Breakthrough Bleeding on Birth Control


Breakthrough bleeding while on a combination hormonal contraceptive is extremely common in the first month or two, with it happening to as many as 30 percent of women on these kinds of contraceptives.

Unfortunately, it is entirely unpredictable and can cause serious anxiety. It is also among the leading reasons that women quit using combination hormonal contraceptives.

Although common, it tends to occur during a woman's first cycle with the contraceptive and resolve itself after that. For women who still experience breakthrough bleeding after three cycles it is generally recommended they discuss changing brands or contraceptives with their health care provider.

What Happens in Breakthrough Bleeding

Typically, there's a delicate balance created with estrogen and progesterone that maintains and matures the endometrium. While contraceptives that contain these two hormones provide a constant supply of both to the endometrium, modern oral contraceptives have a dose of estrogen that is too low to maintain 'endometrial integrity', while the opposing activity of the progesterone creates an endometrium that is thin, fragile and prone to bleeding.

Causes of Breakthrough Bleeding

There appears to be a consensus in the medical field that the primary cause of breakthrough bleeding while on hormonal contraceptives is … poor patient compliance. In other words, you're not doing it right.

Or put a nicer way, something's gone wrong in how it's being taken to affect it. Either it's not being taken exactly as prescribed and recommended on the packaging (i.e. at the same time every day like with the pill), or a dose was missed, or the patient is also taking a drug or medicine that is somehow contraindicated.

That, or the patient is smoking too, and smoking cigarettes can cause problems with cycle control due to some anti-estrogen properties in cigarette smoke.

Maybe It's Not Your Birth Control …

While the large majority of women who experience breakthrough bleeding while taking a combination hormonal contraceptive, there are other possible reasons for that bleeding, rare or unlikely though they may be, and they include:

  • A sexually transmitted infection like chlamydia
  • Endometrial or cervical polyp
  • Ectopic or intrauterine pregnancy
  • Endocrine abnormalities such as hypothyroidism
  • Cervical cancer
  • Other bleeding disorders

Talking to Your Provider About Breakthrough Bleeding

When discussing breakthrough bleeding with your healthcare provider, you should expect to be asked about whether you are in compliance with the prescription; about any additional symptoms you might be having (abnormal vaginal discharge, pain, bleeding after sex, etc.); and about the possibility of either having a sexually transmitted infection, another issue with your cervix, or even being pregnant.

If the bleeding continues past three months, it is strongly recommended that you speak to your health care provider, because there are many other dosage-related options available to manage that bleeding and still be able to take a combined oral contraceptive. The key is not letting it become a major problem, but rather nipping it in the bud before it does. And the best way to do this is through open communication with your health care provider.


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