What causes breakthrough bleeding on birth control. How common is spotting with different contraceptive methods. When should you be concerned about irregular bleeding while using hormonal contraceptives. What are effective ways to manage or reduce breakthrough bleeding.

What is Breakthrough Bleeding and Why Does it Occur?

Breakthrough bleeding refers to any unexpected vaginal bleeding or spotting that occurs while using hormonal birth control. It’s a common side effect that many women experience, especially in the first few months of starting a new contraceptive method. But what exactly causes this irregular bleeding?

The primary reason for breakthrough bleeding is hormonal fluctuations. Birth control methods work by altering your body’s natural hormone levels to prevent ovulation and pregnancy. These hormone changes can lead to thinning of the uterine lining, making it more prone to shedding and bleeding at unpredictable times.

Common Causes of Breakthrough Bleeding

• Starting a new birth control method
• Missed or late pills
• Interactions with other medications
• Smoking
• Underlying health conditions

Is breakthrough bleeding a sign that your birth control isn’t working? Not necessarily. While frustrating, irregular spotting or bleeding doesn’t typically impact the contraceptive effectiveness of hormonal birth control methods. However, it’s always wise to use backup contraception if you’ve missed pills or are concerned about proper usage.

Which Birth Control Methods are Most Likely to Cause Spotting?

While breakthrough bleeding can occur with any hormonal contraceptive, some methods are more commonly associated with this side effect than others. Understanding the likelihood of irregular bleeding with different birth control options can help you make an informed decision about which method is right for you.

Birth Control Pills

Oral contraceptives, particularly low-dose and ultra-low-dose pills, are frequently linked to breakthrough bleeding. This is especially true during the first few months of use as your body adjusts to the new hormone levels. Continuous or extended-cycle pills, which reduce or eliminate monthly periods, may also lead to more frequent spotting.

Hormonal IUDs

Intrauterine devices that release hormones, such as Mirena or Skyla, often cause irregular bleeding patterns in the initial months after insertion. For most women, this improves within 3-6 months as the body adapts to the localized hormone delivery.

Birth Control Implant

The contraceptive implant (Nexplanon) is known to cause unpredictable bleeding patterns. Unlike with other methods, the bleeding pattern established in the first three months of use often persists throughout the duration of implant use.

Other Methods

The birth control shot (Depo-Provera), vaginal ring, and hormonal patch can also lead to breakthrough bleeding, though typically less frequently than the methods mentioned above.

Factors That Increase Your Risk of Breakthrough Bleeding

While many women may experience some degree of irregular bleeding on birth control, certain factors can increase your likelihood of dealing with this side effect. Being aware of these risk factors can help you anticipate and manage breakthrough bleeding more effectively.

1. Smoking: Cigarette use is strongly associated with increased breakthrough bleeding in women using hormonal contraceptives.
2. Inconsistent use: Missing pills or not using your chosen method as directed can lead to hormone fluctuations and spotting.
3. Certain medications: Some antibiotics, antiseizure drugs, and herbal supplements can interfere with hormonal birth control and cause bleeding.
4. Infections: Sexually transmitted infections like chlamydia or gonorrhea may increase the risk of irregular bleeding.
5. Uterine fibroids: These benign growths can cause bleeding that may be mistaken for birth control-related spotting.

Are there ways to reduce your risk of breakthrough bleeding? Yes, some factors are within your control. Quitting smoking, taking pills consistently at the same time each day, and being cautious about drug interactions can all help minimize your chances of experiencing irregular bleeding.

Managing and Reducing Breakthrough Bleeding

If you’re experiencing persistent or bothersome breakthrough bleeding, there are several strategies you can try to manage or reduce this side effect. Many women find relief through simple adjustments to their birth control regimen or lifestyle changes.

Self-Help Strategies

• Take pills at the same time daily to maintain consistent hormone levels
• Consider scheduling a “period break” every few months if using continuous birth control
• Quit smoking to reduce the risk of irregular bleeding
• Use backup contraception if you’ve missed pills or are concerned about effectiveness

Medical Interventions

If self-help strategies aren’t effective, your healthcare provider may suggest medical interventions to address breakthrough bleeding. These might include:

• Switching to a different formulation of birth control pill
• Adjusting the number of hormone-free days in your pill pack
• Adding short-term estrogen therapy for those using progestin-only methods
• Exploring alternative birth control methods that may be better suited to your body

Can ibuprofen help with breakthrough bleeding? Some healthcare providers recommend taking ibuprofen to reduce bleeding, particularly for women using IUDs or the birth control implant. However, always consult with your doctor before starting any new medication regimen.

