Orthotricyclen & Spotting: Causes & Solutions - Expert Advice

Question
I am 31 and have been on orthotri for six years now.  Mine is a two part question.  First of all, for the past 4-5 months, I have been experiencing slight spotting the week before I'm supposed to begin my cycle and spotting to light bleeding after sex any time of the month.  I admit, I do not take the pill at a regular time each day, but do take it every day.  Could this be the cause?  It's a very messy and embarrassing problem, especially after sex.  Secondly, I'm thinking about switching from the pill to either the patch or an IUD; I hate taking a pill daily.  I'm worried about how the switch in hormone types and levels will affect my body initially.  I went off of ortho for a month once and had horrible acne.  Your advice on both questions is welcome.

Answer
The spotting the week before you are supposed to begin your period may be completely normal. The post-coital bleeding may be due to friction or hyperemia of the walls of the vagina which can bleed following sexual activity. Just keep a careful record of the first day of your bleeding each month. Then see if it is 24-35 days from the start of the bleeding until the start of the bleeding the following month. If it is within these number of days, it is considered normal. It is easy to switch to the patch from the pill. I have lots of patients who swietched because they like the idea of just changing the patch once a week. Just get the patch  and start it on the Sunday you would have started your next pack of pills. Then merely change the patch every Sunday until the last patch in the box. You will get your period during the week you are not wearing the patch.  I do not recommend the IUD because, although it is also 99% effective against pregnancy, it can cause pain and bleeding and the IUD can sometimes travel through the uterus into the abdomen and create serious problems.