Spotting while on birth control pills

So basically... I didn't even have a period, according to my OBGYN. Apparently, there's "no ovulation due to PCOS."
He prescribed me Diane 35. I’m finishing this first round of treatment, and on the 22nd day, I went in for an ultrasound to check my uterine lining (it's clearly thickened now—10mm, whereas before the treatment it was sitting steady at 5mm, or what my doctor calls being in the "resting phase") and to check some cysts, about 5cm on each ovary. He told me I’d bleed "by Saturday." And sure enough, it happened!
But here's the thing... he tells me that for the next pack, specifically the first pill out of the 21, I need to start it on the very first day of my period... which makes sense to me, so I immediately ask him if I should take that "first" 7-day break after those 21 days like the instructions actually say. He goes, "Absolutely not!!" "You always start the first pill with the first day of your period... otherwise, we haven't accomplished anything."
And that's where he and I started clashing... I'm being persistent because the instructions clearly state you take a 7-day break..., but he's just stubborn and insists there's no break, and we just went back and forth like that forever.🙄

Anyway... my period arrived, and I took the first pill (so, month two of treatment). The bleeding only lasted three days.😲
after a few days, I started getting this brownish discharge that lasted about seven days, before finally culminating this afternoon with a massive breakthrough bleed—I'm bleeding everywhere.

Yesterday I called my sister and explained everything to her, telling her not to be lazy and to actually read the instructions, since it says multiple times right there that the 7-day breaks are mandatory.

My sister says she can't get through to the doctor for me, tells me to just show up tomorrow when I can, and suggests my medication is probably "too weak"—meaning I likely need to switch to something stronger.😲

So now... how am I supposed to convince my doctor that I *should* be taking breaks between cycles?? And why did he shorten my break in the first place?? What's the point??
And what could possibly be "stronger"?? Considering I can't stand this kind of hormone therapy at all—from the very start, I've been dealing with nausea, literal vomiting, and depressive moods... which are incredibly hard for me to handle, plus my breasts are so painfully swollen that even wearing a bra is a struggle.

...anyone?🙏

I have been on birth control for ten years now, specifically using Cilest since day one. During my first six months, I experienced breakthrough bleeding twice. My gynecologist suggested I take two pills a day at that time, which implies a higher hormone dose is required to effectively halt that kind of spotting. As for the regimen itself, it follows a cycle of twenty-one days of active pills followed by a seven-day break. I assume this protocol is standard for almost all pill brands.

Hey Amy Jones40🙂

With this way of taking them, I’m basically getting a break for maybe 2 or 3 days tops...
Something just feels off here😕

A few years back, I was on Cilest strictly for birth control. I didn't have PCOS back then, and I NEVER dealt with breakthrough bleeding—I always had a nice, regular 7-day break.
So this whole crazy situation is really throwing me for a loop.

Just speaking as a total amateur... listening to my body and all that... it feels like these Diane 35 pills are just too heavy for me. I actually dug up an old box of Cilest (because I'm a hoarder, clearly😬 and get this!!
Look at the ingredients for Diane35 versus Cilest—the difference in mg for the cyproterone acetate (the anti-androgen part) is freaking night and day.😲

Diane-35:
cyproterone acetate - 2 mg
Cilest:
cyproterone acetate - 0.250 mg

What other therapies besides Diane-35 can be used for PCOS??
Is Cilest an option?? Because if it is, I'd honestly rather switch to that since I never had side effects with it, unlike with Diane.

When my OBGYN and I were talking about treatment, he was dead set on Diane-35 (without even explaining why), while I was being super skeptical because I've read so many horror stories about Diane-35.

Can you or anyone else make sense of all this for me?🙏

Don't even start with Harni... I've been posting on one of their threads for months now and getting zero response.🙄 😁
And then yesterday, I actually called Harni's office, but the nurse basically "politely" shut me down and just asked when I wanted to book an appointment instead.😠 😁
I don't live in the city, so making that trip right now is basically mission impossible...
Same thing happened when I called a few private OB-GYNs in my hometown—nobody will give me a single shred of advice without an in-person exam first.
The headache is that all my results—liver panels and hormone profiles from the last two years—are sitting in my file with my current insurance doctor.
Which means if I decide to go private, I'd probably have to redo every single test from scratch.😲 ... I mean, money isn't the biggest issue, but I'm wondering if I'd have to foot the whole bill myself😲 since I have health insurance and haven't paid a dime for any tests done by my primary provider so far!!
If I go the private route, how much does it cost to redo everything? Do I get billed for every individual lab?

Also, my old doctor (before he retired) told me back in December 2004 that I really needed to see an endocrinologist in Cleveland—which sounds fine to me! He said more testing would make things clearer. But when I went back four months later and met this new guy, he didn't bother referring me to an endocrinologist or even giving me a referral for liver or hormone tests. Instead, he just handed me a prescription for Diane 35.
I listened to him and started the meds, but honestly, I feel like we both messed up—me as the patient and him as the doctor—for starting therapy based on labs that were already 5 or 6 months old.

So, what's the move? Should I ditch this guy for a different insurance-based doctor? Or should I go private and let them bleed me dry for every single test, exam, and ultrasound? Or do I just stick with this new guy and trust him, like every clueless patient is supposed to do?

Anyway, I’d appreciate any input you guys have. Also, does anyone know if there's some kind of on-call OB-GYN in America who'll actually give advice over the phone? I get that you can't do much via phone, but just a few pointers would seriously help me out here.🙏

check this outhttp://www.zdravljeizivot.com/forum/index.php

just asking... Dr. Husar is actually pretty solid—he’s super reliable and doesn't hold back when he's talking to you.

And look, Dr. Harni has a massive patient list, so obviously she can't just pick up the phone every time someone calls, especially if you aren't already one of her regular patients.

Paul, look, I’m no gynecologist, but my best friend happens to be mine, and he’s cleared some things up for me...
Even if it isn't explicitly mentioned on the Diane35 pamphlet, she—like other oral contraceptives—can be taken continuously without any breaks. This method significantly reduces menstruation, which is actually quite common among female athletes. It works by reducing the endometrium (the uterine lining) that usually rebuilds during the placebo week, essentially eliminating the need for bleeding, since that process is just the shedding of old tissue. You might just experience some light brown spotting.

Keep in mind, Diane35 is a high-estrogen formula; its primary purpose isn't really birth control, but rather treating cystic ovaries and acne.
There are plenty of options on the market with much lower estrogen levels—meaning fewer side effects and less of a hormonal shock to your system—such as Logest, or the newer Yasmin...