Spotting Between Periods While on Birth Control

Birth control pills are one of the most common causes of spotting between menstrual periods. This spotting is also known as breakthrough bleeding. If it occurs, it typically happens when an oral contraceptive is either started or switched.

Most cases of breakthrough bleeding are not reason for concern. But it's important to keep track of spotting that is heavy or frequent. This may be a sign of a more serious health concern.

This article explains the symptoms of spotting and how birth control pills cause breakthrough bleeding. It also reviews the different medical conditions treated with oral contraceptives and how this can also lead to abnormal or irregular bleeding.

spotting between periods while on birth control

Verywell / Nusha Ashjaee

Symptoms

Breakthrough bleeding is any amount of vaginal bleeding that occurs between periods. Some women may see only a tinge of blood. Others may experience heavier bleeding that lasts for a day or more.

Lower abdominal cramps, similar to menstrual cramps, may occur either during breakthrough bleeding or a few days prior to it starting.

When birth control pills cause spotting, the bleeding tends to occur one or two weeks before the start of a period. The bleeding usually follows a consistent pattern for several months until the body adjusts to the new hormone levels. Then the bleeding stops.

Primary Causes

Birth control pills contain either estrogen and progesterone or just progesterone (known as the minipill).

These hormones work by blocking the release of an egg (known as ovulation). The consistency of the cervical mucus also changes to make it harder for sperm to reach the egg. Meanwhile, the lining of the uterus becomes thinner to make implantation less likely.

Against this backdrop, breakthrough bleeding is more likely to occur when:

  • Starting birth control pills because the sudden change in hormone levels will alter the timing of your period. It will lead to spotting until your body fully adjusts to the new levels.
  • Changing oral contraceptives because your body has to play catch-up to reach a point of hormonal balance. Until it does, any change in the timing of your period can cause breakthrough bleeding.
  • Skipping doses because your body may respond to the fluctuating hormone levels by shedding uterine tissue before your period is due to begin.

Other Causes

Perimenopause is the stage before menopause when hormonal levels begin to level off. Women are about 40 to 50 years old when they go through perimenopause.

During this phase, women may experience more breakthrough bleeding while on birth control pills. Perimenopausal women are often prone to irregular cycles and heavy bleeding during this phase, too.

People who smoke or who have chlamydia or gonorrhea (sexually transmitted infections) are also at an increased risk for breakthrough bleeding.

Dosages Matter

Breakthrough bleeding is more common when people take low-dosage and ultra low-dosage birth control pills.

Using Birth Control Pills for Health Conditions

Taken correctly, birth control pills can be more than 90% effective in preventing pregnancy. The pills can also be used to treat some gynecological conditions. The usage can cause spotting or bleeding for different reasons.

Some conditions for which birth control pills may be prescribed are:

  • Polycystic ovary syndrome (PCOS) is an hormonal disorder affecting the ovaries, characterized by low progesterone levels. While birth control pills can help treat PCOS, the sudden spike in progesterone can cause spotting due to the shedding of the uterine lining. Irregular bleeding usually stops after a few menstrual cycles.
  • Endometriosis occurs when uterine tissues grow outside of the uterus. Birth control pills can relieve symptoms by keeping the body in a steady hormonal state. Even so, spotting affects up to 50% of women with endometriosis during the first three to nine months of starting oral contraceptives.
  • Uterine fibroids are noncancerous growths that tend to occur during the childbearing years. While birth control pills can reduce heavy vaginal bleeding, they don't always change the size of fibroids. They may even increase them, leading to occasional spotting or bleeding.

When to See a Healthcare Provider

Talk to your healthcare provider if you experience spotting during the first few months of taking a new type of birth control pill.

Also speak up if you experience bleeding that is heavy or persistent or spotting that worsens several months after starting the pills.

The dosage could be too high, and a simple adjustment could fix the problem. Or there may be a co-occurring condition causing the abnormal bleeding.

There could be another explanation, too: Pregnancy. If you’ve missed a pill or taken one later than usual, there’s a risk you are pregnant. The blood could be a sign of implantation.

A thorough evaluation by a healthcare provider should reveal the cause of the bleeding.

Preventing Spotting Between Periods

Taking your birth control pills as instructed can help you avoid spotting between periods. This means taking your pill at the same time each day and never missing a day.

If you have trouble remembering to take your birth control pills, become proactive. Set a reminder on your phone or keep your pill pack near something you reliably reach for every day, such as your toothbrush or wallet.

Skipping doses or taking pills inconsistently are equally bad habits. You may want to use a backup method of birth control until your pill-taking routine is back on track and you resume a regular cycle.

There are other hormonal birth control options you can consider, such as a vaginal contraceptive ring or the patch. Available by prescription, the birth control patch is worn on the abdomen, buttocks, or upper body. It releases progestin and estrogen into the bloodstream.

Intrauterine devices (IUDs) remain effective for several years after they are placed. There are also birth control shots, which need to be given every three months.

With so many choices available, it makes sense to talk with your healthcare provider about selecting the right birth control method for you.

Summary

Birth control pills are one of the more common causes of spotting, or breakthrough bleeding. It can range from light to heavy and is often accompanied (or preceded) by lower abdominal cramps.

Breakthrough bleeding is more likely to occur when starting or switching birth control pills or taking the pills inconsistently.

Call your doctor if you have heavy or persistent bleeding while on birth control pills. The problem may be resolved by reducing the dosage or changing to another form of birth control. Or you may need treatment for an underlying health condition.

A Word From Verywell

Keep a record of the bleeding episodes as well as other symptoms you may have experienced at the time of bleeding. This record can help your healthcare provider narrow the possible causes during an evaluation.

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9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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