When Should You Be Concerned About Breakthrough Bleeding?

While breakthrough bleeding is often harmless, there are situations where it may signal a more serious issue. Being able to distinguish between normal spotting and potentially problematic bleeding is crucial for maintaining your reproductive health.

Red Flags to Watch For

• Heavy bleeding that soaks through one or more pads or tampons an hour for several hours in a row
• Bleeding that lasts for more than 7 days
• Severe pain accompanying the bleeding
• Bleeding after intercourse
• Fever or other signs of infection

Should you always call your doctor about breakthrough bleeding? Not necessarily, especially if it’s light spotting that resolves on its own. However, if you experience any of the red flags mentioned above, or if you’re simply concerned about your bleeding patterns, it’s always appropriate to reach out to your healthcare provider for guidance.

The Impact of Breakthrough Bleeding on Quality of Life

While breakthrough bleeding isn’t typically harmful to your physical health, it can have a significant impact on your quality of life. Understanding these effects and learning how to cope can help you navigate this common side effect more effectively.

Emotional and Psychological Effects

Unexpected bleeding can cause anxiety, frustration, and even embarrassment for many women. It may lead to concerns about birth control effectiveness or underlying health issues. Some women report decreased sexual satisfaction or avoidance of intimate activities due to unpredictable bleeding.

Practical Considerations

Breakthrough bleeding can also present practical challenges. It may require always having menstrual products on hand, lead to stained clothing, or interfere with activities like swimming or exercise. For some women, these inconveniences may outweigh the benefits of their chosen birth control method.

Coping Strategies

• Keep a bleeding diary to track patterns and identify potential triggers
• Always carry menstrual products as a precaution
• Wear dark-colored clothing or use period underwear for added protection
• Communicate openly with your partner about your experiences
• Join support groups or online communities to connect with others facing similar challenges

How can you maintain a positive outlook despite breakthrough bleeding? Remember that for many women, this side effect improves over time. Focus on the benefits of your chosen birth control method and be patient as your body adjusts. If the bleeding significantly impacts your quality of life, don’t hesitate to discuss alternative options with your healthcare provider.

The Future of Birth Control and Breakthrough Bleeding

As medical science advances, researchers continue to explore new contraceptive options and improvements to existing methods. These developments hold promise for reducing the incidence and impact of breakthrough bleeding in the future.

Emerging Technologies

• Novel hormone delivery systems that provide more consistent levels of hormones
• Personalized medicine approaches that tailor contraceptive formulations to individual women’s needs
• Non-hormonal contraceptive methods that may eliminate hormone-related side effects altogether

Ongoing Research

Scientists are investigating the underlying mechanisms of breakthrough bleeding to develop more targeted interventions. This includes studying the role of genetics in individual responses to hormonal contraceptives and exploring new compounds that may stabilize the uterine lining.

What can we expect in the coming years? While it’s difficult to predict specific breakthroughs, the trend is clearly towards more personalized and effective birth control options. As our understanding of reproductive biology grows, so too does the potential for contraceptive methods that offer reliable pregnancy prevention with minimal side effects.

In conclusion, while breakthrough bleeding remains a common challenge for many women using hormonal birth control, it’s important to remember that solutions are available. By working closely with your healthcare provider, staying informed about your options, and advocating for your reproductive health needs, you can find a contraceptive approach that works best for you. Whether you choose to manage breakthrough bleeding with your current method or explore alternative options, remember that your comfort and wellbeing are paramount in any birth control decision.

What You Should Know About Breakthrough Bleeding With Birth Control

Breakthrough bleeding is a common concern among women using hormonal birth control. It’s usually a small amount of spotting at a time when you’re not expecting your period, though some women have heavier bleeding. Most often, my patients come in saying they feel fine, but are noticing a little spotting when they use the bathroom. Should they be worried?

I reassure them that breakthrough bleeding rarely signals a health problem. And it doesn’t mean your birth control isn’t effective at preventing pregnancy. But there are ways we can try to fix it.

Here’s what I tell my patients about birth control and breakthrough bleeding.

It can happen with any type of hormonal birth control.

All these methods work by delivering hormones that prevent pregnancy. These methods include

• birth control pills

• the birth control implant, a small plastic rod that’s placed under the skin of the upper arm

• hormonal IUDs (intrauterine devices)

• the birth control shot given by a health care professional

• the vaginal ring that women can place and remove on their own

• the skin patch that contains hormones

But it’s more common with certain types of birth control.

Breakthrough bleeding happens more often with low-dose and ultra-low-dose birth control pills, the implant, and hormonal IUDs.

