Start Contraceptive PIlls Without Annoying Spot Bleeding? A Potential Solution

About 85 of 100 women who begin their birth control pills will have some spot bleeding. But a new trick might make this percentage a whole lot less! An NIH funded study from the Family Planning department at the Oregon Health & Science University Women's Health Research Unit came up with a novel idea: try antibiotics! Basing their theory on some zinc dependent enzymes that can break down proteins in the lining of the uterus, and showing that this activity can be up regulated by the progesterone in the Mirena and with the Implanon (now called Nexplanon), and with progesterone shots, they thought this might actually be happening in women who were new pill starts! And they were partially right. They used the Teva birth control pill Aviane and they used the Galderma doxycyclin called Oracea. The Oracea pill was selected because at the dosage it is given it is not actually antimicrobial, but works to decrease these inflammatory proteins. And women on this pill combo still got the unscheduled bleeding, but they actually got to the point of not having any periods sooner. Just beginning with a higher dosage of estrogen actually does this two and a recent Cochrane review did conclude that 30 mcg pills have better bleeding than 20 mcg pills, but we don't usually use those continuously as the total exposure dosage of estrogen is a lot higher. One new study published in 2013 on the Mirena IUD couldn't really figure  out how to stop the early use spotting women get, so the gynos don't yet agree on exactly how to fix this issue.

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