Birth Control Pills - Breakthrough Bleeding
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 is usually a small amount of spotting between your periods. Breakthrough bleeding is normal and is usually a temporary side effect with birth control use. It occurs 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. 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, certain antibiotics, 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.
- 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, 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 (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 you taken 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. Most POPs contain 28 pills that are "active" birth control pills (containing norethindrone) with no inactive pills.
Progestin-only pills (POPs) include:
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.
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.
- Amethia, Amethia Lo
- Camrese, Camrese Lo
- Seasonique, LoSeasonique
Continuous-cycle birth control pill
The continuous-cycle birth control pill, which contains both an estrogen and a progestin, eliminates your period all together. You take one pill for each day of the year and there are no placebo pills. Breakthrough bleeding can also occur when taking normal 28-day birth control pills in a continuous manner, with an active pill every day.
The only continuous-cycle birth control pill in the US currently is Amethyst (ethinyl estradiol and levonorgestrel, the generic for Lybrel, which is no longer made.
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.
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. 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 like: 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.
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 don't forget, birth control pills do not provide protection against sexually transmitted infections like HIV or gonorrhea. Use a condom for protection.
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)
- 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 your birth control pill? Here's what to do
- Non-hormonal Birth Control
- Permanent Birth Control
- Antibiotics and Birth Control Pill Interactions: Fact or Fallacy?
- Birth Control and Alcohol: Do They Interact?
- Birth Control Guide
Medicine.com guides (external)
- Progestin-Only Hormonal Birth Control: Pill and Injection. ACOG. Oct. 2020. Accessed June 9, 2022 at https://www.acog.org/womens-health/faqs/progestin-only-hormonal-birth-control-pill-and-injection
- Planned Parenthood. Website. Birth Control Pills. Accessed June 8, 2022 at https://www.plannedparenthood.org/learn/birth-control/birth-control-pill/what-are-the-disadvantages-of-the-pill
- French V (author). What You Should Know About Breakthrough Bleeding With Birth Control. The American College of Obstetricians and Gynecologists (ACOG). Jan. 2021. Accessed June 8, 2022 at https://www.acog.org/womens-health/experts-and-stories/the-latest/what-you-should-know-about-breakthrough-bleeding-with-birth-control
- National Alliance of State Pharmacy Associations (NASPA). Pharmacist Prescribing: Hormonal Contraceptives. Dec. 1, 2021. Accessed June 8, 2022 at https://naspa.us/resource/contraceptives/
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.