With IUDs, women often have spotting and irregular bleeding in the first months after placement. This usually gets better in 2 to 6 months. With the implant, though, the bleeding pattern women have in the first 3 months is usually their pattern going forward.

Some women are more likely to experience it.

Breakthrough bleeding happens more often in women who smoke cigarettes and in women who don’t take their birth control pills consistently. Some medications, like emergency contraception pills, also can cause irregular bleeding. Having certain infections, such as chlamydia or gonorrhea, also can increase risk.

It’s also more common when women who use birth control pills or the ring take a continuous dose of hormones to skip their periods altogether. One more factor: Benign (not cancerous) growths such as uterine fibroids can cause irregular bleeding that’s unrelated to birth control.

Some women can improve breakthrough bleeding on their own.

Quitting smoking can help. So can taking birth control pills at the same time each day.

If you’re getting continuous hormones with birth control pills or the ring, try scheduling a period every few months. This gives the uterus a chance to shed any built-up lining. It can help reduce irregular spotting and bleeding.

Your ob-gyn can help.

Although breakthrough bleeding with birth control isn’t physically harmful, it can be really annoying. When a patient says they’re having spotting or irregular bleeding, we first chat about the factors that might be causing the bleeding. Then we may do a physical exam as well.

After we confirm the bleeding is related to birth control, there are usually a number of options. For example, we can switch from an ultra-low-dose birth control pill to a low-dose pill. We also can change the number of placebo (or pill-free) days. Or we can explore other methods of birth control. With IUDs, implants, or the birth control shot, taking ibuprofen can be helpful, or we can add short-term treatment with estrogen pills.

No matter the situation, talk with your ob-gyn if you’re unhappy with your bleeding. We don’t want women to struggle with breakthrough bleeding, and we definitely have options to improve it.

Published: January 2021

Last reviewed: February 2023

Copyright 2023 by the American College of Obstetricians and Gynecologists. All rights reserved. Read copyright and permissions information.

This information is designed as an educational aid for the public. It offers current information and opinions related to women’s health. It is not intended as a statement of the standard of care. It does not explain all of the proper treatments or methods of care. It is not a substitute for the advice of a physician. Read ACOG’s complete disclaimer.

Why Does Birth Control Cause Spotting?

Written by Hallie Levine

Medically Reviewed by Nivin Todd, MD on June 21, 2022

• Which Types of Birth Control Can Cause Breakthrough Bleeding?
• How Can I Stop Breakthrough Bleeding?
• When Should You Call Your Doctor?

If you go on a hormonal form of birth control, you might expect it to help with pesky bleeding. But breakthrough bleeding is a common side effect of contraceptive use.

It might just be some light spotting when you’re not expecting your period. Or the bleeding might be heavier. That can be surprising, especially if you went on birth control to try to regulate your period.

The good news is breakthrough bleeding isn’t harmful. And it usually can be stopped. Here’s what you need to know.

All forms of hormonal birth control can trigger breakthrough bleeding, including:

Pills. Up to 50% of people who start estrogen-progestin birth control pills have spotting, but this number goes down to less than 10% by the third month of use. You’re more likely to have unscheduled bleeding if you use a low-dose or ultra-low dose birth control pill.

Implants. This is a small rod placed in your upper arm. Almost 80% of users report breakthrough bleeding during the first 3 months.

Intrauterine devices (IUDs). Unscheduled bleeding can happen with both hormonal and copper IUDs.

The birth control shot. Most people who get depot medroxyprogesterone acetate (Depo-Provera) have breakthrough bleeding. But it usually gets better over time.

Hormonal skin patches. Unscheduled bleeding with this form of birth control occurs at about the same rate as hormonal birth control pills.

Breakthrough bleeding is most common with:

• Low-dose birth control pills
• The implant
• Hormonal IUDs

You’re more likely to see breakthrough bleeding if you:

• Smoke
• Don’t take your birth control pills consistently
• Take an emergency contraception pill (Plan B)
• Have an STD like chlamydia or gonorrhea

Using birth control pills or the vaginal ring continuously (meaning you don’t stop for a week each month), may also trigger bleeding.

Give it time. If you’re on a hormonal IUD, oftentimes it will go away on its own within 6 months of insertion. The same is true for birth control pills. It may take time for your body to get used to the hormones in the pill and for the lining of your uterus to become thinner.

However, if you have breakthrough bleeding for the first 3 months on the implant, you can expect it to continue.

Other steps you can take include:

If you smoke, work on quitting. Ask your doctor for help if you need it.

Stay on schedule. Take your birth control pills at the same time every day.

