15 Possible Reasons You’re Spotting On Birth Control Pill

spotting on birth control pill

Last updated on July 28th, 2018 at 04:36 am

Bleeding or spotting on birth control pill can be worrying to women in the first few months.

Are you bleeding between periods just after starting your pills? Did you miss your pills or changed to a new pill?

Birth control pill are drugs that contain synthetic hormones that help prevent pregnancy. When used properly it can prevent pregnancy with more than 99 percent effectiveness thereby reducing unwanted pregnancies and abortion.

This article explains why you are spotting on birth control pill and when to worry about it.


What are birth control pills

Birth control pills are licensed and used in many parts of the world. The main reason women take birth control is to prevent pregnancy. However, there are other uses of birth control. Some are

  • Treatment of heavy period flow in women
  • Help regulate irregular period in women
  • Help reduce menstrual period symptoms
  • Acne breakouts
  • When used for a long time can protect women against cancer

Birth control pills has continued to be popular worldwide. It is estimated that more than 200 million women have tried using a pill worldwide and more that 3 million women are active users in the united kingdom.

Birth control pills are made up of 2 synthetic hormones — Estrogen and progesterone. Both hormones are prescribed in standard doses depending on your pills.

Estrogen dosage is usually between 15 to 35µg. Some pills with low estrogen level may result to lower protection. However, if a pill contains high doses of estrogen, it may cause blood clots to form within blood vessels.

The progestogen-only-pill (POP) contains only synthetic progesterone. It does not contain estrogen and they are used in women at lower times of fertility.

Indications for POP use are

  • Breastfeeding mothers
  • Older age
  • Smoking women
  • Hypertensive or diabetic women


How does birth control pill work

Birth control pills act by blocking ovulation from occurring.

What is ovulation?

During your menstrual cycle, your ovaries releases an egg into the fallopian tube that may be fertilized by the sperm. This release of egg is ovulation.

Ovulation occurs due to hormone changes during different time of the menstrual cycle. Some hormone that play a role during ovulation are

  • GnRH  (Gonadotropin releasing hormone)
  • FSH (Follicle stimulating hormone)
  • LH (Luteinizing hormone)
  • Estrogen
  • Progesterone

How does these hormones affect ovulation?

Just after your period ends, FSH level are high. This stimulates ovarian follicles to increase in size. As these follicle grow in size, they produce estrogen. Estrogen levels continue to rise resulting in surge of LH about 12 – 24 hour before ovulation occurs.

If you can detect your LH surge, then you can know when ovulation will occur. Popular ovulation kits and fertility monitor can detect and predict when ovulation will occur.

After LH surge and rupture of the dominant ovarian follicle, egg is released with increased level of progesterone.

How does birth control pills work?

Oral contraceptive work by suppressing pituitary release of both FSH and LH. Blocking FSH and LH will prevent ovulation from taking place.

Other ways COC pill works are

  • Changing your cervical mucus to be thick thereby preventing sperm transport
  • Preventing implantation due to thinning of the endometrium.

bleeding or spotting on birth control pills infographics


7 Reasons why you’re Spotting on Birth control pill

If you are bleeding on birth control pills, then these are some of the causes:

You just started taking your pills

Are you bleeding after starting a pill?

Spotting after starting a pill is usually mild and resolves in few months.

If you are taking pills for the first time, then it may take about 3 months for your body to adjust to these new synthetic hormones.

However, if you persistently have heavy bleeding while on birth control you should inform your doctor ASAP.

You missed your pills as prescribed

Missing your pills can reduce the effectiveness of your pills. It is important that you always take your pills everyday and at same time. Regularly taking your pills will ensure steady levels of synthetic hormones thereby blocking ovulation.

What to do after missing a pill?

Don’t panic yet. Check the dosage of ethynyl estradiol in your pill.

Is it 30 – 35µg or 20µg pill?

If you missed one or two 30 – 35µg pills or one 20µg pill, you should take your pills as soon as you can remember. Continue taking other pills as prescribed by your physician. There is no reason for additional contraception.

