Heavy Periods After Starting Birth Control: What Could Be the Cause?

Question
I am 45 and recently started taking a low-dose birth control pill to treat perimenopausal symptoms. I had spotting the first three months as well as normal-flow periods with cramps. I started a new pill a month ago and am experiencing the same problem. Why aren't these pills working?

Answer
You may well have either a fibroid tumor of the uterus or some extra buildup of the uterine lining (or a polyp), present before you started the pill.  I think you probably need an evaluation of what's causing the bleeding, probably starting with an exam and possibly an ultrasound.