Understanding Breakthrough Bleeding on Birth Control: A Doctor's Perspective

Question
Dr. Rappaport,
Hopefully you can help me! I have been on the pill now for almost 6 years and I have been on the same pill that I am on now for 14 months. I am on Kariva (an off brand) and last month I missed the very first pill. I talked with the pharmacist and I took 2 the next day at the same time. The middle of the pills in the 2nd week I had some breakthrough bleeding that did not end until my period had finished 2 1/2 weeks or so later.

Now I have started a new pack of pills and am halfway through this pack (2nd week) and I have started bleeding again today. This pack I haven't missed any pills, so I don't understand the breakthrough bleeding.

When I call my doctor's office the nurse can never talk. I go to the office and the nurse (who is really a paramedic) says don't worry about it and if I'm pregnant it will only abort the baby. Which really upset me alot! I don't want to get pregnant as my husband and I can't afford it right now, but I certainly dont' want to create an abortion either! She seems to be very uncaring about my situation.

Someone else told me to just wait another month and see if it does this again.  But thing is I am very sensitive to wearing pads (the flow is not heavy enough for tampons) and wearing a pad for the next 3 weeks my skin gets really irritated.  Plus, the thought of being on my period again for another 3 weeks after ONLY being off a period for 1 1/2 weeks sounds AWFUL!

I am wondering if this is urgent enough to make a doctor's appointment and pay all the money to find out it's nothing... What do you think? Do you know what it could be at all?

Thanks for your help!  

Answer
Continue taking the pills for this month. IF you conctinue to have breakthrough bleeding on this pill, you may need a stronger birth control pill in order to avoid breakthrough bleeding. You are still protected against pregnancy even with breakthrough bleeding. If you do become pregnant while taking the pill, you will NOT abort the baby. There is no problem if you become pregnant while on the pill as long as you stop taking  the pills before the second trimester of pregnancy. However, breakthrough bleeding will not lower the efficacy of the pill. The bleeding is merely annoying. Just continue taking the pills as you were.