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Is Spotting on Birth Control Normal?

By Alicia Wooldridge, MD

Medically reviewed

April 5, 2022

Spotting while on birth control pills, while understandably worrying, is in many cases totally normal.

Spotting is an extremely common side effect for people taking birth control pills.

These episodes are also known as “breakthrough bleeding” and can occur when pills aren’t taken at the same time every day, as your body gets used to a new pill, or in a variety of other situations.

While breakthrough bleeding is not uncommon, it is also important to keep track of your spotting, as it can sometimes be a sign of an underlying problem.

In this article, I will explain the symptoms of spotting, what usually causes it, risk factors to consider, and various other causes of spotting.

How Birth Control Pills Work

Birth control pills are among the most popular methods of preventing pregnancy. In the United States alone, between 2015-2017, almost 13% of people surveyed used birth control pills (also called “oral contraceptives:).

When used perfectly, birth control pills are 99% effective in preventing pregnancy.

Birth control pills contain synthetic steroid hormones, usually either a single hormone (progestin) or two (progestin and estrogen).

These hormones suppress the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) from the pituitary gland in the body.

FSH and LH normally trigger the release of estrogen from the ovaries, which in turn stimulates ovulation, the release of a mature egg from the ovary.

However, when FSH and LH are suppressed, the chances of ovulation—and therefore fertilization by a male sperm cell—are significantly reduced, if not eliminated.

Progestin-only birth control pills also cause mucus in the cervix to thicken, making it more difficult for sperm to reach the egg in the event that ovulation does occur.

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Side Effects of Birth Control Pills

All medications have potential risks and side effects.

Birth control is no exception. It is important to weigh the risks and benefits of any medication before starting it.

Some people who take oral contraceptives may experience minor side effects such as:

Other rare but serious side effects include:

Blood clots
Depression
Gallbladder problems
Heart disease
Liver damage
Stroke

If you experience any of these side effects, speak with your healthcare provider.

Birth control is not for everyone, and other methods of contraception are available to you.

What Causes Spotting?

There are many different causes of spotting while on birth control.

The following are some of the most common.

Starting Birth Control

When starting a new pill, the sudden change in hormone levels may alter the timing of your period, leading to spotting until your body fully adjusts to the new levels.

Changing Birth Control

Whenever you change birth control pills or methods, your body has to play “catch up” to reach a point of hormonal balance.

Until it does, any change in the timing of your period can cause breakthrough bleeding.

Skipping Doses

If you regularly miss doses, your body may respond to the fluctuating hormone levels by bleeding.

This is caused by the premature shedding of uterine tissue before your period is due to occur.

Ovulation

If you are still ovulating while on birth control, you may experience some spotting as the egg is released from the ovary.

Risk Factors

The following may increase your chances of spotting while on birth control pills:

Taking progestin-only pills (also called “minipills”)
Smoking cigarettes
Taking continuous birth control pills (common brands include Seasonale, Seasonique, and Quartette)

If you do smoke, disclose that to your doctor when you ask for a prescription so you can chat through the potential risks.

If you are experiencing breakthrough bleeding on a continuous birth control pill, your healthcare provider may have you take a short break from the medication.

This may help resolve any irregular bleeding.

Other Causes of Spotting

If your birth control is not the cause of your spotting, you may want to investigate other factors that could be leading to your breakthrough bleeds.

Some of these potential causes include:

Age

Adolescents are more likely to experience breakthrough bleeding soon after starting their periods.

Sometimes, several cycles may need to occur for the body to establish a cycle and balance hormones.

On the other hand, menopausal people may notice spotting and irregular periods as they approach the end of their reproductive years.

STIs

Some sexually transmitted infections, or STIs, can lead to abnormal bleeding.

For example, chlamydia and gonorrhea can cause vaginal bleeding between periods due to irritation of the cervix.

Pregnancy

In early pregnancy, more blood vessels are developing in the cervix, which can trigger light bleeding or spotting after sex or an internal exam.

Endometriosis

Endometriosis, a condition where endometrial-type tissue grows outside of the uterus, can cause spotting, along with other symptoms like painful urination or pain during sex.

Cervical Cancer

Bleeding between periods, especially after sex, can be a sign of cervical cancer.

People with cervixes between the ages of 21-65 should get screened for precancerous or cancerous cells every 3 -5 years.

Fibroids and Polyps

Uterine fibroids and polyps are benign growths that can cause spotting in between periods; they can also happen after menopause.

These can be surgically removed if they are causing discomfort.

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.

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When To See a Medical Provider

Spotting may not be a cause for concern at all. It is often a side effect of contraception or cervical irritation, and minor causes of breakthrough bleeding usually resolve without medical intervention.

However, consult a doctor if other symptoms accompany breakthrough bleeding.

Issues such as STIs or fibroids can cause complications if left untreated.

If unexplained bleeding occurs during pregnancy, you should see your healthcare provider.

In some cases, bleeding may simply indicate a sensitive cervix, but it’s better to err on the side of safety.

How K Health Can Help

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Check your symptoms, explore conditions and treatments, and if needed, text with a healthcare provider in minutes.

K Health’s AI-powered app is based on 20 years of clinical data.

Why am I spotting while on birth control?

Spotting is a common side effect of birth control. It's especially common in the first three months of using hormonal contraceptives. It can also occur after you switch from one type of birth control to another, particularly if the pills contain different amounts of estrogen.

Does spotting mean the pill isn't working?

In most cases, spotting does not indicate that your birth control isn't working. There are many reasons you might experience some spotting between periods while using birth control.

What does spotting on birth control look like?

Breakthrough bleeding is usually either light red or dark reddish-brown, like the blood at the beginning or end of a period. However, it may also resemble regular menstrual blood, depending on the cause. This type of bleeding may be sufficient to require the use of a tampon or sanitary napkin.

Can you spot and be pregnant on birth control?

It’s possible. People who become pregnant while on birth control may notice a missed period, implantation spotting, or bleeding.

K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

K Health has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references.

Alicia Wooldridge, MD

Dr. Alicia Wooldridge is a board certified Family Medicine physician with over a decade of experience.

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