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, it's usually not a 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 taking 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 get prompt medical attention.

spotting between periods while on birth control

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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 oral contraceptive doses.

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): This hormonal disorder produces small cysts in the ovaries, and progesterone levels are 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: Uterine tissue grows outside of the uterus in endometriosis. Birth control pills prevent the symptoms by suppressing ovulation and keeping the body in a steady hormonal state. Spotting and light bleeding are common in up to 50% of women during the first three to nine months of using oral contraceptives to treat endometriosis, until hormonal levels are stable.
  • Uterine fibroids: These noncancerous growths 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, this phase 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 hormones in the pills 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.

If you have missed a few pills or have been inconsistent in taking them, 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 other methods of birth control, which are scheduled at less frequent intervals than oral contraceptives.

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

It is important to be evaluated to check whether the bleeding has anything to do with your birth control pills or if something else is causing it. Bleeding, particularly persistent bleeding may be a sign of a serious health concern, including PCOS, thyroid disorders, pelvic inflammatory disease (PID), or cancer.

Frequently Asked Questions

Could I be pregnant if I bleed mid cycle when I’m on the pill?

If you’ve missed a pill or taken one later than usual, there’s a risk you are pregnant and the blood could be a sign of implantation. However, it’s possible to have breakthrough bleeding while on the pill, especially if you use a low-dose pill, smoke, or have an infection.

How effective is the birth control pill?

The typical birth control pill has a failure rate of 7%. Taking the pill at the same time every day lowers the risk of becoming pregnant. Some antibiotics, antifungals, and other medications can make birth control pills less effective, so discuss those drugs with your doctor.  

A Word From Verywell

Although it may be bothersome, spotting does not necessarily mean that something is wrong, but it can happen for a number of reasons, including perimenopause or health issues like PCOS. If you experience spotting whether or not you are taking birth control pills, be sure to talk to your doctor. Your doctor can help to find the cause and treat it. This could be as simple as changing your birth control prescription, but it may involve the management of a medical condition.

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  1. Villavicencio J, Allen RH. Unscheduled bleeding and contraceptive choice: increasing satisfaction and continuation rates. Open Access J Contracept. 2016;7:43-52. doi:10.2147/OAJC.S85565

  2. Zigler RE, Mcnicholas C. Unscheduled vaginal bleeding with progestin-only contraceptive use. Am J Obstet Gynecol. 2017;216(5):443-450. doi:10.1016/j.ajog.2016.12.008

  3. Harvard Health Publishing. Dysfunctional uterine bleeding. March, 2019.

  4. Center for Young Women's Health. Medical uses of the birth control pill. Updated July 19, 2018,

  5. PCOS Society (India). Consensus statement on the use of oral contraceptive pills in polycystic ovarian syndrome women in IndiaJ Hum Reprod Sci. 2018;11(2):96-118. doi:10.4103/jhrs.JHRS_72_18

  6. Weisberg E, Fraser IS. Contraception and endometriosis: challenges, efficacy, and therapeutic importanceOpen Access J Contracept. 2015;6:105-5. Published 2015 Jul 27. doi:10.2147/OAJC.S56400

  7. Kim JJ, Sefton EC. The role of progesterone signaling in the pathogenesis of uterine leiomyomaMol Cell Endocrinol. 2012;358(2):223-31. doi:10.1016/j.mce.2011.05.044

  8. Cho MK. Use of combined oral contraceptives in perimenopausal women. Chonnam Med J. 2018;54(3):153-158. doi:10.4068/cmj.2018.54.3.153

  9. Cleveland Clinic. Birth control: the pill. Reviewed November 4, 2016.

  10. Dean J, Kramer KJ, Akbary F, et al. Norethindrone is superior to combined oral contraceptive pills in short-term delay of menses and onset of breakthrough bleeding: a randomized trial. BMC Womens Health. 2019;19(1):70. doi:10.1186/s12905-019-0766-6

  11. French V. What You Should Know About Breakthrough Bleeding With Birth Control.  American College of Obstetricians and Gynecologists. January 2021.

  12. Center for Disease Control and Prevention. Contraception. August 13, 2020.