Spotting Between Periods While on Birth Control

Spotting between menstrual periods, also known as breakthrough bleeding, can occur under a number of circumstances. When it happens only occasionally, there usually is not reason to be concerned. That said, it's important to keep track of when spotting happens and how heavy the bleeding is if it begins to occur frequently.

The most common cause of spotting is associated with being on birth control pills, particularly during the first few months of taking them or if a dose is missed. Certain medical conditions can also make breakthrough bleeding more likely.

When spotting occurs during pregnancy, is accompanied by severe pain, or involves a large amount of blood, it is important that you discuss these issues and concerns with your doctor.

Symptoms

Breakthrough bleeding is any amount of vaginal bleeding that occurs between periods. Some women see a tinge of blood once or twice during this time, while others may have bleeding for a day or longer.

Sometimes women have accompanying lower abdominal cramps (similar to menstrual cramps) a few days before or during the days when breakthrough bleeding is happening.

If you have breakthrough bleeding while taking birth control pills as prescribed, you may experience it one or two weeks before your period, and it should follow a consistent pattern. Typically, breakthrough bleeding recurs for no longer than a few months after starting a new oral contraceptive, and then it stops.

Women also can have a persistent and/or irregular bleeding pattern when repeatedly skipping doses of their oral contraceptives.

Causes

Birth control pills prevent pregnancy because they contain estrogen and progesterone (some contain only progesterone). These hormones inhibit ovulation, change cervical mucus, and make the endometrium inhospitable.

Adjusting to Oral Contraceptives

As your cycle is adjusting to an oral contraceptive, the changing hormone levels alter the endometrial lining in the uterus. This can cause the timing of your period to change and/or cause breakthrough bleeding.

Skipping Doses

If you skip a dose or more of your birth control pill, your body may detect and respond to the fluctuating hormone levels. This can cause breakthrough bleeding due to premature shedding of some of your uterine lining before your period is due to occur.

Medical Conditions

Beyond the prevention of conception, birth control pills are prescribed to treat a wide variety of health conditions. Doing so may cause spotting and abnormal bleeding for different reasons. Among them:

  • Polycystic Ovary Syndrome (PCOS): A hormonal disorder that causes the development of small cysts in the ovaries. With PCOS, progesterone levels are invariably diminished. By taking a birth control pill, the sudden intake of progesterone can promote the shedding of the uterine lining and, with it, side effects like spotting and bleeding.
  • Endometriosis: A condition in which uterine tissue is found outside of the uterus. By suppressing ovulation, birth control pills keep the body in a steady hormonal state and mask endometriosis symptoms. However, spotting and light bleeding are common in up to 50% of women during the first three to nine months of treatment until hormonal levels are fully stabilized.
  • Uterine Fibroids: Non-cancerous growths in the uterus that tend to develop during the child-bearing years. While birth control pills can reduce heavy vaginal bleeding, they don't always change the size of fibroids and may even increase them, leading to occasional spotting and light bleeding.
  • Perimenopause: Also known as the menopause transition, can precede menopause by several years. If you are in perimenopause, you may be predisposed to spotting and can experience breakthrough bleeding when taking birth control pills.

Though birth control pills can help reduce abnormal vaginal bleeding in certain health conditions, the pills themselves can cause spotting even if you take them as directed.

When to See a Doctor

Talk to your doctor if you experience spotting during the first few months of taking a birth control pill. You may need to use another method of birth control, such as a condom, to prevent pregnancy as your body adjusts to your new cycle.

If you have missed a few pills or have been inconsistent in when and how you’ve been taking your pill, you may want to use a backup method of birth control until you start to consistently take your pills and resume a regular cycle again. In general, birth control pills are effective for preventing pregnancy, but missing doses diminishes their effectiveness.

If you experience breakthrough bleeding while taking birth control pills, continue taking them as prescribed. If you have missed pills, ask your doctor or pharmacist for advice on how to proceed safely. Your instructions will vary depending on the type of birth control pill you are taking, how many pills you missed, and what point you are in your cycle.

Persistent Bleeding

You may have persistent bleeding while using birth control pills. This can occur when the hormones are not at the right dose for you, when you have a medical issue, or if you aren't able to take your pill every day.

If you continue to experience spotting even after a few months of consistently using birth control pills, your doctor might prescribe you a different type of birth control pill to see if it can regulate your bleeding.

There are other options for women who can't take a pill every day due to a busy schedule, frequent travel, or any other reason. You might be a candidate for injectable hormones, which are scheduled at less frequent intervals than oral contraceptives.

It is also important to consider whether the bleeding has anything to do with your birth control pills. Bleeding, particularly persistent bleeding may be a sign of a serious health concern, including PCOs, a thyroid disorder, pelvic inflammatory disease (PID), or cancer.

Persistent or heavy vaginal bleeding should always be investigated by a physician.

A Word From Verywell

Spotting is not usually problematic, but it can happen for a number of reasons, including perimenopause or health issues like polycystic ovary syndrome (PCOS). If you experience spotting while taking birth control pills, be sure to talk to your doctor. You may need a change in your prescription to ensure that you are getting the intended effects of your birth control pills — whether it is the prevention of pregnancy or management of a medical condition.

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