Why You May Be Bleeding Or Spotting While On Hormonal Birth Control

Siena Team
13 Jul 2021

Perplexed as to why you’re finding bloodstains on your underwear or pad even though you’re not on your period? Or worse still, you freak out thinking of the worst-case scenario. 

More often than not, however, you may just be experiencing breakthrough bleeding.  

What is Breakthrough Bleeding? 

It refers to any type or amount of bleeding that occurs outside of your normal menstrual period or even during pregnancy. This could be spotting or heavy bleeding that may even require you to wear a pad or tampon.

Spotting is easily recognisable by tiny pink or red spots and usually lasts for a few days. It also isn’t as serious compared to heavy or continuous breakthrough bleeding. 

Some may also find that they simultaneously experience lower abdominal cramps (similar to menstrual cramps) a few days before or during breakthrough bleeding.

Breakthrough bleeding is usually painless and mostly harmless although of course, it can be an unpleasant and uncomfortable feeling. Here’s more of the science and facts behind it so you understand why it happens if you ever experience it. 

A Potential Side Effect of Hormonal Birth Control 

Breakthrough bleeding is a common side effect that some birth control users experience within the first three to four months after starting hormonal birth control. In that case, this includes any contraception method containing hormones as they’re all likely to cause breakthrough bleeding:

Why do hormonal birth control cause breakthrough bleeding? 

This happens because your body has to take time to adjust to the new hormones. As you experience changing hormone levels, it also alters the endometrial lining in your uterus which thus, causes a change in or disruption of your usual period cycle. Ultimately, this leads to breakthrough bleeding. 

If you’re on oral contraceptives, there’s another reason why you may be experiencing breakthrough bleeding.

When you take a break in between pills (i.e. skipped a dose, frequently forgetting to take your pills on time or you’re on the inactive pills for a week), breakthrough bleeding can also occur. This is a reaction to your body’s attempt in detecting and responding to fluctuating hormone levels which then causes the premature shedding of part of your uterine lining before your period’s due date. 

Spotting is a pretty clear indication that your body hasn’t yet adjusted to the hormones in your birth control or that you missed your pill. Typically, breakthrough bleeding should stop after a few months of consistent use.

But if it does persist, it’s highly recommended you consult a doctor. This could mean your current birth control method might not be the most suitable for you and you may want to consider another method, or it could also be a sign of another bleeding disorder. 

Other Possible Factors That Cause Breakthrough Bleeding

Besides hormonal birth control, there are other reasons which may explain your breakthrough bleeding. 

1. Age

If you’re in the early and developing stages of puberty, you’re more likely to experience breakthrough bleeding after starting your period. Your body requires time to go through several cycles before establishing one and balancing your hormones. 

Women who go through menopause may also experience spotting and irregular periods once they’re no longer in their reproductive years. During perimenopause (also known as a menopause transition preceding menopause by several years), some women may be more susceptible as well. 

2. Sexually Transmitted Infections (STIs) 

Specifically, chlamydia and gonorrhoea can cause excessive bleeding due to the irritation of your cervix, or neck of the uterus. This in turn can lead to unscheduled bleeding.

3. Pregnancy

Breakthrough bleeding can also happen when a fertilised egg attaches itself to your uterine lining, also known as implantation bleeding. But unfortunately, it can also be a sign of an impending miscarriage or an ectopic pregnancy.

4. Other conditions 

The following are several conditions that may also cause unscheduled bleeding: 

  • Cervical cancer — bleeding between periods and especially after sex
  • Endometriosis — a painful condition in which the endometrium grows outside the uterus, thus causing spotting and other painful symptoms
  • Endometrial hyperplasia — overly thick uterine lining that causes bleeding 
  • Polycystic ovary syndrome (PCOS) — a hormonal disorder due to lack of ovulation that produces small cysts in the ovaries and diminishes progesterone levels; excess estrogen causes thickening of the uterus 
  • Uterine fibroids and polyps — benign growths that can cause spotting in between periods, or even after a woman has gone through menopause

Recommendations to Manage Bleeding or Spotting 

It’s unlikely you can stop or avoid breakthrough bleeding once it happens BUT you may be able to decrease the likelihood of even experiencing it though this is dependent on the cause of your bleeding.

For instance, if you know for sure your hormonal birth control pill is the cause for your irregular bleeding, simply ensure that you stick to a consistent schedule by taking the pill around the same time each day without missing a dose. 

If you’re new to birth control, remember it’s normal and breakthrough bleeding should stop after three months. But if the bleeding is frequent, heavy or often accompanied by pain, it might be a warning sign you should attend to as early as possible.

Easing Your Worries

Spotting is common and is usually no huge cause for concern. As a precaution, you may find it useful and important to keep track of when spotting or bleeding occurs and take note of how light or heavy the bleeding is, as well as the frequency of your breakthrough bleeding. 

But of course, if you’d rather be on the safe side, definitely speak with a doctor to rule out more serious health conditions. Or if you simply want to know more about your birth control options, you can comfortably do so at Siena where you can connect with any one of our female doctors from the privacy of your own home!