Determination between periods in birth control.


Spotting between periods, also known as breakthrough bleeding, can occur in a number of circumstances. When this happens only occasionally, it is generally not a cause for concern. However, it is important to keep track of when the spotting appears and how much it bleeds, if it starts to occur frequently.

The most common cause of bleeding is with birth control pills , especially during the first few months or if a dose is missed. Certain medical conditions can also increase the chance of breakthrough bleeding.

If the spots occur during pregnancy, are accompanied by severe pain, or are associated with a large amount of blood, it is important to seek immediate medical attention.

Nusha Ashjai / Get Drug Information


Breakthrough bleeding is any vaginal bleeding that occurs between periods. Some women see the flower once or twice during this time, while others may bleed for a day or more.

Sometimes women have concomitant cramps in the lower abdomen (similar to menstrual cramps ) a few days before or on the days when breakthrough bleeding occurs.

If you have sudden bleeding while taking the contraceptive pill as prescribed, it can occur a week or two before your period and should follow a consistent pattern. As a general rule, breakthrough bleeding recurs no more than a few months after starting a new oral contraceptive and then stops .

Women can also have persistent and / or irregular bleeding if they miss multiple oral contraceptive pills.


Birth control pills prevent pregnancy because they contain estrogen and progesterone (some of them only contain progesterone). These hormones suppress ovulation, alter cervical mucus, and render the endometrium inhospitable.

Adaptation to oral contraceptives

As your cycle adjusts to oral contraceptives, changing hormone levels alter the lining of the endometrium in your uterus. This can change the timing of your period and / or cause breakthrough bleeding .

Skip doses

If you miss a dose or more of the birth control pill, your body can detect and respond to fluctuations in hormone levels. This can cause breakthrough bleeding due to premature separation of part of the lining of the uterus before menstruation begins.

Medical conditions

In addition to preventing conception, birth control pills are prescribed to treat a wide variety of conditions. It can cause abnormal spotting and bleeding for a variety of reasons. From them:

  • Polycystic Ovarian Syndrome (PCOS) : With this hormonal disorder, small cysts form on the ovaries and progesterone levels drop. When taking birth control pills, sudden progesterone can cause the lining of the uterus to shed, resulting in side effects like spotting and bleeding.
  • Endometriosis : With endometriosis, the uterus tissue grows outside the uterus. Birth control pills prevent symptoms by suppressing ovulation and maintaining a constant hormonal balance in the body. Spotting and light bleeding are common in 50% of women during the first three to nine months of using oral contraceptives for endometriosis, until the hormones stabilize.
  • Uterine fibroids : These benign neoplasms usually develop during the childbearing years. Although birth control pills can reduce heavy vaginal bleeding, they do not always change the size of the fibroid, but they can even enlarge it, resulting in occasional spotting and light bleeding.
  • Perimenopause : Also known as transitional menopause, this phase can precede menopause by several years. If you are perimenopausal, you may have breakthrough spotting and bleeding while taking birth control pills.

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

When to contact a healthcare provider

Talk to your doctor if you experience spotting during the first few months of taking birth control pills.

If you have missed some pills or taken them inconsistently, you can use backup birth control until you start taking pills all the time and resume your regular cycle again. Birth control pills are generally effective in preventing pregnancy, but skipping doses will make them less effective.

If you experience heavy bleeding while taking the contraceptive pill, continue taking it as directed. If you miss a pill, talk to your doctor or pharmacist about how to proceed safely. Your instructions will differ based on the type of birth control pill you are taking, how many pills you missed , and where you are in your cycle.

Persistent bleeding

You may experience persistent bleeding while taking birth control pills. This can happen when your hormones are not in the correct dose, when you have health problems, or when you cannot take pills every day.

If you continue to bleed even after several months of continuous birth control pills, your doctor may prescribe another type of birth control pill to see if they can regulate the bleeding.

There are other options for women who cannot take pills every day due to a busy schedule, frequent travel, or for any other reason. She may be a candidate for other contraceptive methods that are prescribed at shorter intervals than oral contraceptives.

Persistent or severe vaginal bleeding should always be evaluated by a doctor.

It is important to get tested to see if the bleeding has something to do with your birth control pills or is causing it. Bleeding, especially persistent bleeding, can be a sign of a serious health problem, including polycystic ovary syndrome, thyroid disease, pelvic inflammatory disease (PID) , or cancer .

Get the word of drug information

While it can be frustrating, catching it doesn't necessarily mean something is wrong, but it can happen for a number of reasons, including perimenopause or health issues like PCOS. If you notice that you are taking birth control pills, be sure to talk to your doctor. Your doctor can help you find the cause and treat it. It can be as simple as changing your prescription for birth control, but it may require treatment for a medical condition.

Frequently asked questions

  • If you miss a pill or take it later than usual, there is a risk that you are pregnant and blood can be a sign of implantation . However, breakthrough bleeding can occur while taking the pills, especially if you are taking low-dose pills, smoke, or have an infection.

  • The failure rate for typical birth control pill use is 7%. Taking the pills at the same time each day and keeping the doses consistent will reduce this risk. Certain antibiotics , antifungals, and other medications can reduce the effectiveness of birth control pills, so discuss these medications with your doctor.

Related Articles
Foods to Avoid If You Have Dry Mouth From Radiation

Dry mouth (xerostomia) is a common side effect of radiation therapy for people undergoing treatment for head and neck cancer. Read more

Thyroid adenoma: Causes, Treatment, and Diagnosis

The thyroid is a small, butterfly-shaped gland in the front of your throat that produces hormones affecting a number of Read more

NSAIDs and You Thyroid Function

Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most frequently taken over-the-counter medications. Due to their systemic or whole body effects, it's Read more

How Doctors Are Failing Thyroid Disease Patients

The thyroid disease community has continually mentioned the lack of support they experience and the difficulty they have navigating the Read more