Bleeding and Birth Control: What’s normal?

Medically reviewed by Sophia Yen, MD, MPH – Written by Pandia Health Editorial Team. Updated on December 18, 2020

So, you’re between periods and you notice some blood when you wipe. Noticing blood when you don’t expect to see any can be worrying, but don’t panic! If you take birth control and aren’t experiencing any pain, this is most likely spotting. Read on to learn about bleeding while on birth control, or spotting.

Spotting is identifiable as irregular bleeding between periods. In most cases, this bleeding is harmless, but that does not make it any less alarming or unpleasant. If you are concerned, it is always best practice to contact a healthcare professional for medical support and peace of mind when you experience unexpected bleeding.

While spotting or irregular bleeding may occur for a number of different reasons, in this article, we are focusing on the relationship between this and contraception. 

Spotting as a side effect

Women can get spotting or breakthrough bleeding within the first 3 to 4 months after they start birth control as their body adjusts to the new hormones introduced by their birth control. Often spotting is caused by NOT taking the birth control pill at the same time of day each day. 

The pill is intended to be taken at exactly the same time every day, and while it’s okay to be off by a few hours, the more diligent you are about taking it at the same time each day, the more effective it will be. 

As long as you take your birth control consistently, any breakthrough bleeding should stop after a few months. If you continue to experience unscheduled bleeding, contact a doctor. While it’s possible your spotting could be managed by changing your birth control, it could be a sign of another bleeding disorder. 

What types of birth control are most likely to cause spotting?

Any contraceptive method that contains hormones is among the most likely to cause breakthrough bleeding:

• Hormonal birth control pills
• Birth control pills containing Ethinyl estradiol and levonorgestrel, which prolong the time between menstruation
• Hormonal and copper IUDs, within the first three months after implantation.
• The patch
• Depo-Provera
• Vaginal rings

While breakthrough bleeding can occur with any of these options, that does not mean it will occur in all women. What works for one person may not work for another. Some women may need to experiment with a few different types of birth control to find their perfect match. 

When is spotting a cause for concern?

If your birth control is not the cause of your spotting, you will need to investigate other factors that could be leading to your breakthrough bleeds. It is recommended that you always consult your doctor when you experience unexpected bleeding in order to rule out any health issues.

Age

Adolescent girls are more likely to experience breakthrough bleeding soon after starting their periods, as several cycles may need to occur for the body to establish a cycle and balance hormones. On the other hand, menopausal women may notice spotting and irregular periods as they leave their reproductive years.

STIs

Some Sexually Transmitted Infections, or STIs can lead to abnormal bleeding. Chlamydia and gonorrhea can cause excessive bleeding due to irritation of the cervix, or neck of the uterus. 

Pregnancy

Breakthrough bleeding can occur when a fertilized egg is implanted in the uterine lining. Although this may be a sign of an impending miscarriage or an ectopic pregnancy, that is not always the case. Pregnant women who experience bleeding should always see a doctor.

Fibroids and Polyps

Uterine fibroids and polyps are benign growths that can cause spotting in between periods or even after a woman has gone through menopause. Thankfully, these can be surgically removed if they are causing discomfort.

Endometriosis

Endometriosis, a condition where endometrial-type tissue grows outside of the uterus, can cause spotting along with other painful symptoms. 

Endometrial Hyperplasia

Endometrial hyperplasia occurs when the uterine lining grows too thick, and in turn, leads to bleeding. Although this condition is typically benign, it can be a precursor to cancer. 

Cervical Cancer

Bleeding between periods, especially after sex, can be a sign of cervical cancer. Women between the ages of 21 and 65 should get screened for precancerous or cancerous cells in the cervix every 3 to 5 years.

Do I get a “real” period on the contraceptive pill?

You do not get a “real” period on the contraceptive pill, patch, or ring. It’s an artificial, arbitrary bleed, caused by the withdrawal of hormones. You can choose to have a withdrawal bleed every month, every 3 months, every 6 months or never. See Dr Sophia Yen’s TEDx talk on the safety/science of #NoPeriods #PeriodsOptional at the bottom of this page

How Can Pandia Help? 

In many cases, spotting is not something you need to worry about.

However, if this bleeding is accompanied by pain, occurs frequently, or is particularly heavy, you should consult a doctor to rule out more serious health conditions. If your spotting is caused by your birth control, you can ask your doctor to prescribe a different type in order to find what works best for your body. 

If you are looking to swap to a different kind of birth control or want to get your birth control delivered right to your mailbox, Pandia Health can help. We take pride in prescribing birth control based on several factors, including age, ethnicity, BMI, and general health — including your previous experience with birth control and spotting.

All these factors can influence your body’s reaction to birth control, which your doctor will consider when reviewing the best options for you. With just one $30 payment a year, you can get access to our expert doctors (available in these states) for 364 days. Get in touch to change your birth control today!

 

Disclaimer: The views expressed in this article intend to inform and induce conversation. They are the views of the author and do not necessarily represent the views of Pandia Health, and are for informational purposes only, even if and to the extent that this article features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment, and should never be relied upon for specific medical advice.