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

Any vaginal bleeding, even light outside the menstrual period, can raise an alarm. Why am I bleeding on the pill when I should not be? Also known as breakthrough bleeding, it is common in women using a hormonal birth control method.

Breakthrough bleeding generally represents spotting on birth control at a time during the menstrual cycle when periods are not expected. The article discusses the various causes of spotting on birth control, what factors influence it, and how to manage it.

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Understanding Breakthrough bleeding

Spotting on birth control or breakthrough bleeding is the bleeding or spotting that occurs in between periods while you are using hormonal birth control. It is different from withdrawal bleeding that occurs while you are off your regular hormonal birth control pills (such as during the pill-free week).

Why am I bleeding on birth control? Breakthrough bleeding can occur at any time when you are using a hormonal birth control method. Spotting on birth control is a common side effect and is rarely a sign of a health problem.

Do types of hormonal birth control affect breakthrough bleeding?

Why am I bleeding on birth control? Breakthrough bleeding may occur with any hormonal birth control, including:

Combined hormonal birth control (pill, vaginal ring, and patch)

Combined hormonal birth control methods contain both progestin (synthetic progesterone) and estrogen. They are quite popular methods of contraception. 

The birth control pills

It is common to experience brown spotting on birth control pills during the initial three months of taking the hormonal pill. The spotting improves gradually over time.Why am I bleeding on the pill when I should not be? Pills containing a lower dosage of estrogen cause spotting more often in comparison to higher dose pills.

Vaginal ring (that you can place and remove in your vagina on your own)

Breakthrough bleeding is also common in women using a vaginal ring containing hormones during the initial few months. The bleeding usually improves within one year of using the ring.

Hormonal skin patch

It is common to notice breakthrough bleeding during the initial couple of months if you have a hormonal skin patch for birth control.

Progestin-only birth control (mini-pill, implant, shot, and IUD)

Why am I bleeding on birth control? It is more common to experience breakthrough bleeding on progestin-only birth control in comparison to combined hormonal birth control.

The mini-pill

Why am I bleeding on the pill when I should not be? Women who use the mini-pill are more prone to unpredictable bleeding in comparison to those who use the combined pill. This is due to the change in hormonal levels caused by the mini-pill. The latter increases the hormones and causes spotting.

Hormonal implant

Why am I bleeding on birth control? Breakthrough bleeding is also common in women using hormonal implants, which usually contain only the progesterone hormone.

Hormonal intrauterine devices (IUDs)

Spotting and unpredictable bleeding are common during the initial few months when using hormonal intrauterine devices. The symptoms tend to decrease with continued use. 

Hormonal shot (Depo-Provera)

Vaginal bleeding often stops or becomes lighter gradually in women using a hormonal shot. However, unpredictable, infrequent, or prolonged bleeding may still occur.

Why am I bleeding on birth control? Breakthrough bleeding occurs more often while using:

• Low-dose birth control pills (containing a low dose of estrogen)
• Hormonal IUDs
• The implants

Why am I bleeding on birth control? Factors that may affect breakthrough bleeding

Starting a new hormonal birth control

Breakthrough bleeding commonly occurs after starting a new hormonal birth control. This is because the body adjusts to the new hormonal levels. Brown spotting on birth control improves a couple of months after using the new birth control.

Missing a pill

Why am I bleeding on the pill when I should not be? If you miss a birth control pill, or even if you take it late, you may experience breakthrough bleeding. This is because missing a pill can cause a sudden drop in the hormone levels.

Having loose stools or vomiting before the pill is fully absorbed by the body can also result in spotting due to reduced hormone levels.

Taking the pill continuously

Why am I bleeding on the pill when I should not be? The usual design of hormonal birth control pills is to take them for three weeks and give a break for one week. During this break, you experience withdrawal bleeding.

When you delay a withdrawal bleeding or avoid it completely by taking the pills continuously, you may experience spotting.

