Some Basics...

• A woman should tell her doctor if she is bleeding more than normal. This means using 2 or more tampons or pads than normal per day. Periods that last 3 or more days longer than normal should also be discussed.
• The first day of menstrual bleeding is the first day of a new cycle. The length of the cycle varies from woman to woman. The range is 24-35 days. The average cycle length is 28 days.
• Menstrual bleeding normally lasts 3-7 days. The most bleeding often happens during the first 3 days of a period.
• Ovulation often happens close to day 14 of the cycle. Women may bleed at this time though it is the middle of their cycle.
• Heavy vaginal bleeding can cause iron deficiency anemia. It is the most common cause of anemia in women of childbearing age.

Caution - Pregnancy

• All women of childbearing age with vaginal bleeding should consider the chance that they are pregnant.
• In early pregnancy, vaginal bleeding can be a sign of serious problems. These include miscarriage or tubal pregnancy.

1. What You Should Know:
   • A woman should tell her doctor if she is bleeding more than normal. This means using 2 or more tampons or pads than normal per day. Periods that last 3 or more days longer than normal should also be discussed.
   • There are some common causes of mild vaginal bleeding. Birth control can also cause irregular bleeding.
   • Here is some care advice that should help.
2. Spotting After a Procedure or Pelvic Exam:
   • The cervix bleeds easily. Even an internal exam, Pap smear, or biopsy can cause some spotting.
   • This spotting should decrease within 24-72 hours.
3. Spotting After First Time You Have Sex:
   • This is common. You may have mild bleeding after the first time you have sex.
   • It should stop within 48 hours and not start again.
4. Iron and Anemia:
   • Heavy periods can cause iron deficiency anemia. It is the most common cause of anemia in women of childbearing age.
   • Women with heavy periods should eat foods rich in iron. They can also take a daily multivitamin pill with iron.
5. Pregnancy Test, When in Doubt:
   • If there is a chance that you might be pregnant, use a urine pregnancy test.
   • You can buy a pregnancy test at the drugstore.
   • It works best first thing in the morning.
   • Follow all package instructions.
6. Call Your Doctor If:
   • Pregnancy test is positive
   • You have trouble with the at-home test
   • Bleeding becomes worse
   • You get worse

1. Spotting Between Periods and Taking Birth Control Pills:
   • This is common. You may have breakthrough bleeding or spotting with most of these pills.
   • It is likely to happen during the first three pill pack cycles.
2. Spotting Between Periods and You Forgot to Take a Birth Control Pill:
   • Missing a pill may cause breakthrough bleeding or spotting.
   • If you forget to take more than one pill a month, use a "back-up" birth control method (condom). Keep using a back-up method until you start the next pill pack.
3. Irregular Bleeding and Using Implanon or Depo-Provera: This is common. Irregular bleeding may be heavier or lighter bleeding than normal. It may also be more or less frequent bleeding than your normal period.
4. Irregular Bleeding and Using the Birth Control Patch: This is common. You may have breakthrough bleeding or spotting with these patches. This is likely to happen during the first 3 cycles (months).
5. Irregular Bleeding and Using the Vaginal Contraceptive Ring (NuvaRing): This is not common. You should not have breakthrough bleeding or spotting with NuvaRing. However, it can happen during the first 1-2 months of use (first 2 cycles).
6. Diary: Keep a record of the days you have any bleeding or spotting.
7. Call Your Doctor If:
   • Irregular bleeding happens more than 2 cycles (2 months)
   • Bleeding becomes worse
   • You get worse

1. Missed 1 Pill:
   • If you forget to take a pill, take it as soon as you remember. Then take the next pill on time. This may mean you take 2 pills in one day.
   • If you forget to take more than 1 pill a month, use a "back-up" birth control method (condom). Keep using a back-up method until you start the next pill pack.
2. Missed 2 Pills:
   • If you forget to take 2 pills, take 2 pills the next 2 days. Then take the next pill on schedule.
   • Never take more than 2 pills in one day. Taking too many pills can upset your stomach or make you vomit.
   • Use a "back-up" birth control method (condom) until you start the next pill pack.
3. Missed 3 Pills:
   • Call your doctor during office hours for instructions on how to best resume your birth control pills.
   • You must use a "back-up" birth control method (condom) until you start the next pill pack.
4. Pregnancy Test, When in Doubt:
   • If there is a chance that you might be pregnant, use a urine pregnancy test.
   • You can buy a pregnancy test at the drugstore.
   • It works best first thing in the morning.
   • Follow all package instructions.
5. Call Your Doctor If:
   • Bleeding becomes worse
   • You get worse