Consider NSAIDs. If you want some type of treatment, your doctor might recommend an over-the-counter or prescription nonsteroidal anti-inflammatory such as ibuprofen. The usual dose is 400–800 milligrams three times a day for 5-10 days. But there’s not a lot of research to support this.

Take a break. Talk to your doctor about scheduling a period every few months if you take birth control pills or use the vaginal ring without stopping for a week. An occasional period allows your uterus to shed any built-up lining, which stops breakthrough bleeding.

Switch your birth control pill. For example, if you’re taking an ultra-low-dose birth control pill, your doctor can prescribe one with a slightly higher dose. Your doctor also might change the number of placebo days. That’s when you take a pill that doesn’t contain hormones to keep you on schedule.

Try another option. If you’re on the birth control pill, your doctor might recommend that you try the vaginal ring instead. Because the ring has more consistent hormone levels than the pill, you are less likely to have spotting. Also, you won’t have bleeding due to a missed pill.

Add another form of birth control. For some methods, like the birth control shot, your doctor might also prescribe a low-dose combination birth control pill for 10-20 days. Some doctors also give shots more often, but it’s not recommended, as there’s no data that shows this practice works.

Let your doctor know if your breakthrough bleeding becomes heavy. That means less spotting and more like an actual period. Or if the bleeding lasts for more than 7 days in a row. In these situations, there may be another cause, such as an infection or fibroids.

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Third extra: why China should have eased birth control long ago

Apparently, by the end of the year, Chinese couples will be allowed to have three children. But the new policy is unlikely to solve China’s aging population and shrinking workforce, says Igor Denisov, a senior fellow at the Institute for International Studies at Moscow State Institute of International Relations (MGIMO). Nevertheless, it is not canceled, but only consistently adjusted. Officially, this is presented as the ability of the party to adapt to changing conditions. However, it is no secret that these conditions themselves were largely created by the previous administrative measures. Especially a lot of complaints are expressed against the rigid policy of “one family – one child”, which was proclaimed in 1980 year. Since 1982, planned childbearing has become a constitutional norm, it is mentioned four times in the Basic Law, and fertility planning is in the first place among the duties of both spouses.

The adoption of the relevant law is ahead, but the Politburo of the Central Committee of the Communist Party of China has already approved changes in the birth control policy.

Unnecessary rigidity

Today, the authorities are trying to achieve balanced economic growth and overcome the progressive decline in the working population. However, the critically low population growth, distortions in the gender and age structure, and even such social problems as the selfishness and infantilism of the generation of “little emperors” – the only children in families – are largely related to the “one family – one child” policy.

The reports of supporters of this course claim that as a result, 400 million new citizens were not born in China, but in fact, the decline in the birth rate was due to 75% of natural social factors: urbanization, increased employment and education of women, the growth of the middle class, who is not so bound by the traditional ideals of a large multi-generational family. These trends are so strong that even allowing all couples to have two children since 2016 has not helped to cope with the demographic collapse.

For 10 girls, 12 guys: how birth control in China led to a shortage of women

The decision on strict birth control was not the only option, and no “demographic catastrophe” most likely threatened China. Since the late 1960s, the birth rate in China has already begun to decline. According to Chinese demographers, if, with the beginning of Deng Xiaoping’s reforms, the former soft course of “later – less often – less” (marry later, take at least a four-year break between births, have two or three children in families) continued, then it would be possible to achieve harmony between the growing number of Chinese and the needs of economic development. However, for this it would not be necessary to concentrate huge state power and bring down exorbitant fines on the families of violators, interfere in the personal lives of millions of people and, most importantly, create a very costly bureaucracy. Probably, Chinese leaders and some of their advisers were strongly impressed by the predictions of the Club of Rome about the danger of uncontrolled population growth, projecting the conclusions of futurologists onto a weak and poor China.

This is a vivid example of how the consequences of a political decision are multiplied by bureaucratic inertia. Even according to fragmentary data, it is clear that not only a self-sufficient control apparatus was formed around the “planned childbearing”, but also serious financial interests arose. Chinese statistics do not take into account the corrupt side of demographic policy, but according to expert estimates, only from 1980 to 2011, up to 2 trillion yuan of fines were officially collected from citizens for “extra” children (about $312.7 billion at the current exchange rate). The budgets of the less developed provinces of the PRC were highly dependent on revenues from this item. Now that Chinese families are almost allowed to have a third child, the story of famous film director Zhang Yimou, who in 2014 had to pay a fine of $1.2 million for three “illegal” children, looks like a bitter irony.

