Breakthrough bleeding can be a common and often unsettling experience for women using hormonal birth control. It’s characterized by spotting or light bleeding that occurs outside of your regular menstrual period, frequently when you least expect it. While it can be alarming, especially if you’re not anticipating your period, it’s important to understand that breakthrough bleeding is usually not a sign of a serious health issue and doesn’t indicate that your birth control is failing to prevent pregnancy. Many women experience this, and fortunately, there are ways to address and manage it.
What is Breakthrough Bleeding and Why Does It Happen?
Breakthrough bleeding is essentially any bleeding or spotting that happens when you’re not expecting your period while using hormonal contraception. This can range from very light spotting, noticeable only when you use the bathroom, to somewhat heavier bleeding in some cases. It can occur with any type of hormonal birth control method, as these methods all work by introducing hormones into your body to prevent ovulation and pregnancy. These methods include:
- Birth control pills: Daily pills containing hormones.
- Birth control implant: A small rod inserted under the skin of the upper arm.
- Hormonal IUDs (Intrauterine Devices): Devices placed in the uterus releasing hormones.
- Birth control shot: An injection administered by a healthcare provider.
- Vaginal ring: A flexible ring inserted into the vagina.
- Skin patch: A patch worn on the skin that releases hormones.
Common Types of Birth Control and Breakthrough Bleeding
While breakthrough bleeding can occur with any hormonal birth control, it is more frequently reported with certain types. Low-dose and ultra-low-dose birth control pills, the birth control implant, and hormonal IUDs are more commonly associated with breakthrough bleeding.
For women using hormonal IUDs, spotting and irregular bleeding are quite common in the initial months following insertion. This typically improves and settles down within 2 to 6 months. However, with the birth control implant, the bleeding pattern established in the first three months is often indicative of the bleeding pattern you can expect to continue.
Factors That Increase the Likelihood of Breakthrough Bleeding
Certain factors can make some women more prone to experiencing breakthrough bleeding while on birth control. Smoking cigarettes is one such factor. Inconsistent use of birth control pills, such as missing pills, can also increase the likelihood of irregular bleeding. Furthermore, some medications, including emergency contraception pills ( Plan B ), are known to cause irregular bleeding as a side effect. Certain infections, like chlamydia or gonorrhea, can also increase the risk of breakthrough bleeding.
Another situation where breakthrough bleeding is more common is when women using birth control pills or the vaginal ring opt for continuous dosing to skip their periods altogether. Additionally, underlying benign conditions such as uterine fibroids can cause irregular bleeding that may be mistaken for or occur alongside breakthrough bleeding, even though it’s not directly related to the birth control itself.
Managing and Improving Breakthrough Bleeding
Sometimes, breakthrough bleeding can be improved with simple lifestyle adjustments. Quitting smoking is a beneficial step for overall health and can also help reduce irregular bleeding. Ensuring you take your birth control pills at the same time every day can also contribute to more consistent hormone levels and potentially lessen breakthrough bleeding.
If you are using birth control pills or the vaginal ring for continuous hormone delivery to skip periods, consider scheduling a withdrawal bleed every few months. This allows your uterus to shed its lining, which can help reduce the incidence of irregular spotting and bleeding in the long run.
When to Seek Help from Your OB-GYN
Although breakthrough bleeding associated with birth control is generally not harmful to your physical health, it can be bothersome and disruptive. If you are experiencing spotting or irregular bleeding that concerns you, consulting with your OB-GYN is a good step. Your doctor will likely discuss potential contributing factors and may perform a physical exam to assess the situation.
Once it’s confirmed that the bleeding is related to your birth control, there are several management options available. These could include switching to a birth control pill with a slightly higher dose of hormones, adjusting the number of placebo days in your pill cycle, or exploring alternative birth control methods altogether. For those using IUDs, implants, or the birth control shot, over-the-counter pain relievers like ibuprofen can sometimes be helpful, or your doctor might suggest a short course of estrogen pills.
The key takeaway is that you don’t have to simply endure breakthrough bleeding. If you are unhappy with your bleeding pattern while on birth control, reach out to your OB-GYN. There are various strategies and solutions available to help improve your experience and find a birth control method that works well for you without unwanted breakthrough bleeding.
