disease). This is a congenital condition, by which I mean, it is genetically programmed, and you get it from your parents. When you suddenly put on a lot of weight, this cholesterol is converted to the estrogen hormone. This is similar to how obese men develop breasts, and young obese girls get their periods at a younger age. In both the cases, they have high levels of estrogen, the female hormone.

In your body too, when fat, which is a store for future use, is more than normal, this is converted to estrogen, which tips the balance between FSH from the brain and the ovarian hormone. FSH (follicle-stimulating hormone), as the name suggests, stimulates the follicle from the ovary. Once the follicle is big enough to ovulate, the FSH is suppressed by the same estrogen hormone from the ovary. But, when the same estrogen hormone is coming from fat, the brain is confused, and the follicle growth stops early, at a smaller follicle size and thus, will not rupture. In the next scan, you will see these follicles as polycystic ovaries. This is usually associated with obesity, irregular cycles, no periods for few months and later, heavy periods with clots and fleshy masses, or spotting on and off, thyroid abnormality and prolactin problem indirectly.

You will develop an extra pad of fat around the mid segment of the body, especially the waist, thighs and breast, no fat beyond elbows and knees, excessive body hair growth, hair fall , dark shade over lower half of the face, acne ,oily face, darkening of the skin over the back of the neck, inner thighs and undersurface of the breast.

PCOD will not allow ovulation to occur on schedule and hence, you cannot get pregnant, until you are treated. It also increases your chances of early pregnancy abortions. But this has a solution, namely weight reduction. Your weight has to be weight (in kg) = height (in cm) - 100. In your case, your target weight is 52 to 55 kg. Once you get your weight to the normal range, you will not need any medication to get your periods or to get pregnant, and your pregnancy will be healthy.

To reduce weight, I suggest the following:

  1. Avoid fasting, junk food, fast foods, red meat, snacking between meals.
  2. Have low calories food, with high proteins.
  3. Regular exercise, especially for the waist and hip area, aerobics, yoga, and brisk walking (swing your hands well).
  4. Try to reduce 2 to 4 kg per month. Do not hurry on weight reduction, as it will be difficult to maintain. As soon as you reduce 5 kg, you will start seeing the changes.

Bloating is due to the side effect of the hormonal imbalance. It will get rectified automatically.

Now, to control bleeding and have everything corrected, this is what we can do:

  1. Have tablet Primolut-N or Norgest 5 mg (Norethisterone) two tablets, thrice a day till the bleeding stops. It will stop in a day or two. Then have two tablets twice a day for two days, followed by one tablet twice a day for 18 days. You will have your periods 5 to 10 days after you stop taking the pills. This is called medical D and C. The whole thickness will come out in a piece, leaving the uterus clean for a new start.
  2. From the start of the next bleeding, have your prescribed birth control pills, once at night for three to six months, cyclically. This will regularize your periods, as well as hormones and also give you time to reduce a few kilograms. After that, your periods will neither be irregular, nor heavy. You will have excellent contraceptive protection too.

Hope I have clarified your query. Do write back. All the best.


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