Hi,

It seems like you are just missing a cycle as a side effect of oral contraceptive and it can occur due to the missed tablet.

This breakthrough bleeding generally is greatest in the first 3 to 4 months after starting OCs and it steadily declines and stabilizes by the end of the fourth cycle. Upon initiation of the method, unscheduled bleeding is thought to be due to a relatively thick endometrium transitioning to a relatively thin endometrium as a result of the progestin-dominant component of all hormonal contraceptives. The fragility of these vessels is due to alterations in their basement membraness, as well as reduced structural support from the endometrial stroma and glands, which are also altered

I would recommend the following things-

1) If the bleeding persists for 3 months, consider changing to a formulation with:

a) Either a higher or lower dose of the same progestogen.

b) A different second-generation progestogen and starting with the lowest available dose.

2) Get regular pap smears done as to prevent the chances of cervical cancer. Studies have shown that having unprotected sexual intercourse increases chances of cervical cancer.

3) Consult a gynecologist for a pelvic exam to check for other causes of bleeding like cervical erosions.

4) If the gynecologist suspects structural abnormality, a trans vaginal ultrasound scan and/or hysteroscopy may be performed.

5) Take a Tab, ferrous sulphate 150 mg and Tab Tylenol 500 mg for temporary relief in pain.

6) Eat a good balanced diet with good portion of proteins carbohydrates and vitamins. Consume diet rich in green leafy vegetables and milk.

Thank you.