Medically reviewed by Sophia Yen, MD, MPH – Written by Pandia Health Editorial Team.
What is breakthrough bleeding?
Breakthrough bleeding (also known as spotting) is bleeding that occurs when you’re not expecting your period. The bleed is usually lighter than your usual menstrual flow, but it can be the same in some cases. Read on to learn and know about breakthrough bleeding: what causes it, when you should speak with your doctor about unexpected bleeding or spotting, and what to do if you experience it. (Hint: it’s always best to talk to your doctor if you experience bleeding when you don’t expect to. It could be an indicator that your birth control is not working. So watch out, you could be at risk of pregnancy if you see breakthrough bleeding. Use a backup method of birth control until you solve the situation if you don’t want to risk getting pregnant.)
What causes breakthrough bleeding?
Having a bleed while taking your active pills can be alarming. Breakthrough bleeding is a common side effect when taking hormonal birth control and often is because you took your daily pill too late or missed a pill. Apart from that, there are many different causes of breakthrough bleeding. Let’s explore some of the most common causes (from most common to least).
Forgetting to take your pill on time
Sometimes it comes down to human error. If you experience unexpected breakthrough bleeding, this could be because you forgot to take your daily pill! Birth control pills need to be taken consistently, ideally at the same time every day and it can be easy to forget. However, it is important that you don’t miss pills in the future. There are many ways to make sure you don’t forget your pills again in the future, such as reminders and apps.
Too low of estrogen in your birth control pill
Birth control pills with low estrogen (< 30 mcg of estrogen) are often to blame for breakthrough bleeding in women using them. That’s one of the reasons why the expert doctors at Pandia Health generally recommend 30 mcg of estrogen in your birth control pill until you are 30 years old (it’s also to protect your bone health).
Progesterone in the pill is not strong enough
The type of progesterone present in your birth control pill, patch, or ring can also have an impact. This is due to the role progesterone plays, with estrogen growing the lining of the uterus and progesterone helping to maintain and nourish it. There are 8 types of progesterone and each has its own strength in preventing breakthrough bleeding. Some are stronger than others. That’s why using a birth control expert doctor results in fewer side effects for you. All the doctors at Pandia Health are trained on our special algorithm to minimize the side effects you experience.
Sexually transmitted infections (STI)
Bleeding between periods is a common symptom of sexually transmitted infections such as gonorrhea and chlamydia. This unexpected bleeding is caused by inflammation of the cervix and is a result of the STI. If you believe you have an STI, it is important that you get tested and receive medical treatment from a doctor or sexual health clinic as soon as possible.
Taking the pill continuously
So, you’ve decided to start using your hormonal birth control to skip your period (didn’t you know that you can make #PeriodsOptional?). Skipping periods is possible with several types of hormonal contraceptives. With the “normal” birth control pills (combined oral contraceptive pills), you can skip the monthly bleed when you don’t take the last week of pills (the sugar pills, placebo pills, bleeding week pills), and you go directly onto your next pack.
Living a period-free life is exciting at first, but a few months later… breakthrough bleeding can start and mess up your plans. In this case, we’re talking specifically about spotting while using birth control pills or the birth control ring to skip your period. It is possible to have a few months without bleeding at all with hormonal contraception, and then experience spotting two to three months later. Each person with a uterus is different. Some can go immediately to #NoPeriods. Some people’s bodies like to bleed every 3 months. Know that there are 8 different progesterones and generally an expert birth control doctor can work through them with you to find the best one for you.
A new birth control prescription
Breakthrough bleeding is often experienced when you switch to a new type of hormonal birth control. Bleeding between periods can be about the body getting used to new hormones. Thankfully, this is usually nothing to be concerned about as long as the bleeding is light and stops after your body has adjusted to your new type of birth control. However, you should use a backup method of birth control for the first 7 days and to be really safe the 1st month when switching between hormonal methods of birth control.
There are many serious risks that come with combining birth control with smoking, such as a greater risk of cardiovascular issues like strokes,heart attacks, blood clots in your legs/chest/head. Studies have also shown that breakthrough bleeding is more often observed in people with uteruses who smoke cigarettes, compared to those who don’t smoke cigarettes. If you are concerned about smoking affecting birth control and your health, there are resources available to help you quit. It is not recommended that anyone who is 35 years old or older AND a smoker use estrogen containing birth control.
Taking new medications
Taking other supplements, over the counter cold medications, or medications can cause breakthrough bleeding because they rev up the liver and it eats through the birth control hormones. This puts you at risk of pregnancy. Specifically, ADHD medications and pseudoephedrine (over the counter cold medication) can increase your liver enzymes working. Always consult your doctor before starting any new supplement or medication.
You may have heard of the phenomenon of ‘period syncing’, which can happen when your cycle syncs with that of your roommate, colleague, co-worker, or sibling, and may lead to breakthrough bleeding. If you spend a lot of time around someone with a particularly regular cycle, you may experience breakthrough bleeding as your cycle of hormone production attempts to match theirs.
It is possible to have light bleeding during the implantation process. It occurs very early during a pregnancy about 2 weeks after fertilization, when a fertilized egg attaches itself to the uterine lining. If you think you might be pregnant, take a pregnancy test asap or see your doctor.
When to worry about breakthrough bleeding?
