Birth control and spotting: is bleeding normal?

Spotting and breakthrough bleeding can happen for many reasons


Spotting in between periods is a common issue

Spotting and breakthrough bleeding are common when initially starting birth control, and shouldn’t alarm you. Breakthrough bleeding is annoying and can ruin underwear and pants — especially when you haven’t prepared for it — but in most cases, it’s not a health problem. Spotting and breakthrough bleeding between periods are especilly likely during the first three months after starting oral contraceptices.

Hormone-based birth control pills, patches, or rings are used by many women of reproductive age, not only to avoid unplanned pregnancies, but also to regulate the menstrual cycle. During the first six months of using a new birth control product, spotting is quite common, as your body still needs to adapt to changing hormone levels. Skipping or being late to take a pill can also cause spotting. 

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Why does birth control cause spotting?

As your doctor probably told you, and as stated on birth control packaging, the pills have to be taken every day at close to the same time. Irregular timing or missing a dose can trigger spotting and breakthrough bleeding, in addition to reducing the efficacy of the medication.  After a few missed doses, the effect of the pill will wears off and ovulation can occur.  This then places you at risk of pregnancy from unprotected sex.  Paying careful attention to your birth control schedule will reduce the likelihood of spotting.

However, during the first six months of using a new birth control pill, patch or ring, you may get breakthrough bleeding even if you make sure you always take the pills on time. The active ingredients of birth control pills are the hormones estrogen and progesterone. Their primary function is to prevent ovulation, but they also reduce the cervical mucus and make other changes that lower the likelihood of getting pregnant to nearly zero. One of the effects is the thinning of the uterus lining, which is why spotting and breakthrough bleeding can happen during the first few months.

If you are concerned about the spotting or if the bleeding becomes severe, it’s always a good idea to see your doctor to rule out any other issues that could be behind the bleeding. Otherwise, just wait and be patient. You’ll see that the breakthrough bleeding becomes less with each cycle and eventually goes away after 5-6 months. However, if it doesn’t stop after six months, it’s best to check with your gynecologist or doctor. There may be alternative birth control options that will work better for you.


When do I need to worry about breakthrough bleeding?

If you don’t use any hormone-based birth control but still experience breakthrough bleeding or spotting in between periods, there are several potential reasons to explain this. It is important however, to talk to a gynecologist or other healthcare professional to help rule out more serious underlying medical issues.

Below we list the most common causes behind spotting and breakthrough bleeding that aren’t birth control related:  


Women in menopause are the most likely to get breakthrough bleeding and irregular periods. 

Teenage girls tend to experience more breakthrough bleeding than adult women, especially for the first few years after they first get their periods. This is because it can take a few years for the menstrual cycle and hormone levels to reach a steady state. 


Breakthrough bleeding can also be caused by implantation of a fertilized egg in the wall of the uterus. Bleeding or spotting is usually short-lived in this case.  Some pregnant women will see repeated spotting during the early weeks of pregnancy, which can be a sign of miscarriage. Therefore, pregnant women are always advised to see a doctor if they notice any spotting or bleeding.

Sexually Transmitted Infections (STIs)

Several STIs including gonorrhea and chlamydia can trigger bleeding and spotting between periods, as they infect and irritate the cervix.

Fibroids and Polyps 

Fibroids and polyps in the uterus are common but generally benign skin growths.  Tey can however cause bleeding between periods. Doctors will surgically remove such fibroids and polyps when bleeding is excessive.


Endometriosis is a condition where the endometrium grows and extends outside of the uterus.  There’s a range of symptoms of this disease, one of which is spotting or bleeding. Many birth control pills can actually relieve the symptoms of endometriosis.

Endometrial Hyperplasia

Endometrial Hyperplasia will cause the uterine lining to grow very thick, which can lead to tissue breakdown and breakthrough bleeding. Endometrial hyperplasia typically is treated with hormone therapy and sometimes, minor surgery.

Cervical Cancer

This is a rare cancer, but women between the ages of 20 and 65 should be regularly screened for it (every 3-4 years). One of the signs of cervical cancer is bleeding between periods, particularly if it happens right after sexual intercourse. 

In the vast majority of cases, breakthrough bleeding isn’t something you’ll need to worry about, regardless of whether you take birth control pills or not. However, when in doubt, it’s always good to get yourself checked by a doctor. 



  • Schrager, Sarina. “Abnormal Uterine Bleeding Associated with Hormonal Contraception.” American Family Physician, vol. 65, no. 10, 2013, p. 2073, Accessed 12 Jun 2020.
  • Wright, Kristen Page, and Julia V Johnson. “Evaluation of Extended and Continuous Use Oral Contraceptives.” Therapeutics and Clinical Risk Management, vol. 4, no. 5, 2008, pp. 905–11, Accessed 12 Jun12 Jun 2020.
  •  Villavicencio, Jennifer, and Rebecca H Allen. “Unscheduled Bleeding and Contraceptive Choice: Increasing Satisfaction and Continuation Rates.” Open Access Journal of Contraception, vol. 7, 31 Mar. 2016, pp. 43–52,, 10.2147/OAJC.S85565. Accessed 12 Jun 2020.

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