One of the perks of using the birth control pill is regulating your period. Most women experience lighter bleeding and lessened symptoms like cramps and period pain. However, a common side effect of the contraceptive pill is breakthrough bleeding, also known as spotting. Spotting on the pill can happen at any time throughout your pack and cycle and can be a frustrating experience to deal with. What causes spotting on the pill? How can you prevent breakthrough bleeding from happening in between periods? And most importantly, how do you stop it? Turns out, prevention may be the key.

What is breakthrough bleeding?

First, let’s understand what bleeding on the pill is. When you take the oral contraceptive pill, there are two types to choose from. The combination pill contains a combination of estrogen and progestin hormones, while the mini pill contains progestin only. When you take the combination pill, there is a week of inactive sugar pills during which you are meant to get your “period.” However, when you are on the pill, the bleeding you experience is not technically your period. Instead, it’s withdrawal bleeding from your body experiencing withdrawal from the hormones you normally take. Because the pill works by thinning your uterine lining (the endometrium), the shedding that occurs during this period week is oftentimes much lighter than a normal menstrual period. 

Breakthrough bleeding, or spotting, when you’re on the pill refers to any bleeding that happens outside of the normal period week. How heavy or light it is and how long it lasts for can vary quite a bit depending on what’s causing it and the time it takes your body to readjust to the hormone dosage. 


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What causes spotting on the pill?

When you start taking a new brand or type of birth control pill, it’s very common to experience spotting as your body adjusts and acclimates to this new combination of hormones. In addition to sporadic spotting, other common side effects of the contraceptive pill include:

  • Nausea
  • Sore or tender breasts
  • Headaches
  • Bloating
  • Mood changes
  • Changes to your skin 

Talk to your doctor if you’re experiencing these side effects and they can help identify the best birth control pill for you

It’s important to note that irregular breakthrough bleeding during the first few months of a new pill is quite common. This could be due to the increase in progestin thinning the uterine lining and thus causing initial bleeding. 

After the first few months of your body adjusting to the new hormones, it’s possible to have irregular bleeding and spotting due to a variety of reasons, including;

  • Switching to a new brand of pill
  • Missing a pill
  • Taking the mini pill
  • Needing a different dose or type of combined pill
  • STIs
  • Having a sensitive cervix
  • Pregnancy 
  • Miscarriages and ectopic pregnancies 
  • Certain medications
  • Cervical abnormalities
  • Thyroid abnormalities

If irregular spotting or withdrawal bleeding continues after the first initial months of starting the pill, see your GP for investigations of other potential causes.

Why switching to a new brand of birth control causes spotting

As mentioned above, it takes time for your body to adjust to the hormones that are in whichever birth control pill you’ve been prescribed. This adjustment period can last from 4 to 6 months, during which it’s fairly common to experience irregular breakthrough bleeding throughout your 28-day cycle. If you’re taking your pill at the exact same time every day and still experiencing breakthrough bleeding after the first 6 months on a new brand of oral contraceptives, talk to your doctor.

How missing a pill causes breakthrough bleeding

The birth control pill is over 99% effective at preventing pregnancy when taken correctly. However, more typical use brings that efficacy rate down to about 92%. So what does it mean to take it correctly? It means that you take your pill at the exact same time every single day. This is to regulate the amount of hormones that you’re putting into your body. So, if you miss a pill or take your pill at different times each day, you’re putting yourself at risk of spotting and also pregnancy because the effectiveness decreases. If you’re vomiting or have diarrhea shortly after taking the pill, this could also cause the hormones to not be absorbed correctly and lead to breakthrough bleeding.

How the mini pill causes spotting

The mini pill contains progestin only, which makes it a good option for women who can’t take estrogen. The mini pill is taken continuously, meaning there are no inactive sugar pills for your “period” week. Because the mini pill doesn’t regulate periods, irregular bleeding is very common. Some women have no periods, while others have light irregular bleeding with no pattern, and others can have quite frequent bleeding. This could happen despite taking the mini pill at the recommended same time (within 3 hours) every day. 

Why the combined pill causes spotting

There are many different combinations of estrogen and progestin available in Australia for the birth control pill. Different combinations of hormones will have different impacts on different women. That’s why it may take a few tries to find the best birth control pill for you. If the combination of hormones you’ve been prescribed is causing breakthrough bleeding, you can ask your doctor to try a different combined pill.