There are a few causes of breakthrough bleeding that are more serious, we will break down some of them in this section. However, see a doctor immediately if:
- Your bleeding continues for more than 7 consecutive days
- You experience bleeding and it becomes more intense or severe
- You experience pain in your lower abdomen or pelvis
- You suspect that you may be pregnant
- You develop a fever
Serious causes of breakthrough bleeding
Fibroids are small tumors that can develop in your uterus and can be caused by a variety of factors including hormonal changes during your periods or menopause or genetics. Fibroids can mess with your menstrual cycle, causing heavy or longer periods and spotting between periods. While they are usually non-cancerous, it is always recommended that you see your doctor if you believe fibroids are causing your symptoms.
Endometriosis is a health condition caused by irregular endometrial tissue growth. It is estimated to affect approximately 10% of women in their childbearing and can have a huge impact on a woman’s menstrual health. In addition to irregular bleeding, the most common symptoms of endometriosis include painful periods, back and/or pelvic pain, and issues with fertility. While endometriosis can be challenging to treat, there are options available to help ease symptoms, including the prescription of birth control to keep the lining stable vs. up and down every month with a bleed.
Pelvic Inflammatory Disease
Pelvic Inflammatory Disease (PID) is a common condition caused by the spread of a bacterial infection to the uterus and/or the fallopian tubes +/- ovaries. It’s most often experienced by women between the ages of 15 to 24 who are heterosexually active. A common symptom is unexpected bleeding, both between periods and after sexual intercourse. To have PID you have to have: pain in the lower abdomen, and pain in specific areas on a pelvic exam. 1 or more of the following also supports the diagnosis of PID: fever (100.4 or higher), vaginal discharge, white blood cells when a provider checks the discharge under a microscope, elevated ESR (blood lab test), elevated CRP (blood lab test), or lab test with gonorrhea or chlamydia. PID is not a condition to ignore because it can worsen if not treated and result in infertility and is an example of a time when you may experience breakthrough bleeding and should be reported to your doctor ASAP. PID can be easily treated with a course of antibiotics but may sometimes require hospitalization depending how severe it is.
How long does breakthrough bleeding last?
How long breakthrough bleeding lasts varies from person to person, but it should not last for longer than a week. When starting a new hormonal birth control, you can experience some breakthrough bleeding or light spotting, but this should go away once your body gets used to the new medication (allow 3 cycles, but again the spotting should not last more than 1 week).
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How to stop breakthrough bleeding?
Ibuprofen or equivalent NSAIDs
If you are using the birth control pill, patch, or ring to skip your period, you can try taking 600 mg of ibuprofen with food up to 3 times a day, for a maximum of 5 days in a row to stop breakthrough bleeding. If you’re taking the pill, make sure to take your pill at the same time every day. This will help to prevent breakthrough bleeding.
If you’re skipping your period, pause your medication
If you’re using the pill to skip your period and have taken at least 3 weeks of active pills in a row, to stop breakthrough bleeding, all you have to do is come off of the medication for 5 days; on day 6, whether or not you are still bleeding, just begin taking the active pills again. The breakthrough bleeding should stop. The 5 days off allows your uterus to clean out, reset, and you can try again. Most people can get farther and farther (more days) without breakthrough bleeding until no more bleeds! If you’re spotting and haven’t taken at least 3 weeks of active pills, continue taking them until you reach the end of the 3rd week. At 3 weeks of active pills in a row, then you can stop taking active pills for 5 days and let your uterus bleed.
Change your birth control
Often breakthrough bleeding can be resolved by changing your birth control. If you’re experiencing unwanted breakthrough bleeding due to your birth control pill, patch,or ring, you always have the option to change it. If you are taking the pill at the same time of day, every day and are still experiencing breakthrough bleeding, we recommend talking to your doctor about trying a different birth control pill. Did you know that there are 8 different progesterones and 2 levels each, over 40 types of birth control pills available, 3 types of rings and 2 types of patches? Finding the right medication for you can help reduce the chances of breakthrough bleeding, and is worth discussing with a doctor.
How Can Pandia Health Help You?
If you are experiencing unexpected bleeding, it is recommended that you talk to your doctor as soon as possible. If it’s not something that needs to be seen in person at the doctor’s office and your doctor is not a birth control expert, Pandia Health is here to help. Our expert birth control doctors are available to prescribe the best birth control for you – it’s easy to get started. We pride ourselves on providing expert birth control care. Our doctors prescribe birth control based on the “Pandia Health algorithm” which takes into account several factors, including age, race as a proxy for genetics (we hope to have genetics in the future), BMI, and your personal medical history, all of which can influence your body’s reaction to birth control. For example, if you are under 30 years old, it’s best to be on a method that has at least 30 mcg of estrogen for your bone health. Try Pandia Health’s online birth control consultation with our exceptional team of doctors who can prescribe your birth control online within 1 business day. And enjoy our FREE delivery service for each of your refills. With just one $30 payment a year, you can get unlimited access to our expert doctors (available in these states) for 364 days. To change your birth control, contact us today!
Disclaimer: This article, even if and to the extent that features the advice of physicians and medical practitioners, it is not, nor is it intended to be, a substitute for professional medical advice, diagnosis or treatment, and should never be relied upon for specific medical advice. Always seek the advice of your doctor/primary care provider for specific health needs.