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.