Birth Control Pills: Why Do I Get Breakthrough Bleeding?

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on March 4, 2024.

When any birth control pill is started, there is a chance of breakthrough bleeding (spotting) in the first few months as your body adjusts to different hormone levels. The chances for breakthrough bleeding are greater with progestin-only pills (POPs or "mini-pill"), continuous-cycle or extended-cycle birth control pills.

Breakthrough bleeding is common, is usually just a small amount of spotting between your periods, and is typically a temporary side effect with birth control use. If you experience unusual, painful or heavy bleeding, contact your healthcare provider right away.

Progestin-only pills (POPs or "mini-pill"), continuous-cycle or extended-cycle birth control pills can cause more frequently breakthrough bleeding. These types of contraceptive regimens may lead to more irregular bleeding than the traditional 28-day schedule (21 days of an active pill and 7 days of inactive pill).

What causes breakthrough bleeding?

You are more likely to have breakthrough bleeding if:

• you miss one or more birth control pills
• take certain drugs or herbal products that interfere with the pill (for example: some antibiotics or St. John's Wort). Drugs or herbal products that increase certain enzymes in your body enzymes may decrease the effectiveness of hormonal contraceptives or increase breakthrough bleeding.
• you have vomiting or diarrhea that may interfere with the absorption of the pill
• you smoke. Women who smoke are more likely to experience breakthrough bleeding than women who do not smoke.

Most women have no ongoing problems with birth control pills and can continue to take them with minimal, if any, side effects. Continue to take your birth control as directed, even if you have breakthrough bleeding. Breakthrough bleeding usually subsides in two to three months.

Sore breasts, nausea or headaches are other temporary side effects you may experience early-on when starting birth control pills.

If breakthrough bleeding does not subside, becomes very heavy, lasts for more than seven days in a row, is painful or occurs after previously regular menstrual cycles, contact your healthcare provider. You may need to change the type of birth control or birth control pill that you use, or use a different method of birth control.

Benign (not cancerous) growths known as fibroids in the uterus can also lead to irregular spotting or heavy bleeding with your period, and your doctor can examine you to diagnose fibroids.

Progestin-only pills

Progestin-only pills (POPs) only contain a progestin and are estrogen-free. Some women choose POPs because they want or need to avoid estrogen or are breastfeeding. Women may have less bleeding or stop having periods altogether while taking POPs, which may be helpful for women who have heavy or painful periods.

Ideally, you should take your birth control pill at the same time each day. However, for most POPs, you MUST take them within the same three hours every day, or you'll need to use a backup method of birth control for at least 2 days (48 hours).

Most POPs contain 28 pills that are "active" birth control pills (containing norethindrone) with no inactive pills. Always review your specific instructions on the Patient Information Leaflet.

Progestin-only pills (POPs) include:

• Camila
• Errin
• Heather
• Jencycla
• Lyza
• Opill (OTC, no prescription required)

A new POP called Slynd (drospirenone) can be taken within 24 hours of missing one active tablet without using a backup method of birth control (instead of the 3 hour window with other POPs). Ask your doctor about this option. The Slynd package is different from most POPs as it contains 24 white active tablets and 4 green inactive tablets and a different active progestin called drospirenone.

• Slynd

Extended-cycle birth control pills

Extended-cycle birth control pills are combined oral contraceptives that contain both a progestin, like levonorgestrel, and an estrogen like ethinyl estradiol. With extended-cycle birth control pills your period occurs 4 times a years. Extended-cycle dosing is typically given as 84 days of active pills and 7 days of inactive pills.

Options include:

• Amethia, Amethia Lo
• Camrese, Camrese Lo
• Daysee
• Introvale
• Jolessa
• Seasonale
• Seasonique, LoSeasonique
• Quartette

Continuous-cycle birth control pill

The only continuous-cycle birth control pill in the US currently is Amethyst (ethinyl estradiol and levonorgestrel). Amethyst has 28 active pills per pack, and you take one active pill every day. There are no inactive (placebo) pills.

