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Dr. Pfeiffer
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I have been on the tri nessa birth control pill for almost

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I have been on the tri nessa birth control pill for almost two years and never experienced any breakthrough bleeding between periods. Yesterday, I forgot to take the pill for about 16 hours (I've since taken it) but I'm still having heavy spotting. Anything I should be concerned about?
Hello.
Break through bleeding isn't uncommon with triphasic pills because the hormone concentration varies weekly.
An isolated event really isn't concerning. If it continues, I would discuss it with your doctor.
Depending on your age and medical history it may need to be investigated, but more likely than not this is normal and will resolve with due diligence on taking the pill. Commonly what happens is you will have to switch to a monophasic pill, which is a pill where the hormone levels are the same and don't vary.
As with any abnormal, or unpredictable bleeding...even with a pill, if pregnancy is a possibility I'd make sure you have a negative pregnancy test.
Dr. Pfeiffer
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