Having a sexually transmitted infection (STI)

Why am I bleeding on birth control? Having an STI may also cause brown spotting. If you suspect your symptoms are due to an STI, then visit a healthcare professional and get tested as early as possible. Gonorrhea and chlamydia are two common STIs that may cause spotting.

Having a benign growth in the uterus

Why am I bleeding on birth control? Irregular bleeding may occur due to benign growths (non-malignant growths) in the uterus, such as fibroids or polyps. This bleeding is not related to birth control. If you are experiencing irregular spotting and birth control is not the possible cause, you should consult your physician.

Taking other medicines

Taking certain medicines may interfere with the absorption of the hormones present in your birth control. Some of these medicines include anti-seizure drugs, antibiotics such as rifamycin, and certain herbal supplements (for example, St. John’s Wort). Taking these medicines may make you prone to experiencing spotting on birth control.

Lifestyle factors

Some of the lifestyle factors that may cause changes in the bleeding pattern are:

• Having excessive stress
• Doing excessive exercise
• Smoking (increases the likelihood of having breakthrough bleeding)
• Recent gain or loss of weight

How to manage spotting on birth control?

Spotting on birth control is a normal and common side effect of using hormonal birth control methods, and it reduces within a few months. However, the following measures may help stop the spotting:

Quit smoking

If you are a smoker, then quitting smoking may help. It is found that spotting on birth control is more common in women who smoke than in those who do not smoke.

Do not miss a pill

Taking a birth control pill at an exact time every day may help reduce spotting on birth control.

Schedule a withdrawal bleed

Taking hormones continuously, whether through birth control pills or a vaginal ring, may trigger brown spotting on birth control. Hence, it may help to take a break. Try to schedule a period or withdrawal bleed every few months. This allows the uterus to shed and dispel any built-up uterine lining. It helps in reducing irregular bleeding and spotting.

Track your irregular spotting/bleeding

By tracking your spotting on birth control, you can get reassurance that the spotting is reducing gradually.

Adjusting the dose of the pill

Your gynecologist may recommend switching from a low-dose estrogen pill to a higher dose.

When to consult a healthcare provider?

You should visit your healthcare provider in the following scenarios:

• If the bleeding continues for eight days or longer in a row
• If the bleeding is severe or increases in quantity
• If the bleeding is accompanied by intense pelvic or abdominal pain
• If the bleeding or pain occurs during sexual intercourse
• If there is a possibility of pregnancy with bleeding
• If you think there is a possible exposure to an STI
• If the bleeding is accompanied by chills or fever

FAQs

Can spotting on birth control and pregnancy occur at the same time?

Light spotting or bleeding is often an early symptom of pregnancy, referred to as implantation bleeding. Hence, it is quite possible to have implantation bleeding on birth control, if you become pregnant on birth control.

What is the color of breakthrough bleeding?

The color of breakthrough bleeding may be brown, pink, or red.

Can spotting on birth control occur due to stress?

Stress may cause irregular bleeding between periods, irrespective of using hormonal birth control. Hence, stress may or may not cause spotting on birth control.

Should you stop using birth control if you experience breakthrough bleeding?

Many women may experience breakthrough bleeding after starting a new method of birth control, and the bleeding usually reduces with time. So, spotting on birth control does not necessarily mean that you stop using your birth control. However, if it disrupts your daily life, consult your gynecologist about different options.

Does spotting imply that the birth control pill is no longer effective?

No, experiencing spotting on birth control does not mean that the birth control is ineffective. If spotting is due to taking certain medicines or missing pills, it is advisable to consult your gynecologist to ensure continued contraceptive protection.

Conclusion

Why am I bleeding on the pill when I should not be? Breakthrough bleeding refers to light vaginal bleeding or spotting between periods while using hormonal contraceptives such as combined pills, vaginal rings, implants, patches, shots, or hormonal IUDs.

Spotting on birth control is common, usually during the initial few months of starting a new birth control method. Spotting does not imply birth control failure but needs attention if severe or persistent.

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