Birth control pills are one of the most common causes of bleeding found during menstruation, also known as breakthrough bleeding. If this happens, it usually happens when starting or changing oral contraceptives.
This is not cause for concern. In fact, most cases of breakthrough bleeding are not either.
That being said, it’s important to keep track of findings in severe or frequent cases, as this could be a sign of a more serious health problem.
This article explains the symptoms of spotting and how birth control pills can cause breakthrough bleeding. It also looks at the different medical conditions that oral contraceptives treat and how this can lead to abnormal or irregular bleeding.
Breakthrough bleeding is any amount of vaginal bleeding that occurs between periods. Some women may see only a small amount of blood, while others may experience heavy bleeding that lasts a day or more.
Lower abdominal cramps, similar to menstrual cramps, can also occur during or a few days before breakthrough bleeding.
When birth control pills cause spots, the bleeding tends to happen a week or two before your period starts. Bleeding usually lasts for several months until the body adjusts to the new hormone levels and the bleeding stops.
Breakthrough bleeding from birth control pills can range from mild to severe and may be accompanied by lower abdominal cramping. In most cases, the bleeding will stop within a few months.
Birth control pills contain estrogen and progesterone, or progesterone alone (called a small pill).
These hormones work by preventing the release of an egg (ovulation), changing the consistency of cervical mucus, making it harder for sperm to reach the egg, and thinning the lining of the uterus to reduce the likelihood of implantation.
Breakthrough bleeding is more likely when:
- Start taking birth control pills: Sudden changes in hormone levels can alter the timing of your periods, leading to discovery until your body fully adjusts to the new levels.
- Switching oral contraceptives: Whenever you switch birth control pills, your body has to “catch up” to reach a hormonal balance point. Any changes in menstrual timing before this time can lead to breakthrough bleeding.
- Skipping doses: If you skip doses frequently, your body may bleed from fluctuations in hormone levels. This is caused by premature shedding of uterine tissue before your period is due.
Perimenopause, also known as the menopausal transition, is the stage before menopause when hormone levels begin to fluctuate and taper off. During this stage, perimenopausal women may experience more breakthrough bleeding while taking birth control pills.
Breakthrough bleeding usually occurs when birth control pills are started or changed. Irregular dosing can also cause spots by prompting premature shedding of uterine tissue.
Using birth control pills to treat health conditions
In addition to preventing pregnancy, birth control pills are often used to treat various gynecological disorders. This can cause spotting or bleeding for different reasons.
Among some of the conditions where birth control pills can be prescribed:
- Polycystic ovary syndrome (PCOS): This hormonal disorder that affects the ovaries is characterized by low levels of progesterone. While birth control pills can help treat PCOS, a sudden rise in progesterone due to the shedding of the lining of the uterus can cause spotting.
- Endometriosis: endometriosis This is when uterine tissue grows outside the uterus. Birth control pills can relieve symptoms by keeping the body in a stable hormonal state. Even so, as many as 50 percent of women with endometriosis develop spots within the first 3 to 9 months of starting oral contraceptives.
- Uterine fibroids: These noncancerous growths tend to occur during reproductive years. While birth control pills can reduce severe vaginal bleeding, they don’t always change the size of fibroids and may even increase them, causing occasional spotting or bleeding.
Birth control pills are sometimes used to treat conditions such as polycystic ovary syndrome (PCOS), endometriosis, and uterine fibroids. As useful as oral contraceptives are in treating these conditions, they can also cause breakthrough bleeding.
When to see a healthcare provider
Talk to your healthcare provider if you develop spots within the first few months of taking birth control pills.
Likewise, let them know if you have heavy bleeding, persistent bleeding, or worsening spots a few months after you started taking birth control pills.
This may be because the dose is too high and needs to be adjusted. Alternatively, there may be concomitant conditions that lead to abnormal bleeding. Only an evaluation by a qualified doctor can reveal the cause.
Call your doctor if you have heavy vaginal bleeding while taking birth control pills or if you continue to have vaginal bleeding for several months after starting oral contraceptives.
prevent discovery between periods
Taking birth control pills as directed can help you avoid spotting between periods.
This means not missing a day and taking your pills at the same time each day.
If you have trouble remembering to take the pill every day, it may be helpful to set a reminder on your phone or keep the pill close to something you can reach each day, such as a purse or a toothbrush.
If you’ve been off or inconsistently taking your pills, you may need to use a backup birth control method until your pills are back on track and your cycle is back on track.
You can also consider other hormonal birth control options. An intrauterine device (IUD) remains effective for several years after it is placed. There are also birth control shots, which only need to be injected every few weeks.
Birth control pills are one of the more common causes of bleeding or breakthrough bleeding. It can range from mild to severe and is usually accompanied by (or preceded by) lower abdominal cramps.
Breakthrough bleeding is more likely to occur when birth control pills are started or changed or when birth control pills are taken inconsistently.
Call your doctor if you have heavy or persistent bleeding while taking birth control pills. The problem can be resolved by reducing the dose or switching to another form of birth control, or you may need treatment for the underlying medical condition.
Bleeding events and other symptoms that may occur while bleeding are recorded. This can help your doctor narrow down possible causes during the evaluation.
Frequently Asked Questions
Can I get pregnant if I bleed during my period while taking birth control pills?
If you miss a pill or take one later than usual, you are at risk of pregnancy. Blood may be a sign of implantation. However, breakthrough bleeding can occur while taking birth control pills, especially if you use low-dose birth control pills, smoke, or have an infection.
How effective are birth control pills?
The typical failure rate for contraceptive use is 7%. Taking birth control pills at the same time every day and not missing one can reduce this risk. Some antibiotics, antifungals, and other medicines can make birth control pills less effective, so discuss these with your healthcare provider.