However, if you missed three or more 30 – 35 µg pills or two or more 20µg pill, then you should take your pill as soon as you remember and ensure additional contraception like condoms for at least 7 days.

You are smoking

Cigarette smoking can cause spotting while on birth control because it blocks estrogen hormone effect.

Dosage of estrogen in your pills

Depending on the type of pill you are on, you may have spotting. The dosage of estrogen pill play a role here. Women on low dose estrogen pills are likely to have breakthrough bleeding than women that are on higher dose estrogen pills.

It is possible your pills could fail if you’re on low dose pills. You should inform your doctor about this frequent spotting.

You are taking old brand of contraceptive

Old regimen contraceptive may cause spotting on birth control more than newer types of contraceptives.

You are vomiting

Vomiting, especially after taking your pill, can affect its absorption and disrupt the level of the hormones in your body.

You have diarrhea

Diarrhea can affect the absorption of pill and may cause bleeding while on birth control.

Drug interaction

Are you taking any anti-fungal drugs with your pills? Are you on ant-seizure therapy?

Anti-tuberculosis, anti-fungal and anti-seizure drugs can affect the metabolism of your pill resulting in breakthrough bleeding.

You should always inform your doctor of drugs you’re taking for best choice of contraception.

You are taking antibiotics

Antibiotics like rifampicin can reduce the effectiveness of your pill and cause spotting. You should inform your doctor if you are on any antibiotics.

You are on newer regimen of pills

New birth control pills like Seasonale, Quartette and Seasonique can cause frequent spotting initially. This is because these pills are taken for an extended time. However, this resolves quickly as your body adjust to these continuous COC pills.

If you’re on continuous COC pills without any break after taking active pills for 21 days, then you could have light spotting between periods.


Other possible reason you are spotting on birth control pill are

Emergency contraception

Vaginal infections


Uterine polyps


How to prevent spotting on the pill?

  1. Take your pills as prescribed by your physician
  2. Inform your doctor of other medications you are taking
  3. Chart days you’re spotting on the pill. If it’s decreasing in frequency, then your body is already adjusting to your pill.
  4. Try having a fake period. In some commonly used birth control pills, you take active pills for 21 days with a free period when you can have a fake period.


Frequently asked questions about bleeding while on pills

These are common questions about bleeding on birth control that may concern you. Let us know if you have any questions not answered below.

Spotting or bleeding while on birth control Am i Pregnant?

Birth control when taken as prescribed and in the same time of the day is more than 99 percent effective. If you notice light spotting before period and worry it could be implantation bleeding, then you shouldn’t worry yet.

Its normal if you spot in the first few months of starting a pill. However, it could still be due to pregnancy, especially if you missed your pill or if you are on low dose estrogen pills. Signs you may be pregnant are:

How to stop bleeding on birth control pills

  • Take your medication as prescribed
  • Are you vomiting? Inform your doctor
  • Take missed pills as soon as you remember
  • Inform your doctor of medications you’re taking
  • Treat vaginal infections
  • Do you have bleeding after intercourse while on birth control? It could be due to vaginal dryness or uterine polyps. Inform your doctor

Brown spotting on the pill?

If you have brown spotting after starting a pill, then its okay. You brown spotting will resolve as your body adjust to your pills

Is it normal to spot or bleed while on birth control?

If you are bleeding between your periods while on birth control, then it may not mean a problem yet. This may occurs after starting a pill.

It could also be due to missed pills, changed pills or other drugs that interfered with your pill’s metabolism.


Can you get pregnant while on birth control and still have periods?

If you are taking your pill as prescribed, the chances of pregnancy is very slim. However, if you missed a pill in the first week, then you could get pregnant.

If you notice sign of pregnancy — nausea, brown vaginal discharge before period, body weakness, then you should get a test done.

If you are still bleeding after a positive pregnancy test, then it may be a miscarriage sign.

Read more: Bleeding during pregnancy


Now its your turn. Are you spotting on birth control pill? Let us know if we could help.


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