Why am I bleeding on the pill when I should not be

Why am I bleeding on the pill when I shouldn't be
Medically reviewed by Richard Honaker M.D.

Key takeaways

  1. Breakthrough bleeding on the pill is a common concern, often causing concern about contraceptive effectiveness, but understanding its causes, duration, and management is crucial for informed decision-making.
  2. Breakthrough bleeding is linked to various factors, including the type of hormonal birth control, its dosage, and individual characteristics, emphasizing the need for personalized solutions and proactive management.
  3. Consultation with a doctor is essential for personalized solutions for breakthrough bleeding, ensuring effective management, and ruling out potential underlying health issues. Regular communication with healthcare professionals is vital for maintaining reproductive health and finding the most suitable contraceptive approach.


Worried about spotting while on birth control? Breakthrough bleeding, which is common for women using hormonal birth control, raises concerns due to unexpected spotting or, at times, heavier bleeding. While it can be inconvenient and frustrating, it’s crucial to understand that breakthrough bleeding doesn’t usually signal a health problem or imply a lack of contraceptive effectiveness. In this blog, we’ll explore the causes of breakthrough bleeding, its duration and intensity, and the steps to address it.

What indicates your breakthrough bleeding?

Breakthrough bleeding, abbreviated as BTB, refers to inter-menstrual bleeding that occurs while taking oral contraceptives. It results from the detachment of an unstable endometrium from the lining, leading to irregular spotting. 

Unlike a typical period bleed, BTB is characterized by its lighter and shorter duration, often appearing as irregular ‘spotting‘ between regular periods. Initial months on the pill may involve spotting or unscheduled bleeding as the body adjusts to hormonal changes. Additionally, switching between contraceptive types or pill formulations can trigger breakthrough bleeding due to variations in hormone dosage. Here are some of the indications of breakthrough bleeding in females: 

1. Breakthrough bleeding is independent of the kind of hormonal birth control

Breakthrough bleeding can occur with any hormonal birth control method, including pills, implants, hormonal IUDs, shots, vaginal rings, and patches. While all these methods function by delivering hormones to prevent pregnancy, the likelihood of breakthrough bleeding varies.

2. Types of birth control prone to breakthrough bleeding

Breakthrough bleeding tends to happen more frequently with low-dose and ultra-low-dose birth control pills, birth control implants, and hormonal IUDs. For women using IUDs, spotting and irregular bleeding are common in the initial months after placement, improving over 2 to 6 months. In contrast, the bleeding pattern with the implant typically remains consistent after the first three months.

3. Females who are more prone to breakthrough bleeding

Certain factors increase the likelihood of breakthrough bleeding. Women who smoke, those inconsistent with their birth control pill regimen, and individuals taking medications like emergency contraception pills face a higher risk. Infections like chlamydia or gonorrhea can also contribute. Continuous use of hormones to skip periods, and the presence of benign growths like uterine fibroids, unrelated to birth control, further elevate the risk.

4. Strategies to address breakthrough bleeding

Some women can take steps to manage and improve breakthrough bleeding independently. Lifestyle changes, such as quitting smoking and maintaining a consistent pill schedule, can be effective. For those using continuous hormones with birth control pills or the ring, scheduling a periodic break to allow the uterus to shed any built-up lining can help reduce irregular spotting and bleeding.

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What causes breakthrough bleeding?

While individual experiences may vary, several factors can lead to breakthrough bleeding between periods when using contraceptive pills, as follows: 

1. Impact of Switching Birth Control Pills

Breakthrough bleeding often emerges during periods of change, such as starting the pill for the first time or transitioning to a new type of oral contraceptive. This common side effect can vary among individuals, emphasizing the importance of understanding the nuances associated with different birth control methods.

2. Progestin-only pills and Bleeding

Progestin-only pills, also known as ‘the mini pill,’ are given to women unable to take contraceptives containing estrogen due to health reasons. While effective, these pills, taken continuously without the conventional ‘sugar pills,’ can increase the likelihood of breakthrough bleeding, adding a layer of complexity to the contraceptive experience.

3. Continuous Pill Use

Skipping the ‘sugar pills’ and opting for continuous use of active pills, thereby skipping the regular period, can elevate the chances of breakthrough bleeding, particularly in the initial months of usage.

4. Missing regular doses

A prevalent cause of breakthrough bleeding is the irregular intake of birth control pills. Missing doses compromise efficacy and increase the chances of spotting. Practical solutions, such as setting daily alarms or exploring alternative contraception methods, can help women maintain consistent pill usage.

5. External Factors Influencing Breakthrough Bleeding

Breakthrough bleeding isn’t solely tied to birth control choices; external factors play a role. Persistent vomiting, diarrhea, and the usage of new medications, including specific antibiotics (azithromycin), epilepsy drugs, antiretroviral drugs for HIV treatment, and St. John’s wort, can contribute to this phenomenon. Understanding these influences helps women navigate their contraceptive journey in a better way.

