Birth Control Pills - Breakthrough Bleeding
Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on May 7, 2020.
Why Do I Get Breakthrough Bleeding?
When any birth control pill is started, there is a chance that breakthrough bleeding (also called spotting) may occur during the first few months of use. Breakthrough bleeding occurs as your body adjusts to different hormone levels. Breakthrough bleeding is normal and is usually a temporary side effect with birth control use.
The chances for breakthrough bleeding are greater with progestin-only pills (POP or "mini-pill"), continuous-cycle or extended-cycle birth control pills. 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).
Progestin-only pills include products such as:
With extended-cycle birth control pills your period occurs 4 times a years. Extended-cycle dosing is given as 84 days of active pills and 7 days of inactive pills. Extended-cycle birth control pill products include:
- Amethia Lo
- Camrese Lo
Continuous-cycle birth control pills eliminate your period all together. Continuous-cycle birth control pill products include:
Breakthrough bleeding can also occur when taking normal 28-day birth control pills in a continuous manner, with an active pill every day.
Mini continuous dosing packs are also an available 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. Mini continuous cycle pills (with 24 or 26 days of active pills) include:
- Lo Loestrin Fe
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 also typically decrease over time.
What Causes Breakthrough Bleeding?
You are more likely to have breakthrough bleeding if you miss a pill, take certain medications that interfere with the pill (i.e., antibiotics, St. John's Wort), or have vomiting or diarrhea that may interfere with the absorption of the pill. Also, women who smoke are more likely to experience breakthrough bleeding than are women who don't smoke. Ask your doctor to help you stop smoking.
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 or lasts for more than seven days in a row, 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. However, be sure not to stop taking the pill before you start a new method of birth control or you’ll increase your risk of pregnancy. And finally, don't forget, birth control pills do not provide protection against sexually transmitted infections.
Learn More: See a full list of hormonal birth control pill options, including generic and proprietary names, dosing, side effects, and user reviews.
- Birth Control Pills
- Birth Control Pills - Periods
- Birth Control Pills: Benefits, Risks and 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 taking your birth control pill? Here's what to do next
- Non-hormonal Birth Control
- Permanent Birth Control
- Planned Parenthood. Website. Birth Control Pills. Accessed March 21, 2018 at https://www.plannedparenthood.org/learn/birth-control/birth-control-pill/what-are-the-disadvantages-of-the-pill
- Ortho MicroNor Package Insert. Janssen Pharmaceuticals. DailyMed. Accessed March 21, 2018 at https://dailymed.nlm.nih.gov/redirect/dailymed/lookup.cfm?setid=6fea0c04-cfbc-4bd2-8a1f-fa3d5ed2a941#nlm42230-3
- Seasonale: Is breakthrough bleeding more common? Drugs.com. Feb. 2016. Accessed March 21, 2018 at https://www.drugs.com/mcf/seasonale-is-breakthrough-bleeding-more-common.
- Choosing a Birth Control Method. Association of Reproductive Health Professionals. Accessed June 19, 2018 at https://www.arhp.org/index.php?error=404&itemId=99999
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.