Spotting Between Periods While on Birth Control

Causes, Complications, and When to See a Doctor

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Otherwise known as “breakthrough bleeding,” spotting between periods while on the birth control pill is very common. This is especially true in the first few months of pills or if you are late when taking your pill.

The birth control pill is composed of the hormones estrogen and progesterone (or less frequently, just progesterone), which inhibit ovulation, change cervical mucus, or make the endometrium inhospitable to implantation. Changing hormone levels, most notably estrogen, and a thin endometrial lining can both cause breakthrough bleeding.

In most cases, breakthrough bleeding isn’t something to be concerned about and will disappear within a few pill packs. If it doesn’t, however, you might want to check in with your prescribing doctor just to be on the safe side. Your doctor can also prescribe you a different type of birth control pill to see if it can regulate your bleeding. 

Causes

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of childbearing age. A hallmark feature of PCOS is irregular or absent periods and is due to an imbalance of sex hormones. Typically women with PCOS have high levels of androgens (like testosterone) and luteinizing hormone (LH) and low levels of progesterone.

This hormonal imbalance not only causes the aggravating symptoms of PCOS, but it can also lead to severe, long-term complications if left untreated.

Women who don't have regular menstrual cycles for prolonged periods of time are vulnerable to endometrial hyperplasia, a condition in which the uterine lining begins to thicken abnormally, increasing the risk of uterine cancer.

Birth control pills are commonly prescribed to women with PCOS to regulate menstrual cycles. In some instances, women with PCOS may be given Provera before beginning treatment with birth control medications.

If you have endometriosis, a condition where tissue similar to the lining of your uterus is found outside of your uterus and throughout the pelvic cavity, your doctor might also prescribe you birth control to regulate any irregular periods you may be having. Your doctor might also prescribe birth control pills if you have fibroids, as this can slow fibroid growth and lessen heavy periods.

When to See a Doctor

If you have been taking the pill exactly as directed and at the same time each day, it should sufficiently protect you against getting pregnant. If you have missed a few pills or have been inconsistent in when and how you’ve been taking your pill, you will want to use a backup method of birth control, like a condom, until you get a period and are ready to start the next pack.

If you experience breakthrough bleeding while taking your birth control pills, continue taking the medications as prescribed. If you are bleeding because of missed pills, consult the package insert or 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 on, how many pills you missed, and what point you are in your cycle. As always, if you have any concerns, make sure to use an additional method of birth control to prevent pregnancy.

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