Amethyst contains both an estrogen and a progestin and eliminates your period all together. You will not have full menstrual bleeding but you may have breakthrough bleeding or spotting for the first 3 to 6 months. This typically decreases over time.

• Amethyst

Mini continuous cycle pills

Mini continuous dosing packs are also an option to lower the impact of a monthly period, but not completely eliminate it. A few extra active estrogen pills in these packs can lead to lighter and shorter periods and more stable hormone levels.

Examples of mini continuous cycle pills (with 24 or 26 days of active pills) include:

• Beyaz (drospirenone, ethinyl estradiol, and levomefolate). Levomefolate is a B vitamin.
• Yaz (drospirenone) and ethinyl estradiol)
• Lo Loestrin Fe (ethinyl estradiol, norethindrone, and ferrous fumarate). Ferrous fumarate is an iron supplement.

Is it safe to use the pill to stop my period?

There is no known medical benefit to having a monthly period.

• Extended-cycle, continuous-cycle, or mini continuous-cycle dosing of birth control is safe and more convenient, especially for women who are involved in sports, who travel frequently, or just plain prefer the convenience.
• Extended-cycle or continuous-cycle birth control may also offer relief for women who suffer from heavy or painful periods, endometriosis, or premenstrual syndrome (PMS).
• Plus, the cost-savings from not having to buy as much product like tampons or pads for your period can be significant.

Breakthrough bleeding or spotting that may occur with continuous or extended-cycle birth control pills will typically decrease over time. Breakthrough bleeding can also occur when taking normal 28-day birth control pills in a continuous manner, with an active pill every day.

Contact your doctor if your spotting or bleeding is concerning for you. You may need to change to another type of pill or different contraceptive.

How do I get birth control pills?

See your doctor for a prescription, or ask your pharmacist if they can prescribe birth control pills. Not all pharmacists offer this service, but it is approved in some US states, for example: Arizona, Arkansas, California, Colorado, Delaware, District of Columbia, Hawaii, Idaho, Illinois, Maryland, Minnesota, Nevada, New Hampshire, New Mexico, North Carolina, Oregon, Utah, Vermont, Virginia, and West Virginia. Call your pharmacy to check.

Opill (norgestrel 0.075 mg) is the first nonprescription, over-the-counter (OTC) birth control pill (oral contraceptive) approved in the United States for all ages.

• On July 13, 2023 the US Food and Drug Administration approved Opill in an Rx-to-OTC switch.
• Opill is a progestin-only pill (POP) and is expected to be available on pharmacy shelves, grocery stores, other retailers and online in March of 2024
• The cost of Opill will be $19.99 for one month pack, $49.99 for a 3-month pack and $89.99 for a 6-month pack. Check online or check with your pharmacy for availability.

Learn more: How effective is Opill OTC birth control?

If you decide to stop the pill, be sure you protected with a new method of birth control or use a barrier method because you’ll greatly increase your risk of pregnancy. And don't forget, birth control pills do not provide protection against sexually transmitted infections like HIV or gonorrhea. Use a male latex condom for female condom protection for that.

Combined oral contraceptives (with both a progestin and an estrogen) should NOT be used in women aged over 35 years who smoke because of a higher risk of serious side effects such as a heart attack, blood clot, or stroke. For a complete list of severe side effects, please refer to the individual drug monographs.

Learn More: See a full list of hormonal birth control pill options (in more detail)

See also

• Birth Control Pills (Oral Contraceptives)
• Birth Control Pills and Your Period
• Birth Control Pills: Benefits, Risks & Side Effects
• Emergency Contraception
• Emergency Contraceptives Available in the U.S.
• Grapefruit and Birth Control Pills: Your Questions Answered
• Hormonal Birth Control (Non-Pill Options)
• Missed your birth control pill? Here's what to do
• Non-hormonal Methods of Birth Control
• Permanent Birth Control

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer