If a patient experiences breakthrough bleeding one month after starting a combination oral contraceptive, what should the nurse practitioner advise?

• A. Use additional protection until resolved
• B. Change to a progestin-only formulation
• C. That breakthrough bleeding in the first 3 months is common
• D. Change to a contraceptive patch for better regulation

Answer: (C)

Breakthrough bleeding occurring in the initial months of starting a combination oral contraceptive is a common phenomenon. The hormones in these contraceptives work to stabilize the endometrial lining, and it often takes time for the body to adjust to the new hormone levels. During the first three months, patients may experience irregular bleeding patterns, including breakthrough bleeding, as their bodies adapt to the medication.

Advising that breakthrough bleeding is common during this adjustment period is important for patient reassurement. It helps set realistic expectations about the contraceptive's side effects and reinforces the discussion that many users experience this phenomenon without requiring any changes to their contraceptive method.

While the other options may address potential concerns, they do not directly address the nature of breakthrough bleeding in the context of newly initiated hormonal contraception. Option one suggests using additional protection, which may not be necessary if breakthrough bleeding does not indicate contraceptive failure. The remaining options propose changing the method of contraception, which is generally not required at this early stage simply due to the occurrence of breakthrough bleeding. Thus, informing the patient that this occurrence is a common experience provides clarity and support during their transition to the new birth control method.