STIs and spotting

Certain sexually transmitted infections (STIs) like chlamydia and gonorrhea can cause bleeding. While the pill is very effective at stopping pregnancy, it does not protect against STIs. Other inflammatory conditions that can cause spotting include vaginitis, endometritis and pelvic inflammatory disease (PID). 

If you have one of these conditions, you may have other symptoms such as pelvic pain, cloudy urine, abnormal vaginal discharge or a foul odour. Talk to your doctor if you have any of these symptoms.

Having a sensitive cervix

If your cervix gets irritated or injured, it can cause bloody discharge that looks like spotting or bleeding between cycles. This could happen during intercourse, after a vaginal exam or during pregnancy. It’s important to see your doctor for a physical examination and, if needed, a cervical screening test. Cervical screening tests are recommended every 5 years or when a woman experiences symptoms such as irregular vaginal bleeding or bleeding with sexual activity.  

Being pregnant while on the pill

Even though the pill is designed to prevent pregnancy, it is still possible for you to get pregnant while on the pill. That’s because the effectiveness rate of the pill drops from over 99% down to 92% with “typical” use, meaning you might forget to take one or don’t take it at the same time daily. If you’re pregnant, you might notice spotting. If you think you might be pregnant, take a pregnancy test or see your doctor.

Miscarriages and ectopic pregnancies 

Bleeding during pregnancy can sometimes be a sign of a miscarriage or ectopic pregnancy. Miscarriages occur when a fetus dies within the womb before 20 weeks. An ectopic pregnancy is when the fertilised egg implants in the fallopian tube, abdominal cavity or cervix instead of inside the uterus. 

Miscarriages can cause heavy bleeding for two weeks or longer, as well as dizziness or pain or cramping in your abdomen. Contact your doctor immediately if you experience any of these symptoms and are pregnant. 

Ectopic pregnancies can become a medical emergency. In addition to light to heavy vaginal bleeding, symptoms of an ectopic pregnancy include sharp abdomen or pelvis pain, severe pain on one side of the abdomen, dizziness or fainting and rectal pressure. Contact your doctor immediately if you experience any of these symptoms. 

Certain medications can also cause spotting

Some drugs interfere with birth control pills, including antibiotics, certain epilepsy medications and St. John’s wort. Talk to your doctor about the medications you’re taking if you’re taking hormonal birth control pills so they can best advise you on a treatment plan that doesn’t impact the effectiveness of the pill. 

Cervical abnormalities and spotting

Certain cervical abnormalities can also cause breakthrough bleeding, such as cervical cancer, cervical ectropion, polyps and HPV. It’s important to have a doctor conduct a cervical examination to exclude or manage any of these conditions.

Thyroid abnormalities and spotting

Abnormal thyroid hormone levels can cause irregular bleeding. Getting a blood test done will help determine whether your breakthrough bleeding is caused by an overactive or underactive thyroid.

How to stop breakthrough bleeding on the pill 

Most cases of spotting while on the pill are temporary and will resolve themselves over time. Because spotting is unexpected and unscheduled, it can be frustrating and annoying. But is there a way to stop breakthrough bleeding on the pill immediately? 

Unfortunately there isn’t a foolproof way to stop breakthrough bleeding immediately, and the best course of action is to take your medication at the same time every day to keep it from happening in the first place. If spotting is still happening, talk to your doctor about alternative forms of contraceptives or different combinations of hormones that could be better suited to your needs. Wearing panty liners is a good way to help prevent staining clothing and be prepared for any situation. 

If you find that you’re still spotting after six months, you can explore different combinations of hormones to find a pill that better suits your needs. For example, you can change the dosage or type of estrogen or progestin that is in your medication. You could also consider a different type of contraception altogether, such as the ring, implant, shot or IUD

Getting the contraceptive pill online with Rosemary Health

If you’ve been prescribed the birth control pill before and want to get the pill delivered, you can get your rescripts online through Rosemary. An annual care plan costs $52 (just $1 per week!) plus the price of your pill and comes with free delivery and unlimited follow-ups with your doctor for the entire year. Start your online visit today and never miss a pill again.


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