[Treatment of metrorrhagia, breakthrough bleeding and spotting under contraceptives]

Breakthrough bleeding and spotting are common side effects of contraceptives. These side effects may decrease the compliance and thus it is important to try to alleviate them. All the combined estrogen progestin contraceptives may be associated with abnormal bleeding. It is important to try to understand the mechanisms of these troubles and readapt the composition of the pill. It is difficult to edict recommendations to be used systematically but generally higher estrogens (and progestogens) containing pills are less associated with bleeding. Progestins also are associated with bleeding problems and the combination of estrogens may help if they are possible. Mirena can help in women with menorraghia but still breakthrough bleeding and spotting may occur. There is not one answer and the solution has to be found for each woman sometimes empirically.