Birth control and spotting

Spotting or intermenstrual bleeding is defined as light bleeding during the times when you’re not menstruating. It is completely normal among women who are taking the pill. One study of women taking a combined contraceptive pill found that 24% of them experienced spotting in the first three months, decreasing to 4% thereafter.

Some pills such as those containing only progesterone are more likely to cause spotting compared to those that also contain estrogen. That’s because estrogen helps maintian the lining of the uterus and if there is too little estrogen, the endometrial tissues can shed and cause bleeding.

If you experience spotting, it’s usually nothing to worry about. Most women only experience intermenstrual bleeding during the first three months of taking a new pill. It usually goes away soon after, but if bleeding continues or you experience heavy blood loss between periods, it’s best to contact your healthcare provider.

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What can I do to stop breakthrough bleeding?

If spotting continues or becomes bothersome, there are a couple of things you can do:

Switch to a different contraceptive method. You could try a different contraceptive pill that contains a higher dose of estrogen.
If you are currently on the mini-pill, you could take a low-dose of estrogen to stop intermenstrual bleeding. Speak to your doctor about that option.

When spotting is not related to oral birth control

Women who experience intermenstrual bleeding while taking the pill usually have nothing to worry about. But there are some cases of spotting which may require medical attention.

Pregnancy. In some cases, pregnancy can cause spotting. If you’ve missed taking a few contraceptive pills or have recently come off the pill, you could be pregnant. You can purchase a pregnancy test from a pharmacy or supermarket to check.
Infections. If you notice other symptoms such as pain in the lower abdomen or vaginal discharge alongside spotting, you may have an infection. It’s time to see a doctor.
Stress. Stressful situations increase the level of a hormone called cortisol which can interfere with your body’s natural defense mechanisms and hamper immune system responses. High levels of stress have also been associated with heavier periods.

References

Wright, K. P., & Johnson, J. V. (2008). Evaluation of extended and continuous use oral contraceptives. Therapeutics and clinical risk management, 4(5), 905–911. https://doi.org/10.1186/s12905-019-0766-610.2147/tcrm.s2143
Dean, J., Kramer, K., Akbary, F., Wade, S., Hüttemann, M., Berman, J., & Recanati, M. (2019). Norethindrone is superior to combined oral contraceptive pills in short-term delay of menses and onset of breakthrough bleeding: a randomized trial. BMC Women's Health, 19/1. https://doi.org/10.1186/s12905-019-0766-6
Amabebe, E., & Anumba, D. (2018). Psychosocial Stress, Cortisol Levels, and Maintenance of Vaginal Health. Frontiers in endocrinology, 9, 568. https://doi.org/10.3389/fendo.2018.00568
“Dysfunctional uterine bleeding.” (2019). Retrieved October 18, 2019, from <https://ndnr.com/endocrinology/dysfunctional-uterine-bleeding/>