6. When Breakthrough Bleeding Signals Something More

Bleeding between periods isn’t exclusively linked to birth control; it can signal underlying medical issues such as sexually transmitted infections (gonorrhea, chlamydia), miscarriages, ectopic pregnancies, or cervix injuries. Therefore, it emphasizes the importance of consulting a healthcare professional to eliminate the risks of breakthrough bleeding. 

7. Misdiagnosis

In certain instances, breakthrough bleeding may be mistaken for implantation bleeding, a phenomenon occurring 10-14 days after conception when a fertilized egg implants into the uterine lining. Recognizing the distinctions between these types of bleeding is vital for accurate interpretation and informed decision-making.

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How long does it last?

Breakthrough bleeding, ranging from a few days to light spotting, is a common aspect of hormonal birth control. While some instances may resolve quickly, persistent breakthrough bleeding lasting beyond seven days needs immediate medical attention. Consult an online doctor if the bleeding extends beyond the typical timeframe.

How to stop breakthrough bleeding?

The good news is that breakthrough bleeding tends to decrease significantly over time. Statistics indicate that the likelihood of experiencing breakthrough bleeding drops to just 10% after 12 months on the pill. Whether it’s light bleeding between periods or longer, heavier unscheduled bleeds, understanding the distinctions between normal and not-so-normal breakthrough bleeding is crucial. Approximately 70% of women face this challenge during their initial pill cycle within 3-6 months of use.

Breakthrough bleeding can be a frustrating side effect of hormonal birth control, but practical steps exist to alleviate these inconveniences. It’s crucial, however, to consult with your GP before making any contraceptive changes to ensure the best decision for your body.

1. Strategic Breaks

For those facing vaginal bleeding lasting three days or more while consistently using birth control pills, studies indicate that taking a four-day break from active pills can be a viable option. This break allows the complete shedding of the uterine lining, known as the endometrium, before resuming pill usage.

2. Exploring alternative contraception

Persistent breakthrough bleeding may prompt consideration of alternative progestogen types. Studies suggest that birth control pills containing gestodene or norethisterone could potentially alleviate this issue. Additionally, modifying the dosage or type of estrogen in the pill, such as increasing ethinylestradiol dosages, has shown promise in managing breakthrough bleeding.

3. Shifting to different progesterone

For those still suffering from persistent breakthrough bleeding, exploring alternative contraceptives becomes valuable. Switching to a different type of contraception, such as the ring or contraceptive injection, can eliminate concerns about forgetting daily doses and offer relief from the challenges associated with pill-induced breakthrough bleeding.

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Should I consult an OB-GYN?

While breakthrough bleeding with birth control is not physically harmful, it can be undeniably frustrating. When patients report spotting or irregular bleeding, discussions about potential causes and physical examinations follow. 

Upon confirming the link between breakthrough bleeding and birth control, OB-GYNs offer a range of solutions. These may include transitioning from ultra-low-dose to low-dose birth control pills, adjusting the number of placebo days, or exploring alternative birth control methods like IUDs, implants, or birth control shots. 

While breakthrough bleeding is common, it’s crucial to recognize signs of potentially serious underlying conditions like sexually transmitted infections and inter-menstrual bleeding. If you experience specific unusual symptoms, consult a doctor at the earliest such as

It encourages individuals to communicate regularly with their GP about any irregular bleeding or side effects, facilitating the identification of the most suitable contraceptive for individual bodies and lifestyles.

Faqs about why am I bleeding on the pill when I shouldn’t be

Do birth control pills cause birth defects if taken during early pregnancy?

Taking birth control pills during early pregnancy doesn’t seem to elevate the risk of birth defects. Although some research has suggested a potential association with increased risks of low birth weight, preterm birth, or urinary tract concerns in newborns when birth control pills are used near conception, the evidence remains inconclusive.

Can you take the pill to stop your periods?

Yes, you can use birth control pills to delay or halt your period. Initially packaged as 21 days of active hormone pills and seven days of inactive pills, birth control pills allow for menstrual-like bleeding during the inactive pill phase.

I am on the pill and have missed a period. Am I pregnant?

A late or missed period while on birth control doesn’t necessarily indicate pregnancy. Various factors, such as changes in your birth control method, hormonal imbalances, increased stress levels, inadequate calorie intake, intense exercise, or underlying health conditions, can contribute to a delayed period.

Can stress cause bleeding on the pill?

Stress can lead to spotting while on the pill. Elevated levels of emotional and physical stress trigger an increased release of cortisol, disrupting the usual hormonal balance by reducing estrogen and progesterone secretion, consequently influencing your menstrual cycle.

Your Doctors Online uses high-quality and trustworthy sources to ensure content accuracy and reliability. We rely on peer-reviewed studies, academic research institutions and medical associations to provide up-to-date and evidence-based information to the users.

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