The burden of demography

It is possible that soon the government will have to pay extra for the birth of children. The Politburo’s decision came less than a month after the seventh general population census in China’s history was summed up. The results were more alarming than expected. Firstly, the planned baby boom did not take place. Immediately after the permission for two children in the family, some scientists predicted a sharp rise in the birth rate, but it turned out that after a short-term surge, it fell again. If in 2000 (that is, at the height of the “one-child” policy), the number of births in China was 17.71 million, then in 2020 only 12 million children were born. Secondly, the census showed that China is confidently turning into a “country of gray hair” and can grow old faster than it gets rich.

The combination of these two factors is extremely unfavorable for the country’s development prospects. If, in the interests of stability, the authorities try to maintain an increase in living standards (and the population is already accustomed to prosperity and does not expect the situation to worsen), then by 2050 state spending on the social sphere may amount to about a third of GDP. Apparently, we will have to raise the retirement age (now it is 50-55 years for women and 60 years for men). The decline in the working-age population leads to higher wages, which reduces the competitiveness of Chinese exports. The “demographic dividend” is no longer relevant for China, and it is becoming increasingly difficult to hope for an increase in the birth rate.

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Barriers are the rising cost of housing and the cost of quality education. So the decision on the “three-child policy” cannot be called populist. The government’s Xinhua News Agency had to stop and remove a poll about the party’s new appeal from social media. Less than 5% of respondents said they were ready to have a third child even now, and 92% do not consider such a prospect at all.

It is possible that in order to encourage the birth rate, the state will have to turn to business: the pioneers of this approach have already appeared. Some companies have announced big bonuses for employees who decide to have a third child. The whole question is how many employees of private companies will take this step, because business owners are unlikely to support a child until adulthood.

The decline in the birth rate and the aging of society are visible manifestations of changes in the value orientations of the Chinese, who are less and less following the old traditions. Calls here are unlikely to change anything, in order to eliminate disparities, the state will have to strengthen its social role and begin to actively invest in human capital, confirming that citizens are more than just a denominator in the formula for calculating GDP per capita.

The opinion of the author may not coincide with the point of view of the editors

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Birth control: an overview – women’s health in general there is one) fits exactly you, it takes time, research and thought.

If you are interested in birth control, our doctors and staff will work with you to find the right birth control.

As an overview, below are some common forms of birth control that you may want to consider. One is not necessarily better than the other, it just depends on what suits you.

Hormonal IUD : IUD is small, almost undetectable and prevents pregnancy for at least one year (sometimes up to five years). Hormonal IUDs prevent pregnancy by secreting a very small amount of the progestin hormone levonorgestrel daily. Progestin acts locally in the uterus to prevent pregnancy.

Non-hormonal IUD : The non-hormonal IUD prevents pregnancy by using a tiny copper thread wrapped around the T (a form of the IUD). We offer Paraguard (non-hormonal) and Mirena (hormonal) IUDs. Call us for more information on these methods.

implant : An implant is a very small rod that is inserted under the skin of a woman’s upper arm to provide birth control. It is invisible and prevents pregnancy for up to 4 years.

Shot : The shot, sometimes referred to as “Depo”, is an injection of the hormone progestin that provides birth control for three months. It can be administered at home or by a healthcare professional.

Patch : The patch is a thin beige plastic piece that looks like a square patch. It’s easy to use and works like a pill, but you only need to change the patch once a week.

Pill : Combination birth control pill is a daily medication containing two hormones (estrogen and progestin) to prevent pregnancy.

Ring : The ring is a small, flexible piece of plastic that is inserted into the vagina to provide birth control. It works like a pill, but you only need to insert it once a month.

Condom : Condoms are one of the most popular forms of birth control. They slide over the penis to prevent pregnancy and reduce the risk of STIs by keeping semen inside the condom and out of the vagina.

Internal condom : Sometimes called a female condom. This is the pouch that you insert into your vagina. This is a method that gives you complete control. Internal condoms work just like condoms, except you wear them inside rather than on the penis. They keep sperm inside the condom and out of the vagina.

Diaphragm valve : The diaphragm is a domed silicone cup that is inserted into the vagina a few hours before intercourse to prevent pregnancy. To work effectively, it must be used along with spermicides to prevent sperm from reaching the eggs.

Cervical Cap : A cervical cap is a silicone cap that you insert into your vagina to cover your cervix and keep sperm from entering your uterus. For it to work effectively, it must be used with a spermicide.

Sponge : The sponge is a small piece of white foam that is inserted into the vagina. It can be inserted 24 hours before sex.

Spermicide : Spermicide is a chemical that you inject deep into your vagina right before sex.