OB-GYN (Obstetrician-Gynecologist) | Female Pelvic Medicine and Reconstructive Surgery Questions OB-GYN

I have prolonged breakthrough bleeding?

I'm a 30 year old female, height: 5'4" weight: 133 lbs, blood pressure is usually good but will sometimes run on the "low-ish" side, and I exercise almost daily. I take Arimidex 2mg along with the POP Norethindrone 0.35 daily. I am prescribed this off-label to treat my endometriosis because so far nothing else has worked besides surgery. I've had 3 excision surgeries, and my body does not respond to Lupron for whatever reason so we stopped trying that years ago. I take all of these pills (2 of the arimidex 1mg, and 1 norethindrone 0.35 bcp) at the same exact time every single day when my morning alarm goes off. I used to take the Arimidex alone daily by itself for a while, and it didn't stop me from ovulating at all but my cycles kept getting shorter and shorter (last time was around 18 days w/ 7 days luteal phase). Other than that, I tolerated it well, but I started getting bone pain and that started getting bad.

We added the norethindrone as sort of an add-back therapy and it has completely taken away the bone pain. I do not do well at all on high doses of synthetic progestins, on higher doses, I will get really bad side effects such as EXTREME MOOD SWINGS worse than PMDD (yes, I hit the caps lock on purpose) and severe daily migraines with aura, etc... so my ob-gyn put me on the POP dose that's typically used for birth control. He said it should also serve me as a form of birth control...but I'm not sure of this as long as I'm taking the Arimidex along with it, so my hubby and I continue to use condoms (just in case). I added the norethindrone 0.35 to my regime on the first Sunday after I started my last menstrual period, which was actually on day 2 of my cycle. It gave me mood swings at first, but that has since leveled out.

I started having a breakthrough bleed, however, on day 14 of taking the pill, and have been bleeding for 9 days straight. I do strict fertility charting with bbt etc, and I normally ovulate around days 12-16 of my cycle when I'm on the Arimidex alone w/out the BCP. Of course, my chart showed that I did not ovulate this cycle, which was expected, yet I think it's interesting how I started bleeding around the same time that I would normally have ovulated. It has not been a heavy bleed or anything, but it is more than spotting, more like a light bleed to a sometimes medium bleed. I have not had any severe pain, but yesterday I did have some mild [very bearable] cramps that felt like minor period cramps, but just in the uterus and not anywhere else...although I did have some pain in my left ovary for a few days before I started bleeding. I know breakthrough bleeding is common with women on the bcp especially POPs... but does what I'm describing sound normal or should I be concerned?

My ob-gyn doesn't seem too concerned, since I haven't had any severe pain. I'm wondering if the Arimidex added along with it is causing a longer "breakthrough" bleed since it suppresses estrogen...but will it eventually stop or will it just continue then? I'd like a second opinion other than my ob-gyn who does not do endosurgery. He is new to the game as my old ob-gyn & surgeon can no longer treat me.

30 years old
Complaint duration: 9 days 0 months 0 years
Medications: Daily: Arimidex 2mg, norethindrone 0.35, Tenex 2mg, Wellbutrin 150mg ER, Metformin 500mg. As Needed: Percocet 5-10mg, Xanax 1mg, Baclofen 10mg, Mobic 15mg
Conditions: Endometriosis, Adenomyosis, Fibroid (1), Infertility, Chronic Pain, Prediabetes, IBD, chronic insomnia, mental conditions (adhd, MDD, Pmdd, PTSD, panic disorder)

1 Answer

OB-GYN(Obstetrician-Gynecologist)|FemalePelvicMedicineandReconstructiveSurgeryOB-GYN
Endometriosis is a incurable chronic condition that requires a multidisciplinary approach. I see you are not only on medicines for suppressing endometriosis, but pain meds and antidepressants. I would seek out someone in your area that is an expert in endometriosis.